Pulmonary Diseases

Question 1

2 risk factors for COPD (emphysema + chronic bronchitis)

Answer 1

1. Smoking
2. Alpha-1 antitrypsin deficiency

Question 2

How is COPD evaluated?

((emphysema + chronic bronchitis)

Answer 2

PFTs: FEV1/FVC < 0.7
CXR: Hyperinflation, flat diaphragm
ABG: Chronic respiratory acidosis.

Question 3

What are 3 complications of COPD?

(emphysema + chronic bronchitis)

Answer 3

1. Respiratory failure
2. Cor pulmonale
3. Pneumothorax

Question 4

What is the most common cause of URI?

Answer 4

Viral: Rhinovirus, coronavirus, influenza.

Question 5

2 things that improve surviva/mortality in COPD

Answer 5

1. oxygen therapy (Only for PaO₂ < 55 mmHg or SpO₂ < 88%)
2. smoking cessation

Question 6

What is the treatment for viral URI?

Answer 6

Supportive care: Decongestants, analgesics, fluids.

Question 7

A COPD patient presents with respiratory acidosis (pH < 7.35, CO₂ > 50) and hypoxia despite O₂ → tx?

Answer 7

BiPAP

Question 8

tx of COPD from mild, moderate, severe, to very severe?

Answer 8

• mild: SABA or SAMA
• moderate: LAMA (tiotropium) or LABA (salmeterol)
• severe: LAMA + LABA +/- ICS
• very severe: O2 if hypoxic, lung resection

(LAMA is first line for long-term maintenance)

Question 9

When should antibiotics be used for URI?

Answer 9

Only for bacterial infections like strep throat (amoxicillin) or bacterial sinusitis.

Question 10

… = Rescue inhaler for both COPD & asthma

Answer 10

SABA (Albuterol)

Question 11

When is Roflumilast used in COPD?

Answer 11

PDE-4 inhibitor : severe COPD w/bronchitis & exacerbations

Question 12

= Add-on for acute COPD exacerbations

Answer 12

SAMA (Ipratropium)

mnemonic: O₂, BAM-S (O₂, Bronchodilators, Antibiotics, Steroids)

Question 13

What is the mnemonic for smoking cessation medications?

Answer 13

BANS
Bupropion
Acamprosate
Nicotine replacement
Varenicline (Chantix)

Question 14

…= First-line maintenance therapy for COPD

Answer 14

LAMA (Tiotropium)

Question 15

$

COPD exacerbations: tx (3)

Answer 15

1. O2
2. SABA (albuterol) + SAMA (Ipratopium) via nebulizer
3. ABX: azithromycin, doxy, amoxicillin-clavulanate
4. Prednisone

mnemonic: O₂, BAM-S (O₂, Bronchodilators, Antibiotics, Steroids)

Question 16

= Add-on for COPD & asthma maintenance, but NEVER use alone in asthma (always pair with ICS!)

Answer 16

LABA (Salmeterol)

Question 17

What are complications of smoking?

Answer 17

Lung cancer, COPD, CAD, stroke, peripheral arterial disease.

Question 18

What screening is recommended for smokers?

Answer 18

Low-dose CT for lung cancer (age 50-80, ≥20 pack-years).

Question 19

What is the most common cause of bacterial pneumonia?

Answer 19

Streptococcus pneumoniae.

Question 20

How is pneumonia diagnosed?

Answer 20

CXR: Lobar consolidation (typical), interstitial pattern (atypical).

Question 21

What is the treatment for community-acquired pneumonia?

(inpatient vs. outpatient)

Answer 21

Inpatient: Ceftriaxone + azithromycin OR levofloxacin
Outpatient: Amoxicillin ± macrolide or doxycycline OR levofloxacin

Question 22

What are 3 MC complications of pneumonia?

Answer 22

1. Abscess
2. ARDS
3. pleural effusion

Question 23

4 most common microbes that cause Hospital-Acquired Pneumonia (HAP)

Answer 23

1. pseudomonas
2. MRSA
3. Klebsiella
4. E.coli

(ventilator-associated pneumonia/VAP is caused by pseudomonas, MRSA and acinetobacter)

Question 24

How do you know when to admit a patient w/CAP?

Answer 24

CURB-65 ≥2

Question 25

Microbe that causes CAP + GI symptoms + hyponatremia →

Answer 25

Legionella

Question 26

When do you vaccinate for pneumonia?

Answer 26

* Infants (<2 yrs): PCV13 (Conjugate) → More immunogenic * Adults >65 OR Immunocompromised: PPSV23 (Polysaccharide) * AND YEARLY FLU SHOT! (high. risk pateitns in between get PPSV23 early)

Question 27

How is Venous Thromboembolism (VTE) diagnosed? | DVT or PE = VTE just different locations

Answer 27

DVT: Compression ultrasound PE: CT pulmonary angiography (gold standard) D-dimer (low probability rule-out).

Question 28

What is the treatment for VTE?

Answer 28

Anticoagulation: DOACs (apixaban, rivaroxaban) or heparin → warfarin bridge Thrombolysis if massive PE. (filter if cannot anticoagulate or recurrent DVT, but filter does NOT replace anticoagulation)

Question 29

What are 2 MC complications of VTE?

Answer 29

1. Chronic thromboembolic pulmonary hypertension 1. recurrence

Question 30

EKG finding for PE

Answer 30

S1Q3T3 (only 20% of cases)

Question 31

How does a saddle PE cause death

Answer 31

right heart failure (sudden collapse and shock → Think massive PE or saddle PE!)

Question 32

What is the next step in management if: * Wells Score ≤ 4 → * Wells Score > 4 →

Answer 32

Low probability → Do D-dimer High probability → Go straight to CTA (skip D-dimer!)

Question 33

What pulmonary complication can occur with long-term nitrofurantoin use?

Answer 33

interstitial lung disease or hypersensitivity pneumonitis → presents with dyspnea, dry cough, and infiltrates on imaging. (presents within a week, stops a day after Rx dc'd)

Question 34

What are the **key physical exam differences** between COPD and CHF?

Answer 34

**COPD:** Decreased breath sounds, wheezing, barrel chest, prolonged expiration **CHF:** Crackles (rales), S3 gallop, elevated JVP, peripheral edema, orthopnea

Question 35

What are the chest X-ray findings in CHF vs COPD?

Answer 35

**CHF:** Cardiomegaly (>1/2 thoracic width), Kerley B lines, pleural effusions, pulmonary vascular congestion **COPD:** Hyperinflated lungs, flattened diaphragms, decreased vascular markings, barrel chest

Question 37

What are the top 5 life-threatening causes of dyspnea you must not miss?

Answer 37

1. Pulmonary embolism (PE) 2. Myocardial infarction (MI) 3. Tension pneumothorax 4. Cardiac tamponade 5. Anaphylaxis