Rosh Review- Pulmonology Exam Questions and Answers Already Passed
What is Sampter's triad? - Answers Asthma
Nasal polyps
Allergy to aspirin.
What presents with HIV patient with fever, gradual onset of nonproductive cough, CD4 count <200,
increased LDH?
Dx and Tx? - Answers Pneumocystis Pneumonia (PCP)
Opportunistic FUNGAL infection
Can have oral candidiasis and weight loss on presentation as well
Organism:
Pneumocystis Jirovecii
Occurs in immunocompromised patients : HIV or post transplant
Dx:
Chest Xray:
Bat wing appearance (bilateral interstitial infiltrates)
Tx:
IV Bactrim!
,Steroids if Po2 <70 or Alveolar-arterial oxygen gradient <35 mm Hg
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? - Answers Bactrim!
What are the main causes of transudate vs exudate? - Answers Transudate:
CHF, Cirrosis, Nephrotic Syndrome, Pulmonary Embolism
Exudate:
Malignancy, Bacterial/Viral Pneumonia, Tuberculosis, Pulmonary Embolism, Pancreatitis, Esophageal
Rupture, Collagen Vascular disease, Chylothorax/Hemothorax
What accounts for up to 90% of all transudative pleural effusions? - Answers CHF!
What diagnostic criteria is used in Light's criteria? - Answers ASSESS PLEURAL EFFUSION (transudative vs
exudative)
Serum Protein
Pleural fluid lactate dehydrogenase (LDH)
used to distinguish between transudative and exudative pleural effusions.
Pleural:Serum Protein --> <.5 = transudate
Pleural:Serum LDH --> <.6 = transudate
Pleural Fluid LDH --> <2/3 upper limit of normal = transudate
What presents with depressed level of consciousness with unilateral focal/patchy consolidations in
dependent segments of lungs?
,Tx? - Answers Aspiration Pneumonitis
Where stroke patients or those with altered level of consciousness via drugs etc can aspirate large
amounts of gastric contents causing inflammatory chemical injury and can lead to aspiration
pneumonia!
Tx:
Prophylactic antibiotics NOT recommended
What presents with symptoms of pneumonia (increased productive cough, fever, chills, malaise,
dyspnea) with otalgia and bullous myringitis?
Tx? - Answers Strep Pneumo Pneumonia!
ALSO indicates Mycoplasma Pneumonia
bullous myringitis--> bullae filled with blood forms on the TM and burst with effusing blood --> most
commonly seen with strep pneumo
Tx:
Antibiotics aimed at strep pneumo ( Macrolide)--> Clarithromycin or Azithromycin
What presents with rapid onset fever and dysphagia, patient leaning forward with inspiratory stridor
and drooling?
Dx and Tx? - Answers Epiglottis!
Dx:
Chest Xray Lateral:
, Thumb Print sign!
Most common cause:
HIB (Haemophilus Influenza)
Tx:
Airway management
Steroids
IV antibiotics
What presents with cough > 5 days, mucopurulent sputum, with recent illness, wheezing and rhonchi?
Dx and Tx? - Answers Bronchitis!
Most common cause:
Viral (Influenza A, B, Parainfluenza, RSV)
Inflammation of Bronchi (lower airway)
Dx:
Clinical
Chest Xray--> thickening of bronchial walls
until 10 days --> Observe and support with fluids and rest
What is Sampter's triad? - Answers Asthma
Nasal polyps
Allergy to aspirin.
What presents with HIV patient with fever, gradual onset of nonproductive cough, CD4 count <200,
increased LDH?
Dx and Tx? - Answers Pneumocystis Pneumonia (PCP)
Opportunistic FUNGAL infection
Can have oral candidiasis and weight loss on presentation as well
Organism:
Pneumocystis Jirovecii
Occurs in immunocompromised patients : HIV or post transplant
Dx:
Chest Xray:
Bat wing appearance (bilateral interstitial infiltrates)
Tx:
IV Bactrim!
,Steroids if Po2 <70 or Alveolar-arterial oxygen gradient <35 mm Hg
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? - Answers Bactrim!
What are the main causes of transudate vs exudate? - Answers Transudate:
CHF, Cirrosis, Nephrotic Syndrome, Pulmonary Embolism
Exudate:
Malignancy, Bacterial/Viral Pneumonia, Tuberculosis, Pulmonary Embolism, Pancreatitis, Esophageal
Rupture, Collagen Vascular disease, Chylothorax/Hemothorax
What accounts for up to 90% of all transudative pleural effusions? - Answers CHF!
What diagnostic criteria is used in Light's criteria? - Answers ASSESS PLEURAL EFFUSION (transudative vs
exudative)
Serum Protein
Pleural fluid lactate dehydrogenase (LDH)
used to distinguish between transudative and exudative pleural effusions.
Pleural:Serum Protein --> <.5 = transudate
Pleural:Serum LDH --> <.6 = transudate
Pleural Fluid LDH --> <2/3 upper limit of normal = transudate
What presents with depressed level of consciousness with unilateral focal/patchy consolidations in
dependent segments of lungs?
,Tx? - Answers Aspiration Pneumonitis
Where stroke patients or those with altered level of consciousness via drugs etc can aspirate large
amounts of gastric contents causing inflammatory chemical injury and can lead to aspiration
pneumonia!
Tx:
Prophylactic antibiotics NOT recommended
What presents with symptoms of pneumonia (increased productive cough, fever, chills, malaise,
dyspnea) with otalgia and bullous myringitis?
Tx? - Answers Strep Pneumo Pneumonia!
ALSO indicates Mycoplasma Pneumonia
bullous myringitis--> bullae filled with blood forms on the TM and burst with effusing blood --> most
commonly seen with strep pneumo
Tx:
Antibiotics aimed at strep pneumo ( Macrolide)--> Clarithromycin or Azithromycin
What presents with rapid onset fever and dysphagia, patient leaning forward with inspiratory stridor
and drooling?
Dx and Tx? - Answers Epiglottis!
Dx:
Chest Xray Lateral:
, Thumb Print sign!
Most common cause:
HIB (Haemophilus Influenza)
Tx:
Airway management
Steroids
IV antibiotics
What presents with cough > 5 days, mucopurulent sputum, with recent illness, wheezing and rhonchi?
Dx and Tx? - Answers Bronchitis!
Most common cause:
Viral (Influenza A, B, Parainfluenza, RSV)
Inflammation of Bronchi (lower airway)
Dx:
Clinical
Chest Xray--> thickening of bronchial walls
until 10 days --> Observe and support with fluids and rest
