Pulmonology

Question 1

How do you diagnose PE with abnormal chest xray?

Answer 1

CT scan with IV contrast

Question 2

What are 4 things you do when pt comes in with asthma exacerbation?

Answer 2

SpO2 gt 90%, give nebulizer tx q30m x3, give steroids, measure PEFR (peak expiratory flow rate)

Question 3

Hyponatremia and lung cancer = ?

Answer 3

Small cell, SIADH

Question 4

COPD exacerbation, you want antibiotics, but there is a prolonged QT, what do you give them?

Answer 4

Doxycycline, NOT azithromycin

Question 5

How do you diagnose COPD?

Answer 5

PFTs

Question 6

Who gets antibiotics in COPD exacerbation?

Answer 6

productive cough, increased sputum

Question 7

How do you screen lung cancer?

Answer 7

CT scan

Question 8

COPD exacerbation, you want antibiotics, there is no heart history, what do you give them?

Answer 8

Azithromycin preferred, doxycycline is ok

Question 9

PCWP in ARDS? In CHF?

Answer 9

Normal or low; high

Question 10

How do you diagnose PE with bad kidneys?

Answer 10

V/Q scan (need a normal CXR for this to work)

Question 11

What is the definition of ARDS?

Answer 11

Noncardiogenic pulmonary edema

BNP, Echo, PCWP normal; CXR shows pulmonary edema, P/F ratio less than 200

Question 12

Biopsy of a lung cancer in the middle of the lung parenchyma, how do you do it?

Answer 12

VATS (video assisted thorascopic surgery)

Question 13

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

Answer 13

Bronchoscopy with EUS (endoscopic ultrasound)

Question 14

How do you spot an inhaled corticosteroid by its name?

Answer 14

-asone

Question 15

When do you use tPA in a PE?

Answer 15

Massive PE - hypotension!

Question 16

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

Answer 16

diuresis

Question 17

Sand blasting and rock quarries, lung disease?

Answer 17

Silicosis (correlation with TB)

Question 18

What medications are used in an asthma exacerbation?

Answer 18

Albuterol + ipratropium, methylprednisone/prednisone

Question 19

Asthma question, the wheezing stops but air movement is reduced. What do you do?

Answer 19

Intubate

Question 20

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

Answer 20

Thoracostomy (chest tube)

Question 21

For diffuse parenchymal lung disease, when do you give O2 supplementation?

Answer 21

When SpO2 is less than 88%

Question 22

Wheezing, flushing, diarrhea, lung cancer, what’s the diagnosis? What test can you get?

Answer 22

Lung carcinoid; 5-HIAA in the urine

Question 23

How long do you bridge someone with heparin to coumadin?

Answer 23

INR 2-3 or for 5 days, whichever is longer

Question 24

Ship-yards, construction, and lung cancer = ?

Answer 24

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

Question 25

How do you diagnose asthma?

Answer 25

PFTs, FEV1/FVC is reduced and reversible

Question 26

What is the mechanism of action of beclomethasone?

Answer 26

inhaled corticosteroid (-asone)

Question 27

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

Answer 27

low pO2, low CO2, respiratory alkalosis (may also see a metabolic acidosis)

Question 28

What are the danger of LABAs?

Answer 28

Asthma related death (must be used with inhaled corticosteroids)

Question 29

Lung cancer and hypercalcemia = ?

Answer 29

Metastatic disease OR PTH-rp from squamous cell carcinoma

Question 30

Who do you screen for lung cancer and how?

Answer 30

55-80 yo, gt 30 pack years, ongoing smoker (or have quit within 15 years); low dose CT

Question 31

What is the mechanism of action of formoterol?

Answer 31

Long acting beta agonist

Question 32

How do you diagnose PE with good kidneys?

Answer 32

CT scan with IV contrast (otherwise use V/Q scan - though you need a normal CXR)

Question 33

First long-acting medication in COPD management?

Answer 33

LAMA - tiotropium

Question 34

PE and metastatic cancer tx?

Answer 34

low molecular weight heparin only (no bridge)

Question 35

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

Answer 35

Stage IV (metastatic) cancer

Question 36

Cushing's syndrome and lung cancer = ?

Answer 36

small cell, ACTH producing (would fail low and high dose dex suppression test)

Question 37

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

Answer 37

hemothorax

Question 38

How do you spot a long acting beta agonist by its name?

Answer 38

-oterol

Question 39

Bilaterally fluffy infiltrates and hypoxemia (3)?

Answer 39

CHF, ARDS, PCP pneumonia

Question 40

Heart block from which diffuse parenchymal lung disease?

Answer 40

sarcoid

Question 41

Aeronautics, nuclear, which diffuse parenchymal lung disease?

Answer 41

Berylliosis

Question 42

CO2 is elevated from baseline but pt is moving air in a COPD exacerbation, what do you do?

Answer 42

BiPAP (non-invasive positive pressure ventilation)

Question 43

Shipyards, construction, lung cancer?

Answer 43

Asbestosis

Question 44

What is the mechanism of action of zafirlukast?

Answer 44

Leukotriene-antagonist (-leukast)

Question 45

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

Answer 45

Lateral decubitus xr OR u/s

Question 46

How do you bx a lung cancer on the periphery of the lung?

Answer 46

Percutaneous, CT guided

Question 47

What disease can coal miner's develop and what are the symptoms?

Answer 47

Caplan syndrome - arthralgias + pulmonary fibrosis

Question 48

Adenosine deaminase is high in the pleural fluid, what does that mean?

Answer 48

TB

Question 49

Air mvmt stops or the CO2 rises in a COPD exacerbation, what do you do?

Answer 49

intubate

Question 50

Sarcoid on a CXR? Bx?

Answer 50

bilateral hilar lymphadenopathy; non-caseating granuloma

Question 51

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

Answer 51

DVT, ultrasound!

Question 52

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

Answer 52

Thoracotomy (surgery)

Question 53

When do you use a IVC filter?

Answer 53

when patient has a contraindication to anticoagulation

Question 54

What is the ARDS protocol (3)?

Answer 54

low tidal volume (to reduce pressure and prevent overdistension of alveoli), high respiratory rate (so CO2 doesn't accumulate), PEEP (to keep good alveoli open)

Question 55

Pleural plaques on CXR?

Answer 55

Asbestosis

Question 56

What improves COPD mortality?

Answer 56

Oxygen and smoking cessation