Pulmonary Medicine

Question 1

For a person w/ excessive daytime sleepiness, electroencephalography would be used to screen for _______.

Answer 1

Narcolepsy

Question 2

For a person w/ excessive daytime sleepiness, polysomnography would be used to screen for _______.

Answer 2

Sleep apnea

Question 3

In a pt with Dyspnea, the physical findings of increased jugular venous pressure, a right ventricular heave, a right-sided S3 that increases with inspiration, increased P2, or a tricuspid murmur suggest what Dx?

Answer 3

Pulmonary htn

Question 4

What is the cause of chylothorax?

Answer 4

Obstruction of the thoracic duct.

Question 5

What is the most common etiology of chylothorax? The second most common?

Answer 5

Malignancy (esp. Non-Hodgkins lymphoma); iatrogenic

Question 6

In a pt w/ limited scleroderma, increasing dyspnea, normal pulmonary exam, increased P2, tricuspid regurgitation, and abnormal DLco indicate what?

Answer 6

Pulmonary htn

Question 7

What is egophony?

Answer 7

Increased resonance of voice sounds leading o a high-pitched or bleating quality of the voice.

Question 8

What does egophony indicate?

Answer 8

Consolidation or fibrosis in the lungs.

Question 9

After thoracocentesis, What is required in a Pleural effusion w/ empyema and pH >7?

Answer 9

Tube thoracostamy (chest tube)

Question 10

What is the other term for a thoracentesis?

Answer 10

Pleural tap

Question 11

What is the other term for thoracostomy?

Answer 11

Chest tube

Question 12

What criteria should a parapneumonic effusion meet in order to merit tube thoracostomy?

Answer 12

One of the following: presence of pus, Gram-stain shows bacteria, or pH<7.0

Question 13

In pneumonia, thoracentesis is indicated in the presence of free-flowing fluid > ___ mm in height on a lateral decubitus radiograph.

Answer 13

10

Question 14

What effusion protein to serum protein ratio classifies an exudate according to Light’s criteria?

Answer 14

> 0.5

Question 15

What effusion LDH to serum LDH ratio classifies an exudate according to Light’s criteria?

Answer 15

> 0.6

Question 16

Are malignant pleural effusions usually transudative or exudative?

Answer 16

Exudative

Question 17

Small exudative pleural effusion with a very high amylase and squamous cells. Hx of retching and vomiting with the acute onset of left-sided chest pain. Dx?

Answer 17

Esophageal rupture

Question 18

What drug is used to treat beta blocker induced bronchoconstriction?

Answer 18

Ipratropium bromide

Question 19

What happens to the Pco2 in a mild asthma attack? As severity increases?

Answer 19

Below normal; normalizes; Pco2 above normal is an ominous sign.

Question 20

What is the best Tx for a usually well-controlled asthma pt (on beta agonists and inhaled steroids) who has “lost control” and had a prolonged exacerbation following a respiratory tract infection?

Answer 20

Short course of oral corticosteroids

Question 21

Acute asthma exacerbation: what Tx should be administered if the pt continues to deteriorate after 1 hour of inhaled beta agonists and anticholinergic?

Answer 21

Magnesium sulfate (IV or inhaled)

Question 22

Aside from sinus tachycardia, what are the characteristic ECG changes of pulmonary embolism?

Answer 22

s1q3t3

Deep s in lead I, large q in lead III, t wave changes in lead III