ID/Pulm

Question 1

Silicosis risks

Answer 1

sa blasting, stone cutting, quarry exposure, mining

Question 2

beryllium risk

Answer 2

high tech electronics manufacturing

Question 3

farmer lung

Answer 3

hypersensitivity pneumonitis from exposures to organic agricultural dusters, fungal spores, vegetable products, insect fragments, animal feces, etc

Question 4

Higher risk oof 30 day mortality for PNA

Answer 4

Confusion
Uremia
RR > 30
Bun >20
Age > 65
Hypotension
Male
CHF or COPD

Question 5

dx mumps

Answer 5

myalgia, fatigue, loss of appetite, fever, PAROTITIS, orchitis

orchitis complications –> infertility, meningitis, encephalitis

Question 6

Measles dx

Answer 6

cough, coryza, conjunctivitis, Koplik spots

Question 7

Abx choice in critically ill PNA

Answer 7

-lactam (CTX, cefotaxime) or Unsayn + macrolide
- macrolide alone
- macrolide + resp flouroquinolone

**steroids can improve LOS, duration abx, risk of ARDS

Question 8

Tx of post-strep-glomerulonephritis

Answer 8

SUPPORTIVE
- HTN/edema> thiazide or loop diuretic

Treating strep or impetigo correctly does NOT prevent subsequent APSGN

Question 9

indications for skin testing for PCN allergy

Answer 9

hx of hives or pruritic rash –> if negative, do amoxicillin challenge under observation

Question 10

Malignant characteristics of pulm nodules

Answer 10

ground glass
>6mm
non-calcified
doubling in 1 mo
irregular or spiculated borders

Question 11

Tx based on COPD GOLD stage

Answer 11

A- sama or saba
B- laba or lama
C- ICS

Question 12

biomarkers for sarcoidosis?

Answer 12

none exist, but ACE might be elevated in 75% oof untreated patients

Question 13

When to bx in sarcoidosis

Answer 13

only accessible/safe bx site if very symptomatic and tx is indicated

Question 14

tx of sarcoidosis

Answer 14

1st line= steroids
2nd line- methotrexate, azathioprine, leflunomide, biologics

Question 15

dx of sarcoidosis

Answer 15

1) compatible clinical and radiologic presentation (hilar adenopathy)
2) path w/ noncaseating granulomoas
3) exclusion with other diseases

Question 16

dx COPD

Answer 16

FEV1/FVC <70 irreversible with bronchodilators

Question 17

tx for acute rheumatic fever

Answer 17

NSAIDs

Question 18

abx coverage for acute chest syndrome in sickle cell

Answer 18

cover for mycoplasma and chlamydophila w/ azithromycin and 3rd gen cephalosporin

Question 19

indication for thrombolysis over anticoagulation in PE

Answer 19

hypotension

Question 20

meningitis ppx

Answer 20

Cipro, azithro, CTX x1 day

or Rifampin x2 days

Question 21

lights criteria

Answer 21

prot >0.5, LDH >0.6= EXudate=EXtra= high numbers

malignancy, PNA, viral illness, asbestos

Question 22

cat scratch disease dx/tx

Answer 22

bartonella –> regionoal LAD
self limiting! do NOT I&D

Question 23

lymes management

Answer 23

Stage 1= EM –> TREAT w/ doxy, no need to test
Late lyme (neurologic, 7th nerve palsy, cardiac A-V block, etc) –> test with ELISA, confirm with Western blot

Question 24

Jarisch herxeimer reaction

Answer 24

Febrile prodrome from spirochete lysis at time of treatment

-RPR, lyme
- Tx= supportive, continue antibiotic

Question 25

anti-HTNsive med that can have benefit in OSA

Answer 25

Spiro (diuretic + resistant HTN effect)

Question 26

Tx of UTI in elderly

Answer 26

1= bactrim 2= nitrofurantoin if GFR> 40 Cipro only if high comomunity resistance to above

Question 27

Antibitiotic for sinusitis

Answer 27

Augmentin. Previously Azithromycin but nw resistant. Levo if allergic to PCN or chronic sinusitis

Question 28

FIRST imaging for osteo

Answer 28

Xray, then MRI. Can do CT if MRI contraindicated