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ABIM IM Recert > Medstudy Pulmonary > Flashcards

Medstudy Pulmonary Flashcards

1
Q

What is the treatment of active tuberculosis?

A

4-drug therapy (isoniazid, rifampin, pyrazinamide, ethambutol) for 2 months and 2-drug therapy (isoniazid, rifampin) for the remaining 4 months.

Total therapy duration: 6 months.

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2
Q

What is the treatment of latent tuberculosis?

A

Isoniazid for 6 - 9 months.

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3
Q

What is the best diagnostic test to diagnose cystic fibrosis?

A

Sweat chloride test

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4
Q

The gene for cystic fibrosis is encoded on which chromosome?

A

7

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5
Q

What percentage of patients with cystic fibrosis have a negative sweat chloride test?

A

1 - 2%

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6
Q

How do you treat a massive pulmonary embolism in a hemodynamically unstable patient?

A

IV thrombolytics (along with oxygen and vasopressors if needed)

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7
Q

What effect does pregnancy have on asthma?

A

Some women experience worsening of symptoms; others experience improvement or no change.

Asthma can present for the first time during or after pregnancy.

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8
Q

What are some of the causes of a chylous pleural effusion (i.e. thoracic duct leak)?

A
  • Trauma
  • Lymphoma
  • Mediastinal cancer/fibrosis
  • Lymphangioleiomyomatosis
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9
Q

A pulmonary artery wedge pressure elevation indicates what about the volume status?

A

That the patient is volume over-loaded.

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10
Q

What’s the normal pulmonary artery wedge pressure?

A

4 - 12 mmHg

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11
Q

Is the systemic vascular resistance high or low in septic shock?

A

Very low

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12
Q

Is the cardiac output high or low in septic shock?

A

High

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13
Q

How does pregnancy affect thromboembolic risk?

A

Increases risk

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14
Q

Levels of which coagulation factors increase in pregnancy?

A

Factors 1, 2, 8, 9 and 10

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15
Q

What affect does supplemental oxygen have on respiratory acidosis?

A

It can worsen the acidosis by causing more hypercapnia by depressing the respiratory drive.

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16
Q

What pulmonary problem is methotrexate associated with?

A

Interstitial lung disease/pulmonary fibrosis

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17
Q

What is the mainstay for treatment of asthma of any severity? (2021 Global Initiative for Asthma i.e. GINA guidelines)

A

Inhaled corticosteroids

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18
Q

When are systemic steroids used for asthma?

A
  • Acute exacerbation of asthma symptoms
  • Peak expiratory flow of less than 50%
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19
Q

Should antibiotic decisions be based solely on tracheal aspirate?

A

No

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20
Q

What is the best test to diagnose interstitial lung disease?

A

High resolution CT chest

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21
Q

What is thromboembolic disease in (solid tumor) malignancy treated with?

A

Low molecular weight heparin (enoxaparin)

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22
Q

What phases/stages does pertussis have?

A

1) Catarrhal
2) Paroxysmal
3) Convalescent

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23
Q

What stage of pertussis resembles a simple upper respiratory tract infection?

A

Catarrhal

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24
Q

What stage of pertussis has the characteristic whooping cough?

A

Paroxysmal

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25
Q

How long is the catarrhal stage of pertussis?

A

5 - 12 days

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26
Q

During what stage of pertussis are patients most infectious?

A

Catarrhal

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27
Q

How long is the paroxysmal stage of pertussis?

A

1 - 2 weeks

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28
Q

What does adding ciprofloxacin to a patient’s medications do if the patient is already on theophylline?

A

Increases the level of theophylline and may cause related toxicity

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29
Q

What test differentiates sarcoidosis from berylliosis?

A

Beryllium lymphocyte proliferation test a.k.a. lymphocyte transformation test

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30
Q

What percentage of patients with right heart strain on echocardiogram from a pulmonary embolism will develop shock?

A

10%

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31
Q

What percentage of patients with right heart strain on echocardiogram from a pulmonary embolism will die in the hospital?

A

5 - 10%

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32
Q

Does aspergillosis have draining skin lesions?

A

No

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33
Q

What percentage of histoplasmosis patients have skin lesions?

A

5 - 10%
(Erythema nodosum or erythema multiforme)

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34
Q

Does histoplasmosis have draining skin lesions?

A

No

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35
Q

Does blastomycosis have draining skin lesions?

A

Yes

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36
Q

Why is enteral feeding started early when a patient is on a ventilator?

A

Because it reduces risk of pneumonia

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37
Q

Which eosinophilic granulomatosis is associated with lytic bone lesions, diabetes insipidus (DI) and exophthalmos?

A

Langerhans cell histiocytosis

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38
Q

What is the most effective intervention for slowing down the progression of COPD and improving survival?

A

Smoking cessation

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39
Q

Has any pharmacologic intervention for COPD been shown reduce mortality and improve survival?

A

No

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40
Q

What investigation would you do to diagnose tracheal stenosis?

A

Pulmonary function tests with flow volume loop

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41
Q

What is considered a positive PPD skin test in a patient who has been in close contact with someone who has active tuberculosis?

A

5 mm or more

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42
Q

What is considered a positive PPD skin test in a healthy person with no risk factors?

A

15 mm or more

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43
Q

What is considered a positive PPD skin test in a severely immunocompromised patient?

A

5 mm or more

44
Q

What is considered a positive PPD skin test in a person with intermediate risk such as someone with diabetes or a prisoner?

A

10 mm or more

45
Q

When do you use IV thrombolytics (tPA) in case of pulmonary embolism?

A

When the patient is hemodynamically unstable.

46
Q

What is the treatment in a patient with a malignancy and a pulmonary embolism who is at risk of decompensation?

A

Unfractionated heparin
(allows option of rescue perfusion with tPA)

47
Q

Does vancomycin cover Streptococcus pneumoniae?

A

Yes

48
Q

What oxygen saturation levels are indications for continuous oxygen therapy in COPD?

A
  • 88% or less in COPD
  • 89% or less in COPD with cor pulmonale (pulmonary artery hypertension)
49
Q

Which tuberculosis drug is associated with color vision problems?

A

Ethambutol

50
Q

Which tuberculosis drug is changes the color of urine to orange-red?

A

Rifampin

51
Q

Which is the highest yield test for tuberculosis?

A

Pleural biopsy

52
Q

At what PaO2 does the patient qualify for continuous oxygen therapy?

A

< 55 mmHg

53
Q

Can sarcoidosis patients have uveitis?

A

Yes

54
Q

Which asthma treatment is effective even in the presence of chronic beta-blockade?

A

Ipratropium

55
Q

Hypersensitivity pneumonitis puts patients at increased long-term risk of what?

A

Pulmonary fibrosis/interstitial lung disease

56
Q

What is mild pneumonia in young adults treated with?

A

Azithromycin

57
Q

What should you do if a pneumonia is complicated by a pleural effusion?

A

Thoracentesis

58
Q

What intervention reduces mortality in ARDS?

A

Setting tidal volume to 6 ml/kg of predicted body weight

59
Q

If the patient has obstructive lung disease, then what should the FEV1/FVC percentage be?

A

Less than 70%

60
Q

Is interstitial lung disease associated with fever?

A

No

61
Q

What should you think of if patient has flu-like illness that does not respond to antibiotics?

A

Cryptogenic organizing pneumonia

62
Q

How do you treat cryptogenic organizing pneumonia?

A

Glucocorticoids for 6 - 12 months

63
Q

Which COPD patients have higher mortality with lung volume reduction surgery?

A

FEV1 less than 20%
DLCO less than 20%
Homogeneous disease

64
Q

What is the risk of pulmonary embolism in patients who don’t get prophylaxis after knee surgery?

A

70%

65
Q

Which surgical procedures put people at highest risk of pulmonary embolism if prophylaxis is not given?

A

Knee surgery (~ 70%)
Hip surgery (Just under 70%)

66
Q

Which interstitial lung disease has upper lobe predominance?

A

Silicosis

67
Q

Is the %DLCO high, normal or low in emphysema?

A

Low

68
Q

Is the %DLCO high, normal or low in chronic bronchitis?

A

Normal

69
Q

If patient becomes hypotensive after you intubate them then what’s the diagnosis?

A

Pneumothorax

70
Q

What is the fastest way to assess for a pneumothorax?

A

Bedside ultrasonography

71
Q

If a hunter gets pneumonia - what should you consider?

A

Tularemia

72
Q

If an HIV patient with pneumonia has LDH three times normal, then what is the organism?

A

Pneumocystis jiroveci (PJP)

73
Q

What is the treatment for Pneumocystis jiroveci pneumonia (PJP)?

A

Trimethoprim/sulfamethoxazole.

Corticosteroids are added if pO2 is less than 70 mmHg or if A-a gradient is more than 35 mmHg.

74
Q

Which drugs slows down decline in forced vital capacity in interstitial lung disease?

A

Pirfenidone
Nintedanib

75
Q

What is the treatment of acute methemoglobinemia?

A

100% oxygen and methylene blue

76
Q

Does ceftriaxone treat Pseudomonas aeroginosa?

A

No

77
Q

Does pyrazinamide cause hyperuricemia?

A

Yes

78
Q

What defines an empyema versus an exudative effusion?

A

Growth of bacteria means it’s an empyema

79
Q

What is the WBC count in an empyema?

A

> 50,000 cells/mm3

80
Q

Does amyotrophic lateral sclerosis cause extrinsic restrictive lung disease?

A

Yes

81
Q

How high does the CD4 count need to be before patient will react to tuberculin skin test?

A

> 200

82
Q

Should you ever do the 250 TU tuberculin skin test?

A

No

83
Q

Are controls recommended for tuberculin skin test?

A

No

84
Q

Can you breast-feed in case of acute rubella infection?

A

Yes

85
Q

Can you breast-feed in case of active untreated tuberculosis infection?

A

No

86
Q

Can you breast-feed in case of active treated tuberculosis infection?

A

Yes

87
Q

Can you breast-feed in case of active HIV infection?

A

No

88
Q

Does mild histoplasmosis require therapy?

A

No

89
Q

Are histoplasmin skin tests useful?

A

No

90
Q

Is smoking associated with a higher risk of spontaneous pneumothorax?

A

Yes

91
Q

Does treatment asymptomatic GERD alter the clinical course of asthma?

A

No

92
Q

Does treatment symptomatic GERD alter the clinical course of asthma?

A

Yes

93
Q

Which is the safest steroid inhaler to use in pregnancy?

A

Budesonide

94
Q

What percentage of patients with asthma during pregnancy do worse?

A

33% (1/3)

95
Q

What percentage of patients with asthma during pregnancy do better?

A

33% (1/3)

96
Q

What percentage of patients with asthma during pregnancy remain stable?

A

33% (1/3)

97
Q

What happens to pleural LDH in the setting of chronic diuretic use?

A

It increases

98
Q

Can pleural cholesterol levels differentiate between transudate and exudate?

A

Yes

99
Q

What is the pleural cholesterol level in transudates?

A

Less than 45 mg/dL

100
Q

What is the pleural cholesterol level in exudates?

A

More than 45 mg/dL

101
Q

How is a patient with a positive tuberculosis skin test and no evidence of active tuberculosis treated?

A

Isoniazid prophylaxis and pyridoxine supplement

102
Q

What is the only effective treatment for patients with COPD, hypoxia and pulmonary hypertension?

A

Oxygen therapy

103
Q

Do patients with occupational asthma have pulmonary infiltrates?

A

No

104
Q

At what PaO2 should continuous oxygen be prescribed in patients with cor pulmonale or erythrocytosis?

A

Less than or equal to 59 mmHg

105
Q

At what O2 saturation should continuous oxygen be prescribed in patients with cor pulmonale or erythrocytosis?

A

Less than or equal to 89%

106
Q

What condition is associated with pleural fluid with low glucose levels, and normal protein and WBC levels?

A

Rheumatoid arthritis pleural effusions

107
Q

Should you use a thiazide diuretic in a patient with sarcoidosis?

A

No (can cause high calcium levels)

ABIM IM Recert (42 decks)

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