Rosh Review- Pulmonology Questions & Answers Solved 100% Correct!!

A 35-year-old woman comes to the clinic complaining of difficulty seeing, blurred vision, eye pain, and cough. She describes the cough as being dry and nonproductive. She has no past medical history and takes no medications. Ophthalmologic examination shows uveitis. Chest X-ray reveals bilateral hilar adenopathy. Which of the following laboratory findings would also most likely be associated with this patient's condition? - Elevated ACEI! C reactive protein and ESR are also mildly elevated A pleural effusion is most difficult to detect in which radiographic position? - Supine! At what pH is a parapneumonic effusion or empyema suggested? - pH <7.2 For which bacterial pneumonia are alcoholics at higher risk? - Klebsiella! How soon after blood transfusion initiation will anaphylaxis occur? - Within minutes! It is triggered by presence of IgA antibodies in IgA-deficient patients. In a patient with AIDS, what medication is given prophylactically at a CD4 count of less than 100 cells/μL to prevent infection with toxoplasmosis gondii? - Bactrim! In what risk patients is a D-Dimer appropriate in the work up of pulmonary embolism? - In low risk patients in whom a negative test effectively rules out pulmonary embolism! In high risk patients can probably just go straight to CT angiography for initial assessment In which population is Klebsiella pneumonia most commonly seen in? - COPD, Alcoholics, ElderlyIs a clot in the superficial femoral vein a DVT? - Yes! The superficial femoral vein is a deep vein Is Homan's sign a reliable examination finding in the evaluation of deep venous thrombosis? - Homan's sign is pain in the calf with dorsiflexion of the ankle. It is an insensitive and nonspecific sign of a deep venous thrombosis. Is magnetic resonance angiography recommended in the diagnosis of PE? - No, its poor resolution caused by cardiopulmonary motion artifact limits its usefulness. Is the lactate dehydrogenase level high or low in an exudate pleural fluid? - High! The differential diagnosis of interstitial lung disease (ILD) includes which three major conditions? - Lung Malignancy Lung infection Heart Failure What accounts for up to 90% of all transudative pleural effusions? - CHF! What are examples of Obstructive Lung Disease?**** - Bronchitis, Bronchiolitis, Bronchiectasis, COPD, Emphysema, Asthma Airway Resistance: INCREASED Compliance: INCREASEDRecoil: INCREASED What are examples of Restrictive Lung Disease? - Cystic Fibrosis, Sarcoidosis, Pneumoconioses, Pulmonary Fibrosis, Interstitial Lung Disease, Hypersensitivity Pneumonitis, Collagen Vascular Disease, Chest wall disorders, severe obesity, and neuromuscular disorders such as Gullian Barre! PARENCHYMAL ABNORMALITIES! What are standard treatments for varying presentations of Pulmonary Embolism? - Hemodynamically stable with tachycardia: Anticoagulation (Unfractionated heparin bridge to warfarin for 3-6 months) Hemodynamically unstable with shock, respiratory failure, or massive PE: Thrombolytics Embolectomy (last resort) What are the classic symptoms of active tuberculosis? - Persistent malaise, anorexia, weight loss, fever, night sweats, and a chronic cough are classic symptoms What are the classifications on readings of PPD skin tests? - >5 is positive for: HIV, Recent contact with TB positive patient, Nodular or fibrotic changes on Xray, Organ transplant (immunosuppressed) >10 is positive for: Recent arrivals from high TB countries, IV drug users, Resident/employee of high risk area, comorbid conditions, children <4 years old,>15: for normal, healthy individuals What are the different classifications for asthma? - Mild intermittent: Occurs <2/ week, <2/month Mild persistent: Occurs >2/week, <5 per month, doesn't happen daily, FEV still >80 Moderate persistent: Occurs daily, FEV is now between 60-80 Severe persistent: Occurs continuously, FEV <60 What are the indications and common side effects of Albuterol? - Indications: Bronchospasm Asthma exacerbation Exercise-induced bronchospasm Hyperkalemia Common Side Effects: Hypokalemia**** Tremors Tachycardia, Hypertension Agitation and AnxietyDONT use in pregnancy -Category C What are the initial, gold standard, and secondary diagnostics for patients with kidney disease that are all performed for assessing Pulmonary Embolism? - Initial: Chest CT Angiography Gold Standard: Pulmonary Angiography Contraindicated CT due to impaired Kidney Function: V-Q Perfusion Scan What are the lab/spirometry findings of Obstructive vs Restrictive Lung Disease? - Obstructive: Increased airway resistance, increased compliance and decreased parenchymal recoil Functional Vital Capacity (FVC): INCREASED or Normal! Forced Expiratory Volume (FEV1): DECREASED Restrictive: Decreased airway compliance and increased recoil Functional Vital Capacity (FVC): Decreased Forced Expiratory Volume (FEV1): Normal ...Decreased?????????FEV1/FVC Ration--> Near Normal! What are the local and systemic side effects of inhaled corticosteroids? - Local: Cough, dysphonia, oropharyngeal candidiasis. Systemic: Adrenal suppression, osteoporosis, skin thinning, easy bruising and cataracts. What are the main causes of transudate vs exudate? - Transudate: CHF, Cirrosis, Nephrotic Syndrome, Pulmonary Embolism Exudate: Malignancy, Bacterial/Viral Pneumonia, Tuberculosis, Pulmonary Embolism, Pancreatitis, Esophageal Rupture, Collagen Vascular disease, Chylothorax/Hemothorax What are the MOAs for beta 2 agonists, anticholinergics, corticosteroids in treating asthmatic exacerbation? - Beta Agonists: Increase cAMP (induce bronchodilation) Anticholinergics: Decrease bronchoconstriction Corticosteroids: Decrease inflammation, administer early