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Pulmonology Flashcards Master EL Husseiny’s Essentials of Pulmonology in just 2 hour

[qwiz style=”width: auto !important; min-height: auto !important; border-width: 4px !important; border-color: #0099cc !important; ” align=”center”]

[h] Pulmonology Flashcards

[i] Master EL Husseiny’s Essentials of Pulmonology in just 2 hour

[q] The main difference between Asthma and chronic obstructive pulmonary disease (COPD) is …..?

[c*] Show me the answer

[f] Reversibility.

[q] …. are the most common stimuli to cause asthma exacerbation?

[c*] Show me the answer

[f] Respiratory infections. Studies have documented that viruses (respiratory syncytial virus in young children, rhinoviruses in adults) are the major causes.

[q] What is the best initial treatment?

Patient with history of asthma who experience acute exacerbation in response to exercise?

[c*] Show me the answer

[f] Short-acting beta-adrenergic agonists such as albuterol, used 10-20 minutes prior to exercise, are typically sufficient to prevent symptoms. They are considered first-line therapy if used only intermittently (less than daily).

A combination of beta agonists and antileukotriene agents may also be used in high-performance athletes.

[q] What is the best initial treatment?

Patient with history of asthma who experience acute exacerbation after having GERD?

[c*] Show me the answer

[f] Proton-pump inhibitor (PPI) therapy has been shown to improve both asthma symptoms and peak expiratory flow rate in asthma patients with evidence of comorbid GERD, and a PPI trial (esomeprazole) should be initiated in this patient.

[q] Pathogenesis of Aspirin intolerant Asthma involves …….?

[c*] Show me the answer

[f] Arachidonic acid is diverted to the production of proinflammatory leukotrienes via the 5-lipoxygenase pathway.

[q] What is the most accurate diagnostic test?

Patient presenting with dyspnea, tachypnea, prolonged expirations, respiratory wheezing?

[c*] Show me the answer

[f] Pulmonary function testing (PFTs). Spirometry will show a decrease in the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC). The FEV1 decreases more than the FVC.

[q] The best initial diagnostic test in an acute exacerbation of Asthma is …..?

[c*] Show me the answer

[f] Peak expiratory flow (PEF) or arterial blood gas (ABG)

[q] ABG in patient with acute exacerbation of asthma will show ….?

[c*] Show me the answer

[f] Respiratory Alkalosis.

Acute asthma exacerbation causes increased respiratory drive and hyperventilation, leading to decreased partial pressure of carbon dioxide (PaCO2).

Hyperventilation results in a decrease in the PaCO2 and a primary respiratory alkalosis, which is the typical presentation in an acute asthma exacerbation.

[q] Pulmonary Function Testing in Asthma patient will show ….?

[c*] Show me the answer

[f] PFTs show an obstructive pattern that typically reverses with bronchodilation:

– Decreased FEV1 and decreased FVC with a decreased ratio of FEV1/FVC.

– Increase in FEV1 of more than 12% and 200 mL with the use of albuterol.

– When the patient is asymptomatic, the most accurate test of reactive airway disease is a 20% decrease in FEV1 with the use of methacholine (provocative challenge test).

[q] The best initial treatment for patients with newly diagnosed asthma or intermittent asthma is ……?

[c*] Show me the answer

[f] An as- needed short-acting beta-2 agonist (albuterol).

[q] What is the best next step in management?

Asthmatic patient complaining in follow-up visit that his symptoms is not controlled with albuterol?

[c*] Show me the answer

[f] Add a long-term control agent to a SABA. Low-dose inhaled corticosteroids (ICS) are the best initial long-term control agent.

[q] The best initial therapy for acute asthma exacerbation is …..?

[c*] Show me the answer

[f] Oxygen combined with inhaled short-acting beta agonists such as albuterol and a bolus of steroids.

If the patient does not respond to oxygen, albuterol, and steroids or develops respiratory acidosis (increased pCO2), the patient may have to undergo endotracheal intubation for mechanical ventilation. These patients should be placed in the intensive care unit.

[q] What is the best next step in management?

Asthmatic patient who use short-acting beta agonists inhaler for years complaining of muscle weakness, tremor, headache, palpitations, arrhythmias, and EKG changes?

[c*] Show me the answer

[f] Obtaining a serum electrolyte panel would be helpful to confirm and assess the severity of patient’s hypokalemia.

[q] An elevated or even normal PaCO2 in asthmatic patient with acute exacerbation suggests ……?

[c*] Show me the answer

[f] Inability to meet increased respiratory demands (likely due to respiratory muscle fatigue) and impending respiratory failure. Endotracheal intubation and mechanical ventilation are indicated in patients with severe asthma unresponsive to maximal medical therapy and who have signs of impending respiratory arrest.

[q] Theophylline has a narrow therapeutic index, and toxicity can occur from accumulation by reduced clearance or decreased metabolism. The most feared complication of theophylline toxicity are …..?

[c*] Show me the answer

[f] Central nervous system stimulation (headache, insomnia, seizures), and cardiac toxicity (arrhythmia).

[q] What is the most likely diagnosis?

Patient with history of heavy smocking presenting with shortness of breath worsened by exertion + Productive cough + expiratory wheezing + x-ray shows hyperinflated lung with flattened diaphragm + pulmonary function test shows o Decreased FEV1, decreased FVC, decreased FEV1/FVC ratio (˃ 70%).

[c*] Show me the answer

[f] Chronic Obstructive Pulmonary Disease.

[q] Mention 3 findings can help distinguish between chronic bronchitis and emphysema:

[c*] Show me the answer

[f] 1. The diffusion capacity of the lung for carbon monoxide (DLCO) which measures gas exchange between the alveoli and pulmonary capillary blood, remains normal in chronic bronchitis (intact alveolar and capillary structures), but the alveolar destruction that occurs in emphysema results in decreased DLCO.

2. The chest x-ray in chronic bronchitis reveals prominent bronchovascular markings and a mildly flattened diaphragm. In contrast, the chest x-ray in emphysema reveals decreased vascular markings and hyperinflated lungs.

3. Patients with predominant chronic bronchitis may demonstrate more pronounced hypoxemia than patients with emphysema.

[q] The only interventions which have been shown to decrease mortality in patients with COPD are …….?

[c*] Show me the answer

[f] Home oxygen and smoking cessation.

[q] The criteria for initiating Long-term supplemental oxygen therapy (LTOT) in COPD patients include ……?

[c*] Show me the answer

[f]

Resting arterial oxygen tension (PaO2) ≤55 mm Hg or pulse oxygen saturation (SaO2) ≤88% on room air.

PaO2 <60 mm Hg or SaO2 <90% in patients with cor pulmonale, evidence of right heart failure, or hematocrit >55%.

[q] The management of acute episodes of increased shortness of breath in COPD patients is similar to the treatment of acute asthma exacerbations + ….?

[c*] Show me the answer

[f] Antibiotics because bacterial infection is by far the most commonly identified cause.

All patients with acute exacerbation of chronic obstructive pulmonary disease should receive inhaled bronchodilators B2 agonists and anticholinergics and systemic glucocorticoids. In addition, supplemental oxygen, antibiotics, and ventilatory support should be administered when indicated.

[q] In COPD, the diaphragmatic flattening and muscular shortening caused by hyperinflation result in ……?

[c*] Show me the answer

[f] more difficulty in decreasing intrathoracic pressure during inspiration and therefore increase the work of breathing.

[q] What is the most likely diagnosis?

40 years old patient (not smoker) presenting with basilar predominate emphysema + unexplained elevated liver enzymes?

[c*] Show me the answer

[f] Alpha-1 antitrypsin (A1AT) deficiency.

[q] What is the most likely diagnosis?

Patient who work in insulation presenting with dyspnea that worsen with exertion + digital clubbing + pulmonary function test shows  FEV1, FVC, TLC, and residual volume are decreased, FEV1/FVC ratio is normal + reduced diffusion capacity of carbon monoxide (DLCO) + CT shows honeycombing pattern?

P[c*] Show me the answer

[f] Pneumoconioses (Asbestosis).

[q] Obstructive lung disease can be due to intermittent cause like asthma or chronic cause like COPD. How to differentiate between both through DLCO?

[c*] Show me the answer

[f] DLCO is normal in asthma, but decreased in COPD due to decrease of the surface area.

[q] Restrictive lung disease may be due to ILD or due to chest wall thickness. How to differentiate between them through DLCO?

[c*] Show me the answer

[f] DLCO is normal in Chest wall thickness and decreased in ILD.

[q] What is the most likely diagnosis?

Farmer who is (Bird fancier, bird breeder) presenting with cough, dyspnea, fever and malaise?

[c*] Show me the answer

[f] Hypersensitivity pneumonitis (HP).

Studies have shown that the best treatment for HP is avoidance of antigen exposure. In many patients, this produces complete remission.

With chronic exposure, patients may develop pulmonary fibrosis and a restrictive pattern on lung spirometry.

[q] Asbestosis is associated with increase cancer risk like …..?

[c*] Show me the answer

[f]

The most common cancer associated with asbestosis is bronchogenic carcinoma (adenocarcinoma or squamous cell carcinoma).

Pleural or peritoneal mesotheliomas are also associated with asbestos exposure but are not a common as bronchogenic cancer.

[q] It is thought that silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to ….?

[c*] Show me the answer

[f] TB.

[q] What is the most likely diagnosis?

African American female with shortness of breath on exertion and occasional fine rales on lung exam + bilateral hilar adenopathy in chest X-ray + Bronchoalveolar lavage shows high CD4:CD8 ratio?

[c*] Show me the answer

[f] Sarcoidosis.

[q] Cystic fibrosis patient presenting with Dyspnea and wheezing + Recurrent episodes of very high-volume purulent sputum production + high resolution CT shows abnormally dilated airways with tram track appearance?

[c*] Show me the answer

[f] Bronchiectasis.

[q] The most common cause mortality in cystic fibrosis patient is …..?

[c*] Show me the answer

[f] Chronic lung disease.

[q] The most common cause of pancreatic insufficiency in children is ….?

[c*] Show me the answer

[f] Cystic fibrosis.

[q] The cause of infertility in cystic fibrosis male patient is …?

[c*] Show me the answer

[f] Obstructive azoospermia from congenital bilateral absence of the vas deferens.

[q] The cause of infertility in cystic fibrosis female patient is …?

[c*] Show me the answer

[f] Women are infertile because chronic lung disease alters the menstrual cycle and thick cervical mucus blocks sperm entry.

[q] The most accurate diagnostic test in cystic fibrosis patient is ….?

[c*] Show me the answer

[f] Sweat chloride test. Pilocarpine increases acetylcholine levels which increases sweat production. Chloride levels in sweat above 60 meq/L on repeated testing establishes the diagnosis.

[q] The most common pathogen isolated from sputum cultures in infants and young children is ……?

[c*] Show me the answer

[f] Staphylococcus aureus.

[q] ….. is the most common cause of CF-related pneumonia in adults and contributes to life-threatening decline of pulmonary function?

[c*] Show me the answer

[f] Pseudomonas aeruginosa.

[q] Symptomatic relief of polyps in cystic fibrosis patient with recurrent rhinosinusitis includes ……?

[c*] Show me the answer

[f] Intranasal glucocorticoids and, in some cases, surgical resection.

[q] What is the most likely diagnosis?

Patient presenting with dyspnea that worsen with exertion + sometimes he experiences syncope and chest pain + no history of cardiac and lung diseases + physical examination shows wide splitting of the second heart sound + chest X-ray shows widening of the proximal part of the pulmonary artery + Echocardiography shows systolic pulmonary hypertension 29 mmHg

?[c*] Show me the answer

[f] Idiopathic Pulmonary Hypertension.

[q] Drugs available for treatment of pulmonary hypertension are:

[c*] Show me the answer

[f]

Prostacyclin analogues (PA vasodilators): epoprostenol, treprostinil, iloprost, beraprost, or selexipag.

Endothelin antagonists: bosentan, ambrisentan.

Phosphodiesterase inhibitors: sildenafil, tadalafil.

cGMP stimulators: riociguat.

[q] What is the most likely diagnosis?

40 years old male come with his sleep partner complaining from loud snoring during sleep + he wakes up alot from sleep due to difficulty in breathing + excessive daytime sleeping + chronic headache + loss of concentration and impaired memory?

[c*] Show me the answer

[f] Obstructive Sleep Apnea.

[q] The gold standard diagnostic test for Obstructive sleep apnea is ….?

[c*] Show me the answer

[f] When OSA is suspected, nocturnal polysomnography is the gold standard for diagnosis.

Experiencing >15 obstructive respiratory events (apneas or hypopneas) per hour is diagnostic of OSA.

There are 2 types of abnormal ventilation during sleep:
Apnea (cessation of breathing for >10 seconds).
Hypopnea (reduced airflow causing SaO2 to decrease by > 4%).

[q] What is the most likely diagnosis?

Patient with history of acute pancreatitis 3 days ago presenting with severe respiratory distress with hypoxemia + chest x ray shows bilateral lung infiltrate + Swan Ganz catheter shows normal PCWP + PO2/FiO2 ratio 150?

[c*] Show me the answer

[f] Acute Respiratory Distress Syndrome.

[q] Why mechanical ventilation setting in patient with ARDS include low tidal volume ventilation (LTVV) (6 mL/kg of ideal body weight)?

[c*] Show me the answer

[f] To decreases the likelihood of over-distending alveoli and provoking barotrauma due to high plateau pressures (pressure applied to small airways and alveoli).

[q] Increasing positive end-expiratory pressure (PEEP) also improves oxygenation in ARDS patient by …..?

[c*] Show me the answer

[f] PEEP prevents alveolar collapse during respiratory cycles and may also reopen some alveoli that have already collapsed, reducing shunting. Therefore, increasing PEEP would not only improve oxygenation but also directly counteract one of the mechanisms by which ARDS causes hypoxemia.

[q] The most important complication of mechanical ventilation are ….?

[c*] Show me the answer

[f] Pneumothorax and acute circulatory failure and sudden cardiac death (SCD) in hypotensive or hypovolemic patients.

Delivery of positive pressure ventilation to such patients can rupture the fragile lung parenchyma, resulting in air leakage into the pleural space. Pneumothorax may result, which can cause absent breath sounds on the affected side and lead to compression of structures in the mediastinum and impaired right ventricular filling, resulting in hypotension and tachycardia.

Positive pressure mechanical ventilation causes an acute increase in intrathoracic pressure, which, in a severely hypovolemic patient with low central venous pressure, can collapse venous capacitance vessels (inferior vena cava) and cut off venous return. This sudden loss of right ventricular preload can cause acute circulatory failure and sudden cardiac death (SCD).

[q] What is the most likely diagnosis?

Patient presenting with acute-onset dyspnea, pleuritic chest pain, Tachypnea and tachycardia + chest x-ray is normal + ABG shows hypoxia and respiratory alkalosis + ECG shows sinus tachycardia + history of DVT?

[c*] Show me the answer

[f] Pulmonary embolism (PE).

[q] What is the best next step if the patient is likely to have pulmonary embolism?

[c*] Show me the answer

[f] The spiral CT has become the standard of care in terms of diagnostic testing to confirm the presence of a PE.

[q] What is the best next step if the patient is unlikely to have pulmonary embolism?

[c*] Show me the answer

[f] D-dimer is the answer when the pretest probability of PE is low and you need a simple, noninvasive test to exclude thromboembolic disease.

[q] What is the best next step in treatment of the patient who is likely to have pulmonary embolism?

[c*] Show me the answer

[f] Give oxygen and start LMWH immediately before the diagnosis is confirmed and while the diagnostic workup is being completed. Once the diagnosis is confirmed –> Warfarin: should be started with heparin and continued for 6 months for both pulmonary emboli and DVT.

[q] Antidote of heparin in case of toxicity is …..?

[c*] Show me the answer

[f] Protamine sulfate –> chemical inactivation.

[q] What is the best next step in management?

Patient presenting with thrombocytopenia 5 days after using heparin as anticoagulant for DVT?

[c*] Show me the answer

[f] Stop any type of heparin and give direct thrombin inhibitor (Argatroban).

Heparin-induced thrombocytopenia (HIT): development of IgG antibodies against heparin-bound platelet factor 4 (PF4). Antibody-heparin-PF4 complex activates platelets –> thrombosis and thrombocytopenia.

[q] What is the most likely diagnosis?

Patient presenting with diffuse skin necrosis after using warfarin as anticoagulant for DVT?

[c*] Show me the answer

[f] Warfarin skin necrosis is a rare procoagulant effect that occurs in patients who have preexisting protein C deficiency and receive warfarin. Protein C is also a vitamin-dependent factor with a shorter half-life than factor VII. A “transient hypercoagulable state” occurs when warfarin is started in patients with subclinical protein C deficiency. This leads to diffuse thrombosis of the skin and other organs. By starting patients on heparin and warfarin at the same time, you minimize the risk for this complication.

[q] In case of renal failure, which type of heparin you will use?

[c*] Show me the answer

[f] Unfractionated heparin is recommended in patients with decreased estimated glomerular filtration rate as it is more convenient to monitor its therapeutic level via activated partial thromboplastin time (aPTT). Once the heparin produces therapeutic anticoagulation (goal PTT >1.5-2 times normal), warfarin is initiated.

[q] When are thrombolytic is the right answer in case of pulmonary embolism?

[c*] Show me the answer

[f] Thrombolytics (tPA, streptokinase) are not used routinely in pulmonary embolism and should be reserved for:

1. Patients that become hemodynamically unstable (hypotension [systolic BP <90] and tachycardia).

2. Acute RV dysfunction.

[q] When is an inferior vena cava (IVC) filter the right answer in pulmonary embolism?

[c*] Show me the answer

[f]

Contraindication to the use of anticoagulants (melena, CNS bleeding).

Recurrent emboli while on a NOAC or fully therapeutic warfarin (INR of 2-3).

Right ventricular (RV) dysfunction with an enlarged RV on echo. In this case, disease is so severe that an IVC filter is placed because the next embolus, even if seemingly small, could be potentially fatal.

[q] When are direct-acting thrombin inhibitors (argatroban) the answer?

[c*] Show me the answer

[f] In heparin-induced thrombocytopenia (HIT).

[q] Causes of hypoxemia with normal A-a gradient are ……?

[c*] Show me the answer

[f] High altitude and hypoventilation are the two causes of hypoxemia that originate from a low alveolar PO2 and both of them have a normal A-a gradient.

[q] Pneumonia causes hypoxemia with high A-a gradient due to …..?

[c*] Show me the answer

[f] Pneumonia causes hypoxemia due to right-to-left intrapulmonary shunting and an extreme ventilation/perfusion mismatch. Increased concentration of inspired oxygen does not correct hypoxemia caused by intrapulmonary shunting.

[q] Pulmonary embolism causes hypoxemia with high A-a gradient due to …..?

[c*] Show me the answer

[f] A significant pulmonary embolism causes an acute pulmonary V/Q imbalance, which results in hypoxemia. The hypoxemia leads to hyperventilation and respiratory alkalosis. An elevated alveolar- arterial oxygen gradient is commonly seen in patients with PE.

[q] What is the most likely diagnosis?

Patient with chronic cough (lasting >8 weeks) tell you that he experiences elimination of nasal discharge and cough with the use of H1 histamine receptor antagonists?

[c*] Show me the answer

[f] Upper airway cough syndrome.

[q] What is the most likely diagnosis?

Patient with chronic cough (lasting >8 weeks) that relieve with the use of PPI?

[c*] Show me the answer

[f] GERD.

[q] The initial criteria for extubation readiness include?

[c*] Show me the answer

[f]

pH >7.25.

Adequate oxygenation on minimal support (fraction of inspired oxygen [FiO2 <40% and positive end- expiratory pressure [PEEP] <5 mm Hg).

Intact inspiratory effort and sufficient mental alertness to protect the airway.

[q] Because there is short-term risk of recurrent respiratory failure requiring reintubation, most patients who meet the above criteria should undergo ….?

[c*] Show me the answer

[f] Spontaneous breathing trial (SBT) to help confirm readiness for extubation.

[q] What is the most likely diagnosis?

Patient presenting with cough lasting >5 days after upper respiratory viral infection with mild dyspnea and chest wall discomfort + normal chest x-ray?

[c*] Show me the answer

[f] Acute Bronchitis. The illness is self-limiting (although cough and airway hypersensitivity may persist for weeks), and only symptomatic treatment (nonprescription pain relievers) is indicated.

[q] What is the most likely diagnosis?

Patient presenting with fever, cough, chest pain, and foul-smelling sputum + Chest x-ray show a thick-walled cavitary lesion with air fluid level?

[c*] Show me the answer

[f] Lung Abscess. In the absence of specific microbiologic diagnosis, clindamycin is good empiric coverage for the “above the diaphragm” anaerobes most often found.

[q] What is the most likely diagnosis?

Patient presenting with fever, productive cough with rusty sputum production, dyspnea, pleuritic chest pain + chest x-ray shows lobar pneumonia with parapneumonic pleural effusion?

[c*] Show me the answer

[f] Lobar pneumonia.

[q] What is the most likely diagnosis?

Patient presenting with high-grade fever (>39), gastrointestinal symptoms (diarrhea), and neurologic symptoms (confusion) + Hyponatremia + chest x-ray shows bilateral interstitial infiltrate + sputum Gram stain showing many neutrophils but no organisms?

[c*] Show me the answer

[f] Legionella pneumonia. Urine antigen testing is rapidly available, highly specific, and the most common method to confirm the diagnosis.

[q] What is the most likely diagnosis?

Patient presenting with low grade fever, nonproductive cough, mild dyspnea, chest x-ray shows bilateral interstitial infiltrate?

[c*] Show me the answer

[f] Atypical pneumonia.

[q] – The most common cause of community-acquired pneumonia in all groups is ……., while Hospital- acquired or ventilator-associated pneumonia shows a predominance of …….?

[c*] Show me the answer

[f] The most common cause of community-acquired pneumonia in all groups is S. pneumoniae (however, viruses are the most common cause in children age <5).

Those patients who develop pneumonia after 5-7 days in the hospital are at increased risk of infection from drug-resistant, Gram-negative bacilli (Pseudomonas, Klebsiella, E. coli, etc.) or gram-positive cocci such as methicillin-resistant Staphylococcus aureus (MRSA).

[q] Patients with CAP are often risk stratified using …… to help guide treatment and treatment location (home, medical floor, intensive care unit) decisions?

[c*] Show me the answer

[f] The pneumonia severity index or CURB-65 criteria.

[q] Empiric therapy of hospital-acquired pneumonia is with ……?

[c*] Show me the answer

[f] Third generation cephalosporins with antipseudomonal activity (such as ceftazidime) or carbapenems (such as imipenem) or with beta-lactam/beta-lactamase inhibitor combinations (such as piperacillin/tazobactam) and coverage for MRSA with vancomycin or linezolid.

[q] Positional changes that make the consolidation more gravity dependent ……… ventilation/perfusion mismatch?

[c*] Show me the answer

[f] Positional changes that make the consolidation more gravity dependent worsen ventilation/perfusion mismatch, increase intrapulmonary shunting, and lead to worsened hypoxemia.

When this patient is lying on his left side, gravity induces an increase in blood flow to the left lung, where there is markedly reduced V due to alveolar consolidation. The result is a more profound V/Q mismatch (V remains approximately zero, but Q increases), increased right-to-left intrapulmonary shunting, and worsening hypoxemia. The opposite occurs when this patient is lying on his right side (decrease in Q to the area of alveolar consolidation), leading to a more favorable V/Q mismatch and improvement in hypoxemia.

[q] In case of aspiration pneumonia, the most dependent area of the lung to be involved in the supine position is …….., and in erect position is …..?

[c*] Show me the answer

[f] In the supine position the posterior segments of the upper lobes and superior segments of the lower lobes are most affected, whereas in erect patients the bases of the lower lobes are most affected. Aspiration of the abscess fluid is necessary for a specific bacteriologic diagnosis.

[q] What is the most likely diagnosis?

45 years old immigrant presenting with fever, cough, productive sputum, weight loss and night sweats + chest x-ray shows apical cavitation and calcified nodules + Sputum examination is positive for  acid-fast bacilli (AFB) + patient started tumor necrosis alpha inhibitor and corticosteroid for rheumatoid arthritis 2 months ago?

[c*] Show me the answer

[f] Pulmonary Tuberculosis.

[q] Initial therapy of TB before the results of sensitivity testing are known consists of ……?

[c*] Show me the answer

[f] 4-drug therapy with isoniazid (INH), rifampin (Rif), pyrazinamide (PZA), and ethambutol (ETB). All 4 drugs are continued for the first 2 months or until sensitivity testing is known. PZA and ETB are then discontinued, and therapy continues with INH and rifampin for another 4 months. This makes routine therapy last for a total of 6 months. The fourth drug, ETB, is given if the sensitivity is not known.

[q] The only forms of TB that definitely must be treated for longer than 6 months are ……?

[c*] Show me the answer

[f] TB meningitis (12 months) and TB in pregnancy (9 months).

[q]  ……. should generally be combined with vitamin B6 (pyridoxine) to prevent peripheral neuropathy?

[c*] Show me the answer

[f] INH-induced peripheral neuropathy is caused by pyridoxine (vitamin B6) deficiency. INH binds the active form of pyridoxine, resulting in renal excretion. Most patients have large enough stores of pyridoxine to tolerate increased excretion; however, those with malnourishment, pregnancy, or certain comorbid illnesses (diabetes mellitus) may develop a deficiency.

[q] …… is associated with causing a benign change in the color of all bodily fluids to orange/red (Rifampin → Red/orange body fluids)?

[c*] Show me the answer

[f] Rifampin.

[q] ….. is associated with optic neuritis, which can cause color blindness and other visual disturbances?

[c*] Show me the answer

[f] Ethambutol “Eyethambutol”.

[q] The first step in evaluation of solitary pulmonary nodules is to …..?

[c*] Show me the answer

[f] Obtain any previous radiographic lung images to compare the size with old x- rays. Absence of growth over 2-3 years rules out malignancy.

[q] If previous films are not available, …. should be performed to further characterize the lesion?

[c*] Show me the answer

[f] CT. CT scan is more sensitive than chest x-ray to identify these features and also can detect other small nodules that may represent metastasis.

[q] Lesions with high malignancy risk require …… ; lesions with low risk can be monitored with …… Lesions with intermediate risk for malignancy should undergo ……?

[c*] Show me the answer

[f] surgical excision, serial CT scans, further imaging and biopsy depending on radiographic findings.

[q] Which type of lung cancer?

60 years old Patient with history of heavy smoking presenting with centrally located lung mass + cough, dyspnea, weight loss + Cushing syndrome + SIADH + muscles weakness?

[c*] Show me the answer

[f] Small cell lung cancer.

[q] Which type of lung cancer?

60 years old female without history of heavy smoking presenting with peripherally located cancer + cough, dyspnea, weight loss + digital clubbing + joint pain?

[c*] Show me the answer

[f] Adenocarcinoma of the lung.

[q] Which type of lung cancer?

60 years old Patient with history of heavy smoking presenting with centrally located lung mass + cough, dyspnea, weight loss + hypercalcemia?

[c*] Show me the answer

[f] Squamous cell carcinoma.

[q] Which type of lung cancer?

60 years old patient with history of heavy smoking presenting with peripherally located cancer + cough, dyspnea, weight loss + gynecomastia and galactorrhea?

[c*] Show me the answer

[f] Large cell carcinoma.

[q] What is the most likely diagnosis?

60 years old patient with history of heavy smoking presenting with cough, dyspnea, weight loss + radiating arm pain and paresthesias, weakness of the arm and hand + Hoarseness +  swelling of the head, neck and arms?

[c*] Show me the answer

[f] Superior pulmonary sulcus (SPS) tumor (Pancoast tumor).

[q] What is the best next step in management?

40 years old patient presenting with dyspnea, decreased breath sounds, decreased tactile fremitus, and dullness to percussion over the effusion + x-ray was done and showed accumulation of fluid in pleural space with obliteration of the costophrenic angel?

[c*] Show me the answer

[f] Diagnostic thoracentesis is the preliminary investigation of choice in the management of pleural effusion, except in patients with classic signs and symptoms of congestive heart failure, where a trial of a diuretic is warranted.

 

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