Pulm Qs

Question 1

radiation pneumonitis present with? when? CT shows?

Answer 1

cough and/or dyspnea approximately 6 weeks after the exposure. CT imaging typically shows hazy opacities with ground-glass attenuation.

Question 2

idiopathic pulmonary fibrosis - CT findings? PE findings?

Notable missing feature?

Answer 2

bilateral peripheral and lower lobe–predominant interstitial thickening with honeycombing

Clubbing

not associated with mediastinal and hilar lymphadenopathy.

Question 3

Lambert-Eaton myasthenic syndrome has a strong association with this cancer?

Answer 3

SCLC

Question 4

Small cell lung cancer typically presents on imaging as?

Answer 4

a large hilar mass with bulky mediastinal lymphadenopathy.

Question 5

Absolute contraindications to lung transplantation?

Answer 5

malignancy within the last 2 years, HBV/HCV with histologic evidence of significant liver damage, active or recent smoking, drug or alcohol abuse, severe psychiatric illness, documented nonadherence with medical care, and absence of social support.

Question 6

Mild persistant asthma? recommended treatment options?

Answer 6

more than 2 days per week but not daily with an FEV1 of greater than or equal to 80% of predicted.

A leukotriene agonist or low-dose inhaled glucocorticoid

Question 7

Chronic eosinophilic pneumonia is associated with? improve with?

Answer 7

peripheral and upper lobe–predominant areas of consolidation

Steroids

Question 8

Vocal Cord Dysfunction - gold standard for diagnosis? Treatment?

Answer 8

laryngoscopy

speech pathology

Question 9

Omalizumab is indicated in patients with?

Answer 9

moderate to severe persistent asthma +

(1) symptoms inadequately controlled with inhaled glucocorticoids,
(2) evidence of allergies to perennial aeroallergens, and
(3) serum IgE levels between 30 and 700

Question 10

Next step in a patient with cough or unexplained dyspnea but with normal spirometry?

Answer 10

bronchial challenge testing (such as with methacholine)

Question 11

When is in-flight supplemental oxygen is usually recommended?

Answer 11

O2 sat<92

Question 12

out-of-center sleep testing is appropriate for?

Answer 12

high pretest probability of uncomplicated moderate to severe obstructive sleep apnea (ie NOT for patients with HF, pulm disease, or cenral sleep apnea)

Question 13

Breakdown product effects of methanol? ethylene glycol?

Answer 13

Formic acid, which is toxic to the retina of the eye

oxalic acid, which crystalizes in renal tubules and causes kidney injury

Question 14

hen suspicion for pleural malignancy is high but pleural fluid cytology is negative?

Answer 14

repeat fluid cytology

Question 15

preferred and most sensitive diagnostic imaging study for chronic thromboembolic pulmonary hypertension?

Answer 15

VQ scanning

Question 16

CCBs are beneficial in PAH only if? Otherwise, use?

Answer 16

positive vasoreactivity test

phosphodiesterase-5 inhibitors (sildenafil, tadalafil) or endothelin receptor antagonists (bosentan, ambrisentan)

Question 17

Anticentromere antibody is associated with?

Answer 17

limited cutaneous systemic sclerosis and the risk of developing pulmonary hypertension.

Question 18

characteristic of severe tricyclic antidepressant overdose?

Answer 18

progressive somnolence, hypotension, widening of the QRS interval, seizure, and anticholinergic signs (fever, tachycardia, mydriasis, reduced bowel sounds)

Question 19

Why not use this med to treat Aortic dissection?

Answer 19

Hydral - increase aortic wall shear stress and are more difficult to use in predictably controlling blood pressure

Question 20

Non-pulmonary findings in cystic fibrosis?

Answer 20

recurrent pancreatitis, male infertility

Question 21

Burkholderia cepacia - think>

Answer 21

sputum culture in cystic fibrosis

Question 22

timecourse for radiation pneumonitis v radiation fibrosis?

Answer 22

<3 months after treatment

v occurs 6 to 24 months after

Question 23

Lymphangioleiomyomatosis - affects (molecullarly)? What develops in the lungs? Presentation?

Molecular marker?

Treatment?

Answer 23

mTOR

thin-walled cysts

Pneumothorax

elevated levels of vascular endothelial growth factor-D (VEGF-D)

Sirolimus

Question 24

When should PCV13 be given before PPSV23?

Answer 24

functional or anatomic asplenia, cochlear implants, persistent cerebrospinal fluid leak, and significant immunocompromising conditions.

Question 25

Treatment of high-altitude pulmonary edema?

adjunctive treatment?

Answer 25

supplemental oxygen, rest, and consideration of descent from altitude

vasodilators such as nifedipine