Pulmonary Disease Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Pulmonary Disease flashcards as text
A patient develops acute respiratory distress syndrome (ARDS) after sepsis. Which ventilator strategy has been shown to reduce mortality?
Answer: Low tidal volume (6 mL/kg IBW) lung-protective ventilation
The ARDSNet trial demonstrated that low tidal volume ventilation (6 mL/kg IBW) with plateau pressure <30 cmH2O reduces mortality in ARDS.
A 38-year-old woman presents with recurrent DVTs and pulmonary emboli despite anticoagulation. Echocardiography shows right ventricular enlargement. CT pulmonary angiography reveals chronic thromboembolic disease. What is the definitive treatment?
Answer: Pulmonary endarterectomy (PEA)
Pulmonary endarterectomy is the definitive treatment for chronic thromboembolic pulmonary hypertension (CTEPH) in surgically accessible disease.
Which of the following best distinguishes cardiac pulmonary edema from ARDS on laboratory and physiologic testing?
Answer: PCWP >18 mmHg in cardiac edema but ≤18 mmHg in ARDS
The Berlin definition of ARDS requires PCWP ≤18 mmHg (or absence of heart failure) to exclude cardiogenic pulmonary edema.
A 55-year-old man with a central lung mass is found to have hyponatremia (Na 118 mEq/L) with low serum osmolality and high urine osmolality. Which paraneoplastic syndrome explains this?
Answer: Syndrome of inappropriate ADH (SIADH)
Small cell lung cancer most commonly causes SIADH, leading to euvolemic hyponatremia with inappropriately concentrated urine.
A patient with severe COPD has a resting PaO2 of 52 mmHg on room air. Which intervention has been shown to improve survival in this patient?
Answer: Long-term domiciliary oxygen therapy (LTOT) >15 hours/day
The NOTT and MRC trials demonstrated that long-term oxygen therapy (>15 h/day) reduces mortality in COPD patients with resting PaO2 ≤55 mmHg.
A 60-year-old woman presents with Raynaud's phenomenon, dysphagia, and progressive dyspnea. PFTs show a restrictive pattern with reduced DLCO. HRCT reveals basilar ground-glass and honeycombing. What is the most likely underlying systemic condition?
Answer: Systemic sclerosis (scleroderma)
Systemic sclerosis is strongly associated with interstitial lung disease (typically NSIP or UIP pattern) combined with Raynaud's phenomenon and dysphagia from esophageal dysmotility.
A traveler returning from the Ohio River Valley presents with fever, mediastinal lymphadenopathy, and yeast forms with intracellular inclusions on bronchoalveolar lavage. Which antifungal is first-line treatment for disseminated disease?
Answer: Liposomal amphotericin B
Disseminated histoplasmosis is treated with liposomal amphotericin B for severe disease, followed by step-down to itraconazole.