Pulm

Question 1

CXR with enlarged heart, interstitial edema, Kerly B lines indicates….

Answer 1

CHF

Question 2

CXR with cavity containing air-fluid levels indicates….

Answer 2

abscess

Question 3

CXR with thickened peritracheal stripe and splayed carina bifurcation indicates….

Answer 3

LA enlargement (e.g. MS via rheumatic fever, mediastinal lymphadenopathy)

Question 4

define a pleural effusion on CXR

Answer 4

fluid >1cm on lateral decubitus XR (for small pleural effusions – sometimes more obvious on AP/PA if larger)

Question 5

describe the type of pleural effusion seen with cancers and malignancies

Answer 5

1) Bloody Transudative

2) Exudative

Question 6

describe pleural effusion seen in RA

Answer 6

transudative with low pleural glucose

Question 7

transudative pleural effusion with low pleural glucose indicates….

Answer 7

RA

Question 8

describe pleural effusion seen in TB

Answer 8

transudative with high lymphocytes

Question 9

transudative pleural effusion with high lymphocytes indicates….

Answer 9

TB

Question 10

Lights Criteria

Answer 10

Transudative Effusion if:

• LDH <200
• LDH eff / serum <0.6
• Protein eff / serum <0.5

Question 11

Pt presents with pleuritic chest pain, hemoptysis, tachypnea, dec pO2, tachycardia should be evaluated for….

Answer 11

PE

Question 12

Indicate Classic and Random presentation of PE based on the following tests:

• (1) EKG
• (2) CXR
• (3) ABG

Answer 12

1- sinus tachy (classic), R heart strain (submassive PE)

2- clear (classic), dec vascular markings (random), wedge infarct (random)

3- low CO2, low O2 (classic)

Question 13

what is the first step if it is highly suspected someone has a PE

Answer 13

give heparin before any diagnostic imaging (CTA, V/Q scan)

Question 14

describe the indications for the following in a PE:

• (1) thrombolytics
• (2) surgical thrombectomy
• (3) IVC filter

Answer 14

1- severe, massive or submassive PE
2- life-threatening
3- if Pt has contraindications to anticoagulation

Question 15

describe some of the diagnostic findings in ARDS

Answer 15

1) PaO2/FiO2 <200 [<300 = acute lung injury]
2) bilateral alveolar infiltrates on CXR
3) PCWP <18 (= non-cardiogenic)

Question 16

what are the indications to start O2 in COPD

Answer 16

PaO2 <55mmHg OR SpO2 <88%

if cor pulmonale, paO2 <59mmHg

Question 17

what is the best prognostic factor for COPD

Answer 17

FEV1 (spirometry)

Question 18

what can improve mortality in COPD

Answer 18

• stop smoking

- continuous O2 for 18hrs/day

Question 19

what is the goal SpO2 in COPD

Answer 19

94-95% b/c chronic CO2 retainers –> hypoxia is only respiratory drive

Question 20

COPDer with finger clubbing indicates….

Answer 20

(hypertrophic osteoarthropathy) possible lung malignancy

Question 21

what sign may indicate need for lung malignancy workup, especially in a COPDer

Answer 21

hypertrophic osteoarthropathy (clubbing)

Question 22

what is importantly monitored in an acute asthma exacerbation and why

Answer 22

PCO2

• should be low (tachypnea)
• if normalizing –> muscle fatigue –> impending respiratory failure –> intubate

Question 23

what chronic infection is associated with Asthma

Answer 23

Allergic Bronchopulmonary Aspergillus

Question 24

CXR with 1cm nodules in upper lobes and eggshell calcifications indicates….

Answer 24

silicosis

Question 25

what must be monitored in patients with silicosis

Answer 25

yearly TB screening, PPD >10mm is positive (give INH for 9 mo)

Question 26

Asbestosis imaging findings

Answer 26

reticulonodular process in lower lobes with pleural plaques

Question 27

CXR with reticulonodular process in lower lobes with pleural plaques indicates....

Answer 27

asbestosis

Question 28

describe 'farmer's lung' CXR

Answer 28

Hypersensitivity Pneumonitis - patchy lower lobe infiltrates with thermophilic actinomyces

Question 29

describe the the association with the following calcified nodules findings seen on CXR: - (1) popcorn calcification - (2) concentric calcification - (3) eccentric calcification

Answer 29

1- hamartoma (most common) 2- old granuloma (benign) 3- possible malignancy (especially if large, >3cm)

Question 30

____ is the most common lung cancer, non-smokers

Answer 30

adenocarcinoma

Question 31

Adenocarcinoma of the lung: - (1) location - (2) common complication - (3) common metastasis

Answer 31

1- periphery (may occur in old PNA scars) 2- exudative pleural effusion (with high hyaluronidase) 3- liver, bone (lytic), brain**, adrenals**

Question 32

describe pleural effusion due to adenocarcinoma

Answer 32

exudative with high hyaluronidase

Question 33

CXR with peripheral cavitation and CT showing distant metastasis indicates....

Answer 33

large cell carcinoma of the lung

Question 34

indicate Tx for small cell lung CA and non-small cell lung CA

Answer 34

SCLC- chemo, radiation NSCLC- resection