Semmelweis Pulmonology

Question 1

CXR indications

Answer 1

Chest pain, fever, cough, shortness of breath

1) Infection
2) Inhaled foreign body
3) Chest trauma
4) PTX
5) HF
6) Lung cancer
7) Monitor disease progression & ICU patients
8) Screening CXR with pos. tuberculin skin test

Question 2

CXR contraindications

Answer 2

Absolute: None
Relative: Pregnancy, Children

Question 3

HRCT indications

Answer 3

Normal CXR but symptoms/pulm. function test suggesting diffuse lung disease

Assess disease activity

Select optimal biopsy site

Question 4

MRI indications

Answer 4

1) Chest wall/mediastinal structures (Pancoast tumor)
2) Info. about tissue composition
3) Hematomas
4) Lymph nodes
5) Cysts
6) Operability
7) PE (in case of contrast allergy)
8) Lung metastasis to the brain

Question 5

US indications

Answer 5

PTX
Lesions of pleura
Pleural effusion

Question 6

Bronchoscopy indications

Answer 6

Diagnostic:

1) Suspected lung cancer
2) Staging of lung cancer
3) ILD
4) Microbiological sampling
5) Broncho-esophageal fistula

Therapeutic:

1) Aspiration (airway secretions, foreign body)
2) Airway stenosis (heat, cryo, mechanical, balloon, stent)

Question 7

Bronchoscopy contraindications (CUUSSHH)

Answer 7

Compliance (Non-compliant/cooperative patient)
Unstable angina/MI within 6 weeks
Unstable bronchial asthma
Severe respiratory failure
SVC syndrome
HTN pulmonary
Hemodynamic instability/Hemorrhagic diatheses (renal failure, cirrhosis, anticoag. th.)

Question 8

Biopsy contraindications

Answer 8

Low PLT count
High INR
Renal failure
Anticoagulant treatment

Question 9

TNB indications

Answer 9

Peripheral pulmonary mass not accessible by bronchoscopy

inoperable tumor, high risk patient

Question 10

TNB contraindications

Answer 10

Mechanical ventilation
Contralateral pneumonectomy 
Vascular lesions
Hydatid cyst
Pulmonary HTN
Bullous lung disease
Bleeding disorder

Question 11

Thoracoscopy indications

Answer 11

Exudative effusion evaluation
Pleurodesis in recurrent malignant effusions & rec. PTX
Breaking up loculations in empyema
Dg. of malignant & tuberculous pleural diseases

Question 12

Video-assisted thoracoscopic surgery indications

Answer 12

Correction of PTX
Bullectomy, lung volume reduction surgery (emphysema)
Wedge resection
Lung parenchyma biopsy
Lobectomy, pneumonectomy

Question 13

Thoracentesis indications

Answer 13

Diagnostic: New/unknown etiology pleural fluid that is >10mm thick
Therapeutic: Relieve symptoms in pleural effusion

Question 14

Thoracentesis contraindications

Answer 14

Bleeding disorder/anticoagulation
Minimal fluid volume
Severe pulmonary disease
Uncontrolled cough

Question 15

Pleurodesis indications

Answer 15

Recurrent malignant pleural effusion & PTX
Dyspnea improves after thoracentesis
Good status after thoracentesis
Lung reexpansion after thoracentesis

Question 16

Bronchodilator reversibility test

Answer 16

Indications:
Diagnosis/follow-up of asthma
Differentiaton of asthma vs. COPD
Contraindications: None

Question 17

Bronchial provocation test

Answer 17

Indications:
Suspected asthma with normal spirometry & flow volume results

Contraindications: 
Severe airway obstruction
Recent MI/stroke
FEV1 <1L or <50% predicted value
Hypertension severe
Aortic aneurysm

Question 18

Indications of ergospirometry

Answer 18

Determine origin of dyspnea (cardiac/pulmonary cause)
Select candidates for heart transplantation, lung resection
Prognosis in heart disease, pulmonary vascular disorder, CF
Preoperative assessment, post-op follow-up

Question 19

Contraindications of ergospirometry

Answer 19

Contraindications: 
Acute coronary syndrome
Resting O2 sat <85%
Decompensated HF
Acute renal failure
Uncontrolled arrhythmias
Acute myocarditis, pericarditis
Untreated thyrotoxicosis

Indications to STOP examination:
Syncope
Abrupt decrease in BP
HTN
Pallor
AMS

Question 20

Allergy test indications

Answer 20

Asthma, eczema, allergic rhinitis
Urticaria, angioedema
Systemic symptoms following insect sting

Question 21

Allergy test contraindications

Answer 21

Elderly
Comorbidities
Skin conditions
Medications (antihistamines, TCAs, BZDs, antipsychotics)
Anaphylaxis recently

Question 22

ABG indications

Answer 22

1) Respiratory failure (acute/chronic)
2) Severe illness leading to met. acidosis (HF, LF, RF, hyperglycemic states in DM, MOF, sepsis, burns, poisons/toxins)
3) Ventilated patient
4) Sleep studies

Question 23

PET-CT indications

Answer 23

Lung cancer staging & lymphatic spread
Distant metastases
Follow up of therapy
Check for recurrence

Question 24

Inhaler indications

Answer 24

Asthma/COPD w/ w/o acute excerbations

Pt. who exhibit expiratory wheezing

Question 25

O2 therapy indications

Answer 25

Acute emergency oxygen:
Cardiac arrest
Hypotension 
MI
Low CO states (shock, HF)
Respiratory failure
Hypoxemia (pneumonia, COPD, asthma, IPF, PH, PE)
CO poisoning / drug overdose

LTOT in COPD

Question 26

O2 therapy contraindications

Answer 26

Absolute: Untreated PTX, Drugs

Relative: Asthma, COPD, Claustrophobia, Fever, Seizures

Question 27

LTx indications

Answer 27

High risk of death due to lung disease within 2 years if LTx is not performed

Diseases:
COPD
IPF
Bronchiectasis
Emphysema (A1AT)
iPAH
LAM
ILDs
Sarcoidosis

Question 28

LTx contraindications

Answer 28

Absolute:
Smoking
Other orgain failure
Malignancy, chronic HBV/HCV, HIV
Psychiatric disorder, non-compliance

Relative:
Age>70
Ventilator-depedent respiratory failure
CAD
Previous thoracic surgery
Obesity

Question 29

NIV indications

Answer 29

Type I & Type II respiratory failure
OSAHS
CHF
Acidosis

Question 30

NIV contraindications

Answer 30

CV instability
AMS/Unconscious/Uncooperative
Copious secretions/Emesis
Craniofacial abnormalities
Obesity
Burns
Foreign body in airways