Integration and Review of Respiratory Medicine (2)

Question 1

Be able to make a chart comparing and contrasting the different types of pneumonia.

Answer 1

Question 2

All forms of pneumonia present with what?

Answer 2

fever and cough

Question 3

How would you treat a patient with pneumonia?

Answer 3

symptomatic treatment using appropriate antibiotics

Question 4

What is pneumonia?

Answer 4

an infection that inflames the air sacs ofW one or both lungs

Question 5

Is effusion LDH high are low when there is exudative pleural effusion? (Explain)

Answer 5

high

Effusion LDH / Serum LDH >0.6

Question 6

Is protein effusion high in exudative pleural effusion?

Answer 6

yes

effusion protein/serum protein > 0.5

> 3gm/dl of protein rich fluid

Question 7

What is a hallmark feature of lung abscess?

Answer 7

round 3D cavity with air-fluid levels

Question 8

Difference between P. jirovecii and P. carinii?

Answer 8

P. carinii infects rats whereas P. jirovecii infects humans

Question 9

Clinical Features of Pneumocystis pneumonia to remember.

Answer 9

opportunistic fungal pulmonary pathogen

patient with AIDS presenting with dyspnea on exertion, dry cough, and fever.

CD4 count is low (below 200/μl)

Question 10

Best diagnostic tool for pneumocystis pneumonia.

Answer 10

sputum stain

Question 11

Treatment for pneumocystis jirovecii.

Answer 11

Trimethoprim/sulfamethoxazole (TMP/SMX) is the best therapy both for treatment and for prophylaxis. Other drugs-dapsone, pentamidine

Question 12

What should make you suspicious that individual may have TB?

Answer 12

cough for more than 15 days

Question 13

How would you diagnose someone with TB?

Answer 13

sputum microscopy, culture, radiology, blood investigations

Question 14

How would you treat a patient with TB?

Answer 14

INH prophylaxis (TST positive, no disease-LTBI), ATT(REST OTHERS)

Question 15

PPD testing iw not useful for what population of patients?

Answer 15

those who are symptomatic or those with abnormal chest x-rays. These patients should have sputum acid fast testing done

Question 16

List type of patients who would be considered as having a positive PPD test if they have an induration larger than 5 mm.

Answer 16

HIV-positive patients
* Glucocorticoid users
* Close contacts of those with active TB
* Abnormal calcifications on chest x-ray
* Organ transplant recipients or other immunosuppressed pts.

Question 17

List the type of patients who would be considered as having a positive PPD test if their induration is larger than 10 mm.

Answer 17

Recent immigrants from high prevalence countries.
iv drug users,
Healthcare workers
Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
Close contacts of someone with TB
Hematologic malignancy, alcoholics, diabetes mellitus, ESRD,
Children ≤4 yrs age.
Children and adolescents exposed to adults in high-risk categories

Question 18

List the patients who would have a positive PPD test if induration ins larger than 15 mm.

Answer 18

those with no risk factors

Question 19

What are some safety concerns related to the treatment of TB by anti-TB meds?

Answer 19

hepatotoxicity

Question 20

What are the regimens recommended by WHO for the treatment of LTBI?

Answer 20

6-month or 9-month isoniazid daily,
3-month rifapentine plus isoniazid weekly,
3- or 4-month isoniazid plus rifampicin daily,
3– or 4-month rifampicin alone daily

Question 21

Be able to draw out flow diagram fro the algorithm for diagnosing Pulmonary thromboembolism.

Answer 21

Question 22

What is the principal imaging test for diagnosis of pulmonary thromboembolism?

Answer 22

CT angiogram

Question 23

What is becoming an important 2nd line diagnostic test for PE?

Answer 23

Lung scanning (V/Q) area that is ventilated with decreased perfusion (V/Q-infinity)

Question 24

Be able to create flow diagram on algorithm fro PE management.

Answer 24

Question 25

What is sleep apnea?

Answer 25

sleep breathing disorder characterized by repeated cessation of breathing during sleep

Question 26

What are the different types of sleep apnea?

Answer 26

obstructive sleep apnea (OSA)

central sleep apnea (CSA)

Question 27

What is OSA?

Answer 27

most common form characterized by the relaxation of throat muscles leading to a reduced/cessation of airflow despite a respiratory drive

Question 28

What is CSA

Answer 28

decreased central nervous system respiratory drive leading to decreased airflow and ventilatory effort during sleep

Question 29

What are the main clinical features of sleep apnea?

Answer 29

loud snoring
excessive daytime fatigue/sleepiness

Question 30

What is the gold standard test for sleep apnea?

Answer 30

laboratory Polysomnography

Question 31

What is a major lab finding in those with sleep apnea?

Answer 31

polycythemia