Pulmonary Disease Essentials 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 Essentials flashcards as text
A 45-year-old HIV-positive patient (CD4 count 80 cells/μL) presents with dry cough, fever, and diffuse bilateral ground-glass opacities. LDH is elevated. What is the most likely diagnosis?
Answer: Pneumocystis jirovecii pneumonia (PCP)
PCP is the most common AIDS-defining opportunistic lung infection, typically presenting with subacute dry cough, hypoxia, elevated LDH, and bilateral ground-glass opacities when CD4 < 200.
Which spirometry pattern is consistent with a diagnosis of restrictive lung disease?
Answer: FEV1/FVC ≥ 0.70 with reduced TLC
Restrictive lung disease is defined by reduced TLC (< 80% predicted) with a preserved or elevated FEV1/FVC ratio on spirometry.
A 60-year-old man presents with obstructive sleep apnea confirmed on polysomnography with AHI of 32 events/hour and lowest SpO2 of 81%. He declines CPAP. What is the next best alternative therapy?
Answer: Mandibular advancement device
Mandibular advancement devices are the preferred alternative to CPAP in moderate-to-severe OSA when CPAP is declined, repositioning the jaw to enlarge the upper airway.
A patient with ARDS is on mechanical ventilation. Current settings: TV 8 mL/kg IBW, PEEP 8 cmH2O, FiO2 0.70, plateau pressure 34 cmH2O. Which change should be made immediately?
Answer: Reduce tidal volume to 6 mL/kg IBW
The ARDSNet protocol mandates tidal volumes of 4-6 mL/kg IBW to limit ventilator-induced lung injury; plateau pressure > 30 cmH2O indicates overdistension requiring TV reduction.
Which finding on Light's criteria indicates an exudative pleural effusion?
Answer: Pleural fluid LDH/serum LDH ratio > 0.6
Light's criteria identify exudate if any one of three criteria is met: pleural/serum protein > 0.5, pleural/serum LDH > 0.6, or pleural LDH > 2/3 upper limit of normal serum LDH.
A 55-year-old male ex-smoker (40 pack-years, quit 3 years ago) presents for lung cancer screening. Which imaging modality is recommended by USPSTF guidelines?
Answer: Low-dose CT (LDCT) annually
USPSTF recommends annual LDCT screening for adults aged 50-80 with ≥ 20 pack-year history who currently smoke or quit within the past 15 years.
A patient with bronchiectasis has repeated Pseudomonas aeruginosa infections. Which maintenance therapy is most appropriate to reduce exacerbation frequency?
Answer: Inhaled tobramycin or aztreonam alternating monthly
Inhaled anti-pseudomonal antibiotics (tobramycin or aztreonam on alternating month schedules) suppress Pseudomonas colonization and reduce exacerbations in bronchiectasis.