Pulmonology

Question 1

Asthma Dx Tests

Answer 1

PFTs,
FEV1/FVC decreased
Reversible and inducible

Question 2

Asthma Presentation

Answer 2

Wheezing, SOB, Cough
Asthma, Atopy, Allergies
Hyperresonance

Question 3

If asthma suspected with normal PFT what do you do

Answer 3

Methylcholine challenge test

Question 4

If asthma is suspected and PFT is abnormal what do you do

Answer 4

Give albuterol, if there is improvement asthma is confirmed

Question 5

Asthma Category 1, Intermittent

Answer 5

daytime-<2/wk
Nighttime-<2/month
FEV1-80%

Question 6

Asthma Category 2, Mild Persistent

Answer 6

daytime-<1/day, >2/wk
Nightime-<1/wk, >2/mon
FEV1-80%

Question 7

Asthma Category 3, Moderate Persistent

Answer 7

daytime->1/day
Nightime->1/wk
FEV1-60-80%

Question 8

Asthma Category 4, Severe Persistent

Answer 8

daytime->1/day
Nightime-Frequent
FEV1-<60%

Question 9

Asthma Category 5

Answer 9

Refractory, requires oral steroids

Question 10

Asthma Category 1 Tx

Answer 10

Short acting Bronchodilator- Albuterol

Question 11

Asthma Category 2 Tx

Answer 11

SABA + Inhaled Corticosteroid (-asone)

Question 12

Asthma Catgory 3 Tx

Answer 12

SABA + ICS or LTA + LABA

Question 13

Asthma Category 4 Tx

Answer 13

Increase the dose of the ICS

Question 14

Lung Cancer Work up

Answer 14

1. CXR
2. CT SCAN
3. Biopsy

Question 15

Lung CA Biopsy methods

Answer 15

Bronchoscopy- when the mass is in the bronchus
CT guided percutaneous-when the lesion is peripheral
VATS when the lesion is in the middle of the lung

Question 16

Who needs Lung CA Screening

Answer 16

Low dose CT scan yearly
Age 55-80
30 pack year history
quit smoking <15 years

Question 17

Pulmonary nodule, probably benign

Answer 17

<8mm, smooth, no smoking, calcified, age <45

Question 18

Pulmonary nodule, Probably malignant

Answer 18

> 2 cm, Spiculated, Smoking, Age >70

Question 19

Pulmonary Nodule Workup

Answer 19

1. Check old films, see if size has changed

Question 20

Small Cell Cancer
Location
Paraneoplastic syndromes
Tx

Answer 20

Central
AcTH (Cushing)
SIADH
Chemo/radiation

Question 21

Squamous Cell CA
Location
Paraneoplastic Syndromes
Tx

Answer 21

Central
PTHrP- causes hypercalcemia
Resection, then chemo/radiation

Question 22

Adenocarcinoma
Location
Pathology

Answer 22

usually non-smokers or those exposed to asbestos

Peripheral

Question 23

Carcinoid

Answer 23

Serotonin syndrome
5HIAA in the urine
flushing, wheezing, diarrhea

Question 24

LIGHTS CRITERIA

Answer 24

LDH >2/3 Upper limit of normal
LDHf/LDHs >0.6
TPf/TPs >0.5
if any are positive it is an exudate

Question 25

causes of transudative pleural effusion

Answer 25

CHF, Nephrosis, Gastrosis, Cirrhosis,

Question 26

Causes of exudative pleural effusion

Answer 26

Malignancy, Pneumonia, TB

Question 27

Elevated ADA in pleural effusion

Answer 27

Tuberculosis

Question 28

Pleural Effusion Workup

Answer 28

``` 1. Imaging Lateral decubitus x-ray US CT 2. Septations present-thoracostomy fails thoracotomy ```

Question 29

Pleural effusion with CHF

Answer 29

Diuresis first if that fails then thoracentesis

Question 30

When is V/Q Scan used in PE

Answer 30

If patient has a normal chest x-ray and abnormal kidneys

Question 31

When do you use IV contrast CT

Answer 31

Normal Kidneys

Question 32

COPD Management

Answer 32

Corticosteroids ICS, Oral, IV Oxygen keep O2 sat 88-92, given if SpO2 <88% PaO2 <55 Prevention Dilators-short acting, long acting, oral Experimental Rehab

Question 33

COPD Treatment

Answer 33

SABA as needed, then LAMA (Tiotropium), LABA (olol), ICS, PDE4 Inhibitors, Steroids

Question 34

COPD Exacerbation workup

Answer 34

CXR, ABG, ECG

Question 35

COPD Exacerbation Tx

Answer 35

Antibiotics: Doxycycline, Azithromycin Bronchodilators: Albuterol, Ipratropium

Question 36

ARDS, what is the PCWP & LV Fxn

Answer 36

PCWP-Normal | LV Fxn-Normal or increased

Question 37

ARDS Patient

Answer 37

Very sick patient as in Septic shock, TRALI, Near drowning P/A <200 CXR- pulmonary edema

Question 38

ARDS Tx

Answer 38

Intubation

Question 39

ARDS Ventilator settings

Answer 39

CO2- Low Tidal Volume High Respiratory Rate PEEP

Question 40

Interstitial Lung Disease Pt Hx

Answer 40

Chronic, Insidious Hypoxemia Dry Cough, Dry Crackles, PFT- restrictive pattern

Question 41

Interstitial Lung Disease Dx Workup

Answer 41

CXR High res CT (Ground Glass Appearance FEV1/FVC is elevated or normal

Question 42

Interstitial Lung Disease Tx

Answer 42

Steroids

Question 43

Causes of Interstitial Lung Disease

Answer 43

Sarcoidosis, SLE, RA, Systemic Sclerosis, Asbestosis, Pneumoconiosis Drug induced=blemomycin, Amiodarone, Radiation

Question 44

Sarcoidosis Pt Hx

Answer 44

Hx- Bilateral lymphadenopathy heart block bells palsy erythema nodosum

Question 45

Sarcoidosis Dx Work up | Tx

Answer 45

``` CXR CT PFT Biopsy-non-caseating granulomas Tx-Steroids ```

Question 46

Asbestosis Hx, Dx

Answer 46

``` Shipyards, Construction Pleural plaques on x-ray Dx: Imaging Biopsy- barbell bodies Tx: Stop Smoking ```

Question 47

Silicosis Hx

Answer 47

Sandblasting, Rock quarries

Question 48

Berylliosis Hx

Answer 48

Aeronautics, Electronics

Question 49

Coal Miners Lung Hx

Answer 49

Coal miner

Question 50

Hypersensitivity Pneumonitis Hx

Answer 50

24-48 hrs after exposure, then resolves after being away from exposure for 24-48 hrs