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USMLE Step 3 Exam Prep Questions And Answers ()
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USMLE World Respiratory Exam Prep Questions And Answers (202472025)What are characteristics of lung consolidation? - ✔✔bronchial breath sounds,
dullness to percussion, increased fremitus, bronchoscopy, egophony, and whispered
pectoriloquy on physical exam. Bronchial breath sounds have a full expiratory
phase.
What are characteristics of pleural effusion? - ✔✔fluid blocks sound transmission
from the air-filled lungs, causing dullness to percussion, decreased breath sounds,
decreased tactile fremitus, and transmitted voice sounds
What is pulmonary contusion? - ✔✔not uncommon after high-speed car accidents
sx develop in first 24hrs
patchy alveolar infiltrate on CXR is typical
What are signs of hypovolemic shock? - ✔✔flat neck veins, significant bruising and
abdominal distention on physical exam
severe hemorrhage causes decreased venous return and therefore decreased end
diastolic volume and cardiac output. It also causes increased sympathetic activity to
constrict the venous capacitance vessels, compensating for the hypovolemia by
improving venous return
How does PEEP affect patients in hypovolemic shock? - ✔✔PEEP increases
intrathoracic pressure, which decreases venous return to the heart and thereby
decreases the ventricular preload. In pts with hypovolemic shock, this effect may
cause circulatory collapse if the patient's intravascular volume is not replaced before
mechanical ventilation is attempted
How should pts with massive hemoptysis be managed? - ✔✔achieve hemodynamic
stability
- intubate to protect airway
- receive emergent bronchoscopy to both visualize and stabilize the bleeding
,What is bronchiectasis and how is it diagnosed? - ✔✔cough, mucopurulent sputum,
and hemoptysis that often responds to antibiotics
Dx: CXR: frequently abnormal but not sufficient for diagnosis
High-Res CT: definitive test for diagnosis
What are the factors that determine RQ (Respiratory Quotient)? - ✔✔proportions of
metabolic fuels being oxidized for ATP production.
- close to 1.0 indicates predominant oxidation of carbohydrates and net lipogenesis
- RQ for protein and lipid as sole sources of energy are 0.8 and 0.7, respectively
How is lung compliance calculated? - ✔✔perform the end-inspiratory hold
maneuver
How is airway resistance calculated? - ✔✔examining the peak airway pressures
How is PEEP calculated? - ✔✔end expiratory hold maneuver
**What is aspirin sensitivity syndrome and what is the mechanism? - ✔✔**pseudo-
allergic reaction
results from aspirin-induced prostaglandin/leukotriene misbalance in susceptible
individuals
Tx: avoid NSAIDs and use of leukotriene receptor antagonists (drug of choice)
What is suggestive of humoral immunity defect? - ✔✔recurrent bacterial infections
, Dx: quantitative measurement of serum immunoglobulin levels help to establish the
diagnosis
What is COPD and asthma differentiated? - ✔✔bronchodilator response test used to
demonstrate reversibility of airway obstruction
- asthma demonstrates airway reactivity
What is Light's criteria and what is it used for? - ✔✔transudate vs. exudate
- pleural fluid protein/serum protein ratio >0.5
- pleural fluid LDH/serum LDH ratio >0.6
- pleural fluid LDH greater than 2/3 of the upper limit of normal for serum LDH
What are causes of exudative effusion? - ✔✔infection (pneumonia and TB)
malignancy
PE
connective tissue disease
iatrogenic causes
What are causes of transudative effusion? - ✔✔CHF
increased intravascular hydrostatic pressure
hypoalbuminemia
When should legionella pneumophila be suspected? - ✔✔cough
fever >39 degrees
GI sx
confusion
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