Pulmonology E1: BOLDED items

What is the zone responsible for delivering air?
a. Tracheal zone
b. Respiratory zone
c. Oxygenation zone
d. Conducting zone

Conducting zone

What is the zone responsible for gas exchange with the blood?
a. Tracheal zone
b. Respiratory zone
c. Oxygenation zone
d. Conducting zone

Respiratory zone

Where does voluntary control of breathing originate?
a. Cerebral cortex
b. Medulla oblongata
c. Pons
d. B&C

Cerebral cortex

Where does involuntary control of breathing originate?
a. Cerebral cortex
b. Medulla oblongata
c. Pons
d. B&C

B&C

What nerve innervates the diaphragm?
a. Spinal nerves (T1-T11)
b. Phrenic nerve (C3-C4)
c. Spinal nerves (T4-T11)
d. Phrenic nerve (C3-C5)

Phrenic nerve (C3-C5)

What is surfactant important for?
a. Reduce friction between the alveoli
b. Transport oxygen and CO2
c. Keep alveoli open for gas exchange
d. Allow for the transport of RBCs

Keep alveoli open for gas exchange

Which of the following is FALSE about chest XRs?
a. The routine study for lung disease
b. Screening test for lung cancer
c. Allows for the visualization of PNA
d. Not as sensitive as a CT

Screening test for lung cancer

What form of imaging is the "gold standard" for diagnosis of a pulmonary embolism?
a. CT pulmonary angiogram
b. Chest CT without contrast
c. Chest XR
d. Chest US

CT pulmonary angiogram

Which of the following statements is TRUE?
a. V/Q mismatch is not a normal variant
b. The V/Q ratio will be high in the apex due to a higher perfusion
c. The V/Q ratio will be low in the base due to a lower perfusion
d. V/Q shunting is not a normal variant

V/Q shunting is not a normal variant

What is the normal O2 sat range on room air?
a. 95-100%
b. 96-100%
c. 97-100%
d. 94-100%

96-100%

What O2 sat warrants the need for supplemental oxygen?
a. < 88%
b. < 90%
c. < 92%
d. < 94%

< 88%

Which of the following is NOT indicative of transudative pleural fluid?
a. CHF
b. Hypoalbuminemia
c. Infection
d. Cirrhosis

Infection

Which of the following is NOT indicative of exudative pleural fluid?
a. Infection
b. Nephrotic syndrome
c. Inflammation
d. Hemorrhage

Nephrotic syndrome

What is an indication for a needle decompression?
a. Pneumonia
b. Tension pneumothorax
c. COPD
d. CHF

Tension pneumothorax

Which of the following has the highest FiO2?
a. Non-rebreather
b. Face mask
c. High flow nasal cannula
d. Nasal cannula

High flow nasal cannula

T/F: In obstructive diseases, you would expect to get a decrease in FEV1

True

T/F: In restrictive diseases, you would expect to get a decrease in FEV1

False

T/F: In obstructive diseases, you would expect to get a decrease in RV

False

T/F: In obstructive diseases, you would expect to get a decrease in TLC

True

What is the normal pH range?
a. 7.32-7.42
b. 7.35-7.45
c. 7.38-7.44
d. 7.30-7.40

7.38-7.44

What is sensitive to arterial pO2?
a. Carotid bodies
b. Medulla
c. Aortic arch
d. A&C

A&C

Where are the chemoreceptors sensitive to pCO2 and pH located?
a. Cerebral cortex
b. Carotid bodies
c. Aortic arch
d. Medulla

Medulla

Which of the following is NOT a possible cause for respiratory acidosis?
a. Fever
b. Obesity
c. Spinal cord injury
d. Narcotics

Fever

Which of the following is NOT a possible cause for respiratory alkalosis?
a. CHF
b. CNS tumor
c. Sepsis
d. Anxiety

CNS tumor

Which of the following is NOT a possible cause for metabolic acidosis with a high anion gap?
a. Iron
b. Ethanol
c. Methanol
d. Spironolactone

Spironolactone

Which of the following is NOT a possible cause for metabolic acidosis with a normal anion gap?
a. Uremia
b. Acetazolamide
c. Diarrhea
d. Hyperalimentation

Uremia

T/F: Lactic acidosis is caused by conditions with impaired tissue perfusion

True

Which of the following does NOT cause lactic acidosis?
a. Hypotension
b. Hypoxia
c. Anemia
d. None of the above

None of the above

T/F: Antibiotics are recommended for treatment of URIs

False

Which of the following types of PNA is most commonly associated with hotel AC systems?
a. Mycoplasma
b. Legionella
c. Streptococcus
d. Klebsiella

Legionella

Which of the following types of PNA is most commonly seen in college aged students?
a. Mycoplasma
b. Legionella
c. Streptococcus
d. Klebsiella

Mycoplasma

Which of the following types of PNA is has an associated symptom of currant jelly sputum?
a. Mycoplasma
b. Legionella
c. Streptococcus
d. Klebsiella

Klebsiella

Which of the following types of PNA is has an associated symptom of rust colored sputum?
a. Mycoplasma
b. Legionella
c. Streptococcus
d. Klebsiella

Streptococcus

Which of the following types of PNA is has an associated symptom of hyponatremia and diarrhea?
a. Mycoplasma
b. Legionella
c. Streptococcus
d. Klebsiella

Legionella

Which of the following types of PNA is has an associated symptom of bullous myringitis (severe ear pain)?
a. Mycoplasma
b. Legionella
c. Streptococcus
d. Klebsiella

Mycoplasma

Which of the following types of PNA is has an associated symptom of hoarseness?
a. Mycoplasma
b. Chlamydia
c. Streptococcus
d. Klebsiella

Chlamydia

Which of the following types of PNA is most commonly associated with alcoholics?
a. Mycoplasma
b. Legionella
c. Streptococcus
d. Klebsiella

Klebsiella

Which of the following types of PNA is most commonly associated with patients with COPD?
a. H. Influenza
b. Legionella
c. Streptococcus
d. Klebsiella

H. Influenza

Which of the following types of PNA is most commonly associated with patients with cystic fibrosis?
a. Mycoplasma
b. Pseudomonas
c. Streptococcus
d. Klebsiella

Pseudomonas

Which of the following types of PNA is most commonly seen in patients < 1 y/o?
a. Parainfluenza
b. Streptococcus
c. RSV
d. Pseudomonas

RSV

Which of the following types of PNA is most commonly seen in patients > 2 y/o?
a. Parainfluenza
b. Streptococcus
c. RSV
d. Pseudomonas

Parainfluenza

What is the 1st line outpatient treatment for typical and atypical CAP?
a. Amoxicillin
b. Azithromycin
c. Doxycycline
d. Augmentin

Azithromycin

What is the treatment for typical CAP in pediatric patients?
a. Amoxicillin
b. Azithromycin
c. Doxycycline
d. Augmentin

Amoxicillin

What is the treatment for atypical CAP in pediatric patients?
a. Amoxicillin
b. Azithromycin
c. Doxycycline
d. Augmentin

Azithromycin

What is the treatment for typical and atypical CAP if comorbidities or increased resistance to macrolides exists?
a. Amoxicillin
b. Ciprofloxacin
c. Levofloxacin
d. Doxycycline

Levofloxacin

What is the first line treatment for inpatient (non-ICU) CAP?
a. Cefdinir or Ceftaroline & Azithromycin
b. Cephalexin or Ceftaroline & Azithromycin
c. Ceftriaxone or Ceftaroline & Azithromycin
d. Cephalexin or Ceftaroline & Amoxicillin

Ceftriaxone or Ceftaroline & Azithromycin

What is the first line treatment for inpatient (non-ICU) CAP if you suspect MRSA?
a. Cefdinir or Ceftaroline & Azithromycin & Clindamycin
b. Cephalexin or Ceftaroline & Azithromycin & Vancomycin
c. Ceftriaxone or Ceftaroline & Azithromycin & Vancomycin
d. Cephalexin or Ceftaroline & Amoxicillin & Linezolid

Ceftriaxone or Ceftaroline & Azithromycin & Vancomycin

What is the most common cause of HIV associated pneumonia?
a. H. influenzae
b. S. pneumoniae
c. P. aeruginosa
d. Pneumocystic jirovecii

Pneumocystic jirovecii

What is a unique symptom of anaerobic pneumonia and lung abscesses?
a. Hemoptysis
b. Foul smelling purulent sputum
c. Currant jelly sputum
d. Weight gain

Foul smelling purulent sputum

What is the treatment of anaerobic pneumonia and lung abscesses (patient has NKDA)?
a. Beta-lactam/Beta-lactamase inhibitor
b. Cephalosporin
c. Macrolide
d. Clindamycin

Beta-lactam/Beta-lactamase inhibitor

What is the treatment of anaerobic pneumonia and lung abscesses (patient has allergy to beta lactams)?
a. Penicillin
b. Cephalosporin
c. Macrolide
d. Clindamycin

Clindamycin

What is the most common cause of lower respiratory tract infections in children < 1 y/o?
a. H. influenza
b. RSV
c. S. pneumonia
d. Pseudomonas

RSV

What is the most common cause of bronchiolitis?
a. Adenovirus
b. Parainfluenza
c. Rhinovirus
d. RSV

RSV

What is the most common cause of epiglottitis in children?
a. H. influenza type a
b. H. influenza type b
c. S. pneumoniae
d. Pseudomonas

H. influenza type b

What is the most common cause of epiglottitis in adults?
a. H. influenza type a
b. H. influenza type b
c. S. pneumoniae
d. Pseudomonas

S. pneumoniae

What is the most common cause of epiglottitis in immunocompromised patients?
a. H. influenza type a
b. H. influenza type b
c. S. pneumoniae
d. Pseudomonas

Pseudomonas

What is NOT a presenting symptom of epiglottitis?
a. Cough
b. Drooling
c. Muffled voice
d. Tripod posture

Cough

What is the CXR finding for epiglottitis?

Thumb print sign

What stage of pertussis is the most infectious?
a. Catarrhal
b. Paroxysmal
c. Convalescent

Catarrhal

T/F: If labs were drawn on a patient with pertussis, there would be leukocytosis with lymphocytosis

True

What is the first line treatment for pertussis?
a. Penicillin
b. Beta-lactam/Beta-lactamase inhibitor
c. Tetracyclines
d. Macrolides

Macrolides

What is the CXR finding for croup?

Steeple sign

What disease state is characterized by a barking (seal like) cough and inspiratory stridor worse at night?
a. RSV
b. Pneumoniae
c. Croup
d. Epiglottitis

Croup

What is the gold standard treatment for croup?
a. Racemic epinephrine
b. Macrolides
c. Amoxicillin
d. Intubation

Racemic epinepherine

What should you observe when measuring a PPD test?
a. Erythema
b. Induration

Induration

What TB drug has a side effect of orange body fluids?
a. INH
b. Rifampin
c. Ethambutol
d. Pyrazinamide

Rifampin

What TB drug has a side effect of optic neuropathy?
a. INH
b. Rifampin
c. Ethambutol
d. Pyrazinamide

INH

What TB drug has a side effect of red-green vision loss?
a. INH
b. Rifampin
c. Ethambutol
d. Pyrazinamide

Ethambutol

What TB drug has a side effect of photosensitive dermatitis?
a. INH
b. Rifampin
c. Ethambutol
d. Pyrazinamide

Pyrazinamide

What mycotic lung disease originates from the midwest and southeast regions?
a. Histoplasmosis
b. Coccidiodomycosis
c. Blastomycosis
d. Aspergillosis

Histoplasmosis

What mycotic lung disease is due to inhalation of contaminated soil?
a. Histoplasmosis
b. Coccidiodomycosis
c. Blastomycosis
d. Aspergillosis

Histoplasmosis

What is the first line treatment for histoplasmosis?
a. Amphotericin B
b. Clindamycin
c. Fluconazole
d. Itraconazole

Itraconazole

What mycotic lung disease is related to valleys (ie. San Joaquin Valley)?
a. Histoplasmosis
b. Coccidiodomycosis
c. Blastomycosis
d. Aspergillosis

Coccidiodomycosis

What mycotic lung disease has an associated symptom of erythema nodosum?
a. Histoplasmosis
b. Coccidiodomycosis
c. Blastomycosis
d. Aspergillosis

Coccidiomycosis

What mycotic lung disease originates from areas with the Great Lakes and rivers?
a. Histoplasmosis
b. Coccidiodomycosis
c. Blastomycosis
d. Aspergillosis

Blastomycosis

What mycotic lung disease can have an associated symptom of verrucous lesiosn?
a. Histoplasmosis
b. Coccidiodomycosis
c. Blastomycosis
d. Aspergillosis

Blastomycosis

What is the first line treatment for mild/moderate blastomycosis?
a. Amphotericin B
b. Voriconazole
c. Fluconazole
d. Itraconazole

Itraconazole

What is the first line treatment for moderately severe/severe blastomycosis?
a. Amphotericin B
b. Voriconazole
c. Fluconazole
d. Itraconazole

Amphotericin B

What is the first line treatment for CNS blastomycosis?
a. Amphotericin B
b. Voriconazole
c. Fluconazole
d. Itraconazole

Voriconazole

What is the defining feature of asthma?
a. Mucous plugging
b. Airway collapse
c. Bronchial/Airway hyperresponsiveness
d. Bronchial/Airway hyporesponsiveness

Bronchial/Airway hyperresponsiveness

What is the effect of asthma of FEV1?
a. Increase
b. Decrease

Decrease

What is the effect of asthma of FVC?
a. Increase
b. Decrease

Decrease

What is the effect of asthma of RV?
a. Increase
b. Decrease

Increase

What is the effect of asthma of TLC?
a. Increase
b. Decrease

Increase

What is the effect of asthma of FRC?
a. Increase
b. Decrease

Increase

What stage of asthma would have an FEV1 of 60-80%?
a. Intermittent
b. Mild persistent
c. Moderate persistent
d. Severe persistent

Moderate persistent

What stage of asthma would have an FEV1 of <60%?
a. Intermittent
b. Mild persistent
c. Moderate persistent
d. Severe persistent

Severe persistent

What stage of asthma would have a normal FEV1?
a. Intermittent
b. Mild persistent
c. Moderate persistent
d. A&B

A&B

What SABA is used as an emergency inhaler and can be used for EIA?
a. Albuterol
b. Levalbuterol

Levalbuterol

What LABA can be used for an acute exacerbation?
a. Formoterol
b. Salmeterol

Formoterol

What is an important side effect of ICS use?
a. Sore throat
b. Oral thrush
c. Hairy tongue
d. Lip swellin

Oral thrush

What is a black box side effect of leukotriene receptor antagonists?
a. Mood disorders
b. Strokes
c. MI
d. HTN

Mood disorders

What drug class works well in those that have aspirin-exacerbated respiratory disease?
a. LABA
b. LAMA
c. SABA
d. Leukotriene receptor antagonists

Leukotriene receptor antagonists

T/F: Slow onset asthma exacerbations are more common in males

False

T/F: Fast onset asthma exacerbations are more common in males

True

What can trigger a slow onset asthma exacerbation?
a. Exercise
b. URI
c. Allergens
d. Stress

URI

What is a unique symptom of asthma exacerbations?
a. Abdominal pain
b. Hemoptysis
c. Silent chest
d. Vomiting

Silent chest

T/F: All COPD is caused by prolonged exposure to harmful particles or gases

False

What subtype of emphysema is associated with smoking/toxic gas exposure?
a. Centriacinar
b. Panacinar
c. Paraseptal

Centriacinar

What subtype of emphysema is associated with an alpha-1 antitrypsin deficiency?
a. Centriacinar
b. Panacinar
c. Paraseptal

Panacinar