Pulm 1

Question 1

A-a gradient is normally what? When is it higher?

Answer 1

Normally 5-15

Increased in PE, pulmonary edema, R-L shunt

Oxygen not getting into arteries

Question 2

Pharyngitis criteria?

Answer 2

CENTOR criteria

Cough absence
Exudate
node
temp
OR age (15)

0-1 no antibiotic
2-3 throat culture
4-5 means treat

Question 3

Sinusitis caused by what? What is mucor?

Answer 3

Strep pneumo H influ, moraxella

Mucor is fungal diabetes

Same as ear infection, so give Amox or doxy or levo

Question 4

Murmurs and squatting?

Answer 4

What is the physiology to it?

Question 5

Bronchotis most common cause?

tx?

Answer 5

Virus MOST COMMON

Mycoplasma or strep pneuma if smoker

Tx antibiotics if chronic other lung disease. (otherwise supprotive is first line)

Fluoroquinolones or macrolides

Question 6

Atypical pneumonia CXR and types?

Answer 6

Mycoplasma, LEGIONELLA, chlamydophila.

XR shows diffuse and patchy

Question 7

Most common cause of pneumo in youngster?

Answer 7

RSV

Question 8

Strep pneumo pneumonia?

Tx?

Answer 8

RUST COLORED SPUTUM

Amox is first line, but lots of tuff works

Question 9

Who gets H influx pnuemo? presentation?

Answer 9

COPD, sickle cell

Slow onset
Beta lactams and everything again

Question 10

Most common pneumonia after influenza?

Answer 10

Strep, but staph can happen again

Question 11

Staph pneumo CXR?

Answer 11

Abscess forming. It is post influx often

Question 12

Klebsiellan pneumo in who? Symptoms?

Answer 12

CURRANT JELLY sputum in people who aspirate

Cephs and aminoglycosides

Question 13

Psuedomonas pneuma in who?

Tx?

Answer 13

Ventilators, chronic ill, cystic fibrosis

Empiric antibiotics?
Pip tazo, cefepime, Cipro, levo

If sepsis, do pip taco with levo

Question 14

GBS pneumo in who?

Answer 14

infants.

B lactams, amp and gent

Question 15

Enterobacter pneumo?

Answer 15

Tx third gen cep or carbopanem

Question 16

Cold agglutinin test is what?

Answer 16

Mycoplasma pneumo

tx macrolides

most common pneuma in young adults

Question 17

Legionella pneumo symptoms? Tx?

Answer 17

Can have confusion, needs macrolide or fluoroquinolone

Question 18

Atypical pneumonia tx?

Answer 18

Macrolide or fluoroquine

Mycoplasma
Legionella
Chlamydophila

Question 19

Empiric antibiotics for pneumonia?

Answer 19

Levo or moxi for primary

Or beta lactam with macrolide

Question 20

Old people are gross, so you see moe anaerobes and G- rods for pneumonia

Answer 20

But strep pneuma still most comon

Question 21

Strep pneumo vaccination indication?

Answer 21

65 years

Long term health issue including alcohol, DM, Sickle cell

Resistance to infection lower from something like treatment OR NO SPLEEn

Smokers 19 or older

Question 22

IF YOU SMOKE YOU NEED PNEUMO VACCINATION

Answer 22

OH

Question 23

Pneumonia with caves?

Answer 23

Histoplasmosis

Also HISTORIC mississippi

Question 24

Eastern north america fungal pneumonia?

Answer 24

Blasto

Question 25

Fungal pneumo tx?

Severe?

Histo or blasto?

Coccidio?

Answer 25

If severe, ampho B

Itraconazole

Fluconoazole

Question 26

Tx for PCP? CD4 count for PCP?

Answer 26

200!

You see rising LDH

21 days of antibiotics: BACTRIM

Question 27

What is ghon complex?

Answer 27

Ghon focus (calcified granuloma) with hilar lymph on CXR in PRIMARY TB

Question 28

PPD is positive at 5 mm when?

Answer 28

Immunodeficient or TB findings on CXR or working very close with the disease

Question 29

secondary tb lung findings?

Symptoms?

Answer 29

Caseous cheesy

Fever, hemoptysis, weight loss, night sweats

Can have extra pulmonary TB just about anywhere! GREAT IMITATOR

Question 30

Dx of tb?

Answer 30

weakly gram positive acid fast, Slow growing so hard to culture

Culture takes weeks

ACID FAST EVERY morning on sputum 3 days in a row

Question 31

Latent Tb tx?

PRimary or secondary TB?

Answer 31

INH for 6 months

RIPE: Rifampin, INH, Pyran, Etham 2 months

Give B6 (pyrdoxine) for INH

Question 32

Vaccination for Tb only affects ppd for about 10 years

Answer 32

Oh ok