(Masoomeh) Pulmonology p177 - 188

Question 1

Best initial step in all lung nodule

Answer 1

compare the size of the nodule with an old chest X-ray

Question 2

features of a malignant pulmonary nodule and its tx

Answer 2

enlarging, spiculated, sparse, eccentric calcifications, present in smokers and age greater than 40
resect the nodule

Question 3

features of benign pulmonary nodule

Answer 3

small, dense central calcification, smooth border in non smokers and age less than 30

Question 4

dx test for intermediate probability of malignant pulmonary lesion

Answer 4

intermediate probability of malignancy: transthoracic biopsy for peripheral lesions and bronchoscopic biopsy for central lesions

Question 5

adverse effect of transthoracic biopsy

Answer 5

pneumothorax

Question 6

How to tell whether the content of the lesion is malignant without a biopsy?

Answer 6

PET-positron emission tomography scan

Question 7

which type of pneumoconioses..
1--sand blasting, rock mining, tunneling
2--cotton
3--coal
4-shipyard workers, insulators
5--electronic manufacture
6--moldy sugar cane

Answer 7

1--silicosis
2--byssinosis
3--coal worker pneumoconiosis
4--asbestosis (associated with bronchogenic carcinoma)
5--berylliosis (granulomas on biopsy)
6--bagassossis

Question 8

presentation of pulmonary fibrosis

Answer 8

dyspnea, fine rales or bibasilar crackles, loud P2 heart sound and finger clubbing,

Question 9

dx tests of pulmonary fibrosis—initial and most accurate

Answer 9

initial is chest x-ray and most accurate is lung biopsy

Question 10

PFT results in pulmonary fibrosis

Answer 10

decrease DLCO, FEV1, FVC, TLC, RV,

normal FEV1/FVC

Question 11

tx of pulmonary fibrosis

Answer 11

steroids, prednisone

Question 12

define sarcoidosis and its pulmonary sx

Answer 12

non caseating granulomatous disease common in African American, presents with dyspnea, bilateral hilar lymphadenopathy and pulmonary reticular infiltrates

Question 13

dx–initial and accurate test of sarcoidosis

tx of sarcoidosis

Answer 13

initial is chest xray and accurate is lymph node biopsy
elevated ACE levels in 60% ,hypercalciuriain 20% and hypercalcemia in 5% of cases
tx=steroids

Question 14

source of pulmonary embolism

Answer 14

DVT fom large vessels of legs in 70% and pelvic veins in 30%

Question 15

what is pathogenesis and etiology of DVT

Answer 15

STASIS from immobility, surgery, trauma, joint replacement or thrombophilia(factor V leiden mutation), antiphospholipid syndrome, malignancy

Question 16

sx of pulmonary embolism

Answer 16

dyspnea, SOB, tachypnea, tachycardia, pleuritic chest pain with clear lungs

Question 17

most accurate dx test for pulmonary embolism

Answer 17

CTAngiography

Question 18

dx test for DVT

Answer 18

lower extremity doppler study but accurate is angiography

Question 19

tx of pulmonary embolism

Answer 19

Heparin and warfarin

Question 20

when do we use IVC filter for DVT

Answer 20

when there is contraindication to anticoagulants
recurrent emboli on heparin
right ventricular dysfunction

Question 21

when to give thrombolytics

Answer 21

hemodynamically unstable pts

acute right ventricle dysfunction

Question 22

what to give if heparin induced thrombocytopenia develops

Answer 22

direct acting thrombin inhibitors

argatroban, lepirudin

Question 23

define pulmonary HTN

Answer 23

systolic BP greater than 25mm hg, diastolic greater than 8mm hg

Question 24

etiology of Pulmonary HTN

Answer 24

idiopathic, COPD, fibrosis, hypoxia

Question 25

best initial and accurate test for PHTN

Answer 25

CXR,CT

swan ganz catheter

Question 26

findings of EKG and echo in PHTN

Answer 26

EKG-Right axis deviation, RA and RV hypertrophy

Ech0=RA & RV hypertrophy

Question 27

tx of phtn

Answer 27

Bosentan-endothelin antagonist
PDEinhibitor-sildanefil
prostacyclin analogue-epoprostenol

Question 28

curative tx for idiopathic phtn

Answer 28

lung transplantation

Question 29

sx of obstructive sleep apnea

Answer 29

snoring, daytime somnolence, nocturnal hypoventilation…common in obese pts.

Question 30

dx and tx of osa

Answer 30

polysomnography

weight loss, avoid alcohol, CPAP(continuous positive airway pressure)

Question 31

illness/injuries associated with ARDS

Answer 31

sepsis/aspiration
lung contusion
near drowning
burns or acute pancreatitis

Question 32

dx for ARDS

Answer 32

cxr=bilateral infiltrates
air bronchograms
p02/fi02 rationbelow 300
normal PCWP

Question 33

tx for ARDS

Answer 33

low tidal volume mechanical ventilation

positive end expiratory pressure