Pulm Flashcards
1
Q
pts w/ COPD usually have how many pack yrs?
A
20+
2
Q
COPD has FEV1/FEC below ___
A
0.7
3
Q
1st line for sx relief in COPD
A
SABA +/- ipratropium (SAMA)
4
Q
consider ____ deficiency in young / non-smoker w/ COPD
A
alpha 1 antitrypsin
5
Q
AECOPD most common cause
A
viral URI
6
Q
3 cardinal sx defining AECOPD
A
- Increased cough severity/frequency
- Increased sputum volume and/or change in character
- Worsened dyspnea/SOB
7
Q
tx for mild AECOPD - 2 meds
A
O2, duoneb, PO prednisolone
8
Q
abx for mod uncomplicated AECOPD
A
azithromycin 500mg then 250 mg PO QD X 4 days,
clarithromycin 500mg PO bid or clarithromycin XR 1g PO QD
9
Q
chronic bronchitis dx must have Irreversible reduction in maximal airflow velocity and productive cough for most days of the month for __ months over __ consecutive years
A
3 months, 2 years
10
Q
hallmark sx of emphysema
A
dyspnea/SOB
11
Q
finding on CXR or CT that is pathognomonic for emphysema
A
subpleural bullae
12
Q
periodic episodes of diarrhea (serotonin release), flushing, tachycardia, and bronchoconstriction/wheezing (histamine release) and hemodynamic instability (eg hypotension)
A
carcinoid syndrome
13
Q
80% of mesothelioma is from _____
A
asbestos exposure
14
Q
● Most common primary lung cancer in smokers, women, men, & non-smokers
A
adenocarcinoma
15
Q
centrally located lung CA is likely which types (2)?
A
SCC, SCLC
16
Q
type of lung CA ASW most paraneoplastic syndromes
A
SCLC
17
Q
paraneoplastic syndrome seen w/ SCC
A
hyperCa
18
Q
● Horner’s Syndrome
A
unilateral enophthalmos, ptosis, miosis, and anhidrosis on the same side of apical lung tumor
19
Q
annual low dose chest CT for whom?
A
those 50-80 who have no symptoms of lung cancer AND a 20 pack-year history who currently smoke or have quit within 15 years
20
Q
MCC of transudative pleural effusion
A
CHF
21
Q
gold standard for dx of pleural effusion
A
thoracentesis
22
Q
scoring systems for OSA (2)
A
stopbang, epworth sleepiness scale
23
Q
metabolic state in obesity hypoventilation syndrome
A
compensatory respiratory acidosis
- Reduced nocturnal carbon dioxide clearance. Kidneys retain bicarbonate to compensate
24
Q
MCC of acute bronchiolitis
A
RSV
25
acute bronchitis: more commonly viral or bacterial?
viral
26
main 3 bacteria in acute bronchitis
S. pneumonia, H. influenzae, M. catarrhalis
27
5 MCC of hemoptysis
acute bronchitis, bronchiectasis, necrotising PNA, TB, bronchogenic carcinoma
28
MCC of epiglottitis
Haemophilus influenzae B
29
XR finding in epiglottitis
thumb sign
30
tx for epiglottitis
1) maintain airway
2nd or 3rd gen cephalosporin (Ceftriaxone or Cefotaxime) + anti-staphylococcal agent (Vancomycin)
31
3 criteria of latent TB
+PPD, no symptoms, negative imaging
32
TB in cervical LNs
scrofula
33
TB in vertebrae
Pott's dz
34
gold standard for TB dx
AFB (acid fast bacilli) sputum culture x 3
35
RIPE drugs for TB
Rifampin, Isoniazid, Pyrazinamide, Ethambutol (RIPE) for 2 months for initial phase
Rifampin and Isoniazid for 4 months for continuation phase
36
supplement vitamin ___ w/ INH
B6
37
latent tB tx
-INH + rifapentine weekly X 3months (3HP)
-Or Rifampin x 4 months (4R) OR Isoniazid + Rifampin x 3 months (3HR)
38
MCC of croup
parainfluenza virus
39
XR finding for croup
steeple sign (on AP)
40
tx for mild croup
supportinve, O2, dexamethasone
41
add ____ for mod-severe croup
nebulised epi
42
tx for whooping cough
Azithromycin
43
give oseltamivir for flu w/in ___ hrs of sx onset
48
44
Most common cause of viral pneumonia in adults.
influenza
45
Most common cause of lower respiratory tract infection in children worldwide – virtually all get it by age 3;
RSV
46
what is the Dx? Destruction of smooth muscle and elastic tissue and permanent dilation of bronchi and bronchioles caused by chronic necrotizing infections
bronchiectasis
47
gold standard for dx of bronchiectasis
chest CT
48
CXR showing dilated airways with thickened walls, mucous plugs, tram-track or ring-like appearance of dilated and thickened bronchi. dx?
bronchiectasis
49
gold standard test for CF
sweat test (elevated Cl)
50
most common cause of PNA in CF during 1st few months of life (2)
S. aureus, H. influenza
51
MCC of PNA in CF after 1st few months of life
pseudomonas
52
other body systems to check in CF pts (2)
GI: pancreas (90%): steatorrhea, frequent BMs, T1DM, malabsoprtion. other: delayed meconium, liver dz, GERD
ENT: nasal polyps and chronic sinusitis (50%)
53
when to give dexamethasone for COVID
inpatient + O2 req
54
major Paxlovid interaction
statins
55
MCC of CAP
Strep pneumo
56
bac causing CAP in alcoholics
klebsiella
57
MCC of bac PNA post-influenza
S aureus
58
other body systems to ask about in legionella PNA (2)
GI and neuro.
GI (diarrhea, abdominal pain) and neurological symptoms (HA, confusion, ataxia) in the setting of acute respiratory illness and infiltrate on CXR may be tip off to diagnosis.
59
● Most common AIDS-defining illness and cause of death in patients with AIDS
PJP
60
gold standard tx for PJP
bactrim
61
preferred tx for aspiration PNA outpatient
Augmentin. Alts: clindamycin fluoroquinolone
62
non-HAP aspiration PNA: which organisms? (2)
mainly anaerobes and streptococci
63
fungal PNA w/ ● Hx of travel to Ohio or Mississippi river valleys and exposure to bird or bat droppings
histoplasmosis
64
MCC of cor pulmonale
COPD
65
gold standard for dx of cor pulmonale
right heart catheterization
66
examples of hypercoagulable states
factor V leiden, prothrombin, protein C & S deficiency, cancer, chemo, pregnancy, obesity
67
gold standard for PE dx
chest CT angiography
68
EKG pattern for cor pulmonale and PE
S1Q3T3
69
definitive dx for pulm HTN
Right Heart Catheterization (RHC):
70
1st test to order for pulm HTN
echo
71
what dx? - Chest Xray (Peripheral reticular opacities, ground glass)
- Chest CT (sub-pleural honeycombing)
Idiopathic Pulmonary Fibrosis
72
where is the problem in Coal workers' lung?
upper lung fields
73
where is the problem in restrictive lung dz from asbestos?
calcified plaques on diaphragms or lat chest wall
74
2 skin manifestations of sarcoidosis
erythema nodosum, lupus pernio
75
- Samter’s triad
asthma + chronic rhinosinusitis w/ nasal polyps + sensitivity to Aspirin or NSAIDs
76
quantify reversibilty of FEV1 in asthma
> 12% or 200 ml increased than original
77
asthma pt needs more than SABA. next rx?
ICS
78
LEADING cause of death in premature infants
Hyaline Membrane Disease
79
lung CA w/ mucin production
adenocarcinoma
80
most malignant lung nodules are located in which lung fields
upper
81
2 Pyrazinamide SE to think of
hyperuricemia, photosensitivity rash
82
noncaseating granuloma. think what dx?
sarcoidosis
83
for suspected sarcoidosis, order what unusual lab? expected result?
ACE level. elevated
84
pneumoconiosis with "eggshell" calcifications
silicosis
85
pneumoconiosis with calcified plaques along diaphragm or lateral wall
asbestosis
86
Outpatient cap with comorbidities
Augmentin OR 2nd gen cephalosporin
+
Macrolide
OR
FQ
87
3 tx for moderate acute asthma exacerbation
Saba, sama, systemic steroid
88
Tx for severe asthma exacerbation that is not responding to tx
IV Mg sulfate
89
Lights criteria looks at amounts of what 2 things
Pleural protein and LDH
90
2 MCC of ARDS
Sepsis, severe PNA
91
MCC of hemoptysis
bronchitis
92
CAP tx for outpatient with DM
[augmentin OR cefpodoxime] + [macrolide OR doxy]
93
Which of the following is most closely associated with the development of acute cor pulmonale?
A Acute bronchitis
B Hospital-acquired pneumonia
C Left-sided heart failure
D Pulmonary embolism
PE
94
which type of COPD has a barrel chest?
emphysema
95
which vaccine is recommended for revax in immunocompromised pts: PCV13 or PPSV23?
PPSV23
96
Which of the following chest x-ray abnormalities would most likely be seen in a patient with hypersensitivity pneumonitis?
Lobar consolidation
Apical infiltration
Granulomatous inflammation
Diffuse nodular densities
Diffuse nodular densities
97
Which of the following medications is most likely to cause acute tubular necrosis?
Trimethoprim-sulfamethoxazole (Bactrim)
Acetaminophen
Cephalothin (Kefzol)
Gentamicin
In hospitalized patients up to 25% of patients receiving aminoglycosides sustain some degree of acute tubular necrosis. Gentamicin is one of the most toxic aminoglycosides, streptomycin is the least nephrotoxic of the aminoglycosides.
98
A 15 year-old male presents with a 1 week history of hacking non-productive cough, low grade fever, malaise and myalgias. Examination is unremarkable except for a few scattered rhonchi and rales upon auscultation of the chest. The chest x-ray reveals interstitial infiltrates and a cold agglutinin titer was negative. Which of the following is the most likely diagnosis?
acute bronchitis
viral pneumonia
mycoplasma pneumonia
pneumococcal pneumonia
The patient's clinical symptoms as well as chest x-ray findings and negative cold agglutinin titer are most consistent with viral pneumonia.
While the gradual onset of symptoms suggest mycoplasma, the negative cold agglutinin titer makes this less likely.
99
A 3 month-old male presents with a hoarse cough and thick purulent rhinorrhea for the past 2 days. The mother noted that yesterday he appeared to get worse and seemed to have increasing problems breathing and trouble feeding. Examination reveals a temperature of 100.2 degrees F and respiratory rate of 80/minute with nasal flaring and retractions. Lung examination reveals a prolonged expiratory phase with inspiratory rales. He is tachycardic. Pulse oximetry reveals oxygen saturation of 89%. Chest x-ray reveals hyperinflation with diffuse interstitial infiltrates. dx? intervention?
bronchiolitits, hospitalisation
100
A 15 year-old male was seen last week with complaints of sore throat, headache, and mild cough. A diagnosis of URI was made and supportive treatment was initiated. He returns today with complaints of worsening cough and increasing fatigue. At this time, chest x-ray reveals bilateral hilar infiltrates. A WBC count is normal and a cold hemagglutinin titer is elevated. The most likely diagnosis is
tuberculosis.
mycoplasma pneumonia
pneumococcal pneumonia.
staphylococcal pneumonia
The insidious onset of symptoms, the interstitial infiltrate on chest x-ray, and elevated cold hemagglutinin titer make this diagnosis the most likely.
101
A 64 year-old with COPD receiving their first 23-valent pneumococcal polysaccharide vaccine (PPSV23) should be revaccinated in
1 year.
3 years.
5 years.
10 years
5. Administer 1 final dose of PPSV23 at 65 years or older. This dose should be given at least 5 years after the most recent dose of PPSV23. Click here to review the latest guidelines
102
A patient taking bleomycin (Blenoxane) should be monitored for which of the following side effects?
Optic neuritis
Hyperuricemia
Encephalopathy
Pulmonary fibrosis
Pulmonary fibrosis
