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ABIM IM Recert > Boards Vitals Pulmonary > Flashcards

Boards Vitals Pulmonary Flashcards

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1
Q

When a patient has asthma, polyposis (nasal polyps) and NSAID sensitivity - what should you think of?

A

Aspirin exacerbated respiratory disease

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2
Q

What should you do for patients with ARDS, hypoxia and worsening mental status?

A

Intubation and mechanical ventilation

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3
Q

What cells are involved in inflammation in COPD?

A
  • CD8-positive T lymphocytes
  • Neutrophils
  • CD68-positive macrophages
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4
Q

Which cells are involved in the pathogenesis of all cases of asthma, but not in the inflammation related to COPD?

A

CD4-positive T lymphocytes

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5
Q

Are mast cells involved in the pathogenesis of COPD?

A

No

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6
Q

Which cells are involved in the pathogenesis of some cases of asthma, but not in the inflammation related to COPD?

A

Eosinophils

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7
Q

Which conditions cause decreased surface area of alveolar-capillary membranes?

A
  • Emphysema
  • Lung resection
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8
Q

What causes the hypoxemia in a lobar pneumonia?

A

Ventilation-perfusion mismatch

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9
Q

Silicosis predisposes to tuberculous infection because crystalline silica can inhibit the ability of macrophages to kill phagocytized mycobacteria due to disruption of phagolysosomes (impaired macrophage-phagolysosome function).

True or false?

A

True

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10
Q

Patient presents with progressive shortness of breath and fatigue. Oxygen saturation is on the lower side. Physical examination shows prominent jugular venous pulsations and a parasternal heave.

Diagnosis?

A

Pulmonary hypertension

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11
Q

How many categories of pulmonary hypertension are there?

A

5

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12
Q

What happens to endothelin in pulmonary hypertension?

A

Increases

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13
Q

What happens to nitric oxide in pulmonary hypertension?

A

Decreases

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14
Q

What group is pulmonary artery hypertension?

A

Group 1

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15
Q

What is the cause of pulmonary hypertension Group 2?

A

Left heart failure

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16
Q

What is the cause of pulmonary hypertension Group 3?

A

Intrinsic lung disease

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17
Q

What is the cause of pulmonary hypertension Group 4?

A

Chronic thromboembolic disease

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18
Q

What is the cause of pulmonary hypertension Group 5?

A

Multifactorial etiologies

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19
Q

What happens to prostacyclin in pulmonary hypertension?

A

Decreases

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20
Q

Does acetazolamide help high altitude pulmonary edema?

A

No

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21
Q

What is the mainstay of treatment of high-altitude pulmonary edema?

A

Oxygen
(Descent also important)

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22
Q

In normal pleural fluid what is the predominant cell type?

A

Macrophages

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23
Q

Is macrolide monotherapy indicated for outpatient community acquired pneumonia therapy in the United States?

A

No (> 25% macrolide resistance)

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24
Q

What is used to predict the likelihood of a pulmonary embolism?

A

Wells score

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25
What are patients treated with Bleomycin at risk for?
Lung toxicity
26
What percentage of patients on Bleomycin develop fatal interstitial lung disease?
Up to 10%
27
Immunocompromised patient has bilateral ground glass opacities, cough, fever and elevated beta-D-glucan assay. Diagnosis?
Pneumocystis pneumonia
28
Does cryptococcal pneumonia have ground glass opacities on imaging?
No
29
Does cryptococcal pneumonia have clustered nodular pattern and cavitation on imaging?
Yes
30
Does the alveolar-arterial O2 gradient change with hyperventilation?
No
31
Does the partial pressure of carbon dioxide (PaCO2) increase, decrease or stay the same with hyperventilation?
Decreases
32
Bronchoalveolar lavage is notable for a thick, milky, opaque fluid, in a patient with bilateral, diffuse ground glass opacities. Diagnosis?
Silicosis
33
Does decreasing tidal volume improve oxygenation in ARDS?
No
34
Does increasing PEEP improve oxygenation in ARDS?
Yes
35
Does treating patients with glucocorticoids improve oxygenation in ARDS?
No
36
Does treating patients with glucocorticoids reduce mortality in ARDS?
Yes
37
How is Legionella diagnosed?
Urinary antigen
38
Can a chest X-ray diagnose the specific type (organism) of pneumonia?
No
39
What is the first line drug for pulmonary artery hypertension in patients with positive vasoreactivity?
Calcium channel blockers
40
What is the first line drug for pulmonary artery hypertension in patients with negative vasoreactivity and severe symptoms?
Epoprostenol (Prostacyclin or prostacyclin analogue)
41
What happens to nitric oxide levels when patient is given a phosphodiesterase type 5 inhibitor?
Increase
42
In mild Alzheimer's dementia should you use galantamine or memantine?
Galantamine
43
Is a solid or semi-solid pulmonary nodule more likely to be malignant?
Semi-solid (solid with ground glass opacity)
44
Does small cell lung cancer usually occur in people who smoke or don't smoke?
Smoke
45
Lung mass with pathology showing undifferentiated small round blue cells. Diagnosis?
Small cell lung carcinoma
46
Lung mass with pathology showing sheets of epithelial cells with psammoma bodies. Diagnosis?
Mesothelioma
47
Lung mass with pathology showing anaplastic pleomorphic giant cells. Diagnosis?
Large cell carcinoma
48
Lung mass with pathology showing sheets of large pleomorphic cells containing keratin and intracellular bridges. Diagnosis?
Squamous cell carcinoma
49
Which treatment has evidence of greatest reduction in mortality in COPD?
Oxygen therapy
50
Does lung transplantation reduce mortality significantly in COPD?
No
51
Does lung transplantation improve quality of life in COPD patients?
Yes
52
Do systemic corticosteroids decrease morbidity and mortality in patients with COPD?
No
53
What is the gold standard for ruling out asthma?
Methacholine challenge test
54
What is the first line treatment for allergic rhinitis?
Nasal steroids
55
Young women with history of spontaneous pneumothorax and CT chest showing diffuse thin-walled cysts. Diagnosis?
Pulmonary lymphangioleiomyomatosis
56
What does TGF-beta (transforming growth factor beta) do?
Induces fibroblast proliferation
57
What is the mechanism of action of pirfenidone?
Inhibits TGF-beta
58
What is the mechanism of action of pirfenidone?
Inhibits TGF-beta (reduces fibroblast proliferation)
59
What is the mechanism of action of bosentan?
Endothelin 1 receptor antagonist
60
What is bosentan used to treat?
Pulmonary hypertension
61
What is omalizumab used to treat?
Allergic asthma
62
Is spirometry and bronchoprovocation typically normal at rest in exercise induced asthma?
No
63
What is seen on pleural biopsy in mesothelioma?
Spindle cells
64
Alpha-1 antitrypsin deficiency increases the activity of which enzyme?
Neutrophil elastase
65
Is the mechanism of oxygen-induced hypercapnia in chronic obstructive pulmonary disease (COPD) due to decreased respiratory drive?
No
66
What is the mechanism of oxygen-induced hypercapnia in chronic obstructive pulmonary disease (COPD)?
Increased ventilation/perfusion mismatch
67
What is the most common organism causing community acquired pneumonia?
Streptococcus pneumoniae
68
Patient with asthma has symptoms more than 2 days a week but not every day - what severity of asthma is this?
Mild persistent asthma
69
What is the primary method of hypoxemia in ARDS?
Intrapulmonary shunt (V/Q mismatch)
70
Which variable is monitored to indicate prognosis in case of septic shock?
Lactic acid
71
What is the pleural LDH in SLE related ILD?
Elevated
72
What percentage of SLE patients develop ILD?
3 - 7%
73
What drug class is nintedanib?
Tyrosine kinase inhibitor
74
Are nighttime headaches associated with obstructive sleep apnea?
No
75
Can a lung abscess be seen on CXR?
Yes - lucent area surrounded by consolidation
76
Which syndromic cause of infertility is associated with dextrocardia?
Primary ciliary dyskinesia (Kartagener syndrome)
77
Is silicosis reversible?
No
78
Can antitussives help in acute bronchitis?
Yes
79
Streptococcus pneumoniae has a capsular polysaccharide that acts as a major virulence factor. True or false?
True
80
How is the diagnosis of sarcoidosis confirmed?
Biopsy
81
What, when associated with life-threatening hypoxia is an indication for administering a neuromuscular blocking agent, in mechanically ventilated patients?
Severe ventilator desynchrony
82
Which ventilatory injury can later lead to pulmonary fibrosis?
Diffuse alveolar damage from high inspired oxygen
83
What is the treatment of organophosphate toxicity?
Atropine plus pralidoxime
84
Absence of breath sounds on one side, with new hypoxemia and hypotension. Diagnosis?
Tension pneumothorax
85
Smoking cessation eight weeks before surgery reduces the risk of complications. True or false?
True
86
Which selective endothelin A receptor antagonist has been shown to limit the progression of idiopathic pulmonary hypertension?
Ambrisentan

ABIM IM Recert (42 decks)

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