Medstudy Pulmonary Flashcards
What is the treatment of active tuberculosis?
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.
What is the treatment of latent tuberculosis?
Isoniazid for 6 - 9 months.
What is the best diagnostic test to diagnose cystic fibrosis?
Sweat chloride test
The gene for cystic fibrosis is encoded on which chromosome?
7
What percentage of patients with cystic fibrosis have a negative sweat chloride test?
1 - 2%
How do you treat a massive pulmonary embolism in a hemodynamically unstable patient?
IV thrombolytics (along with oxygen and vasopressors if needed)
What effect does pregnancy have on asthma?
Some women experience worsening of symptoms; others experience improvement or no change.
Asthma can present for the first time during or after pregnancy.
What are some of the causes of a chylous pleural effusion (i.e. thoracic duct leak)?
- Trauma
- Lymphoma
- Mediastinal cancer/fibrosis
- Lymphangioleiomyomatosis
A pulmonary artery wedge pressure elevation indicates what about the volume status?
That the patient is volume over-loaded.
What’s the normal pulmonary artery wedge pressure?
4 - 12 mmHg
Is the systemic vascular resistance high or low in septic shock?
Very low
Is the cardiac output high or low in septic shock?
High
How does pregnancy affect thromboembolic risk?
Increases risk
Levels of which coagulation factors increase in pregnancy?
Factors 1, 2, 8, 9 and 10
What affect does supplemental oxygen have on respiratory acidosis?
It can worsen the acidosis by causing more hypercapnia by depressing the respiratory drive.
What pulmonary problem is methotrexate associated with?
Interstitial lung disease/pulmonary fibrosis
What is the mainstay for treatment of asthma of any severity? (2021 Global Initiative for Asthma i.e. GINA guidelines)
Inhaled corticosteroids
When are systemic steroids used for asthma?
- Acute exacerbation of asthma symptoms
- Peak expiratory flow of less than 50%
Should antibiotic decisions be based solely on tracheal aspirate?
No
What is the best test to diagnose interstitial lung disease?
High resolution CT chest
What is thromboembolic disease in (solid tumor) malignancy treated with?
Low molecular weight heparin (enoxaparin)
What phases/stages does pertussis have?
1) Catarrhal
2) Paroxysmal
3) Convalescent
What stage of pertussis resembles a simple upper respiratory tract infection?
Catarrhal
What stage of pertussis has the characteristic whooping cough?
Paroxysmal
How long is the catarrhal stage of pertussis?
5 - 12 days
During what stage of pertussis are patients most infectious?
Catarrhal
How long is the paroxysmal stage of pertussis?
1 - 2 weeks
What does adding ciprofloxacin to a patient’s medications do if the patient is already on theophylline?
Increases the level of theophylline and may cause related toxicity
What test differentiates sarcoidosis from berylliosis?
Beryllium lymphocyte proliferation test a.k.a. lymphocyte transformation test
What percentage of patients with right heart strain on echocardiogram from a pulmonary embolism will develop shock?
10%
What percentage of patients with right heart strain on echocardiogram from a pulmonary embolism will die in the hospital?
5 - 10%
Does aspergillosis have draining skin lesions?
No
What percentage of histoplasmosis patients have skin lesions?
5 - 10%
(Erythema nodosum or erythema multiforme)
Does histoplasmosis have draining skin lesions?
No
Does blastomycosis have draining skin lesions?
Yes
Why is enteral feeding started early when a patient is on a ventilator?
Because it reduces risk of pneumonia
Which eosinophilic granulomatosis is associated with lytic bone lesions, diabetes insipidus (DI) and exophthalmos?
Langerhans cell histiocytosis
What is the most effective intervention for slowing down the progression of COPD and improving survival?
Smoking cessation
Has any pharmacologic intervention for COPD been shown reduce mortality and improve survival?
No
What investigation would you do to diagnose tracheal stenosis?
Pulmonary function tests with flow volume loop
What is considered a positive PPD skin test in a patient who has been in close contact with someone who has active tuberculosis?
5 mm or more
What is considered a positive PPD skin test in a healthy person with no risk factors?
15 mm or more
What is considered a positive PPD skin test in a severely immunocompromised patient?
5 mm or more
What is considered a positive PPD skin test in a person with intermediate risk such as someone with diabetes or a prisoner?
10 mm or more
When do you use IV thrombolytics (tPA) in case of pulmonary embolism?
When the patient is hemodynamically unstable.
What is the treatment in a patient with a malignancy and a pulmonary embolism who is at risk of decompensation?
Unfractionated heparin
(allows option of rescue perfusion with tPA)
Does vancomycin cover Streptococcus pneumoniae?
Yes
What oxygen saturation levels are indications for continuous oxygen therapy in COPD?
- 88% or less in COPD
- 89% or less in COPD with cor pulmonale (pulmonary artery hypertension)
Which tuberculosis drug is associated with color vision problems?
Ethambutol
Which tuberculosis drug is changes the color of urine to orange-red?
Rifampin
Which is the highest yield test for tuberculosis?
Pleural biopsy
At what PaO2 does the patient qualify for continuous oxygen therapy?
< 55 mmHg
Can sarcoidosis patients have uveitis?
Yes
Which asthma treatment is effective even in the presence of chronic beta-blockade?
Ipratropium
Hypersensitivity pneumonitis puts patients at increased long-term risk of what?
Pulmonary fibrosis/interstitial lung disease
What is mild pneumonia in young adults treated with?
Azithromycin
What should you do if a pneumonia is complicated by a pleural effusion?
Thoracentesis
What intervention reduces mortality in ARDS?
Setting tidal volume to 6 ml/kg of predicted body weight
If the patient has obstructive lung disease, then what should the FEV1/FVC percentage be?
Less than 70%
Is interstitial lung disease associated with fever?
No
What should you think of if patient has flu-like illness that does not respond to antibiotics?
Cryptogenic organizing pneumonia
How do you treat cryptogenic organizing pneumonia?
Glucocorticoids for 6 - 12 months
Which COPD patients have higher mortality with lung volume reduction surgery?
FEV1 less than 20%
DLCO less than 20%
Homogeneous disease
What is the risk of pulmonary embolism in patients who don’t get prophylaxis after knee surgery?
70%
Which surgical procedures put people at highest risk of pulmonary embolism if prophylaxis is not given?
Knee surgery (~ 70%)
Hip surgery (Just under 70%)
Which interstitial lung disease has upper lobe predominance?
Silicosis
Is the %DLCO high, normal or low in emphysema?
Low
Is the %DLCO high, normal or low in chronic bronchitis?
Normal
If patient becomes hypotensive after you intubate them then what’s the diagnosis?
Pneumothorax
What is the fastest way to assess for a pneumothorax?
Bedside ultrasonography
If a hunter gets pneumonia - what should you consider?
Tularemia
If an HIV patient with pneumonia has LDH three times normal, then what is the organism?
Pneumocystis jiroveci (PJP)
What is the treatment for Pneumocystis jiroveci pneumonia (PJP)?
Trimethoprim/sulfamethoxazole.
Corticosteroids are added if pO2 is less than 70 mmHg or if A-a gradient is more than 35 mmHg.
Which drugs slows down decline in forced vital capacity in interstitial lung disease?
Pirfenidone
Nintedanib
What is the treatment of acute methemoglobinemia?
100% oxygen and methylene blue
Does ceftriaxone treat Pseudomonas aeroginosa?
No
Does pyrazinamide cause hyperuricemia?
Yes
What defines an empyema versus an exudative effusion?
Growth of bacteria means it’s an empyema
What is the WBC count in an empyema?
> 50,000 cells/mm3
Does amyotrophic lateral sclerosis cause extrinsic restrictive lung disease?
Yes
How high does the CD4 count need to be before patient will react to tuberculin skin test?
> 200
Should you ever do the 250 TU tuberculin skin test?
No
Are controls recommended for tuberculin skin test?
No
Can you breast-feed in case of acute rubella infection?
Yes
Can you breast-feed in case of active untreated tuberculosis infection?
No
Can you breast-feed in case of active treated tuberculosis infection?
Yes
Can you breast-feed in case of active HIV infection?
No
Does mild histoplasmosis require therapy?
No
Are histoplasmin skin tests useful?
No
Is smoking associated with a higher risk of spontaneous pneumothorax?
Yes
Does treatment asymptomatic GERD alter the clinical course of asthma?
No
Does treatment symptomatic GERD alter the clinical course of asthma?
Yes
Which is the safest steroid inhaler to use in pregnancy?
Budesonide
What percentage of patients with asthma during pregnancy do worse?
33% (1/3)
What percentage of patients with asthma during pregnancy do better?
33% (1/3)
What percentage of patients with asthma during pregnancy remain stable?
33% (1/3)
What happens to pleural LDH in the setting of chronic diuretic use?
It increases
Can pleural cholesterol levels differentiate between transudate and exudate?
Yes
What is the pleural cholesterol level in transudates?
Less than 45 mg/dL
What is the pleural cholesterol level in exudates?
More than 45 mg/dL
How is a patient with a positive tuberculosis skin test and no evidence of active tuberculosis treated?
Isoniazid prophylaxis and pyridoxine supplement
What is the only effective treatment for patients with COPD, hypoxia and pulmonary hypertension?
Oxygen therapy
Do patients with occupational asthma have pulmonary infiltrates?
No
At what PaO2 should continuous oxygen be prescribed in patients with cor pulmonale or erythrocytosis?
Less than or equal to 59 mmHg
At what O2 saturation should continuous oxygen be prescribed in patients with cor pulmonale or erythrocytosis?
Less than or equal to 89%
What condition is associated with pleural fluid with low glucose levels, and normal protein and WBC levels?
Rheumatoid arthritis pleural effusions
Should you use a thiazide diuretic in a patient with sarcoidosis?
No (can cause high calcium levels)
