OME - Day 4

Question 1

Biopsy of a lung cancer adjacent to the trachea, what test do you use?

Answer 1

Endoscopic Ultrasound / Bronchoscopy (EUS is better)

Question 2

Biopsy of a lung cancer in the middle of the lung parenchyma, what test do you use?

Answer 2

VATS

Question 3

Biopsy of a lung cancer on the periphery, what test do you use?

Answer 3

Percutaneous, CT guided

Question 4

Cushing’s Syndrome and lung cancer = ?

Answer 4

Small cell, ACTH

Question 5

How do you screen lung cancer?

Answer 5

CT scan

Question 6

Hyponatremia and lung cancer = ?

Answer 6

Small cell, SIADH

Question 7

Lung Cancer and Hypercalcemia

Answer 7

Metastatic disease OR PTH-rp from Squamous cell carcinoma

Question 8

Ship-yards, construction, and lung cancer =?

Answer 8

Asbestosis, pleural plaques, adenocarcinoma (don’t forget mesothelioma)

Question 9

What do you get to evaluate a lung cancer?

Answer 9

CT scan

Question 10

Wheezing, flushing, diarrhea, lung cancer, what’s the diagnosis?

Answer 10

Carcinoid, 5-HIAA in the urine

Question 11

Adenosine Deaminase is high in the pleural fluid, what does that means?

Answer 11

TB

Question 12

Pleural effusion has malignant cells in it, what does that mean?

Answer 12

Metastatic cancer

Question 13

The pleural effusion fluid is loculated, what do you do?

Answer 13

Thoracostomy (chest tube)

Question 14

The pleural effusion is an empyema, what do you do?

Answer 14

Thoracotomy (surgery)

Question 15

There are a lot of red blood cells in the pleural effusion, what does that mean?

Answer 15

Hemothorax

Question 16

You find an effusion on CXR, no heart failure, what do you do?

Answer 16

Lateral Decubitus OR ultrasound

Question 17

You find an effusion on CXR, they have heart failure, what do you do?

Answer 17

Diuresis

Question 18

How do you diagnose PE with abnormal chest x-ray?

Answer 18

CT scan with IV Contrast

Question 19

How do you diagnose PE with bad kidneys?

Answer 19

V/Q scan

Question 20

How do you diagnose PE with good kidneys?

Answer 20

CT Scan with IV Contrast

Question 21

How long do you bridge someone with heparin to Coumadin?

Answer 21

INR 2-3 or 5 days, whichever is longer

Question 22

One leg is more swollen than the other, what do you do?

Answer 22

DVT, Ultrasound

Question 23

PE and IVC filter?

Answer 23

Contraindication to anticoagulation, remove filter as soon as anticoagulation is over

Question 24

PE and metastatic cancer tx?

Answer 24

Low Molecular Weight Heparin only (no bridge)

Question 25

PE and tPA?

Answer 25

Massive pe (hypotension)

Question 26

What does the ABG look like in a PE (that you'll see on the USMLE)?

Answer 26

low pO2, low pCO2, Respiratory Alkalosis

Question 27

Bilaterally fluffy infiltrates and hypoxemia

Answer 27

CHF, ARDS, PCP pneumonia

Question 28

PCWP in ARDS?

Answer 28

Normal or low

Question 29

What is the ARDS protocol?

Answer 29

Low tidal volume, high respiratory rate, PEEP

Question 30

What is the definition of ARDS?

Answer 30

Noncardiogenic (BNP, Echo, PCWP normal) pulmonary edema (CXR), P/F ratio < 200

Question 31

Lung disease and working in construction or shipyards - dx?

Answer 31

Asbestosis

Question 32

Lung disease and pleural plaques - dx?

Answer 32

Asbestosis/Mesothelioma

Question 33

Lung disease and mesothelioma - dx?

Answer 33

Asbestosis

Question 34

Lung disease and sand blasting - dx?

Answer 34

Silicosis

Question 35

Lung disease and aeronauticals - dx?

Answer 35

Berylliosis

Question 36

Lung disease and bilateral hilar lymphadenopathy suggests ___?

Answer 36

Sarcoidosis

Question 37

Lung disease in an African American woman suggests ___?

Answer 37

Sarcoidosis

Question 38

Diagnose sarcoidosis

Answer 38

NON-caseating granulomas on biopsy (NOT ace levels, NOT vit levels)

Question 39

No allergies at home on the weekends, but lots of allergies at work suggests ___

Answer 39

hypersensitivity pneumonitis

Question 40

What imaging helps the most with DPLD / ILD?

Answer 40

High Resolution CT