IM III: Pulmonology

D. limb girdle muscular dystrophy - extrapulmonary cause of restrictive lung dz - ddx includes skeletal abnormalities, trauma, or neurologic processes

A 19yo with history of a spinal cord injury presents for evaluation of dyspnea x 2 months. On exam, the patient appears to be mildly uncomfortable. Vital signs are remarkable for respiratory rate of 24 and room air oxygen saturation of 94%. PFTs are shown. Of the following, what is the most likely dx? A. asthma B. emphysema C. hypersensitivity pneumonitis D. limb girdle muscular dystrophy E. pulmonary hypertension

D. restrictive; extrapulmonary - FVC = low - FEV1/FVC = normal - TLC = low - DLCO = normal

A 19yo with history of a spinal cord injury presents for evaluation of dyspnea x 2 months. On exam, the patient appears to be mildly uncomfortable. Vital signs are remarkable for respiratory rate of 24 and room air oxygen saturation of 94%. PFTs are shown. What type of lung problem is this? A. obstructive (w/out air trapping) B. obstructive with air trapping C. restrictive; pulmonary D. restrictive; extrapulmonary E. none of the above

A) Typical bacteria

A lobar pneumonia is more typical of: A) Typical bacteria B) Atypical bacteria

C. restrictive lung disease

A low FVC and low total lung capacity are expected in which type of lung problem? A. normal lung function B. obstructive lung disease C. restrictive lung disease

A. Sarcoidosis - 90% w/ pulm involvement Non-caseating = solid - caseating - necrotic (cheesy) core, seen in TB

A multisystem, granulomatous disorder of unknown etiology characterized by noncaseating granulomas in affected tissues. A. Sarcoidosis B. Pneumoconiosis C. Idiopathic pulmonary fibrosis D. Berylliosis

C. reticulonodular markings - it is NOT unusual to have normal CXR in early stages of PH - normal CXR doesn't rule out PH

All of the following are classic CXR findings associated with Pulmonary hypertension EXCEPT A. peripheral hypovascularity B. prominent pulmonary artery C. reticulonodular markings D. right ventricular enlargement

F. postnasal drip - focal areas of edema & pallor

Cobblestoned mucosa in the naso-oropharyngeal area is consistent with which of the following diagnoses? A. cough-variant asthma B. GBAS infection C. GERD F. postnasal drip E. candidiasis

Mechanical: •Obesity •Ascites •Pregnancy •Scoliosis/Kyphosis •Pleural effusion Neuromuscular: •Myasthenia gravis •Polio •Guillain-Barre Syndrome •Muscular dystrophy

Extrinsic causes of restrictive lung disease

A. restrictive lung disease - low FVC - normal FEV1/FVC

FVC = 70% FEV1/FVC = 80% What does this suggest? A. restrictive lung disease B. obstructive lung disease (w/out air trapping) C. obstructive lung disease with air trapping D. normal lung function E. impossible to determine

C. obstructive lung disease with air trapping - low FVC - low FEV1/FVC

FVC = 76% FEV1/FVC = 68% What does this suggest? A. restrictive lung disease B. obstructive lung disease (w/out air trapping) C. obstructive lung disease with air trapping D. normal lung function E. impossible to determine

B. obstructive lung disease (w/out air trapping) - normal FVC - low FEV1/FVC

FVC = 82% FEV1/FVC = 66% What does this suggest? A. restrictive lung disease B. obstructive lung disease (w/out air trapping) C. obstructive lung disease with air trapping D. normal lung function E. impossible to determine

C. Residual Volume FVC = Tidal Volume + Inspiratory Reserve Volume + Expiratory Reserve Volume

FVC is the sum of all of the following EXCEPT A. Expiratory Reserve Volume B. Inspiratory Reserve Volume C. Residual Volume D. Tidal Volume

A) Immunocompromised

Fungal pneumonias are more commonly seen in which patients? A) Immunocompromised B) Young patients C) Old Patients D) Smokers

C) Chest tube, hospital admission, surgical intervention

Which of the following accurately describes the treatment required for a Secondary spontaneous pneumothorax. A) Oxygen and observation B) Needle decompression C) Chest tube, hospital admission, surgical intervention D) 3 way occlusive dressing

D) A and B Very common inpatient antibiotic regimen is: •Ceftriaxone + Macrolide (Azithromycin) or Doxycycline •Fluoroquinolone monotherapy

Which of the following are common inpatient antibiotic regimens for CAP: A) Fluoroquinolone monotherapy B) Ceftriaxone + Macrolide or Doxycycline C) Vancomycin D) A and B E) A and C

E) All of the above

Which of the following are potential obstructive consequences of lung cancer? A) Bronchial or tracheal obstruction B) Compression of recurrent laryngeal nerve causing hoarseness C) Superior vena cava syndrome D) Pancoast syndrome E) All of the above

F) All of the above

Which of the following can cause pneumonia? A) Typical Bacteria B) Atypical bacteria C) Fungi D) Viruses E) A, B, and C F) All of the above

F) All of the above

Which of the following can cause viral pneumonias? A) Influenza B) Coronaviruses C) Parainfluenza D) Adenovirus E) Respiratory syncytial virus F) All of the above

C. the median survival in patients with IPF is 10-15 years •Median survival in patients diagnosed with IPF is 2-5 years - Average patient lives 4 years after diagnosis

Which of the following is FALSE about IPF? A. patients with IPF should be followed by a pulmonologist B. IPF is the most common ILD to be referred for lung transplant C. the median survival in patients with IPF is 10-15 years D. there is no cure for IPF

A) An infection of the upper respiratory tract - FALSE Bronchitis is lower respiratory infection without evidence of pneumonia, so no involvement of parenchyma here

Which of the following is FALSE regarding Acute Bronchitis? A) An infection of the upper respiratory tract B) Involves the bronchi C) Has no evidence of pneumonia D) MCC are viral pathogens E) Makes up 10% of ambulatory visits

A. vasodilation •Affects small muscles •Characterized by: - vasoconstriction - hyperplasia - hypertrophy - fibrosis

Group 1 pulmonary HTN is characterized by all of the following EXCEPT A. vasodilation B. hyperplasia C. fibrosis D. hypertrophy

D. A problem with the vessels (arteries) themselves Group 1: Pulmonary arterial hypertension

Group 1 pulmonary hypertension A. A blockage in the vessels B. A problem with the heart as a pump C. A problem with the lungs D. A problem with the vessels (arteries) themselves E. Unclear multifactoral mechanisms

B. A problem with the heart as a pump Group 2: PH from left-sided heart disease

Group 2 pulmonary hypertension A. A blockage in the vessels B. A problem with the heart as a pump C. A problem with the lungs D. A problem with the vessels (arteries) themselves E. Unclear multifactoral mechanisms

C. A problem with the lungs Group 3: PH from chronic hypoxic lung disease •Pulmonary circulation in hypoxic lung disease compensates by trying to constrict pulmonary arterioles and squeeze as much oxygen out of the diseased alveoli as possible •This causes vessel wall remodeling/thickening over time--> permanent narrowing of lumens even in absence of vasoconstriction

Group 3 pulmonary hypertension A. A blockage in the vessels B. A problem with the heart as a pump C. A problem with the lungs D. A problem with the vessels (arteries) themselves E. Unclear multifactoral mechanisms

A. A blockage in the vessels Group 4: PH from chronic blood clots

Group 4 pulmonary hypertension A. A blockage in the vessels B. A problem with the heart as a pump C. A problem with the lungs D. A problem with the vessels (arteries) themselves E. Unclear multifactoral mechanisms

E. Unclear multifactoral mechanisms Group 5: Unclear (sarcoidosis, hematologic disorders, etc.)

Group 5 pulmonary hypertension A. A blockage in the vessels B. A problem with the heart as a pump C. A problem with the lungs D. A problem with the vessels (arteries) themselves E. Unclear multifactoral mechanisms

B) Transudative effusion Light's Criteria Fluid is exudative if one of these is met: •Ratio of pleural fluid protein to serum protein is greater than 0.5 •Ratio of pleural fluid LDH to serum LDH is greater than 0.6 •Pleural fluid LDH is greater than two-thirds the upper limit of normal serum LDH

If the ratio of pleural fluid protein to serum protein is 0.4, the patient has a(n): A) Exudative effusion B) Transudative effusion

D) Squamous cell

Hypercalcemia can be seen in any type of lung cancer, and is due to the tumor secreting its own PTH. It is MC in: A) Carcinoid B) Large cell C) Adenocarcinoma D) Squamous cell E) Small Cell

C) SIADH

Hyponatremia seen in small cell lung cancer is due to: A) Horner syndrome B) Pancoast syndrome C) SIADH D) SVC Syndrome

F. both B & C •Endothelin receptor antagonists - ambrisentan •Phosphodiesterase-5 inhibitors - Tadalafil, sildenafil (Viagra) also these but don't need to know: - sGC stimulator - Prostanoids (oral or parenteral)

If a patient with PAH is NOT vasoreactive, what is the treatment of choice? A. calcium channel blocker (nifedipine) B. endothelin receptor antagonists C. phosphodiesterase-5 inhibitors D. both A & B E. both A & C F. both B & C G. all of the above

A. calcium channel blocker (nifedipine)

If a patient with PAH is vasoreactive, what is the treatment of choice? A. calcium channel blocker (nifedipine) B. endothelin receptor antagonists C. phosphodiesterase-5 inhibitors D. both A & B E. both A & C F. both B & C G. all of the above

C) >30mm

If a pulmonary mass is ________, it is considered malignant until proven otherwise. A) >10mm B) >20mm C) >30mm D) >50mm

E) Refer to specialist

If a pulmonary nodule is 8-30mm in size and has a high risk (>65%) for malignancy, you should: A) Do nothing, this is benign B) Watch with CT surveillance C) Surgically resect it D) Do a PET scan E) Refer to specialist

D) Do a PET scan

If a pulmonary nodule is 8-30mm in size and has a low/moderate risk (5-65%) for malignancy, you should: A) Do nothing, this is benign B) Watch with CT surveillance C) Surgically resect it D) Do a PET scan E) Refer to specialist

B) Watch with CT surveillance

If a pulmonary nodule is 8-30mm in size and has a very low risk (<5%) for malignancy, you should: A) Do nothing, this is benign B) Watch with CT surveillance C) Surgically resect it D) Do a PET scan E) Refer to specialist

B) Watch with CT surveillance *assess growth of nodule over time

If a pulmonary nodule is <8mm without any concerning risk factors for malignancy, you should: A) Do nothing, this is benign B) Watch with CT surveillance C) Surgically resect it D) Do a PET scan E) Refer to specialist

E) Refer to specialist

If a pulmonary nodule is >30mm you should: A) Do nothing, this is benign B) Watch with CT surveillance C) Surgically resect it D) Do a PET scan E) Refer to specialist

A. Sarcoidosis

If an individual presents with Lofgren syndrome, you can make the diagnosis of _____________. A. Sarcoidosis B. Berylliosis C. Idiopathic pulmonary fibrosis D. Silicosis

A) Exudative effusion Light's Criteria Fluid is exudative if one of these is met: •Ratio of pleural fluid protein to serum protein is greater than 0.5 •Ratio of pleural fluid LDH to serum LDH is greater than 0.6 •Pleural fluid LDH is greater than two-thirds the upper limit of normal serum LDH

If one of the three criteria in Light's criteria is met, then the patient has a(n): A) Exudative effusion B) Transudative effusion

A) Exudative effusion

If pleural fluid is greater than 2/3 the upper limit of normal for serum LDH the patient has a(n): A) Exudative effusion B) Pleural effusion

B) Transudative effusion Light's Criteria Fluid is exudative if one of these is met: •Ratio of pleural fluid protein to serum protein is greater than 0.5 •Ratio of pleural fluid LDH to serum LDH is greater than 0.6 •Pleural fluid LDH is greater than two-thirds the upper limit of normal serum LDH

If the Ratio of pleural fluid LDH to serum LDH is 0.5, the patient has a(n): A) Exudative effusion B) Transudative effusion

A) Exudative effusion Light's Criteria Fluid is exudative if one of these is met: •Ratio of pleural fluid protein to serum protein is greater than 0.5 •Ratio of pleural fluid LDH to serum LDH is greater than 0.6 •Pleural fluid LDH is greater than two-thirds the upper limit of normal serum LDH

If the Ratio of pleural fluid LDH to serum LDH is 0.8, the patient has a(n): A) Exudative effusion B) Transudative effusion

B. Caplan syndrome - peripheral pulmonary rheumatoid nodules--> can worsen lung function & increase fibrosis

Individuals with Coal Worker's Pneumoconiosis and rheumatoid arthritis can develop which rare syndrome? A. Guillan-barre syndrome B. Caplan syndrome C. Lofgren syndrome D. Turner syndrome

D. Silicosis

Individuals with _______________ are at an increased risk for TB. A. Asbestosis B. Berylliosis C. Coal workers' pneumoconiosis D. Silicosis E. Sarcoidosis E. all of the above

C. use non-estrogen containing contraception - Estrogen plays a role in the pathogenesis of PAH

Individuals with group 1 PH with childbearing potential are advised to do which of the following? A. use estrogen-containing contraception B. use progesterone-containing contraception C. use non-estrogen containing contraception D. use non-progesterone containing contraception use E. avoid all oral contraceptives

Deoxygenated blood from body--> Venae cavae--> Right side of heart --> Pulmonary arteries--> Lungs--> Pulmonary veins--> Left heart--> Body

Pulmonary circulation

A. low •Average mean pulmonary artery pressure around 15 mmHg in mammals

Pulmonary circulation is a ________ pressure system. A. low B. high

False •In a patient in whom you have a high clinical suspicion for lung cancer, a normal chest xray does not rule out lung cancer! •Tumor can be too small or can be hidden on xray •Next step would be CT scan

T/F: Lung xray rules out lung cancer

False Secondary spontaneous PTX is associated with connective tissue diseases

T/F: Primary spontaneous PTX is associated with connective tissue diseases

True

T/F: Small pleural effusions can be asymptomatic

True

T/F: Subsolid nodules have a higher risk of malignancy

False: *Right and left each have separate pleural space

T/F: The right and left lung share a pleural space

True

T/F: The same viruses that cause a URI can cause acute bronchitis

True

T/F: You can have a bacterial co-infection with viral pneumonia due to influenza

True •Neuroendocrine cells --> paraneoplastic syndromes (SIADH, Cushing)

T/F: there are many paraneoplastic syndromes that can be caused by lung cancers

B. restrictive lung disease - TLC <80% = low - helps confirm restrictive lung dz in patients with low FVC on spirometry - sensitive & specific for restrictive lung dz

TLC <80% would indicate which of the following? A. obstructive lung disease B. restrictive lung disease C. both A & B D. none of the above

E. B or C - normal or high (usually >100% predicted) in obstructive lung disease

TLC will be _____________ in obstructive lung disease. A. low B. normal C. high D. A or B E. B or C

C. normal; poor PE (vascular issue) - normal ventilation (air into alveoli) - poor perfusion (oxygen out of alveoli) --> issue of getting oxygen out of the alveoli **other conditions such as ILD & PNA cause poor ventilation & normal perfusion (something keeping air from getting into alveoli)

The V/Q mismatch seen as a result of PE is characterized by ____________ ventilation and ____________ perfusion. A. poor; poor B. poor; normal C. normal; poor

Tension Pneumothorax

Unstable vital signs, signs of shock, and tracheal deviation are suggestive of what type of PTX?

C. GERD - heartburn or sour taste in mouth

What cause should be of highest suspicion for a cough accompanied by sour taste in mouth? A. asthma B. postnasal drip C. GERD D. postviral pertussis E. lung disease or cancer

E. lung disease or cancer

What cause should be of highest suspicion for a cough in someone with a history of smoking? A. asthma B. postnasal drip C. GERD D. postviral pertussis E. lung disease or cancer

B. postnasal drip

What cause should be of highest suspicion for a cough w/ associated runny nose and/or drainage in throat? A. asthma B. postnasal drip C. GERD D. postviral pertussis E. lung disease or cancer

A. asthma - a/w eczema, allergies

What cause should be of highest suspicion for a cough w/ associated wheezing and/or dyspnea? A. asthma B. postnasal drip C. GERD D. postviral pertussis E. lung disease or cancer

D) Sputum

What do you want to culture if looking for the causative pathogen in pneumonia? A) Blood B) Urine C) Stool D) Sputum

chronic thromboembolic pulmonary hypertension--> Group 4 - 1/2 of patients with CTEPH have no apparent history of acute PE

What does CTEPH stand for, and what group of pulmonary HTN is it associated with?

B. total lung capacity - vital capacity + residual volume = total lung capacity (TLC)

What does plethysmography measure? A. forced vital capacity B. total lung capacity C. inspiratory reserve volume D. expiratory reserve volume

B) Streptococcus Pneumoniae

What is the most common cause of CAP? A) Haemophilus influenzae B) Streptococcus Pneumoniae C) Staph Aureus D) Klebsiella Pneumoniae E) Pseudomonas Aeruginosa

C. acute viral respiratory tract infection

What is the most common cause of an acute cough? A. acute exacerbation of asthma B. acute exacerbation of COPD C. acute viral respiratory tract infection D. pneumonia E. pulmonary embolism

C) CHF *90% of pleural effusions

What is the most common cause of pleural effusion? A) Cirrhosis B) Nephrotic syndrome C) CHF D) Pneumonia

C. left sided heart failure

What is the most common cause of right sided heart failure? A. chronic lung disease B. coronary artery disease C. left sided heart failure D. pulmonary stenosis

B) Mycoplasma pneumoniae - walking pneumonia = atypical

What is the most common cause of walking pneumonia? A) Haemophilus influenzae B) Mycoplasma pneumoniae C) Legionella pneumophila D) Klebsiella Pneumoniae E) Pseudomonas Aeruginosa

B) COPD

What is the most common lung disease to cause PTX? A) TB B) COPD C) ISD D) CF

A) Cough and/or systemic symptoms Cough (50-75%) Systemic symptoms (55-90%) •Weight loss •Anorexia •Fatigue/weakness

What is the most common presentation of lung cancer? A) Cough and/or systemic symptoms B) Chest pain C) Dyspnea D) Hemoptysis

D. dyspnea on exertion •Cough, rales, clubbing possible as well

What is the most common presenting symptom of asbestosis? A. chest pain B. headache C. dry cough D. dyspnea on exertion E. clubbing of fingers

B. cigarette smoking most common in men >60yo w/ smoking history

What is the most significant risk factor for idiopathic pulmonary fibrosis? A. age 60-80 B. cigarette smoking C. history of asthma D. male gender E. occupational exposures F. microaspirations from GERD

C) Lung Cancer *generally poor prognosis

What is the number 1 cause of cancer death worldwide? A) Pancreatic cancer B) Colon cancer C) Lung Cancer D) Breast Cancer

C) Acute Cough Can be productive or non-productive (Non-specific either way, not a predictor of bacterial etiology) •1-3 weeks in duration

What is the number 1 symptom of acute bronchitis? A) H/A B) Nasal congestion C) Acute Cough D) Sore throat

B. Warfarin (LMWH) anticoagulation: - LMWH alone is preferred tx in pregnancy (or active maligancy) - Factor Xa inhibitor contraindicated in pregnancy & renal insufficiency --> ex. Xarelto, Eliquis

What is the preferred treatment for a stable PE in a patient who is pregnant? A. Factor Xa inhibitor (DOAC) B. Warfarin (LMWH) C. both A & B D. none of the above

C. both A & B - LMWH + Factor Xa inhibitor

What is the preferred treatment for a stable PE? A. Factor Xa inhibitor (DOAC) B. Warfarin (LMWH) C. both A & B D. none of the above

B. regular use of ICS •Primary treatment for cough-variant asthma is regular use of inhaled corticosteroid •Treatment may take several weeks to be effective

What is the primary treatment for cough-variant asthma? A. regular use of LABA B. regular use of ICS C. as needed SABA D. as needed ICS-formoterol

D) 5th ICS mid-axillary line

What is the site for a Chest tube? A) 2nd ICS mid clavicular line B) 2nd ICS mid-axillary line C) 5th ICS mid-clavicular line D) 5th ICS mid-axillary line

A) 2nd ICS mid clavicular line

What is the site for a Needle chest decompression? A) 2nd ICS mid clavicular line B) 2nd ICS mid-axillary line C) 5th ICS mid-clavicular line D) 5th ICS mid-axillary line

C) Surgical Resection

What is the treatment for stage 1 lung cancer? A) Chemo/Radiation +/- surgical resection B) Chemo and possible palliative radiation/surgery w/ palliative care C) Surgical Resection D) All of the above

A. surgical resection

What is the treatment for stage 1-2 non-small cell lung cancer? A. surgical resection B. chemo/ radiation +/- surgical resection C. chemo +/- radiation +/- surgical resection D. chemo only

C) Surgical Resection

What is the treatment for stage 2 lung cancer? A) Chemo/Radiation +/- surgical resection B) Chemo and possible palliative radiation/surgery w/ palliative care C) Surgical Resection D) All of the above

A) Chemo/Radiation +/- surgical resection

What is the treatment for stage 3 lung cancer? A) Chemo/Radiation +/- surgical resection B) Chemo and possible palliative radiation/surgery w/ palliative care C) Surgical Resection D) All of the above

B) Negative pressure within the pleural space *Negative pressure (vacuum) Keeps lungs expanded by sucking them against chest wall *Right and left each have separate pleural space

What keeps the lungs expanded? A) Negative pressure within the lungs B) Negative pressure within the pleural space C) Positive pressure within the pleural space D) No one knows

B) Bacterial Pneumonia

What may elevated procalcitonin be more indicative of? A) Viral pneumonia B) Bacterial Pneumonia

C. lung - infiltration of lung tissue or hilar LAD

What organ is most commonly involved at presentation of sarcoidosis? A. kidney B. liver C. lung D. skin E. spleen

B. they may feel claustrophobic - enclosed booth for testing

What should you warn patients about prior to plethysmography testing? A. it will be painful B. they may feel claustrophobic C. they will be exposed to radiation D. there is a high risk for allergic reaction E. all of the above

D. lung transplant

What surgical option is considered in individuals with PAH who do not respond to medical therapy? A. IVC filter B. pulmonary endarterectomy C. valve replacement D. lung transplant

A. BeLPT BeLPT will identify patients who have been sensitized to beryllium - CXR & PFTs will look the same in sarcoidosis & berylliosis - CXR and CT --> Reticulonodular findings, ground glass opacities, Hilar adenopathy - PFTs --> restrictive pattern with decreased DLCO

What test will differentiate berylliosis from sarcoidosis? A. BeLPT B. CT scan C. CXR D. PFTs

A. low FVC; decreased DLCO - restrictive pattern & decreased DLCO

What will PFTs show in IPF? A. low FVC; decreased DLCO B. low FVC; normal DLCO C. low FEV1/FVC; decreased DLCO D. low FEV1/FVC; normal DLCO

A. low FVC; decreased DLCO - restrictive pattern & decreased DLCO

What will PFTs show in Sarcoidosis? A. low FVC; decreased DLCO B. low FVC; normal DLCO C. low FEV1/FVC; decreased DLCO D. low FEV1/FVC; normal DLCO

B) Blunting of costophrenic angles *will see blunting of costophrenic angles, often a meniscus at superior aspect of the effusion

What will you see on chest x-ray of a pleural effusion? A) Ground glass appearance B) Blunting of costophrenic angles C) Normal CXR D) Loss of lung markings

B. Strep pneumoniae

What's the most common bacterial cause of community acquired pneumonia? A. Haemophilus influenzae B. Strep pneumoniae C. Mycoplasma pneumoniae D. Klebsiella pneumoniae

B. pleural plaques - reticulonodular findings & honeycombing also seen in IPF

Which of the following CXR findings is unique to asbestosis and would not be seen in IPF? A. honeycombing in lower lobes B. pleural plaques C. reticulonodular findings D. all of the above

B. COPD The 3 MCC of chronic cough are: •Postnasal drip •Asthma •GERD - Responsible for 90% of cases of chronic cough - Responsible for 99% of cases in patients who: --> Are nonsmokers --> Don't take an ACE inhibitor --> Have a normal CXR

Which of the following is NOT one of the 3 most common etiologies of chronic cough? A. asthma B. COPD C. GERD D. postnasal drip

C) Supportive tx (+ anti-tussives) •There is no role for antibiotics in the treatment of bronchitis - OTC cough supression - Bronchodilators for patients with wheezing or underlying pulm disease - Benzonatate (Tessalon pearls) (rx cough suppression)

Which of the following is the treatment of Acute bronchitis? A) Antibiotics B) Antivirals C) Supportive tx (+ anti-tussives) D) Antibiotics

B. when its negative, you can safely rule out a VTE D-dimer for VTE: - high sensitivity (97%) - low specificity (35%) - low rate of false negatives, high rate of false positives

Which of the following is true about D-dimer? A. when its positive, you can confidently rule in a VTE B. when its negative, you can safely rule out a VTE C. both A & B D. none of the above

D. both A & B - positive Homan's sign is calf pain w/ dorsiflexion at ankle - indicates DVT in calf vein

Which of the following is true about Homan's sign? A. positive Homan's sign suggests DVT B. it is performed by extending the knee and dorsiflexing the foot C. the sign is positive if this movement results in anterior leg pain D. both A & B E. both B & C F. all of the above

True. - as well as PE patients with low risk of death

T/F Most patients with DVT are treated as outpatients.

C. Coal Worker's Pneumoconiosis - PMF a/w poor prognosis - PMF also complication of silicosis

10-40% of individuals with __________________ will develop progressive massive fibrosis w/ nodules >10mm. A. Asbestosis B. Berylliosis C. Coal workers' pneumoconiosis D. Sarcoidosis

A. order D-dimer - low-intermediate probability of PE (Wells' score = 1)

23yoF presents to ER w/ 4-6 hours of right sided chest pain. She has no significant past medical history, takes no medications, denies any recent hospitalizations or surgeries. The pain started while she was lifting weights at the gym this morning. The patient's roommate was diagnosed with a PE a few months ago and so the patient is concerned her pain may be due to a blood clot and so comes for evaluation. The patient herself has no history of blood clots. She has otherwise been feeling well and denies any respiratory symptoms or cough. Her vital signs are normal. Her physical exam, including examination of her lower extremities, is unremarkable. What would you do for this patient? A. order D-dimer B. send directly to imaging C. send patient home with no further testing

E. pulmonary hypertension - no evidence of obstruction or restriction (r/o other options) - low DLCO may be caused by obstruction of blood flow to the alveolar capillaries--> a pulmonary vascular issue - could be secondary to anemia, pulmonary embolism, or pulmonary hypertension - Elevated JVP and a loud P2 are physical exam findings seen in pulmonary HTN, so this should rise to the top of the ddx, but certainly more evaluation is warranted here (labs, including CBC and D-dimer, EKG)

38yoF without significant past medical history presents with dyspnea x 2 months. She is comfortable appearing but is mildly tachycardic (heart rate 104) and tachypneic (respiratory rate 26) and hypoxic with room air oxygen saturation of 88%. Her lungs are clear to auscultation bilaterally. However, on cardiovascular exam she is noted to have a loud P2 and elevated jugular venous pressure. Her PFTs are shown. Of the following, what is the most likely dx? A. asthma B. emphysema C. hypersensitivity pneumonitis D. limb girdle muscular dystrophy E. pulmonary hypertension

E. none of the above - FVC = normal - FEV1/FVC = normal - TLC = normal - DLCO = low

38yoF without significant past medical history presents with dyspnea x 2 months. She is comfortable appearing but is mildly tachycardic (heart rate 104) and tachypneic (respiratory rate 26) and hypoxic with room air oxygen saturation of 88%. Her lungs are clear to auscultation bilaterally. However, on cardiovascular exam she is noted to have a loud P2 and elevated jugular venous pressure. Her PFTs are shown. What type of lung problem is this? A. obstructive (w/out air trapping) B. obstructive with air trapping C. restrictive; pulmonary D. restrictive; extrapulmonary E. none of the above

B. send directly to imaging - high probability of PE (Wells score >6)

45 yoF who is currently undergoing treatment for breast cancer presents to the ER w/ right sided chest pain x 4-6 hours. She had a right sided mastectomy 1 week ago and initially thought her pain was related to that procedure, but she is now feeling short of breath and concerned something else might be going on. On examination, the patient is tachycardic and you note that she has an area of erythema, warmth, and swelling in her right thigh. Initial EKG performed in the triage area demonstrates sinus tachycardia without ST-segment or T wave changes to suggest a cardiac cause. What would you do for this patient? A. order D-dimer B. send directly to imaging C. send patient home with no further testing

B. emphysema - obstructive w/ low DLCO --> COPD (emphysema)

62 yoM with a 30 pack-year smoking history presents with a productive cough and dyspnea x 3 months. On exam, the patient is thin and in no distress. His vital signs are significant only for a respiratory rate of 24 breaths per minute. On exam, he has diminished lung sounds bilaterally. CV exam is normal. PFTs are shown. Of the following etiologies, which is the most likely? A. chronic bronchitis B. emphysema C. hypersensitivity pneumonitis D. limb girdle muscular dystrophy E. pulmonary hypertension

B. obstructive with air trapping - FVC = low - FEV1/FVC = low - TLC = high - DLCO = low

62 yoM with a 30 pack-year smoking history presents with a productive cough and dyspnea x 3 months. On exam, the patient is thin and in no distress. His vital signs are significant only for a respiratory rate of 24 breaths per minute. On exam, he has diminished lung sounds bilaterally. CV exam is normal. PFTs are shown. What type of lung problem is this? A. obstructive (w/out air trapping) B. obstructive with air trapping C. restrictive; pulmonary D. restrictive; extrapulmonary E. none of the above

Bronchodilator challenge

A 27yoM presents for evaluation of occasional episodes of wheezing and chest tightness which seem to occur after exercise and when exposed to cold air. He has never smoked and is otherwise healthy. Your clinic is able to perform in-office spirometry, results are shown. Instead of sending patient for TLC and DLCO, what else could be done in office to get more diagnostic info?

A. obstructive (w/out air trapping) - FVC = normal - FEV1/FVC = low

A 27yoM presents for evaluation of occasional episodes of wheezing and chest tightness which seem to occur after exercise and when exposed to cold air. He has never smoked and is otherwise healthy. Your clinic is able to perform in-office spirometry, results are shown. What type of lung problem is this? A. obstructive (w/out air trapping) B. obstructive with air trapping C. restrictive; pulmonary D. restrictive; extrapulmonary E. normal lung function

A. asthma - obstructive, reversible - FEV1/FVC improved after bronchodilator - don't need to send for full PFTs - manage in office, re-eval with full PFTs if patient doesn't respond to tx

A 27yoM presents for evaluation of occasional episodes of wheezing and chest tightness which seem to occur after exercise and when exposed to cold air. He has never smoked and is otherwise healthy. Your clinic is able to perform in-office spirometry. You then administer a bronchodilator and reassess spirometry. Results are shown. What diagnosis is most likely based on these results? A. asthma B. COPD C. interstitial lung disease D. limb girdle muscular dystrophy E. pulmonary embolism

C. restrictive; pulmonary - FVC = low - FEV1/FVC = normal - TLC = low - DLCO = low - patient had hypersensitivity pneumonitis (type of restrictive pulmonary dz)

A 30yoF presents for evaluation of dyspnea on exertion, which has been present for 2 months. She is a life-long non-smoker with no prior history of asthma or other pulmonary problems. She works as a manager at a publishing company. She has two cats and several parakeets at home. Her pulmonary function testing is shown. What type of lung problem is this? A. obstructive (w/out air trapping) B. obstructive with air trapping C. restrictive; pulmonary D. restrictive; extrapulmonary E. normal lung function

C. reassure them that cough is often the last symptom to resolve after a cold, recommend Flonase

A 32yo patient diagnosed with a respiratory tract infection 4 weeks ago calls your office, stating that all of their symptoms have resolved except for their cough. They have no PMH or history of smoking. How will you manage this patient? A. assess reversibility of lungs with spirometry before/after bronchodilator administration B. prescribe oral steroid (prednisone x5 days) C. reassure them that cough is often the last symptom to resolve after a cold, recommend Flonase D. send them for a CXR for suspected pneumonia

C. hypersensitivity pneumonitis - type of interstitial lung disease - likely bc works in zoo, exposure to antigen

A 35yo zookeeper presents with progressive cough and shortness of breath over the past few months. On exam, the patient appears to have labored breathing. Her heart rate is 105, respiratory rate is 26, room air oxygen saturation is 90%. You hear fine crackles in bilateral lungs. Cardiovascular exam is normal. PFTs are shown. Of the following, what is the most likely dx? A. asthma B. emphysema C. hypersensitivity pneumonitis D. limb girdle muscular dystrophy E. pulmonary hypertension

C. restrictive; pulmonary - FVC = low - FEV1/FVC = normal - TLC = low - DLCO = low

A 35yo zookeeper presents with progressive cough and shortness of breath over the past few months. On exam, the patient appears to have labored breathing. Her heart rate is 105, respiratory rate is 26, room air oxygen saturation is 90%. You hear fine crackles in bilateral lungs. Cardiovascular exam is normal. PFTs are shown. What type of lung problem is this? A. obstructive (w/out air trapping) B. obstructive with air trapping C. restrictive; pulmonary D. restrictive; extrapulmonary E. none of the above

D. restrictive; extrapulmonary - FVC = low - FEV1/FVC = normal - TLC = low - DLCO = normal --> patient had limb girdle muscular dystrophy

A 36yoF presents with a several month history of worsening dyspnea on exertion. She is a life-long non-smoker and has no history of asthma or other known pulmonary diseases. She has had to stop going for runs with her weekly running group because she can no longer keep up with the group members. Her PFTs are shown. What type of lung problem is this? A. obstructive (w/out air trapping) B. obstructive with air trapping C. restrictive; pulmonary D. restrictive; extrapulmonary E. normal lung function

b) History of melanoma Rationale: History of malignancy increases the likelihood that a pulmonary nodule is malignant. This patient is young, has a nodule <8 mm in size, and has a nodule in a lower lobe, all of which are more consistent with a benign etiology.

A 37-year-old patient with history of melanoma presents to clinic for evaluation of a 6 mm pulmonary nodule discovered incidentally in the left lower lobe on a chest xray. Which of the following features would increase the risk that the etiology of this nodule is malignant? a) Patient's age b) History of melanoma c) Size of nodule d) Location in left lower lobe

c) CT scan in 12 months Rationale: This patient has a solitary pulmonary nodule which is <8 mm in size and so reassessing with repeat CT scan in 12 months is most appropriate.

A 55-year-old woman presents to clinic for evaluation of a pulmonary nodule. She had a chest xray performed 2 weeks ago to evaluate for rib fracture after falling, and a 7 mm nodule was found incidentally. Which of the following would be the best next step in evaluation of this finding? a) Biopsy b) Surgical resection c) CT scan in 12 months d) PET scan

E. normal lung function - FVC = normal - FEV1/FVC = normal - TLC = normal - DLCO = normal --> normal! re-screen in 3-5 years

A 55yoM undergoes pulmonary function testing as part of a routine health-screening test. He has no pulmonary complaints. He is a lifelong non-smoker but had a prior history of asbestos exposure while serving in the Navy so is at risk for lung disease. His pulmonary function test results are shown. What type of lung problem is this? A. obstructive (w/out air trapping) B. obstructive with air trapping C. restrictive; pulmonary D. restrictive; extrapulmonary E. normal lung function

B) Malignant

A fast growing, spiculated nodule in the upper lobe should make you think: A) Benign B) Malignant

c)Congestive heart failure Rationale: Based on Light's Criteria, this patient has a transudative pleural effusion which is most commonly caused by congestive heart failure. The other 3 answer choices are causes of exudative pleural effusions.

A 60 year-old man with a history of multiple myocardial infarctions presents to his primary care provider complaining of increasing dyspnea on exertion. His provider performs a chest x-ray and notes the presence of cardiomegaly and a moderate-sized right pleural effusion. A diagnostic thoracentesis is performed with these results: •Pleural protein to serum protein ratio = 0.33 •Pleural LDH to serum LDH ratio = 0.4 •Pleural fluid LDH is <2/3 limit of normal for serum What is the most likely cause of this patient's pleural effusion? a)Malignancy b)Pneumonia c)Congestive heart failure d)Tuberculosis

C. mixed restrictive-obstructive lung disease - FVC = low - FEV1/FVC = low (suggests obstructive) - TLC = low (suggests restrictive) - DLCO = low - extrapulm restrictive (kyphoscoliosis) - obstructive (smoking- COPD) - won't give us an exam Q where the answer is mixed!!

A 60yoF with history of kyphoscoliosis and 30 pack-year smoking history presents with progressive dyspnea and cough x 6 months. Her PFTs are shown. What type of lung problem is this? A. obstructive lung disease B. restrictive lung disease C. mixed restrictive-obstructive lung disease D. normal lung function

C. Idiopathic pulmonary fibrosis - CXR can show reticulonodular changes - Lung biopsy can be used to confirm diagnosis if in doubt

A 65 year old patient with smoking history presents with cough and dyspnea x 6 months. He has no history of exposure to dusts. PFTs demonstrate a restrictive pattern. CT chest shows honeycombing. Which of the following ILDs best fits this description? A. Sarcoidosis B. Asbestosis C. Idiopathic pulmonary fibrosis D. Berylliosis

d)Referral to a pulmonologist Rationale: This vignette tells you that the nodule has a 70% calculated risk of malignancy (which should not be surprising when you read about all of the features which are suggestive of malignancy!). Risk of malignancy >65% is high risk and so this patient should be referred to a pulmonologist or thoracic surgeon for further evaluation (likely staging and biopsy or resection).

A 65-year-old patient with 30 pack-year smoking history presents to primary care for follow up of solitary pulmonary nodule evaluation. On CT, the nodule is noted to be 20 mm, located in the left upper lobe, and has a spiculated border. The calculated probability of malignancy is 70%. Which of the following would be the next best step in the evaluation of this nodule? a)Repeat CT scan in 6 months b)Reassurance c)Repeat CT scan in 12 months d)Referral to a pulmonologist

B. obstructive with air trapping - FVC = low - FEV1/FVC = low - TLC = high - DLCO = low

A 65yoM presents to his primary care provider with complaints of increasing dyspnea on exertion. He has a 40 pack-year smoking history and is retired following a career as a building contractor. His pulmonary function testing is shown. What type of lung problem is this? A. obstructive (w/out air trapping) B. obstructive with air trapping C. restrictive; pulmonary D. restrictive; extrapulmonary E. normal lung function

B. emphysema - obstructive lung dz w/ low DLCO --> lung tissue problem (COPD) rather than airway problem (asthma)

A 65yoM presents to his primary care provider with complaints of increasing dyspnea on exertion. He has a 40 pack-year smoking history and is retired following a career as a building contractor. His pulmonary function testing is shown. Which of the following diagnoses is most likely? A. asthma B. emphysema C. interstitial lung disease D. scoliosis

B) Transudative

A ________________ effusion occurs d/t increased hydrostatic pressure or low plasma oncotic pressure. A) Exudative B) Transudative

A) Exudative

A ________________ effusion occurs d/t inflammation and increased capillary permeability. A) Exudative B) Transudative

A chronic cough is >8 weeks in duration.

A chronic cough is ______________ in duration.

C) Referral to thoracic surgeon for consideration of pleurodesis or indwelling pleural catheter Pleurodesis •Either mechanical irritation or a substance, such as talc, deposited in the pleural space causes scar tissue and obliteration of the pleural space Indwelling pleural catheter placement •Just exactly what it sounds like •Kept in place for weeks - months •Option for patients too frail to undergo pleurodesis

A patient has a persistent pleural effusion despite multiple thoracenteses and medical therapy. What is the next step? A) CPAP B) Additional thoracenteses C) Referral to thoracic surgeon for consideration of pleurodesis or indwelling pleural catheter

D) Do a PET scan *Low/moderate risk (5-65%) --> PET scan

A patient presents with a 10mm pulmonary nodule. The risk for this nodule being malignant is determined to be 55%. What should your next step be? A) Do nothing, this is benign B) Watch with CT surveillance C) Surgically resect it D) Do a PET scan E) Refer to specialist

B) Watch with CT surveillance *Very low risk (<5%) --> CT Surveillance

A patient presents with a 12mm pulmonary nodule. The risk for this nodule being malignant is determined to be 4%. What should your next step be? A) Do nothing, this is benign B) Watch with CT surveillance C) Surgically resect it D) Do a PET scan E) Refer to specialist

E) Refer to specialist *High risk (>65%) --> Refer

A patient presents with a 22mm pulmonary nodule. The risk for this nodule being malignant is determined to be 75%. What should your next step be? A) Do nothing, this is benign B) Watch with CT surveillance C) Surgically resect it D) Do a PET scan E) Refer to specialist

B) Watch with CT surveillance

A patient presents with a 6mm, smooth, nodule in the lower right lobe. What should you next step be? A) Do nothing, this is benign B) Watch with CT surveillance C) Surgically resect it D) Do a PET scan E) Refer to specialist

A) Restrictive lung problem *Excess pleural fluid causes mechanical restriction - the lung cannot expand to its normal volume

A pleural effusion causes a: A) Restrictive lung problem B) Obstructive lung problem

C) Chylothorax

A pleural effusion consisting of lymphatic fluid d/t impaired thoracic duct drainage. A) Empyema B) Hemothorax C) Chylothorax

B) Pleural space *space between the parietal and visceral pleura

A pleural effusion is an excess accumulation of fluid in the: A) Lungs B) Pleural space C) Alveoli

A) Empyema

A pleural effusion that is frankly purulent - an abscess in the pleural space. A) Empyema B) Hemothorax C) Chylothorax

C) A or B

A pneumothorax is caused when air enters the pleural cavity through: A) A hole in the chest wall B) A hole in the lung C) A or B

C) Secondary Spontaneous PTX

A pneumothorax which occurs without an inciting event (i.e., trauma) and in a patient with underlying lung disease (e.g., COPD) A) Iatrogenic PTX B) Primary Spontaneous PTX C) Secondary Spontaneous PTX D) Tension PTX

B) Primary Spontaneous PTX

A pneumothorax which occurs without an inciting event (i.e., trauma) and in a patient without underlying lung disease (e.g., COPD) A) Iatrogenic PTX B) Primary Spontaneous PTX C) Secondary Spontaneous PTX D) Tension PTX

C) Tall, young, thin men

A primary spontaneous PTX is associated with: A) Tall young thin women B) Short, overweight, men C) Tall, young, thin men D) Tall, overweight, men

C) <30mm

A pulmonary nodule is a small (_______), usually solitary, incidentally discovered lesion in the lungs. A) <10mm B) <20mm C) <30mm D) <50mm

A score of ≤6 suggests a low-intermediate probability of PE, while a score of >6 has a high probability of PE. <2 = Low probability of PE 2-6 = Intermediate probability of PE >6 = High probability of PE **for testing purposes, know ≤6 = low-intermediate and >6 = high

A score of _________ suggests a low-intermediate probability of PE, while a score of _________ has a high probability of PE.

B. a blood clot anywhere in the venous system DVT: a blood clot formed in deep veins of the extremities PE: the presence of a blood clot in a pulmonary artery or one of its branches

A venous thromboembolism (VTE) is defined as.... A. a blood clot formed in deep veins of the extremities B. a blood clot anywhere in the venous system C. the presence of a blood clot in a pulmonary artery or one of its branches

A. Sarcoidosis

Acute, symmetrical polyarthritis of the ankles is most suspicious for which of the following? A. Sarcoidosis B. Pneumoconiosis C. Idiopathic pulmonary fibrosis D. Gout

C. reduced serum ACE level - serum ACE level may be elevated (~75% of pts w/ sarcoidosis) - granulomas secrete vitamin D--> leads to hypercalcemia - hypercalcemia = bones, stones, groans, and psychiatric overtones

All of the following are associated with sarcoidosis EXCEPT A. hepatitis B. uveitis C. reduced serum ACE level D. hypercalcemia

D. myasthenia gravis CV causes of dyspnea: •Heart failure - The pump itself is failing to adequately circulate blood - Think systolic vs. diastolic vs. valvular abnormality vs. arrhythmia •Anemia - Not enough delivery trucks (red blood cells) to deliver the oxygen •Thrombus/embolism - Blood supply to lungs is blocked (PE) or supply to heart itself is blocked (MI) •Pulmonary hypertension - Too much pressure in a low-pressure system causes problems in the other parts of the circuit

All of the following are cardiovascular causes of dyspnea EXCEPT A. anemia B. embolism C. heart failure D. myasthenia gravis E. pulmonary hypertension

C. decreased respiratory rate - tachypnea (incr RR) seen in 54% of patients other common signs: •Signs of DVT (47%) --> Homans' sign •Tachycardia (24%) •Rales or decreased breath sounds (17%) •Jugular venous distension (14%)

All of the following are common signs of pulmonary embolism on physical exam EXCEPT A. JVD B. decreased breath sounds C. decreased respiratory rate D. tachycardia E. rales

C. patient with suspected asthma Contraindications to PFTs exist and include: •Acutely ill patients or patients with decompensated disease •Active TB or covid •Pneumothorax •Undifferentiated hemoptysis

All of the following are contraindications for PFTs EXCEPT A. active COVID infection B. patient in the ER with SOB C. patient with suspected asthma D. pneumothorax E. undifferentiated hemoptysis

D. if the patient fails empiric treatment with azithromycin in suspected postnasal drip If you do NOT suspect one of the big 3 OR the patient fails empiric testing, then: •Chest xray is indicated •Consider PFTs (spirometry) --> empiric tx for postnasal drip is with inhaled nasal steroids (Flonase) NOT an antibiotic

All of the following are indications for ordering a CXR & spirometry in a patient with chronic cough EXCEPT A. if you do not suspect asthma, GERD, or postnasal drip as the cause B. if the patient fails empiric treatment w/ PPI in suspected GERD C. if the patient fails empiric treatment w/ ICS in suspected asthma D. if the patient fails empiric treatment with azithromycin in suspected postnasal drip

D. pulmonary hypertension Respiratory causes of dyspnea: •Control center --> metabolic acidosis --> pregnancy --> hypoxic/hypercapnic conditions --> exercise •Ventilatory pump --> blockage of upper airway --> NMSK dz (GB, MG) --> scoliosis, rib fx, pleural problems, ILD, obstructive lung dz •Gas exchanger --> COPD --> ILD --> pneumonia --> pulmonary edema

All of the following are respiratory causes of dyspnea EXCEPT A. COPD B. hypoxia C. Guillain-barre syndrome D. pulmonary hypertension E. metabolic acidosis

C. 3 months •May be extended 6-12 months in certain patients •Continuing anticoagulation indefinitely is considered in patients with high-risk of recurrence --> (persistent or non-modifiable risk, recurrent episodes of VTE, active cancer) and low risk of bleeding

All patients with VTE are anticoagulated for at least ______________. A. 48 hours B. 2 weeks C. 3 months D. 12 months

E. both A & C •Interstitium can become permanently thickened/scarred/fibrosed which causes - Decreased lung compliance - Diminished gas exchange

Alveolar inflammation can cause the interstitium to become permanently fibrosed, causing which of the following? A. decreased lung compliance B. decreased lung elasticity C. diminished gas exchange D. both A & B E. both A & C F. both B & C G. all of the above

B. obstructive lung disease - problem pushing air out

An FEV1/FVC ratio <70% may indicate which of the following? A. normal lung function B. obstructive lung disease C. restrictive lung disease D. either B or C

D. either B or C - restrictive lung disease--> smaller lung volume - obstructive lung disease with air trapping --> air trapped in lungs (residual volume) isn't moving, takes up more volume ("pseudorestriction")

An FVC <80% may indicate which of the following? A. normal lung function B. obstructive lung disease C. restrictive lung disease D. either B or C

An acute cough is <3 weeks in duration.

An acute cough is ______________ in duration.

B) Pneumonia

An infection of the pulmonary parenchyma is known as: A) Bronchitis B) Pneumonia C) Pharyngitis D) Pleural Effusion

B) Atypical bacteria

An interstitial pneumonia is more typical of: A) Typical bacteria B) Atypical bacteria

C. hypercoagulability Estrogen use? Chance of pregnancy? Malignancy? Personal or family history of blood clots?

Asking your patient about estrogen use or chance of pregnancy can assess for which of the following VTE risk factors? A. endothelial injury B. stasis C. hypercoagulability

A. endothelial injury Recent injuries or procedures/surgeries? History of smoking or hypertension?

Asking your patient about history of smoking or hypertension can assess for which of the following VTE risk factors? A. endothelial injury B. stasis C. hypercoagulability

B. stasis Recent travel? Recent surgeries or hospitalizations?

Asking your patient about travel history can assess for which of the following VTE risk factors? A. endothelial injury B. stasis C. hypercoagulability

A) right lung •Right mainstem bronchus is more vertical --- straighter path into the lung

Aspiration most commonly causes pneumonia in the: A) right lung B) left lung C) Both lungs are affected equally

B) Anaerobes (oral flora) •Fusobacterium, Bacteroides, etc.

Because aspirated contents are coming from oropharynx/GI tract, microbes causing aspiration pneumonia tend to be: A) Aerobic B) Anaerobes C) Atypical

A. asthma & COPD - reversible or irreversible? - given inhaled bronchodilator followed by repeat spirometry to assess for improvements in FEV1/FVC ratios

Bronchodilator challenges can help determine between which of the following? A. asthma & COPD B. pneumonia & COPD C. obstructive & restrictive lung disease D. acute & chronic lung disease

C. Group 3 Group 3: PH d/t hypoxic lung dz causes: •COPD •Pulmonary fibrosis •Obstructive sleep apnea •Obesity hypoventilation syndrome

COPD and OSA are causes of which type of pulmonary hypertension? A. Group 1 B. Group 2 C. Group 3 D. Group 4

A) Hyponatremia carcinoid syndrome •Facial flushing, diarrhea, bronchospasm •Caused by ectopic secretion of many things, especially serotonin

Carcinoid syndrome includes all of the following except: A) Hyponatremia B) Facial flushing C) Diarrhea D) Bronchospasm

A) GI tract *Lung is second MC

Carcinoid tumors are most common in the: A) GI tract B) lung C) Brain D) Liver

A) Resection *often curative

Carcinoid tumors are treated with: A) Resection B) Chemo C) watchful waiting

B. long-term inhalation of coal dust - 20+ years of exposure - present in 10% of coal miners

Coal Worker's Pneumoconiosis is a diffuse parenchymal lung disease caused by... A. limited or remote exposure to coal dust B. long-term inhalation of coal dust

H. all of the above •Epithelium of upper and lower airways - Sinuses - Larynx - Pharynx - Trachea, Bronchi •Tympanic membrane, ear canal •Pleura, pericardium •Esophagus, stomach •Diaphragm

Cough receptors are located in which of the following places? A. epithelium of the larynx B. epithelium of the bronchi C. tympanic membrane D. pericardium E. diaphragm F. A, B & E G. A, C & D H. all of the above

A) Carcinoid E) Small Cell

Cushing Syndrome is MC in which two lung tumors? A) Carcinoid B) Large cell C) Adenocarcinoma D) Squamous cell E) Small Cell

B. sarcoidosis - Berylliosis generally, does not present with systemic (fever, fatigue, malaise) symptoms as in sarcoid - berylliosis is NOT a multisystem disease as sarcoid is

DOE and cough with associated fever, malaise, and fatigue is more suggestive of which of the following? A. berylliosis B. sarcoidosis C. either A or B

•Swelling •Discomfort •Skin changes •Venous distention •Ulcers

DVT can lead to long term symptoms known as "post-thrombotic syndrome". These symptoms include...

A. cool to the touch •DVT classically presents with unilateral extremity edema, pain, warmth, erythema •May be tenderness to palpation along course of vein involved

DVTs present with all of the following EXCEPT A. cool to the touch B. unilateral extremity edema C. pain D. erythema E. tenderness along course of affected vein

EKG •arrhythmia? LVH? RVH? Atrial enlargement? Prior ischemia? Active ischemia? So much good information! PFTs •obstructive or restrictive lung dz? Echocardiogram •cardiomyopathy? diastolic/systolic dysfunction? valve issues? evidence of pulmonary HTN?

Diagnostic testing for dyspnea will vary depending on physical exam findings, but 3 that can be especially helpful are...

A. interstitial lung disease interstitial lung disease (ILD) - intrinsic - DPLD

Diffuse parenchymal lung disease (DPLD) is another term for.... A. interstitial lung disease B. extrapulmonary lung disease C. restrictive lung disease D. obstructive lung disease

C. pleural effusion - DLCO can be low in patients without pulmonary disease (anemia) - pleural effusion = extrinsic RLD

Diffusion capacity (DLCO) will be decreased in all of the following EXCEPT A. anemia B. emphysema C. pleural effusion D. pulmonary fibrosis

B. subjective - subjective sensation of difficulty breathing (described in many ways) - can occur at rest, on exertion, at night, when lying down, acutely or chronically

Dyspnea is a(n) ______________ finding. A. objective B. subjective

D. Silicosis

Eggshell calcifications on CXR are a classic finding of... A. Asbestosis B. Berylliosis C. Coal workers' pneumoconiosis D. Silicosis E. Sarcoidosis

D. V/Q Scan •CTPA less sensitive than V/Q scanning to diagnose chronic clots

For group 4 pulmonary hypertension, you should refer to a specialist who will order which type of imaging? A. CXR B. CTPA C. MRI D. V/Q Scan

C. 2-5 Group 2: tx underlying LHF (HFrEF, HFpEF) Group 3: tx lung dz/ cause of hypoxia Group 4: refer to specialist Group 5: tx underlying cause if identified

For groups ________, the treatment of pulmonary hypertension is directed at the underlying cause. A. 1-5 B. 1, 2 & 3 C. 2-5 D. 4 & 5

A) Legionella and Strep Pneumo

For which if the following etiologies of pneumonia is urine antigen testing helpful in diagnosis? A) Legionella and Strep Pneumo B) Mycoplasma and Fungal C) Pseudomonas and klebsiella D) E. Coli

B. PE •Shallow, hump-shaped opacity in lung periphery due to infarction •Westermark's sign

Hampton's hump is a classic CXR finding associated with which of the following? A. Asbestosis B. PE C. Pnuemothorax D. Pneumonia E. Silicosis

D) Mydriasis •All symptoms ipsilateral to affected side and include •Miosis - constricted pupil •Ptosis - droopy eyelid •Anhidrosis - lack of sweating

Horner syndrome is characterized by all of the following except: A) Miosis B) Anhidrosis C) Ptosis D) Mydriasis

F. A, C & D unstable PE: - ABCs (assess airway, circulation, breathing) first - reperfusion therapy --> thrombolytics --> embolectomy

How are patients with unstable PEs treated? A. ABCs B. anticoagulation C. thrombolytics D. embolectomy E. A, B & D F. A, C & D G. both A & D

- glucocorticoids (prednisone) - immunosuppressive (methotrexate)

How is berylliosis treated if symptomatic or more severe disease?

D. both A & B - exposure avoidance & supportive care - steroids NOT indicated - Lung transplant a consideration (though rare)

How is silicosis managed? A. exposure avoidance B. supportive care C. glucocorticoids (prednisone) D. both A & B E. both A &C F. all of the above

C) 5-15mL

How much fluid is normally present in the pleural space? A) No fluid B) 2-5mL C) 5-15mL D) 10-25mL

A) Exudative effusion Light's Criteria Fluid is exudative if one of these is met: •Ratio of pleural fluid protein to serum protein is greater than 0.5 •Ratio of pleural fluid LDH to serum LDH is greater than 0.6 •Pleural fluid LDH is greater than two-thirds the upper limit of normal serum LDH

If the ratio of pleural fluid protein to serum protein is 0.7, the patient has a(n): A) Exudative effusion B) Transudative effusion

D) Decreased oncotic pressure in capillaries * Not enough protein in the capillaries to keep fluid inside - fluid is pulled into pleural space

In a transudative effusion, what would cause fluid to be pulled across the capillaries and into the pleural space? A) Increased Hydrostatic pressure in capillaries B) Decreased Hydrostatic pressure in capillaries C) Increased oncotic pressure in capillaries D) Decreased oncotic pressure in capillaries

A) Increased Hydrostatic pressure in capillaries *Too much pressure in the capillaries due to excess volume

In a transudative effusion, what would cause fluid to be pushed across the capillaries and into the pleural space? A) Increased Hydrostatic pressure in capillaries B) Decreased Hydrostatic pressure in capillaries C) Increased oncotic pressure in capillaries D) Decreased oncotic pressure in capillaries

B. granulomatosis •Pleural thickening and the development of pleural plaques •Malignant mesothelioma, a cancer of the pleura •Lung cancer in general (small cell and non-small cell)

In addition to asbestosis, exposure to asbestos can lead to all of the following EXCEPT A. mesothelioma B. granulomatosis C. small cell lung cancer D. pleural thickening

C. idiopathic & heritable

In areas where schistosomiasis is not endemic, what are the 2 most common causes of vasculopathy (leading to pulmonary arterial HTN)? A. congenital heart disease & HIV B. drug & toxin induced C. idiopathic & heritable D. portal hypertension & lupus

A. obstructive lung disease - difficulty pushing air out

In which of the following are the lungs more similar to a paper bag, rather than a balloon? A. obstructive lung disease B. restrictive lung disease C. both A & B

C. Sarcoidosis - sarcoid = intrinsic RLD - others are extrinsic (normal DLCO)

In which of the following types of restrictive lung process would a low DLCO be expected? A. Ascites B. Guillain-Barre syndrome C. Sarcoidosis D. Pleural effusion

E) Small Cell •Autoimmune response preventing normal acetylcholine release •Associated with small cell lung cancer •Body thinks it is destroying cancer cells, but is actually making antibodies against its own presynaptic voltage gated calcium channels •Causes slowly progressive proximal muscle weakness •Similar to myasthenia gravis • can have ptosis and diplopia like MG •Sometimes called Lambert-Eaton myasthenic syndrome

Lambert-Eaton syndrome is associated with which lung cancer: A) Carcinoid B) Large cell C) Adenocarcinoma D) Squamous cell E) Small Cell

B) Carcinoid Tumor Usually: - Adenocarcinoma (60%) - Squamous cell carcinoma (20%) - Metastasis (10%)

Malignant pulmonary nodules are usually one of the following except: A) Squamous cell carcinoma B) Carcinoid Tumor C) Adenocarcinoma D) Metastasis

B. Berylliosis

Match the occupational exposure with the syndrome: Electronics manufacturing A. Asbestosis B. Berylliosis C. Coal workers' pneumoconiosis D. Silicosis

D. Silicosis

Match the occupational exposure with the syndrome: Sandblasting A. Asbestosis B. Berylliosis C. Coal workers' pneumoconiosis D. Silicosis

A. Asbestosis - used in construction & ship building

Match the occupational exposure with the syndrome: Ship building A. Asbestosis B. Berylliosis C. Coal workers' pneumoconiosis D. Silicosis

D. Silicosis - also a/w mining

Match the occupational exposure with the syndrome: Stone cutting A. Asbestosis B. Berylliosis C. Coal workers' pneumoconiosis D. Silicosis

B. Berylliosis •Aerospace industry •Electronics manufacturing •Ceramics •Tool & dye making •Jewelry making •Light bulb manufacturing

Match the occupational exposure with the syndrome: aerospace industry A. Asbestosis B. Berylliosis C. Coal workers' pneumoconiosis D. Silicosis

- early mobilization - mechanical methods (compression hose, sequential compression device) - medicine (usu LMWH in hospital)

Methods of preventing VTE

B. Group 2 - PH due to left-sided heart disease - up to 70% of cases - 80% of pulmonary HTN due to LHF, hypoxic lung dz or combination of 2

Most cases of pulmonary hypertension are due to which group? A. Group 1 B. Group 2 C. Group 3 D. Group 4

B. proximal veins in the lower extremity

Most pulmonary emboli originate from which of the following? A. distal veins in the lower extremity B. proximal veins in the lower extremity C. distal veins in the upper extremity D. proximal veins in the upper extremity

A. slow progression of fibrosis •Both slow progression of fibrosis in IPF without mortality benefit

Nintedanib and pirfenidone have been shown to do which of the following in IPF? A. slow progression of fibrosis B. reduce mortality C. restore lung tissue D. both A & B E. all of the above

B. liver - require LFT monitoring

Nintedanib and pirfenidone should be avoided in patients with ___________ disease. A. kidney B. liver C. lung D. heart

B) Stage 1-4

Non-Small cell lung cancers are staged by: A) Limited or extensive B) Stage 1-4

A) Identifying the underlying disorder and treating that *Treatment should be directed at the underlying cause! (thoracentesis can be therapeutic to reduce volume of effusion) •For example, diuresis to decrease osmotic pressure in a patient with CHF •For example, treatment with antibiotics for a patient with a pneumonia

Once you have diagnosed a pleural effusion, what is most important in treating it? A) Identifying the underlying disorder and treating that B) Draining all of the fluid from the pleural space C) Nothing, it resolves on its own

B. dyspnea in supine position

Orthopnea is defined as.... A. constant dyspnea B. dyspnea in supine position C. dyspnea when standing D. dyspnea at night

•CXR - is there infection? Edema? A mass? A pleural problem? •CBC - is there anemia? Infection? •NT-pro BNP - evidence of heart failure? •Chemistry panel - are there metabolic derangements? •6-minute walk test - put a pulse ox on the patient and walk on a flat surface for 6 minutes - do they become hypoxic with exertion?

Other tests to consider in the workup of dyspnea

B. pulmonary fibrosis PE can lead to: •Pulmonary infarction - death of lung tissue •Impaired gas exchange - ventilation/perfusion (V/Q) mismatch •Cardiovascular compromise - obstructive shock

PEs are concerning as they can cause all of the following EXCEPT A. pulmonary infarction B. pulmonary fibrosis C. shock D. V/Q mismatch

C. segmental and subsegmental

PEs that cause pulmonary infarction are more commonly seen in which of the following regions? A. lobar and subsegmental B. saddle and lobar C. segmental and subsegmental D. saddle and segmental

C. obstructive & restrictive lung disease

PFTs are most helpful (and most commonly used) to evaluate or differentiate between..... A. asthma & COPD B. pneumonia & COPD C. obstructive & restrictive lung disease D. acute & chronic lung disease

D) Squamous cell carcinoma •Caused by a tumor in superior sulcus of lung (Pancoast tumor)

Pancoast Syndrome is most commonly caused by which lung cancer? A) Carcinoid tumor B) Small cell lung cancer C) Adenocarcinoma D) Squamous cell carcinoma E) Large cell carcinoma

E) All of the above

Patients with acute bronchitis should be educated on the expected course of their illness. They should be advised to return if: A) They develop a Fever B) They have Dyspnea/worsening dyspnea C) They have Tachypnea D) Their symptoms do not resolve after 3-4 weeks E) All of the above

B) Ventilator associated pneumonia

Pneumonia occurring >48 hours after endotracheal intubation A) Hospital Acquired pneumonia B) Ventilator associated pneumonia C) Community Acquired pneumonia D) Pneumonia isn't real

A) Hospital Acquired pneumonia

Pneumonia occurring >48 hours after hospital admission A) Hospital Acquired pneumonia B) Ventilator associated pneumonia C) Community Acquired pneumonia D) Pneumonia isn't real

C) Community Acquired pneumonia

Pneumonia occurring in a patient not recently in the hospital A) Hospital Acquired pneumonia B) Ventilator associated pneumonia C) Community Acquired pneumonia D) Pneumonia isn't real

E. decreased pulmonary vascular resistance •Clot in pulmonary circulation increases pulmonary vascular resistance •This causes back up into right side of heart--> right ventricle dilates and ventricular septum gets pushed to the left •This reduces preload--> reduces SV--> reduces CO--> HYPOTENSION (obstructive shock)

Pulmonary emboli leads to shock through all of the following EXCEPT A. hypotension B. dilation of the right ventricle C. reduced stroke volume D. reduced cardiac output E. decreased pulmonary vascular resistance

C. great saphenous vein - iliac, femoral & popliteal

Pulmonary emboli usually originate from all of the following EXCEPT A. popliteal vein B. iliac vein C. great saphenous vein D. femoral vein

B. ≥25 MPAP ≥ 25 mmHg is always abnormal

Pulmonary hypertension is defined as a mean pulmonary artery pressure (mPAP) of __________ mmHg at rest. A. ≥15 B. ≥25 C. ≥80 D. ≥120

F. both A & C - progressive DOE - persistent dry cough

Regardless of the etiology, ILDs generally present with which of the following? A. progressive dyspnea with exertion B. episodic purulent cough C. persistent dry cough D. retrosternal pain E. both A & B F. both A & C G. A, B & D H. A, C & D

Smoking #1 also: - Environmental exposures - fam hx - Associated diseases - Personal hx of lung cancer

Risk factors for lung cancer:

C. women age 20-40yo •In the U.S., black population more commonly affected than other racial/ethnic groups •Lifetime risk for black Americans is 2.4% •Lifetime risk for white Americans is 0.85%

Sarcoidosis is most commonly diagnosed in which of the following populations? A. men age 20-40yo B. men age 60-80yo C. women age 20-40yo D. women age 60-80yo

True. - Most patients are asymptomatic, have no progression of disease, and/or go into spontaneous remission (don't require treatment) - 10% of patients will have chronic, progressive disease

T/F Most patients with sarcoidosis do NOT require treatment.

True.

T/F Postviral cough is a frequent cause of subacute cough.

C. upper lobes of lung

Silicosis is associated with the development of silicotic nodules in _______________. A. lower lobes of lung B. middle lobe of right lung C. upper lobes of lung

B. chronic - acute has very poor prognosis - prognosis in chronic varies but generally better than acute

Silicosis more commonly presents as a(n) ____________ condition. A. acute B. chronic

B) Chemo good response, but short remission--> poor prognosis

Small cell lung cancer is treated with: A) Resection B) Chemo C) watchful waiting

C) Bronchial or submucosal

Small cell lung cancer is usually ___________________ in origin. A) Interstitial B) Alveolar C) Bronchial or submucosal D) Pleural

A) Limited or extensive

Small cell lung cancers are staged by: A) Limited or extensive B) Stage 1-4

True.

T/F The higher the mean pulmonary artery pressure (mPAP) the higher the mortality.

False. Location/size of PE does not necessarily correlate to severity of symptoms

T/F The size/location of a PE is almost always correlated to severity of symptoms.

B) Small cell lung cancer

Superior vena cava syndrome is more common in which lung cancer? A) Carcinoid tumor B) Small cell lung cancer C) Adenocarcinoma D) Squamous cell carcinoma E) Large cell carcinoma

All of them are symptoms of lung cancer

Symptoms of lung cancer include (select all that apply): -cough -dyspnea -hemoptysis -chest pain -systemic symptoms

True. Common symptoms include: •"Heartburn" •Sour taste in mouth •Symptoms worse when supine •BUT can be silent (40% of patients with cough 2/2 GERD have no sxs!)

T/F 40% of patients with a cough due to GERD have no other symptoms.

False. Asbestosis is pulmonary fibrosis which develops as a result of long-term (>10 years) asbestos exposure - takes 20-30 years after initial exposure to develop

T/F Asbestosis usually develops after a single exposure to asbestos for >1 hour.

True. •Unlike asbestosis, which is usually related to many years of exposure, berylliosis can occur in people with limited or remote beryllium exposure •Symptoms can develop anywhere from 3 months to 30 years after initial exposure

T/F Berylliosis can occur in people with limited exposure to beryllium.

False. In patients with VTE who are not candidates for anticoagulation, an inferior vena cava (IVC) filter is an option

T/F IVC filters are first line therapy in unstable PE.

False. Any patient in whom you suspect PH should be referred to a pulmonologist or cardiologist with expertise in PH for testing beyond basic EKG, CXR, echocardiogram

T/F In a patient whom you suspect pulmonary hypertension based on physical exam, EKG, CXR and Echo, it is not necessary to obtain a right heart catheterization.

False. only present in 5-10% of sarcoid cases, but 95% diagnostic specificity for sarcoid (no need for biopsy)

T/F Lofgren syndrome is the most common presentation of sarcoidosis.

B. response to empiric therapy w/ PPI •Trial of PPI (proton pump inhibitor) for 2 months - omeprazole

The best way to confirm the diagnosis of GERD is based on.... A. barium swallow B. response to empiric therapy w/ PPI C. response to empiric therapy w/ ICS-formoterol D. endoscopy E. esophageal pH monitoring

C. response to empiric therapy •Spirometry can be helpful to demonstrate an obstructive pattern, but can be normal (airflow obstruction can be reversible) --> one spirometry reading won't show reversibility

The best way to confirm the diagnosis of asthma is based on.... A. CXR results B. spirometry reading C. response to empiric therapy D. sputum culture

B. vagus, phrenic & spinal motor nerves

The cough center in the medulla sends nerve impulses through ________________________ to produce a cough. A. glossopharyngeal, hypoglossal & spinal motor nerves B. vagus, phrenic & spinal motor nerves C. spinal accessory, glossopharyngeal & spinal sensory nerves

B) URI symptoms •Cough often preceded by URI symptoms (remember --> same viruses!) •Nasal congestion •Headache •Sore throat

The cough of acute bronchitis is often preceded by: A) Pneumonia B) URI symptoms C) Otitis Externa D) Asthma exacerbation

D. postviral pertussis

What cause should be of highest suspicion for a cough accompanied by respiratory symptoms at onset? A. asthma B. postnasal drip C. GERD D. postviral pertussis E. lung disease or cancer

B. 2 hours The highest risk of death is in the first 2 hours of onset of PE. - worth risk of giving thrombolytics - shock/massive PE occurs in ~8% patients - 30-50% risk of death with massive PE

The highest risk of death is in the first ____________ of onset of PE. A. 10 minutes B. 2 hours C. 2 days D. 2 weeks

B) CXR and CT

The initial diagnosis of lung cancer is made with: A) MRI B) CXR and CT C) U/S D) Clinical dx

D. vasodilation; proliferation - promote vasodilation - prevent proliferation - keep lumen open and keep walls from becoming stiff

The main goal in treatment of non-reactive PAH is to promote _____________ and prevent ______________. A. vasoconstriction; degradation B. vasodilation; anti-degradation C. vasoconstriction; proliferation D. vasodilation; proliferation

C. steroids

The mainstays of treatment for hypersensitivity pneumonitis are antigen avoidance and ________________. A. antibiotics B. antihistamines C. steroids

B) Scattered, patchy, ground glass opacities

The xray of Covid-19 pneumonia can be best described as: A) Loss of bronchial markings B) Scattered, patchy, ground glass opacities C) Loss of pleural sliding D) Upper lobe consolidation

E. both A & C •After alternative diagnoses excluded, biopsy is needed for definitive dx of sarcoid (histopathologic presence of noncaseating granulomas) unless: - the patient presents with Löfgren Syndrome - the patient is asymptomatic --> spare them the procedure if feeling well, monitor w/ PFTs & imaging

Tissue biopsy is needed to make a definitive diagnosis of sarcoidosis UNLESS A. the patient presents with Lofgren syndrome B. the patient's TB test is negative C. the patient is asymptomatic D. both A & B E. both A & C F. all of the above

Is the patient hemodynamically unstable or stable?

To determine how to approach treatment in an individual with PE, what question must be answered?

D) All of the above

Treatment choice for pneumonia depends on: A) What the likely pathogen is B) Where the pathogen was acquired C) Local antibiogram D) All of the above

B. lupus pernio

Violaceous papules, plaques, and nodules on nose, cheeks, chin and ears is known as __________________ and is associated with sarcoidosis. A. butterfly rash B. lupus pernio C. erythema nodosum D. panniculitis

B. PE

Wells' Criteria is used to determine the pre-test probability of..... A. DVT B. PE C. Septic shock D. Pulmonary HTN

B. PE •Dilation of pulmonary vessels with abrupt cut-off and collapse of pulmonary vessels distal to embolism

Westermark's sign is a classic CXR finding associated with which of the following? A. Asbestosis B. PE C. Pnuemothorax D. Pneumonia E. Silicosis

C. inspiratory rales + digital clubbing - inspiratory crackles/rales (velcro crackles)

What are some possible physical exam findings of ILD? A. expiratory wheezing + digital clubbing B. expiratory wheezing + peripheral edema C. inspiratory rales + digital clubbing D. inspiratory rales + peripheral edema

A & D - clinical S/S of DVT (3 points) - PE is #1 dx or equally likely (3 points)

What are the 2 most important components of the Wells' Criteria? (select 2) A. Clinical signs/symptoms of DVT B. Surgery in previous 4 weeks C. Previous diagnosed PE or DVT D. PE is at the top of your ddx

- Idiopathic pulmonary fibrosis - Sarcoidosis - Pneumoconioses

What are the 3 causes of Interstitial Lung Disease (ILD) that we need to know for the PANCE?

1. history of beryllium exposure 2. positive BeLPT 3. noncaseating granulomas present in biopsied tissue

What are the 3 things needed to make the diagnosis of berylliosis?

•LV systolic dysfunction (HFrEF) •LV diastolic dysfunction (HFpEF) •Valvular abnormality •Cardiomyopathy •Congenital heart disease

What are the causes of left-sided HF?

E) All of the above *Unstable patients should have immediate chest tube placement (5th IC space, mid-axillary line). **Patient with suspected tension PTX should first have needle decompression (2nd IC, mid-clavicular line).

What are the consequences of a tension pneumothorax? A) Decreased cardiac output B) Impaired venous return to the heart C) Obstructive shock D) Death E) All of the above

E. all of the above - angiogram has contrast --> indicated in advanced renal dz, patients w/ contrast allergies - CT uses radiation --> avoid in pregnancy

What are the contraindications for a CTPA? A. advanced renal disease B. contrast allergies C. pregnant patients D. both A & C E. all of the above

- not definitive answer if PE is present (graded from normal to high probability) - patient has to lie still for 30-60 mins - not as readily available

What are the disadvantages of V/Q scans?

A) Hypotonic *The effusion is made up of mostly excess hypotonic fluid without other "stuff" mixed

What best describes transudative effusions? A) Hypotonic fluid B) Hypertonic fluid

D) A and B The CURB-65 score can be utilized in practice to: •Determine the severity of pneumonia (30-day mortality) •Guide medical decision making regarding inpatient vs. outpatient management

What does the CURB-65 score tell us about a patient's pneumonia? A) The 30 day mortality rate for their score B) Whether or not to treat the patient as inpatient vs outpatient C) What antibiotics to use when treating the patient D) A and B E) All of the above

•Estimated pulmonary artery systolic pressure •Assessment of right heart size, wall thickness, and function •Assessment of left heart dysfunction

What information can an Echocardiogram provide in suspected PH?

>80% predicted

What is a normal DLCO?

>70%

What is a normal FEV1/FVC ratio?

>80% of predicted

What is a normal FVC?

D. Amoxicillin other options: - azithro - doxy

What is a reasonable antibiotic choice for a 40 year old patient without comorbidities who is diagnosed with community acquired pneumonia? A. Cephalexin B. Bactrim DS C. Ciprofloxacin D. Amoxicillin

C. Levofloxacin other options: - Augmentin + Azithro or Doxy - Cefpodoxime (3rd gen cephalosporin) + Azithro or Doxy

What is a reasonable antibiotic choice for a 70 year old with multiple comorbidities who is diagnosed with community acquired pneumonia? A. Cephalexin B. Bactrim DS C. Levofloxacin D. Amoxicillin

C) Thoracentesis *draws a sample of fluid to determine cause but also relieves symptoms

What is bost therapeutic and diagnostic in treating pleural effusion? A) Oxygen therapy B) CXR C) Thoracentesis D) Chest tube

B) Infiltrate

What is it called when the alveoli fill up with something other than air? A) Consolidation B) Infiltrate C) A bad day

A) Consolidation *group of infiltrated alveoli

What is it called when there is a group of alveoli that are filled with something other than air? A) Consolidation B) Infiltrate C) A bad day

A) Chest xray *will see blunting of costophrenic angles, often a meniscus at superior aspect of the effusion

What is key to confirming the initial diagnosis of pleural effusion? A) Chest xray B) Thoracentesis C) Clinical dx D) Physical exam

B. elasticity

What is lost in obstructive lung disease? A. compliance B. elasticity C. both A & B D. none of the above

A. compliance

What is lost in restrictive lung disease? A. compliance B. elasticity C. both A & B D. none of the above

E) A and C

What is required to make the Dx of pneumonia? A) Clinical picture of pneumonia B) Infiltrate/consolidation/opacity CT C) Infiltrate/consolidation/opacity on CXR D) A and B E) A and C

D. S1Q3T3 pattern •S wave in lead I, Q wave and inverted T in lead III •Caused by right heart strain - classically taught but uncommon

What is the "classic" EKG finding for pulmonary emboli? A. negative QRS in lead I, positive in lead aVF B. tall P wave in lead II C. prolonged QT interval D. S1Q3T3 pattern

B. DOE Symptoms of PH: •Dyspnea (86%) - especially on exertion •Fatigue (27%) •Chest pain (22%) •Edema (22%) •Syncope (17%) •Dizziness (15%) •Cough (14%) •Palpitations (13%)

What is the #1 most common symptom of pulmonary hypertension? A. chest pain B. DOE C. fatigue D. palpitations E. edema

Smoking! *thought to cause 85-90% of lung cancers

What is the #1 most significant risk factor for developing lung cancer?

C) Adenocarcinoma (50%)

What is the MC type of lung cancer? A) Carcinoid tumor B) Small cell lung cancer C) Adenocarcinoma D) Squamous cell carcinoma E) Large cell carcinoma

C) Infectious granulomas (90%) *hemartoma is second mcc (10%)

What is the MCC of benign solitary pulmonary nodules? A) Hemartoma B) Malignancy C) Infectious granulomas

D. when right sided heart failure is caused by chronic lung disease

What is the definition of cor pulmonale? A. left sided heart failure due to right sided heart failure B. right sided heart failure due to left sided heart failure C. when left sided heart failure is caused by chronic lung disease D. when right sided heart failure is caused by chronic lung disease E. all of the above

B. pulmonary endarterectomy

What is the definitive treatment for CTEPH? A. IVC filter B. pulmonary endarterectomy C. valve replacement D. weight loss

check for vasoreactivity during cath - Patient given vasodilator (usually NO) during right heart cath --> Monitored to see if there is reduction in pulmonary artery pressure

What is the first step in determining treatment for Group 1 PH (PAH)?

B. CTPA CT pulmonary angiogram

What is the gold standard imaging for diagnosing PE? A. doppler ultrasound B. CTPA C. MRI D. CXR E. V/Q Scan

A. doppler ultrasound - can be used in conjunction w/ indeterminate CTPA or V/Q scan to diagnose a PE

What is the gold standard imaging to evaluate for DVT? A. doppler ultrasound B. CTPA C. MRI D. CXR E. V/Q Scan

B. plethysmography

What is the gold standard test for measuring lung volume? A. peak flow B. plethysmography C. spirometry D. metacholine challenge test

D. right heart catheterization Tests that are helpful in making PH diagnosis (primary care setting): •EKG •Chest xray •Echocardiogram THE test to definitively diagnose PH (ordered/performed by PH specialist): •Right heart catheterization

What is the gold standard test to definitively diagnose pulmonary hypertension? A. EKG B. CXR C. echocardiogram D. right heart catheterization

B. inhaled nasal corticosteroid - Flonase, Rhinocort - oral histamines = 2nd line (zyrtec, allegra)

What is the gold standard treatment for postnasal drip? A. duoneb treatment B. inhaled nasal corticosteroid C. oral antihistamine D. oral corticosteroids E. PPI trial

B) Mycoplasma pneumoniae * no cell wall so beta lactams don't work on them

What is the most common cause of Atypical pneumonia? A) Haemophilus influenzae B) Mycoplasma pneumoniae C) Legionella pneumophila D) Klebsiella Pneumoniae E) Pseudomonas Aeruginosa

Tension Pneumothorax

When a flap of tissue causes a one way valve, trapping air in the pleural cavity, this leads to what type of PTX?

D) all of the above •Think about pertussis in un/undervaccinated individuals with acute cough that comes in fits (paroxysms) followed by inspiratory "whoops" and post-tussive emesis

When should you consider testing a patient with acute cough for pertussis? A) Un/undervaccinated individuals B) Coughs that come in fits followed by inspiratory whoops C) Patients with post-tussive emesis D) all of the above

B) If a patient presents with flu like symptoms w/in 48 hours of symptom onset Testing for influenza indicated if patient presents within 48 hours of symptom onset •Symptoms of flu = fever, congestion, cough •Seasonal illness (winter) •Antiviral treatments (e.g., oseltamivir) most effective if started within 48 hours of symptoms onset

When should you test for influenza? A) Anytime a patient presents with an acute cough B) If a patient presents with flu like symptoms w/in 48 hours of symptom onset C) Testing for influenza is not recommended D) If a patient presents with flu like symptoms 48 hours after symptom onset

E. all of the above

Where can things go wrong in the respiratory system, causing dyspnea? A. control center B. gas exchange C. ventilatory pump D. both B & C E. all of the above

A) Carcinoid D) Squamous cell E) Small Cell

Which cancers tend to be Central in origin? (select all that apply) A) Carcinoid B) Large cell C) Adenocarcinoma D) Squamous cell E) Small Cell

B) Large cell C) Adenocarcinoma *LA is in the periphery of the United States Large cell Adenocarcinoma

Which cancers tend to be peripheral in origin? (select all that apply) A) Carcinoid B) Large cell C) Adenocarcinoma D) Squamous cell E) Small Cell

B) Transudative Transparent Transudative *The effusion is made up of mostly excess hypotonic fluid without other "stuff" mixed

Which effusions are transparent? A) Exudative B) Transudative

C) Codeine containing products

Which if the following cough suppressants should you avoid in tx of bronchitis? A) Throat lozenges B) Benzonatate (Tessalon perles) C) Codeine containing products D) Guaifenesin E) Dextromethorphan

B) Smoking Cessation

Which is a better intervention to prevent lung cancer? A) Low Dose CT screening B) Smoking Cessation

C. upper lobes of lung

Which lobe is most commonly affected in Coal Worker's Pneumoconiosis? A. lower lobes of lung B. middle lobe of right lung C. upper lobes of lung

B) Small cell lung cancer

Which lung cancer is strongly correlated with smoking and is extremely rare in never-smokers? A) Carcinoid tumor B) Small cell lung cancer C) Adenocarcinoma D) Squamous cell carcinoma E) Large cell carcinoma

C) Must get a CXR to r/o other things *CXR does not help with diagnosing acute bronchitis - only get if you suspect pneumonia Findings consistent with acute bronchitis include: •Acute cough of 1-3 weeks duration •Lack of fever or systemic symptoms •No findings to suggest pneumonia •Do not have chronic bronchitis/COPD

Which of the Following is FALSE regarding diagnosis of acute bronchitis? A) Mainly clinical B) Need to get a covid test C) Must get a CXR D) Can consider testing for influenza or pertussis based on situation

C) Always need a chest tube for treatment - false •Patients with primary spontaneous PTX can often be treated with oxygen and observation, sometimes needle decompression, but may need chest tube or surgical intervention if not resolving or if recurring (though that is rare)

Which of the following is FALSE regarding Primary spontaneous PTX? A) Due to popping of small outpouching of the visceral pleura called "blebs" B) Associated with thin, tall, men C) Always need a chest tube for treatment

C) Surgical procedures should not be used for palliative care •Laser resection or radiation therapy of obstructive central tumors, bone and brain mets can be palliative •Therapeutic thoracenteses, pleurodesis, or pleural catheter insertion can help palliate malignant pleural effusions

Which of the following is FALSE regarding lung cancer? A) Early referral to a palliative care specialist can help symptom management and even modestly improve survival B) Cancer-related pain is common and should be managed C) Surgical procedures should not be used for palliative care D) Radiation therapy of obstructive central tumors, bone and brain mets can be palliative

C) Nephrotic syndrome

Which of the following is NOT a cause of exudative pleural effusions. A) Pneumonia B) Viral infections C) Nephrotic syndrome D) Tuberculosis E) Malignancy F) Connective tissue diseases

D) Infections *these cause exudative effusions

Which of the following is NOT a cause of transudative pleural effusions? A) Liver disease B) CHF C) Nephrotic syndrome D) Infections

D) Spiculated *spiculated is a characteristic of malignant nodules. Benign are smooth

Which of the following is NOT a characteristic of a benign pulmonary nodule? A) Smaller B) Slow growing or not growing C) Found in the lower lobes MC D) Spiculated E) Central, diffuse, concentric, or popcorn calcification pattern

C) Found in the lower lobes MC *benign nodules are mc found in lower lobes *Malignant nodules are mc found in upper lobes

Which of the following is NOT a characteristic of a malignant pulmonary nodule? A) Larger B) Fast growing C) Found in the lower lobes MC D) Spiculated E) Ground glass or eccentric calcification pattern

D) Legionella Common pathogens in HAP/VAP include: •S. aureus (both MSSA and MRSA) •Pseudomonas aeruginosa (Often antibiotic resistant, Can cause CAP in immunocompromised patients, CF patients) •Klebsiella •Enterobacter •Escherichia coli

Which of the following is NOT a common pathogen in HAP/VAP? A) Klebsiella B) E. Coli C) Staph aureus D) Legionella E) Pseudomonas F) Eneterobacter

C) Bradycardia *Tachycardia is seen

Which of the following is NOT a common systemic symptom of pneumonia? A) Fever B) Fatigue C) Bradycardia D) Malaise

A. age >65 Virchow's Triad - 3 things which increase risk of clot formation: 1. Venous stasis 2. Endothelial injury 3. Hypercoagulability

Which of the following is NOT a component of Virchow's Triad? A. age >65 B. endothelial injury C. hypercoagulability D. venous stasis

C) Superior vena cava syndrome Pancoast syndrome includes: •Shoulder/arm pain (C8-T2 dermatomes) •Horner syndrome (next slide) •Paresthesias, weakness, atrophy in hand (C8, T1)

Which of the following is NOT a component of pancoast syndrome? A) Horner Syndrome B) Shoulder/arm pain (C8-T2 dermatomes) C) Superior vena cava syndrome D) Paresthesias, weakness, atrophy in hand (C8, T1)

D) Abnormal Vital signs E) Pulmonary Consolidation •Physical exam may demonstrate wheezing or rhonchi, but otherwise these patients will be afebrile (fever is rare) with normal vital signs and without evidence of pulmonary consolidation

Which of the following is NOT a finding in Acute bronchitis? (Select all that apply) A) Wheezing or Dyspnea B) Acute Cough C) Rhonchi D) Abnormal Vital signs E) Pulmonary Consolidation

D) Amoxicillin In outpatients >65 or with comorbidities or with recent antibiotic use, empiric treatment options for CAP could include: •Augmentin + Macrolide or Doxycycline •Third generation cephalosporin (Cefpodoxime) + Macrolide or Doxycycline •Fluoroquinolone monotherapy

Which of the following is NOT a reasonable antibiotic choice for outpatient tx of CAP in a patient greater than 65? A) 3rd Gen cephalosporin (cefpodoxime) + Macrolide or Doxycycline B) Augment + macrolide or Doxycycline C) Fluoroquinolone monotherapy D) Amoxicillin

C) Fluoroquinolone In outpatients <65-years-old without comorbidities or recent antibiotic use, reasonable empiric antibiotic choices include: •Amoxicillin •Macrolides (Azithromycin) •Doxycycline

Which of the following is NOT a reasonable antibiotic choice for outpatient tx of CAP in a patient under the age of 65? A) Macrolides (Azithromycin) B) Doxycycline C) Fluoroquinolone D) Amoxicillin

C) Younger age *Older age is Risk factors for pneumonia include: •Older age (>65 years old) •Chronic lung disease •Aspiration/microaspiration •Immunocompromised •Smoking •Substance use disorder In other words, anything which might introduce more pathogens than usual -or- impair your immune system, cough reflex, and mucociliary escalator!

Which of the following is NOT a risk factor for Pneumonia? A) Smoking B) Immunocompromised C) Younger age D) Aspiration E) Substance use disorder F) Chronic lung disease

A) Dry cough *In pneumonia the cough is typically Wet

Which of the following is NOT a typical symptom of pneumonia? A) Dry cough B) Chest pain C) Dyspnea D) Tachypnea

B. cyanosis Abnormal findings due to right sided HF (the congestion in congestive heart failure) •JVD •Hepatomegaly •Edema •Ascites - cyanosis consistent w/ L-sided HF

Which of the following is NOT an abnormal physical exam finding unique right sided heart failure? A. ascites B. cyanosis C. edema D. hepatomegaly E. JVD

C. mid-systolic click Abnormal findings due to PH: 1. Palpable P2 2. Loud P2 - increased pressure above the pulmonic valve delays closing 3. Right ventricular heave - you're going to feel that RV contract against the increased pulmonary vascular resistance

Which of the following is NOT an abnormal physical exam finding unique to pulmonary hypertension? A. palpable P2 B. loud P2 C. mid-systolic click D. right ventricular heave

C) Dullness to percussion of affected side *will have hyperresonance to percussion on affected side

Which of the following is NOT an exam finding in tension pneumothorax? A) Unstable vital signs B) Pleural line and loss of Lung markings on CXR C) Dullness to percussion of affected side D) Chest pain and dyspnea E) Loss of pleural sliding on U/S

C. hemoptysis Common symptoms include: •Dyspnea (73%) --> rapid onset •Pleuritic chest pain (66%) --> worse with inspiration/expiration •DVT symptoms (44%) •Cough (37%) •Orthopnea (28%) •Wheezing (21%) •Hemoptysis (13%) Less common sx: presyncope/syncope, palpitaitons/arrhythmia *acute/sudden SOB or dyspnea? think DVT

Which of the following is NOT one of the 3 most common presentation of PE? A. DVT symptoms B. dyspnea C. hemoptysis D. pleuritic chest pain

B. anxiety

Which of the following is NOT one of the 5 most common causes of chronic dyspnea? A. asthma B. anxiety C. COPD D. interstitial lung disease E. myocardial dysfunction F. obesity/ deconditioning

D) Urine protein **Urea CURB-65 - Confusion - Urea - RR - BP - Age >65

Which of the following is NOT one of the CURB-65 features? A) Respiratory Rate B) Confusion C) Blood pressure D) Urine protein E) Age >65

A. S1Q3T3 pattern •Right atrial enlargement --> Tall P wave in lead II •Right axis deviation --> Negative QRS in lead I, positive in lead aVF •Right ventricular hypertrophy --> Positive QRS in V1 •Right ventricular strain pattern --> T wave inversions, ST segment depressions in V1-V4

Which of the following is NOT one of the EKG findings associated with pulmonary hypertension? A. S1Q3T3 pattern B. T wave inversions, ST segment depressions in V1-V4 C. Tall P wave in lead II D. Negative QRS in lead I, positive in lead aVF E. Positive QRS in V1

C) Exercise The 3 pillars of pneumonia prevention are: 1.Smoking cessation 2.Influenza vaccine 3.Pneumococcal vaccine for patients 65+ years old *Can be given to patients 19-65 who have •Immune compromise •Asplenia •Cochlear implants •CSF leaks ***Covid-19 vaccine is important as well***

Which of the following is NOT one of the three pillars of Pneumonia prevention? A) Influenza vaccine B) Pneumococcal Vaccine for patients >65 (or 19-65 in certain conditions) C) Exercise D) Smoking Cessation

B. Lupus pernio

Which of the following is NOT part of Lofgren syndrome? A. Hilar adenopathy B. Lupus pernio C. Erythema nodosum D. Acute polyarthritis

A. Prednisone --> refer to pulmonologist! they should be managing this

Which of the following is a first-line treatment for sarcoidosis? A. Prednisone B. Nintedanib C. Methotrexate D. Oseltamivir

C. Methotrexate

Which of the following is a second-line treatment for sarcoidosis? A. Prednisone B. Nintedanib C. Methotrexate D. Oseltamivir

E) A and C cirrhosis/liver dz Nephrotic syndrome

Which of the following is a transudative effusion caused by decreased oncotic pressure? A) Cirrhosis/Liver dz B) CHF C) Nephrotic syndrome D) A and B E) A and C

B) CHF

Which of the following is a transudative effusion caused by increased hydrostatic pressure? A) Cirrhosis/Liver dz B) CHF C) Nephrotic syndrome D) A and B E) A and C

B) Small cell lung cancer

Which of the following is also known as "Oat cell" lung cancer? A) Carcinoid tumor B) Small cell lung cancer C) Adenocarcinoma D) Squamous cell carcinoma E) Large cell carcinoma

B. Pneumoconiosis - dust inhalation that is usually work or hobby-related

Which of the following is also known as occupational lung disease? A. Sarcoidosis B. Pneumoconiosis C. Idiopathic pulmonary fibrosis D. Hypersensitivity pneumonitis

A) Hyperresonance to percussion *will see Dullness to percussion in pleural effusions

Which of the following is not a finding of pleural effusions? A) Hyperresonance to percussion B) Diminished/absent breath sounds C) Decreased/absent tactile fremitus D) Dyspnea and Cough E) Chest pain

•Bradypnea *tachypnea is seen with pneumonia

Which of the following is not a vital sign abnormality typically seen in pneumonia? •Bradypnea •Tachycardia •Hypoxia •Hypotension •Fever

C) Decreased tactile fremitus * Increased tactile fremitus

Which of the following is not an exam finding commonly seen with pneumonia? A) Rales B) Bronchial breath sounds C) Decreased tactile fremitus D) Egophany E) Whispered pectoriloquy F) Dullness to percussion

D) Nodule in lower lobe *Nodule in upper lobe is concerning for malignancy

Which of the following is not associated with increased risk of malignancy of pulmonary nodules? A) Age >62 B) Smoking hx C) Spiculated border D) Nodule in lower lobe E) Spiculated border of nodule

A) Carcinoid tumor - RARE *but still on PANCE

Which of the following is not one of the Lung cancers that make up the majority of lung cancers? A) Carcinoid tumor B) Small cell lung cancer C) Adenocarcinoma D) Squamous cell carcinoma E) Large cell carcinoma

B. hypersensitivity pneumonitis

Which of the following is seen in people who farm, who work with birds or animals, work at swimming pools, or use humidifiers? A. asbestosis B. hypersensitivity pneumonitis C. berylliosis D. silicosis

D. postnasal drip Symptoms of postnasal drip include: •Nasal discharge •Sensation of fluid in back of throat •Throat pain or irritation •Throat clearing •...or no symptoms!

Which of the following is the MOST common etiology of subacute and chronic cough? A. asthma B. COPD C. GERD D. postnasal drip

C. interstitial lung disease

Which of the following is the most likely etiology in a patient with a restrictive lung pattern with a low DLCO? A. asthma B. emphysema C. interstitial lung disease D. neuromuscular issue

D. neuromuscular issue - extrapulmonary process (neuromuscular issue, scoliosis)

Which of the following is the most likely etiology in a patient with a restrictive lung pattern with a normal DLCO? A. asthma B. emphysema C. interstitial lung disease D. neuromuscular issue

B. emphysema - damage to alveoli

Which of the following is the most likely etiology in a patient with an obstructive lung pattern with a low DLCO? A. chronic bronchitis B. emphysema C. interstitial lung disease D. neuromuscular issue

A. asthma - obstruction coming from higher than level of alveoli (asthma, chronic bronchitis, bronchiectasis)

Which of the following is the most likely etiology in a patient with an obstructive lung pattern with a normal DLCO? A. asthma B. emphysema C. interstitial lung disease D. neuromuscular issue

A. a normal D-dimer effectively rules out PE Patient's w/ low-intermediate risk (Wells' ≤6) • normal D-dimer effectively rules out PE, no further testing required • elevated D-dimer would prompt need for diagnostic imaging

Which of the following is true about the use of D-dimer in a patient with a Wells' score of 6? A. a normal D-dimer effectively rules out PE B. an elevated D-dimer effectively rules in PE C. D-dimer should NOT be used D. both A & B

C. D-dimer should NOT be used high PE risk (Wells' >6) • DO NOT use D-dimer • Go directly to diagnostic imaging

Which of the following is true about the use of D-dimer in a patient with a Wells' score of 8? A. a normal D-dimer effectively rules out PE B. an elevated D-dimer effectively rules in PE C. D-dimer should NOT be used D. both A & B

A. ACE inhibitors

Which of the following meds classically causes a chronic dry cough? A. ACE inhibitors B. beta blockers C. calcium channel blockers D. thiazide diuretics

B) A patient who is 52 with a 22 pack year smoking hx and who quit smoking 3 years ago •USPSTF does recommend annual lung cancer screening using low dose CT for patients between ages 50-80 who •Have at least 20 pack year smoking history AND •Are current smokers OR quit smoking <15 years ago

Which of the following patients qualifies for annual lung cancer screening with low dose CT? A) A patient who is 45 and has a 20 pack year smoking hx and still smokes B) A patient who is 52 with a 22 pack year smoking hx and who quit smoking 3 years ago C) A patient who is 82 with a 42 pack year smoking hx who quit 14 years ago D) A patent who is 55 with a 10 pack year smoking hx who currently smokes

C) Both A and B

Which of the following should people with a pneumothorax avoid? A) Flying for 1-2 weeks post pneumothorax B) Should not scuba dive for the rest of their life C) Both A and B

C. Blood pressure 80/50

Which of the following would earn a point on the CURB65 scoring system? A. Age 35 B. Respiratory rate 18 C. Blood pressure 80/50 D. Urea 5 mmol/L

E. all of the above

Which of the following would show a restrictive pattern on PFTs and a decreased DLCO? A. Asbestosis B. Berylliosis C. Coal workers' pneumoconiosis D. Silicosis E. all of the above

D) Klebsiella Pneumoniae

Which pneumonia is associated with "currant jelly" sputum? A) Haemophilus influenzae B) Streptococcus Pneumoniae C) Legionella pneumophila D) Klebsiella Pneumoniae E) Pseudomonas Aeruginosa

C) Legionella pneumophila

Which pneumonia is associated with hotel air conditioning systems, hot tubs, and hotel conferences? A) Haemophilus influenzae B) Streptococcus Pneumoniae C) Legionella pneumophila D) Klebsiella Pneumoniae E) Pseudomonas Aeruginosa

C) Secondary Spontaneous PTX

Which type of pneumothorax is due to popping of larger pockets of air in the lungs called bullae? A) Iatrogenic PTX B) Primary Spontaneous PTX C) Secondary Spontaneous PTX D) Tension PTX

B) Primary Spontaneous PTX

Which type of pneumothorax is due to popping of small outpouchings of the visceral pleura called "blebs"? A) Iatrogenic PTX B) Primary Spontaneous PTX C) Secondary Spontaneous PTX D) Tension PTX

D) 50-80 w/ at least 20 pack year smoking hx and who quit smoking <15 years ago or currently smoke •USPSTF does recommend annual lung cancer screening using low dose CT for patients between ages 50-80 who •Have at least 20 pack year smoking history AND •Are current smokers OR quit smoking <15 years ago

Who should be screened for lung cancer? A) 60-75 w/ at least 20 pack year smoking hx and who currently smoke B) 50-80 w/ at least 30 pack year smoking hx and who quit smoking C) 60-80 w/ at least 20 pack year smoking hx and who quit smoking D) 50-80 w/ at least 20 pack year smoking hx and who quit smoking <15 years ago or currently smoke

C. CURB65 helps with decision about inpatient vs. outpatient treatment

Why is it important to know about the CURB65 scoring system? A. CURB65 allows us to make the definitive diagnosis of pneumonia B. CURB65 is helpful in making correct antibiotic choices C. CURB65 helps with decision about inpatient vs. outpatient treatment D. CURB65 is a boy band from the 90's

E. refer to pulmonology If CXR & spirometry do not provide a diagnosis, refer to pulmonology for more advanced testing: •High resolution CT scan with inspiratory and expiratory films •Serum allergy testing •Esophageal pH, barium swallow, or endoscopy (pulm may consult GI for this) •Bronchoscopy

You suspected that a patient's chronic cough x10 weeks was caused by postnasal drip, but they failed empiric testing with flonase (x3 weeks). You ordered a CXR and PFTs which were inconclusive. What do you do next? A. prescribe broad spectrum antibiotics (Vancomycin) B. test for AAT deficiency C. retire as a PA since you couldn't figure it out E. refer to pulmonology

B. parenchyma; interstitium •Parenchyma = alveolar and capillary tissues in the lungs •Interstitium = space between alveoli and capillaries

_____________ refers to the alveolar and capillary tissues in the lungs, while _____________ refers to the space between the alveoli and capillaries. A. interstitium; parenchyma B. parenchyma; interstitium