PULMONOLOGY

Question 1

Define massive hemoptysis

Answer 1

blood loss of 400 mL in 24 hours or 100- 150 mL expectoration at one time.

Question 2

What is the major risk factor for asthma?

Answer 2

Atopy

Question 3

Give the TB treatment category and regimen.

Retreatment of Rifampicin susceptible PTB and EPTB (except CNS, Bones, Joints)

Answer 3

Category II

2 HRZES / 1 HRZE / 5 HRE

Question 4

Give the TB treatment category and regimen.

Retreatment of Rifampicin susceptible CNS, Bone or Joints TB

Answer 4

Category IIa

2 HRZES/ 1 HRZE/ 9 HRE

Question 5

Atypical pathogens for CAP

Answer 5

Mycoplasma, Chlamydia and Legionella

Question 6

Duration of acute cough and differentials

Answer 6

Acute <3weeks

Acute = RTI, Aspiration, inhalation of noxious substances

Question 7

DOC for Low risk CAP with no co-morbids.

Answer 7

Amoxicillin

Question 8

What is the most common risk factor for COPD?

Answer 8

Tobacco smoking

Question 9

Define hypopnea

Answer 9

> 30% reduction in airflow for at least 10s during sleep that is accompanied by either a > 3% desaturation or an arousal.

Question 10

Pneumothorax that occurs in the presence of disease. Most are due to chronic obstructive pulmonary disease.

Answer 10

Secondary Pneumothorax

Question 11

Predicts mortality in CAP

Answer 11

Streptococcus pneumoniae

Question 12

Choroidal tubercle on eye examination is pathognomonic of __________

Answer 12

Miliary TB

Question 13

Pneumothorax that occurs in the absence of underlying lung disease. This is almost exclusive in smokers

Answer 13

Primary Pneumothorax

Question 14

What is the preferred screening test for Latent TB infection in resource- limited setting (alternative is Interferon gamma release assay or IGRA)

Answer 14

TST

Question 15

most hepatotoxic TB drug

Answer 15

Pyrazinamide

Question 16

give examples of LONG ACTING MUSCARINIC ANTAGONISTS (LAMA)

Answer 16

• Tiotropium
• Glycopyronium

Question 17

Pott’s disease (Skeletal TB) commonly affects _____

Answer 17

lower thoracic and upper lumbar in adults.

Question 18

gold standard for diagnosis of OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAHS)

Answer 18

overnight polysomnogram (PSG)

Question 19

Give examples of LONG ACTING BETA AGONIST

Answer 19

• Formoterol
• Indacaterol
• Vilanterol

*LABA is not given without ICS.

Question 20

WHEN DO YOU SUSPECT PNEUMOCYSTIS PNEUMONIA?

Answer 20

Patient with AIDS (with CD4 count of <200/uL) presenting with fever without respiratory symptoms, to mild, persistent, dry cough, to significant hypoxemia and respiratory compromise.

Question 21

What is the Most common cause of pleural effusion

Answer 21

LV heart failure

Question 22

Classic symptoms of COPD

Answer 22

o Dyspnea – progressive over time

o Chronic cough

o Chronic sputum production

Question 23

Stay in hotel or on cruise ship in previous 2 weeks. Think of what organism?

Answer 23

= think of Legionella!

Question 24

Duration and differentials for chronic cough

Answer 24

> 8 weeks

Chronic = Asthma, GERD, Post nasal Drip, ACEi

Question 25

TB drug assoc with **Autoimmune thrombocytopenia**

Answer 25

Rifampicin

Question 26

TB drug associated with **Peripheral neuropathy**

Answer 26

Isoniazid Give Vitamin B6

Question 27

Enumerate the **CLASSIFICATION OF SEVERITY OF AIRFLOW LIMITATION SEVERITY IN COPD (BASED ON POST-BRONCHODILATOR FEV1)**

Answer 27

Question 28

What is the most accurate test in the diagnosis of asthma?

Answer 28

**Pulmonary function test or spirometry.** It will show a decrease in FEV1 to FVC ratio.

Question 29

Clubbing is NOT a sign of COPD. True or false.

Answer 29

True

Question 30

Duration and differentials of Subacute cough

Answer 30

**3-8weeks** **Subacute = Post-viral tussive syndrome**

Question 31

Give the TB treatment category and regimen. ## Footnote **• New Pulmonary TB** **• New Miliary TB** **• New EPTB (except CNS, Bones, Joints)**

Answer 31

**Catergory I** **2 HRZE / 4HR**

Question 32

The tuberculin skin test cannot be used to diagnose active PTB. True or false.

Answer 32

True

Question 33

Give the TB treatment category and regimen. ## Footnote **CNS TB, TB of Bones or Joints**

Answer 33

**Category Ia** **2 HRZE / 10HR**

Question 34

Type of pneumothorax that occurs without antecedent trauma to the thorax

Answer 34

Spontaneous pneumothorax

Question 35

Enumerate evidence of **variable expiratory airflow limitation**

Answer 35

o **Reduced FEV 1 /FVC** ratio (\<0.7) o **Reduced FEV 1** that increases by **\>12%** (and by at least **200 ml** from baseline) **post bronchodilator** o Reduced FEV 1 that increases by **\>12%** (and by at least **200 ml** from baseline) **after 4 weeks on steroid trial** o Decrease in **FEV1 by 20%** with **methacholine or histamine**

Question 36

HOW TO RISK STRATIFY COMMUNITY ACQUIRED PNEUMONIA?

Answer 36

Question 37

flow-volume loop appearance of asthma

Answer 37

**reduced peak expiratory flow** and atypical **scalloped appearance** indicating widespread airflow obstruction.

Question 38

**SHORT ACTING MUSCARINIC ANTAGONIST (SAMA)**

Answer 38

Ipratropium

Question 39

Direct sputum smear microscopy (DSSM)

Answer 39

o Primary diagnostic method o **Two (2**) sputum specimens o Same day (spot-spot) strategy collected **1-hour apart** o Confirmed if **at least one (1) is positive**

Question 40

Egg-shell calcification on CXR

Answer 40

Silicosis

Question 41

recommended treatment for lung abscess

Answer 41

**Clindamycin IV or Beta-lactam with BLIC IV**

Question 42

most common **extrapulmonary TB**

Answer 42

TB lymphadenitis

Question 43

First line agent for Acute severe asthma (life threatening)

Answer 43

SABA

Question 44

What is the most accurate test for the diagnosis of COPD?

Answer 44

Pulmonary function test

Question 45

The most common allergens to trigger asthma are \_\_\_\_\_

Answer 45

Dermatophagoides species (dust mites)

Question 46

The first evidence of response to treatment of CAP

Answer 46

resolution of **fever** within a week and decreasing **WBC count** within 2-4 days.

Question 47

TB drug associated with **Visual impairment (optic neuritis, decreased color perception)**

Answer 47

Ethambutol

Question 48

What is the target oxygen saturation for COPD?

Answer 48

≥ 90%

Question 49

**Anti-IgE** drug against asthma

Answer 49

**Omalizumab** Omalizumab is an IgG against IgE. Decreasing IgE decreases activation and release of mast cells. This drug is reserved for patients who are not controlled on maximal doses of inhaler therapy.

Question 50

What form of TB is considered most infectious?

Answer 50

**Cavitary pulmonary disease and Laryngeal TB**

Question 51

What should be the result of the serum and pleural fluid protein gradient to consider **transudative effusion?**

Answer 51

**\>31 g/L (3.1 g/dl)**

Question 52

Differentiate transudate vs exudate using light's criteria. Give examples.

Answer 52

Question 53

Give examples of **LOW DOSE ICS**

Answer 53

* fluticasone * budesonide * mometasone * triamcinolone * beclometasone * ciclesonide

Question 54

TB drug assoc with **Asymptomatic hyperuricemia**

Answer 54

Pyrazinamide

Question 55

Define Apnea.

Answer 55

cessation of airflow **\> 10s** during sleep accompanied by persistent respiratory effort (obstructive) or absence of respiratory effort (central)

Question 56

What to consider if pleural fluid glucose is \< 60mg/dl?

Answer 56

* Malignancy * Bacterial infections * Rheumatoid arthritis

Question 57

the most common cause of CAP

Question 58

What is the best initial test for TB?

Answer 58

Gene X-pert MTB/Rif

Question 59

When do you start supplemental oxygen in COPD?

Answer 59

* **pO2 \<55 / sat \<88%** * **pO2 \<60 / sat** **\<90%** if with signs of pulmonary hypertension or right heart failure

Question 60

Give examples of **SHORT ACTING BETA AGONISTS (SABA)**

Answer 60

* Salbutamol * albuterol * terbutaline

Question 61

When when will you consider doing an **invasive procedure** in the presence of pleural effusion?

Answer 61

In INCREASING order of importance: 1. Loculated pleural fluid 2. Pleural fluid pH \<7.20 3. Pleural fluid glucose \<3.3mmol/ L (\<60mg/dL) 4. Positive Gram stain or culture of the pleural fluid 5. **Presence of gross pus in the pleural space - most important**

Question 62

Sudden dyspnea enlarged hemithorax with no breath sounds, hyperresonance to percussion and shift of mediastinum to contralateral side

Answer 62

think of tension pneumothorax!