Pulmonary 2

Question 1

restrictive lung disease s/s

Answer 1

progressive dyspnea
dry cough
tachypnea
digital clubbing
inspiratory crackles
normal-high FEV1/ FVC ratio

Question 2

Dx of idiopathic pulmonary fibrosis

Answer 2

HRCT scan–> honeycombing

Question 3

tx of idiopathic pulmonary fibrosis

Answer 3

O2, steroids
fibrinolytics–> nintedanib and pirfenidone
definitive–> lung transplant

Question 4

sarcoidosis cause

Answer 4

autoimmune non-caseating granulomas

common in African American women

Question 5

sarcoidosis s/s

Answer 5

erythema nodosum
lupus pernio
iritis

Question 6

dx of sarcoidosis

Answer 6

biopsy–> noncaseating granulomas
CXR- bilateral hilar lymphadenopathy
elevated ACE

Question 7

sarcoidosis stages

Answer 7

stage 1- hilar lymphadenopathy
stage 2- hilar lymphadenopathy + parenchymal
stage 3- parenchymal
stage 4- upper lobe fibrosis

Question 8

tx of sarcoidosis

Answer 8

oral steroids

Question 9

coal worker’s findings

Answer 9

upper lobes
complicated–> progressive massive fibrosis

Question 10

silicosis findings

Answer 10

eggshell calcification
MC in upper lobes
increased risk TB

Question 11

s/s of lung cancer

Answer 11

WL
cough/ hemoptysis
digital clubbing
hoarseness

Question 11

asbestosis findings

Answer 11

linear streaking at lung bases
complication–> mesothelioma

Question 12

what two types of lung cancer are commonly found peripherally

Answer 12

adenocarcinoma
large cell carcinoma

Question 13

what types of lung cancer are located centrally?

Answer 13

squamous cell carcinoma
small cell carcinoma

Question 14

lung cancer screening guidelines

Answer 14

50-80 yrs old AND
current smoker OR quit in past 15 yrs

Question 15

dx of lung cancer

Answer 15

CXR–> CT –> biopsy

Question 16

lung cancer staging

Answer 16

stage 1- lung tissue only
stage 2- lung tissue with surrounding lymph nodes
stage 3- lung tissue or adjacent resectable structures and lymph nodes within mediastinum
stage 4- spread to opposite lung or other organ

Question 17

tx of lung cancer

Answer 17

NSCLC- surgical removal
SCLC- chemotherapy (cisplatin and etoposide) and/or radiation

Question 18

pulmonary nodule

Answer 18

3 cm or less

Question 19

pulmonary mass

Answer 19

> 3 cm

Question 20

tx of pulmonary nodule

Answer 20

low risk- observation
intermediate risk- biopsy
high risk- surgical removal

Question 21

causes of pulmonary embolism

Answer 21

Fat
Air
Thrombus
Amniotic fluid
Less common- sepsis

Question 22

s/s of pulmonary embolism

Answer 22

dyspnea
pleuritic chest pain
cough
tachypnea/ tachycardia

*loud S2

Question 23

well’s score components

Answer 23

+3- PE #1 DDx; s/s of DVT
+1.5- HR > 100; stasis; hx of PE/ DVT
+1- hemoptysis; malignancy

Question 24

PERC score

Answer 24

1- age 50+ 2- HR > 100 3- O2 < 95% 4- unilateral leg swelling 5- hemoptysis 6- anesthesia in past 4 wks 7- prior hx of PE or DVT 8- hormone use

Question 25

Dx of PE

Answer 25

CTPA is gold standard CXR- normal, westermark or hamptom hump ECG- tachycardia, S1Q3T3

Question 26

PE tx

Answer 26

start heparin drip ASAP stable- DOACs - 2nd line: IVC filter unstable- thrombolytics (alteplase or streptokinase) - 2nd line: embolectomy

Question 27

4 ARDS characteristics

Answer 27

1- occurs within 7 days of trigger 2- bilateral pulm opacities 3- respiratory failure 4- PaO2/FiO2 < 300 mmHg

Question 28

RFs for ARDS

Answer 28

sepsis aspiration of gastric contents

Question 29

Dx of ARDS

Answer 29

CXR- air bronchograms and bilateral infiltrates that spare CPA

Question 30

tx of ARDS

Answer 30

intubation and PEEP (PaO2 > 55 or > 88%)

Question 31

pulmonary HTN s/s

Answer 31

fatigue, dyspnea and syncope with exertion, cough, RHF *loud S2

Question 32

pulmonary HTN diagnostics

Answer 32

TTE--> right cardiac cath elevated BNP

Question 33

pulmonary HTN tx

Answer 33

vasodilators--> sildenafil O2 Diuretics

Question 34

causes of pleural effusion

Answer 34

transudative- HF, renal, liver, atelectasis exudative- infection, inflammation, trauma

Question 35

s/s of pleural effusion

Answer 35

pleuritic CP dyspnea cough dullness to percussion

Question 36

dx of pleural effusion

Answer 36

thoracentesis

Question 37

Light's Criteria

Answer 37

transudative- <0.5 protein, < 0.6 plural: serum LDH, < 2/3 upper limit LDH exudative- opposite

Question 38

tx of pleural effusion

Answer 38

thoracentesis treat underlying cause- transudative--> diuretics and low Na+ large--> drainage and pleurodesis empyema--> drainage and abx

Question 39

types of pneumothorax

Answer 39

primary- no lung disease secondary- lung disease traumatic tension

Question 40

s/s of pneumothorax

Answer 40

unilateral CP and dyspnea hyperresonance to percussion

Question 41

dx of pneumothorax

Answer 41

CXR--> visceral pleural line

Question 42

tx of pneumothorax

Answer 42

small primary- observe large primary- simple needle aspiration or chest tube secondary- chest tube surgery tension- emergent decompression then chest tube placement

Question 43

acute respiratory failure requirements

Answer 43

PO2 < 60 or PCO2 > 50

Question 44

tx of acute respiratory failure

Answer 44

oxygenation- > 92% or 88% COPD ventilation- intubation or BiPAP