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PANCE Pulm
| Question | Answer |
|---|---|
| A 68 y/o male is diagnosed with small cell lung cancer. Which of the following treatment options could be considered in this patient? | CorrectD. Combination chemotherapy |
| Treatment stategies for bronchogenic carcinoma includes | Small cell cancers are highly chemosensitive and usually widespread at detection so chemotherapy is now considered the treatment of choice |
| Which of the following is most likely to cause a false negative PPD? | Aids |
| Which of the following best characterize restrictive ventilatory defects? | Low lung volumes |
| A patient should be tested for tuberculosis prior to being treated with | etanercept (Enbrel). |
| A 54-year-old woman is noted to have a cervical cancer and presents with significant vaginal bleeding with a hemoglobin level of 7 g/dL. Her left leg is swollen, which on Doppler investigation reveals DVT. Tx? | VCF |
| A 25-year-old patient complains of lightheadedness and shortness of breath. She appears anxious. Vital signs include temperature 98.6° F, pulse 90/min, and respiratory rate 30/min. Normal ABG. Tx? | Breath into bag |
| How do you distinguish between acute and chronic CO2 retention (respiratory acidosis)? | Arterial pH and venous HCO3 concentration |
| A 6-year-old male presents to the ED with a 3-day history of productive cough and fever. Arterial blood gas results are:PH 7.24 PCO2 36 mm Hg PO2 100 mm Hg HCO3 16 mEq/L. The principal acid-base derangement is | met acidosis |
| Which of the following therapeutic agents would be the best treatment for a 24 year-old female with a history of intermittent wheezing and dyspnea while exercising 3-4 times a month. | albuterol |
| A solitary pulmonary nodule is found on a pre-employment screening chest x-ray in a 34 year-old nonsmoking male. There are no old chest x-rays to compare. Which of the following is the most appropriate next step in the evaluation? | CT |
| TB tx? | Rifampin, Pyranzinamide, Ethambutol, and Isoniazide |
| PE s/p hip replacement. Tx? | LMWH |
| A 34 year old man was recently diagnosed with exercise induced asthma as a part of the first-line therapy | Initiate a B2-Agonist approximately 20 minutes before exercise. |
| Which of the following pathogens more frequently cause nosocomial pneumonia then community-acquired pneumonia? | s aureus |
| near drowning victim, declining | tracheal intubation w positve pressure vent |
| Recent cough w dark sputum, febrile, does not look ill. Dullness to anterior right hemithorax below 5th rib. Crackles and pectoriloquy over same area. Dx? | R middle lobe pneumonia |
| Which of the following is a general health maintenance recommendation for elderly patients? | influenza vaccine annually each fall |
| PFTs in COPD | B. normal or increased total lung capacity (TLC) C. increased residual volume D. poor reversibility with bronchodilators |
| Cough x 1 year, rales, bilateral diaphragmatic pleural plaques. Exposure to what environmental agents? | asbestos |
| In a patient with a low probability of pulmonary embolism (PE) based on the Wells criteria, which of the following lab studies is most helpful in ruling out a PE? | ddimer |
| COPD'er w pneumonia w lots of gram-negative rods. Dx? | moraxella cat or h flu |
| A 26 year-old man is stung by a bee, and shortly thereafter, a wheal develops at the site of the sting. He soon feels flushed and develops hives, rhinorrhea, and tightness in the chest. He is seen in the urgent care center. Immediate therapy should be to | sub q epi |
| Patient w BCG vaccine, how screen for TB? | chest x ray |
| COPD with pneumonia presents to ER w respt acidosis. Tx? | Begin O2 1L nasal cannula |
| First like tx for CAP | Macrolide, extended-spectrum fluroquinolone, or doxycycline |
| AA insurance physical. On CXR: marked lymphadenopathy in the right paratracheal region. Angiotensin-converting enzyme (ACE) levels are elevated. Which of the following is the most likely diagnosis? | sarcoidosis |
| In emphysema, the single most important factor in slowing the inevitable decline in forced expiratory volume in 1 second (FEV1) and improving life expectancy and quality of life is: | smoking cessation |
| COPD w increasing SOB, productive cough w sputum, Decreasing pH on ABG, tx? | intubate |
| 4 mo old with cough that has turned into staccato paroxysmal forceful cough ending w loud inspiration. WBC 200,000 w 72% lymphocytes. Tx? | Azithromycin |
| Which of the following patients has a contraindication for the use of live attenuated intranasal influenza vaccination? | Asthma |
| Increased wheezing in an asthmatic patient that you are treating indicates: | improved air exchange |
| Which of the following is the most common cause of hemoptysis in the United States? | acute bronchitis |
| Which of the following pathophysiological processes is associated with chronic bronchitis? | mucous gland enlargement and goblet cell hyperplasia |
| IV drug abuser, fever, hemp, holosystolic murmur of 5th intercostal space. Chest X-ray reveals several small cavitary lesions without pulmonary vascular congestion. His most likley diagnosis is? | Tricuspid valve endocarditis with septic pulmonary emboli |
| Pulmonary edema may result in: | hypoxemia w low/normal CO2 and low pH |
| Which of the following is the recommended treatment of a large volume hemothorax? | remove blood |
| In addition to severe respiratory distress, which of the following findings may be indicative of a pneumothorax with mediastinal shift? | tracheal deviation |
| morning sluggishness, snoring, tx for apneic episodes? | nasal CPAP |
| The finding of egophony is most consistent with | lobal pneumonia |
| A patient presents with increasing shortness of breath. On examination there are decreased breath sounds on the right with hyperresonance to percussion. There is tracheal deviation to the left. Of the following which intervention is indicated? | needle decomp |
| Increased total lung capacity, decreased FEV1 | COPD |
| Which of the following is the most common extra-pulmonary finding in a patient with sarcoidosis? | Skin lesions |
| Which of the following will result in decreased serum theophylline levels in a patient with COPD? | Cig smoking |
| Intoxicated patient, lower lobe infiltrate, most likely organism? | Klebsiella |
| Cystic fibrosis pneumonia | pseudomonas |
| Diagnosis of pulmonary hypertension | Pulm capillary wedge pressure |
| Which of the following treatment modalities is only minimally effective in the management of emphysema? | corticosteroids |
| Which of the following represents an obstructive pattern of impairment during spirometry? | Decreased FEV1/FVC ratio, a reduced FEF, an FEV1 less than 80% of predictive value, reduced FV |
| Kussmaul breathing is characterized by | rapid, deep labored breathing |
| Single large lung tumor | adenocarcinoma |
| Which of the following radiologic findings is suggestive of chronic silicosis? | egg shell calcification of enlarged hilar lymph nodes |
| Impedance plethysmography is consistent with a large proximal clot in the left leg. Which of the following would be the most reasonable next step? | admin heparin and order study to R/O plum embolism |
| A 54 y/o alcoholic with fever, chills, and cough with purulent sputum production for 3 days.Temp is 101.5F, RR 20, BP 128/80, P 82, and O2 sat 100% on RA. Left LL base reveals inspiratory crackles with auscultation + egophony, + bronchophony. | cef + axith (rocephin +zithromax) |
| Which of the following best describes the pathophysiology of hypersensitivity pneumonitis? | A cell-mediated immune reaction to inhaled antigens in susceptible persons |
| Which of the following is the first line agent in the outpatient management of Legionella pneumonia? | Azithromycin |
| The major risk factor for bronchogenic carcinoma is | Tobacco smoking |
| What is the most effective prophylaxis against respiratory syncytial virus (RSV) infection in the general pediatric population? | proper hand washing |
| delivers a boy during the 29th week of pregnancy. Within an hour of delivery, the infant is in severe respiratory distress and requires intubation with mechanical ventilation. Best treatment options? | surfactant replacement |
| Which of the following most accurately describes the preferred pharmacologic treatment of moderate persistent asthma in adults? | Daily-inhaled corticosteroids and long-acting, inhaled Beta2-agonists, if neede |
| In emphysema, the disease process is characterized by | destruction of alveolar walls |
| A 65 year-old with COPD receiving their first pneumococcal conjugate vaccination should be revaccinated in | 5 years |
| Which of the following is considered the definitive treatment of severe obstructive sleep apnea? | tracheostomy |
| Which of the following mechanisms leads to a primary pneumothorax? | Rupture of subpleural apical blebs due to high negative intrapleural pressures |
| diagnosed with influenza and discharged with a cough suppressant. She presented back four days later for severe SOB and hypoxemia. CXR showed bilateral interstitial infiltrates and patient's SaO2 was below 80% on ~100% NRB. Tx? | intubate |
| Dx w TB, before treatment, what labs? | AST/ALT |
| Which of the following is the greatest risk factor for the development of drug resistance in the treatment of tuberculosis? | non-adherance to drug program |
| MCC hemoptysis in non-hospitalized patients | acute and chronic bronchitis |
| Which of the following is the only therapy that is documented to alter the natural history of COPD? | oxygen |
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