Pulmonary Board Review

A patient receives PFTs with results of a normal FEV1, FVC, and TLC A patient receives PFTs with results of a normal FEV1, FVC, and TLC. DLCO 140% of predicted. This patient most likely has A) Asthma B) COPD C) Bronchitis D) Alveolar hemorrhage E) Iron deficiency anemia

A patient receives PFTs with results of a normal FEV1, FVC, and TLC A patient receives PFTs with results of a normal FEV1, FVC, and TLC. DLCO 140% of predicted. This patient most likely has A) Asthma B) COPD C) Bronchitis D) Alveolar hemorrhage E) Iron deficiency anemia

Patient with a history of asthma presents to the ED with an acute exacerbation. Initial ABG 7.46/34/70/94%. Patient receives neb treatment with albuterol. After the third treatment, exam reveals decreased breath sounds, RR >30/min, HR 130/min. ABG 7.38/46/70/92%. The most appropriate management is A) Start IV steroids B) Intubate the patient C) Start IV antibiotics D) Increase O2 to 50% by ventimask E) Continue neb treatments

Patient with a history of asthma presents to the ED with an acute exacerbation. Initial ABG 7.46/34/70/94%. Patient receives neb treatment with albuterol. After the third treatment, exam reveals decreased breathsounds, RR >30/min, HR 130/min. ABG 7.38/46/70/92%. The most appropriate management is A) Start IV steroids B) Intubate the patient C) Start IV antibiotics D) Increase O2 to 50% by ventimask E) Continue neb treatments

A patient is incidentally found to have an aspergilloma on a screening chest CT. There is no surrounding fibrosis and the patient has no symptoms. Which of the following is the best management? A) Monitor B) Surgical Resection C) Itraconazole PO D) IV Micafungin E) Amphotericin B instillation into the cavity

A patient is incidentally found to have an aspergilloma on a screening chest CT. There is no surrounding fibrosis and the patient has no symptoms. Which of the following is the best management? A) Monitor B) Surgical Resection C) Itraconazole PO D) IV Micafungin E) Amphotericin B instillation into the cavity

Patient recently immigrated from Peru Patient recently immigrated from Peru. She has a history of asthma, but has recurrent cough and wheeze despite increased use of B2 agonist. CBC shows eosinophils of 20%. ANCA neg, ANA neg. CXR shows round infiltrates. Most likely diagnosis is A) Hypersensitivity pneumonitis B) ABPA C) MTB D) Strongyloides infection E) Churg-Strauss syndrome

Patient recently immigrated from Peru Patient recently immigrated from Peru. She has a history of asthma, but has recurrent cough and wheeze despite increased use of B2 agonist. CBC shows eosinophils of 20%. ANCA neg, ANA neg. CXR shows round infiltrates. Most likely diagnosis is A) Hypersensitivity pneumonitis B) ABPA C) MTB D) Strongyloides infection E) Churg-Strauss syndrome

Patient with a history of high altitude pulmonary edema gets sick every time he goes up to the mountain to ski. He wants to go back next year. What is the best advice for prevention? A) Lasix B) ACE inhibitor C) HCTZ D) Acetazolamide

Patient with a history of high altitude pulmonary edema gets sick every time he goes up to the mountain to ski. He wants to go back next year. What is the best advice for prevention? A) Lasix B) ACE inhibitor C) HCTZ D) Acetazolamide

38 yo chronic smoker presents with progressive dyspnea 38 yo chronic smoker presents with progressive dyspnea. CXR shows interstitial disease with honeycomb appearance in the upper lung fields. PFTs show restrictive pattern. BAL shows Langerhan cells and Biopsy shows giant cells with fibrosis. What is the most likely diagnosis? A) Desquamitive interstitial pneumonia B) Histiocytosis X C) Multiple myeloma D) Hemophagocytic lymphohistiocytosis E) Cryptogenic organizing pneumonia

38 yo chronic smoker presents with progressive dyspnea 38 yo chronic smoker presents with progressive dyspnea. CXR shows interstitial disease with honeycomb appearance in the upper lung fields. PFTs show restrictive pattern. BAL shows Langerhan cells and Biopsy shows giant cells with fibrosis. What is the most likely diagnosis? A) Desquamitive interstitial pneumonia B) Histiocytosis X C) Multiple myeloma D) Hemophagocytic lymphohistiocytosis E) Cryptogenic organizing pneumonia

Patient presents with nasal congestion and rhinorrhea for the past several months. She has a history of allergies which is usually controlled with nasal decongestants and antihistamines. She has been using over the counter medications and it has gotten worse. Exam reveals red edematous mucosa of the nares. Most likely diagnosis is A) Allergic rhinitis B) Rhinitis Medicamentosa C) Nasal polyps D) Deviated nasal septum E) Chronic sinusitis

Patient presents with nasal congestion and rhinorrhea for the past several months. She has a history of allergies which is usually controlled with nasal decongestants and antihistamines. She has been using over the counter medications and it has gotten worse. Exam reveals red edematous mucosa of the nares. Most likely diagnosis is A) Allergic rhinitis B) Rhinitis Medicamentosa C) Nasal polyps D) Deviated nasal septum E) Chronic sinusitis

25 year old presents with purulent nasal discharge and headache for the past 2 days. Has had cough. You would treat with A) IV antibiotics B) Erythromycin C) Amoxicillin D) Decongestants and analgesics E) Sinus CT

25 year old presents with purulent nasal discharge and headache for the past 2 days. Has had cough. You would treat with A) IV antibiotics B) Erythromycin C) Amoxicillin D) Decongestants and analgesics E) Sinus CT

Patient with 30 year history if asthma, central bronchiectasis, peripheral eosinophilia worse when prednisone tapered off. What is the diagnosis ? A ABPA B Eosinophilic Pnumonia C Loeffgrens Syndome D Small cell carcinoma

Patient with 30 year history if asthma, central bronchiectasis, peripheral eosinophilia worse when prednisone tapered off. What is the diagnosis ? A ABPA B Eosinophilic Pnumonia C Loeffgrens Syndome D Small cell carcinoma

75 Year old man with past medical history of polio and kyphoscoliosis now presents with increased fatigue, daytime somnolence, peripheral edema. Patient also reports poor cough. Which of he following investigations will be normal ? A FVC B Pco2 C TLC D DLCO

75 Year old man with past medical history of polio and kyphoscoliosis now presents with increased fatigue, daytime somnolence, peripheral edema. Patient also reports poor cough. Which of he following investigations will be normal ? A FVC B Pco2 C TLC D DLCO

66 year old male with long smoking history and h/o COPD is admitted to the ICU with community acquired pneumonia. CXR shows LLL infiltrate and small pleural effusion. He is started on ceftriaxone and levofloxacin and improves clinically, now off 02 and afebrile. His repeat CXR shows LLL infiltrate but larger pleural effusion. What should be done in his management? A Cont IV fluids B Add Macrolide C Thoracentesis D Switch to oral antibiotics

66 year old male with long smoking history and h/o COPD is admitted to the ICU with community acquired pneumonia. CXR shows LLL infiltrate and small pleural effusion. He is started on ceftriaxone and levofloxacin and improves clinically, now off 02 and afebrile. His repeat CXR shows LLL infiltrate but larger pleural effusion. What should be done in his management? A Cont IV fluids B Add Macrolide C Thoracentesis D Switch to oral antibiotics

31 year old asthmatic is managed on budesonide inhalers and a prn albuterol inhaler. She presents with ongoing cough at night . Which of the following is the best next step in management ? A increase the frequency of albuterol B add ipratropium C add long acting beta agonist D Oral steroids

31 year old asthmatic is managed on budesonide inhalers and a prn albuterol inhaler. She presents with ongoing cough at night . Which of the following is the best next step in management ? A increase the frequency of albuterol B add ipratropium C add long acting beta agonist D Oral steroids

35 Year old women with 3 months of SOB, PFTs reveal FEV1 95%, fvc 100%,TLC 100%, DLCO 60% Predicted. What is the most likely diagnosis? A Alpha 1 antitrypsin deficiency B Chronic bronchitis C IPF D Pulm. Hypertension E Emphysema

35 Year old women with 3 months of SOB, PFTs reveal FEV1 95%, fvc 100%,TLC 100%, DLCO 60% Predicted. What is the most likely diagnosis? A Alpha 1 antitrypsin deficiency B Chronic bronchitis C IPF D Pulm. Hypertension E Emphysema

50 year old male with a 10 pack year smoking history presents with non productive cough. His PFT’s show mild obstruction. What is the best way to differentiate between emphysema and asthma? A Elevated residual volume in emphysema B FEV1 is lower in emphysema C FEV1 response to bronchodilators is diagnostic for asthma D Lower DLCO suggests emphysema

50year old male with a 10 pack year smoking history presents with non productive cough. His PFT’s show mild obstruction. What is the best way to differentiate between emphysema and asthma? A Elevated residual volume in emphysema B FEV1 is lower in emphysema C FEV1 response to bronchodilators is diagnostic for asthma D Lower DLCO suggests emphysema

23 Year old firefighter is caught in a forest fire and presents to ER with hypoxia and smoke inhalation Your testing shows carboxyhemoglobin level of 70%. What is the best management? A 100% O2 B 2- PAM C Sodium thiosulfate D methylene blue

23 Year old firefighter is caught in a forest fire and presents to ER with hypoxia and smoke inhalation Your testing shows carboxyhemoglobin level of 70%. What is the best management? A 100% O2 B 2- PAM C Sodium thiosulfate D methylene blue

Patient with hilar adenopathy, and no infiltrates found on CXR is diagnosed with Sarcoidosis. What is the most likely disease course? A) 10% remission at the end of 5 years B) 30% remission at the end of 5 years C) 50% remission at the end of 5 years D) 90% remission at the end of 5 years

Patient with hilar adenopathy, and no infiltrates found on CXR is diagnosed with Sarcoidosis. What is the most likely disease course? A) 10% remission at the end of 5 years B) 30% remission at the end of 5 years C) 50% remission at the end of 5 years D) 90% remission at the end of 5 years

44 year old male has multiple pelvic and hip fractures and undergoes hip replacement. Two days later he develops fever, mental confusion and SOB. Petechia on the chest are noted. CXR shows diffuse pulmonary infiltrates. Blood gases reveals po2 44, pCO2 of 30, pH 7.48. EKG shows sinus tach. Patient is intubated and transferred to the ICU. Most likely diagnosis? A) ARDS due to sepsis B) Acute Septic Shock C) Non cardiogenic pulmonary edema due to fat emboli D) Alveolar hemorrhage

44 year old male has multiple pelvic and hip fractures and undergoes hip replacement. Two days later he develops fever, mental confusion and SOB. Petechia on the chest are noted. CXR shows diffuse pulmonary infiltrates. Blood gases reveals po2 44, pCO2 of 30, pH 7.48. EKG shows sinus tach. Patient is intubated and transferred to the ICU. Most likely diagnosis? A) ARDS due to sepsis B) Acute Septic Shock C) Non cardiogenic pulmonary edema due to fat emboli D) Alveolar hemorrhage