Internal Medicine EOR Pulmonology Exam (Smarty PANCE)
What is the treatment for acute viral bronchitis? Supportive care - rest, fluids, NSAIDs, dextromethorphan for cough; antibiotics
NOT indicated unless pertussis suspected
When are antibiotics indicated in acute bronchitis? Suspected pertussis (prolonged cough >2 weeks with whooping), high-risk
patients with COPD exacerbation
What defines chronic bronchitis? Productive cough for ≥3 months per year for ≥2 consecutive years (clinical
diagnosis, part of COPD spectrum)
What is the pathophysiology of chronic bronchitis? Chronic inflammation causing mucus gland hyperplasia, increased mucus
production, impaired ciliary function
What are the classic findings in chronic bronchitis ("blue Chronic productive cough, cyanosis, peripheral edema, increased JVP, rhonchi,
bloater")? decreased breath sounds
What is the primary treatment for chronic bronchitis? Smoking cessation (most important), bronchodilators (LABA/LAMA),
corticosteroids for exacerbations, oxygen if hypoxemic
What defines an acute exacerbation of chronic Increased dyspnea, increased sputum volume, increased sputum purulence
bronchitis? (Anthonisen criteria)
What is pneumoconiosis? Occupational interstitial lung disease caused by inhalation of mineral dusts
leading to pulmonary fibrosis
What are the four main types of pneumoconiosis? Silicosis (silica), Asbestosis (asbestos), Coal worker's pneumoconiosis (coal
dust), Berylliosis (beryllium)
What occupations are at risk for silicosis? Sandblasting, mining, quarrying, glass manufacturing, foundry work - silica
exposure
What are the classic radiographic findings in silicosis? Bilateral upper lobe nodules ("eggshell" calcification of hilar lymph nodes),
progressive massive fibrosis in advanced cases
What is the increased cancer risk with asbestosis? Mesothelioma (pleural malignancy) and lung cancer - synergistic increase with
smoking
What are the classic findings of asbestosis on imaging? Bilateral lower lobe interstitial fibrosis, pleural plaques (pathognomonic),
pleural thickening, honeycombing
What is the classic presentation of coal worker's Progressive dyspnea, cough in coal miner; CXR shows small nodules in upper
pneumoconiosis? lobes, may progress to massive fibrosis
What is the treatment for pneumoconiosis? No cure - prevention (respiratory protection), smoking cessation, supportive
care, oxygen therapy, lung transplant for severe cases
, Internal Medicine EOR Pulmonology Exam (Smarty PANCE)
What is the diagnostic test for berylliosis? Beryllium lymphocyte proliferation test (BeLPT) - differentiates from sarcoidosis
(clinically similar)
What complications occur with pneumoconiosis? Progressive respiratory failure, cor pulmonale, increased tuberculosis risk
(especially silicosis), malignancy (asbestosis)
What is asthma? Chronic inflammatory airway disease causing reversible airflow obstruction,
bronchial hyperresponsiveness, and mucus production
What are the classic symptoms of asthma? Episodic wheezing, dyspnea, chest tightness, cough (especially nocturnal or
early morning)
What is the diagnostic test for asthma? Spirometry showing reversible obstruction - FEV1/FVC <70%, FEV1
improvement ≥12% and ≥200mL after bronchodilator
What triggers commonly precipitate asthma Allergens, Smoke/pollution, Temperature changes, Hyperventilation/exercise,
exacerbations? Use mnemonic ASTHMA Meds (ASA, beta-blockers), Anxiety/stress
What is the stepwise approach to asthma management? Step 1: SABA prn; Step 2: +low-dose ICS; Step 3: +LABA; Step 4: medium-dose
ICS/LABA; Step 5: high-dose ICS/LABA +/- biologics
What medication is the cornerstone of persistent Inhaled corticosteroids (ICS) - most effective long-term control medication,
asthma treatment? reduce inflammation
What is the acute treatment for asthma exacerbation? Oxygen, albuterol (nebulized or MDI), ipratropium, systemic corticosteroids
(prednisone 40-60mg x 5 days)
What criteria indicate severe asthma exacerbation PEFR <40% predicted, inability to speak full sentences, accessory muscle use,
requiring hospitalization? altered mental status, PaCO2 >42mmHg
What medications should be avoided in asthma? Beta-blockers (including eye drops), NSAIDs (if aspirin-sensitive), ACE inhibitors
(can cause cough)
What is the role of biologics in severe asthma? For severe uncontrolled asthma - omalizumab (anti-IgE), mepolizumab (anti-IL-
5), dupilumab (anti-IL-4/13)
What is the treatment for acute viral bronchitis? Supportive care - rest, fluids, NSAIDs, dextromethorphan for cough; antibiotics
NOT indicated unless pertussis suspected
When are antibiotics indicated in acute bronchitis? Suspected pertussis (prolonged cough >2 weeks with whooping), high-risk
patients with COPD exacerbation
What defines chronic bronchitis? Productive cough for ≥3 months per year for ≥2 consecutive years (clinical
diagnosis, part of COPD spectrum)
What is the pathophysiology of chronic bronchitis? Chronic inflammation causing mucus gland hyperplasia, increased mucus
production, impaired ciliary function
What are the classic findings in chronic bronchitis ("blue Chronic productive cough, cyanosis, peripheral edema, increased JVP, rhonchi,
bloater")? decreased breath sounds
What is the primary treatment for chronic bronchitis? Smoking cessation (most important), bronchodilators (LABA/LAMA),
corticosteroids for exacerbations, oxygen if hypoxemic
What defines an acute exacerbation of chronic Increased dyspnea, increased sputum volume, increased sputum purulence
bronchitis? (Anthonisen criteria)
What is pneumoconiosis? Occupational interstitial lung disease caused by inhalation of mineral dusts
leading to pulmonary fibrosis
What are the four main types of pneumoconiosis? Silicosis (silica), Asbestosis (asbestos), Coal worker's pneumoconiosis (coal
dust), Berylliosis (beryllium)
What occupations are at risk for silicosis? Sandblasting, mining, quarrying, glass manufacturing, foundry work - silica
exposure
What are the classic radiographic findings in silicosis? Bilateral upper lobe nodules ("eggshell" calcification of hilar lymph nodes),
progressive massive fibrosis in advanced cases
What is the increased cancer risk with asbestosis? Mesothelioma (pleural malignancy) and lung cancer - synergistic increase with
smoking
What are the classic findings of asbestosis on imaging? Bilateral lower lobe interstitial fibrosis, pleural plaques (pathognomonic),
pleural thickening, honeycombing
What is the classic presentation of coal worker's Progressive dyspnea, cough in coal miner; CXR shows small nodules in upper
pneumoconiosis? lobes, may progress to massive fibrosis
What is the treatment for pneumoconiosis? No cure - prevention (respiratory protection), smoking cessation, supportive
care, oxygen therapy, lung transplant for severe cases
, Internal Medicine EOR Pulmonology Exam (Smarty PANCE)
What is the diagnostic test for berylliosis? Beryllium lymphocyte proliferation test (BeLPT) - differentiates from sarcoidosis
(clinically similar)
What complications occur with pneumoconiosis? Progressive respiratory failure, cor pulmonale, increased tuberculosis risk
(especially silicosis), malignancy (asbestosis)
What is asthma? Chronic inflammatory airway disease causing reversible airflow obstruction,
bronchial hyperresponsiveness, and mucus production
What are the classic symptoms of asthma? Episodic wheezing, dyspnea, chest tightness, cough (especially nocturnal or
early morning)
What is the diagnostic test for asthma? Spirometry showing reversible obstruction - FEV1/FVC <70%, FEV1
improvement ≥12% and ≥200mL after bronchodilator
What triggers commonly precipitate asthma Allergens, Smoke/pollution, Temperature changes, Hyperventilation/exercise,
exacerbations? Use mnemonic ASTHMA Meds (ASA, beta-blockers), Anxiety/stress
What is the stepwise approach to asthma management? Step 1: SABA prn; Step 2: +low-dose ICS; Step 3: +LABA; Step 4: medium-dose
ICS/LABA; Step 5: high-dose ICS/LABA +/- biologics
What medication is the cornerstone of persistent Inhaled corticosteroids (ICS) - most effective long-term control medication,
asthma treatment? reduce inflammation
What is the acute treatment for asthma exacerbation? Oxygen, albuterol (nebulized or MDI), ipratropium, systemic corticosteroids
(prednisone 40-60mg x 5 days)
What criteria indicate severe asthma exacerbation PEFR <40% predicted, inability to speak full sentences, accessory muscle use,
requiring hospitalization? altered mental status, PaCO2 >42mmHg
What medications should be avoided in asthma? Beta-blockers (including eye drops), NSAIDs (if aspirin-sensitive), ACE inhibitors
(can cause cough)
What is the role of biologics in severe asthma? For severe uncontrolled asthma - omalizumab (anti-IgE), mepolizumab (anti-IL-
5), dupilumab (anti-IL-4/13)
