Pulm Jeopardy

COPD

100

FEV1/FVC ratio seen in obstructive lung disease

FEV1/FVC ratio <70%

200

Dose/name of steroid and length of need for steroid regimen per GOLD guidelines for management of COPD exacerbation

Prednisone 40 mg daily for 5 days for non-critically ill hospitalized patients 

300

Two medications used for maintenance therapy for Group B COPD

LABA + LAMA

400

Name the two categories used to classify COPD based on current GOLD framework

GOLD 1-4 - spirometry measurement/grade of airflow obstruction (post-bronchodilator FEV₁ % predicted)

ABE assessment - based on symptom burden and exacerbation history

500

Name of two biologics used to manage COPD AND eosinophil count needed to consider use of biologics

Dupilumab (Dupixent) - Anti-IL-4 and IL-13 

Mepolizumab (Nucala) - Anti-IL-5

Eosinophil count >300 

+ 2 moderate or 1 severe exacerbation  

Pneumonia and Flow Volume Curves

100

Lung disease associated with "witch's hat" on flow volume loop

Restrictive lung disease

Appearance of flow loop is due to increased recoil with lower TLC

200

Shortest duration of antibiotic therapy that can be considered for patients with pneumonia per 2026 ATS guidelines

3 days

300

Name 3 differentials for cavitary lung lesions

- Abscess/aspiration PNA

- MRSA

- Nocardia v. Fungal - aspergillosis

- Malignancy

- TB

400

Antibiotic regimen for treatment of severe PNA w/o MRSA or Pseudomonas risk factors

B-lactam AND 

Macrolide OR fluoroquinolone

500

One diagnosis associated with flow volume curve C

Tracheal stenosis

Obstructive substernal goiters

Pulm HTN

100

First diagnostic step when working up someone with suspected pulmonary HTN

Echo

200

Main diagnostic test used to evaluate a patient for CTEPH

VQ scan

300

Pulm HTN group (1-5) that HIV related pHTN falls under

Group 1: Idiopathic, familial, collagen disorders (SLE, RA), HIV, portal HTN

5: chronic hemolytic anemia (sickle cell), myeloproliferative d/o, Sarcoid, Lymphangiomatosis, fibrosing mediastinitis, Langerhan's histiocytosis 

400

Most common, abnormal PFT finding seen in patients with pulmonary HTN

Low DLCO 

Otherwise PFTs tend to be relatively normal 

500

Two main pillars for treatment of group 4 pHTN

Surgical thromboendarterectomy evaluation

Lifelong AC

Pleural Effusions

100

Name 2 criteria (with numerical values) in Light's criteria

• Pleural fluid protein to serum protein ratio >0.5
• Pleural fluid lactate dehydrogenase (LDH) to serum LDH ratio >0.6
• Pleural fluid LDH level >2/3 upper limit of normal for serum LDH

Just need to meet 1 criteria to classify an effusion as an exudate

200

DAILY DOUBLE

Difference between a complicated effusion v. empyema based on pleural fluid studies

300

Diagnosis for patient with exudative pleural effusion with low pH, very low glucose (<30), high LDH level (>1000) and low cell count 

Rheumatoid pleurisy

Same findings with HIGH cell count would indicate an empyema

400

Name 2 of the 3 CT findings where an effusion >10 mm needs to be surgically drained

- Loculations

- Pleural thickening

- Large (>½ hemithorax) effusions

All effusions >10 mm need to be evaluated further with chest imaging (ultrasonography or chest CT).  

Diagnostic thoracentesis is recommended for effusions >10 mm with no high-risk features on imaging

 

500

Name of one (of two) equations used to reclassify incorrectly identified exudates per Light's criteria as true transudates (which is often seen with diuretic use)

Serum-effusion protein difference or Serum-effusion albumin gradient 

Specificity for Light's criteria drops below 80% when diuretics are used

Serum-effusion protein difference >3.1 g/dL or serum-effusion albumin gradient >1.2 g/dL suggests a true transudative effusion

Grab Bag

100

How to classify severity of ARDS AND Tidal volume goal used in management of ARDS

P:F ratio - Severe <100, Mild 200-300

~6-8 mL/kg predicted body weight

200

Name 2 of the 3 FDA approved products for smoking cessation

Nicotine replacement therapy

Varenicline (Chantix)

Bupropion

300

Initial diagnostic test if concerns for allergic bronchopulmonary aspergillosis (ABPA)

Aspergillus skin testing

ABPA is a hypersensitivity to Aspergillus fumigatus which occurs more commonly in asthmatics and cystic fibrosis patients -> recurrent asthma exacerbations, expectoration of dark brown mucus plugs, hemoptysis -> bronchiectasis

Immediate cutaneous hypersensitivity is a characteristic finding in ABPA and indicates likely serum A fumigatus-specific IgE antibodies

Typically also seen eosinophilia, elevated IgE levels and positive IgE and IgG for Aspergillus

400

Name 1 cause of group 4 pHTN other than CTEPH

Pulmonary artery obstruction 

- Tumors (sarcoma, RCC, uterine carcinoma or leiomyoma)

- Arteritis w/o connective tissue disease

- Parasites - hydatidosis

500

Name of triad associated with chronic rhinosinusitis with polyposis, asthma, and aspirin/NSAID sensitivity

Samter's triad

Seen in aspirin-exacerbated respiratory disease (AERD) where NSAIDs can induce life-threatening asthma, nasal and/or ocular symptoms, and facial flushing or erythema

Rx: Montelukast since syndrome is due to excessive leukotriene production