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Clin Med > Pulm > Flashcards

Pulm Flashcards

1
Q

pts w/ COPD usually have how many pack yrs?

A

20+

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2
Q

COPD has FEV1/FEC below ___

A

0.7

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3
Q

1st line for sx relief in COPD

A

SABA +/- ipratropium (SAMA)

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4
Q

consider ____ deficiency in young / non-smoker w/ COPD

A

alpha 1 antitrypsin

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5
Q

AECOPD most common cause

A

viral URI

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6
Q

3 cardinal sx defining AECOPD

A
  • Increased cough severity/frequency
  • Increased sputum volume and/or change in character
  • Worsened dyspnea/SOB
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7
Q

tx for mild AECOPD - 2 meds

A

O2, duoneb, PO prednisolone

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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

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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

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10
Q

hallmark sx of emphysema

A

dyspnea/SOB

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11
Q

finding on CXR or CT that is pathognomonic for emphysema

A

subpleural bullae

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12
Q

periodic episodes of diarrhea (serotonin release), flushing, tachycardia, and bronchoconstriction/wheezing (histamine release) and hemodynamic instability (eg hypotension)

A

carcinoid syndrome

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13
Q

80% of mesothelioma is from _____

A

asbestos exposure

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14
Q

● Most common primary lung cancer in smokers, women, men, & non-smokers

A

adenocarcinoma

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15
Q

centrally located lung CA is likely which types (2)?

A

SCC, SCLC

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16
Q

type of lung CA ASW most paraneoplastic syndromes

A

SCLC

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17
Q

paraneoplastic syndrome seen w/ SCC

A

hyperCa

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18
Q

● Horner’s Syndrome

A

unilateral enophthalmos, ptosis, miosis, and anhidrosis on the same side of apical lung tumor

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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

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20
Q

MCC of transudative pleural effusion

A

CHF

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21
Q

gold standard for dx of pleural effusion

A

thoracentesis

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22
Q

scoring systems for OSA (2)

A

stopbang, epworth sleepiness scale

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23
Q

metabolic state in obesity hypoventilation syndrome

A

compensatory respiratory acidosis

    • Reduced nocturnal carbon dioxide clearance. Kidneys retain bicarbonate to compensate
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24
Q

MCC of acute bronchiolitis

A

RSV

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25
Q

acute bronchitis: more commonly viral or bacterial?

A

viral

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26
Q

main 3 bacteria in acute bronchitis

A

S. pneumonia, H. influenzae, M. catarrhalis

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27
Q

5 MCC of hemoptysis

A

acute bronchitis, bronchiectasis, necrotising PNA, TB, bronchogenic carcinoma

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28
Q

MCC of epiglottitis

A

Haemophilus influenzae B

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29
Q

XR finding in epiglottitis

A

thumb sign

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30
Q

tx for epiglottitis

A

1) maintain airway
2nd or 3rd gen cephalosporin (Ceftriaxone or Cefotaxime) + anti-staphylococcal agent (Vancomycin)

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31
Q

3 criteria of latent TB

A

+PPD, no symptoms, negative imaging

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32
Q

TB in cervical LNs

A

scrofula

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33
Q

TB in vertebrae

A

Pott’s dz

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34
Q

gold standard for TB dx

A

AFB (acid fast bacilli) sputum culture x 3

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35
Q

RIPE drugs for TB

A

Rifampin, Isoniazid, Pyrazinamide, Ethambutol (RIPE) for 2 months for initial phase
Rifampin and Isoniazid for 4 months for continuation phase

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36
Q

supplement vitamin ___ w/ INH

A

B6

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37
Q

latent tB tx

A

-INH + rifapentine weekly X 3months (3HP)
-Or Rifampin x 4 months (4R) OR Isoniazid + Rifampin x 3 months (3HR)

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38
Q

MCC of croup

A

parainfluenza virus

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39
Q

XR finding for croup

A

steeple sign (on AP)

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40
Q

tx for mild croup

A

supportinve, O2, dexamethasone

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41
Q

add ____ for mod-severe croup

A

nebulised epi

42
Q

tx for whooping cough

A

Azithromycin

43
Q

give oseltamivir for flu w/in ___ hrs of sx onset

A

48

44
Q

Most common cause of viral pneumonia in adults.

A

influenza

45
Q

Most common cause of lower respiratory tract infection in children worldwide – virtually all get it by age 3;

A

RSV

46
Q

what is the Dx? Destruction of smooth muscle and elastic tissue and permanent dilation of bronchi and bronchioles caused by chronic necrotizing infections

A

bronchiectasis

47
Q

gold standard for dx of bronchiectasis

A

chest CT

48
Q

CXR showing dilated airways with thickened walls, mucous plugs, tram-track or ring-like appearance of dilated and thickened bronchi. dx?

A

bronchiectasis

49
Q

gold standard test for CF

A

sweat test (elevated Cl)

50
Q

most common cause of PNA in CF during 1st few months of life (2)

A

S. aureus, H. influenza

51
Q

MCC of PNA in CF after 1st few months of life

A

pseudomonas

52
Q

other body systems to check in CF pts (2)

A

GI: pancreas (90%): steatorrhea, frequent BMs, T1DM, malabsoprtion. other: delayed meconium, liver dz, GERD
ENT: nasal polyps and chronic sinusitis (50%)

53
Q

when to give dexamethasone for COVID

A

inpatient + O2 req

54
Q

major Paxlovid interaction

A

statins

55
Q

MCC of CAP

A

Strep pneumo

56
Q

bac causing CAP in alcoholics

A

klebsiella

57
Q

MCC of bac PNA post-influenza

A

S aureus

58
Q

other body systems to ask about in legionella PNA (2)

A

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
Q

● Most common AIDS-defining illness and cause of death in patients with AIDS

A

PJP

60
Q

gold standard tx for PJP

A

bactrim

61
Q

preferred tx for aspiration PNA outpatient

A

Augmentin. Alts: clindamycin fluoroquinolone

62
Q

non-HAP aspiration PNA: which organisms? (2)

A

mainly anaerobes and streptococci

63
Q

fungal PNA w/ ● Hx of travel to Ohio or Mississippi river valleys and exposure to bird or bat droppings

A

histoplasmosis

64
Q

MCC of cor pulmonale

A

COPD

65
Q

gold standard for dx of cor pulmonale

A

right heart catheterization

66
Q

examples of hypercoagulable states

A

factor V leiden, prothrombin, protein C & S deficiency, cancer, chemo, pregnancy, obesity

67
Q

gold standard for PE dx

A

chest CT angiography

68
Q

EKG pattern for cor pulmonale and PE

A

S1Q3T3

69
Q

definitive dx for pulm HTN

A

Right Heart Catheterization (RHC):

70
Q

1st test to order for pulm HTN

A

echo

71
Q

what dx? - Chest Xray (Peripheral reticular opacities, ground glass)
- Chest CT (sub-pleural honeycombing)

A

Idiopathic Pulmonary Fibrosis

72
Q

where is the problem in Coal workers’ lung?

A

upper lung fields

73
Q

where is the problem in restrictive lung dz from asbestos?

A

calcified plaques on diaphragms or lat chest wall

74
Q

2 skin manifestations of sarcoidosis

A

erythema nodosum, lupus pernio

75
Q
  • Samter’s triad
A

asthma + chronic rhinosinusitis w/ nasal polyps + sensitivity to Aspirin or NSAIDs

76
Q

quantify reversibilty of FEV1 in asthma

A

> 12% or 200 ml increased than original

77
Q

asthma pt needs more than SABA. next rx?

A

ICS

78
Q

LEADING cause of death in premature infants

A

Hyaline Membrane Disease

79
Q

lung CA w/ mucin production

A

adenocarcinoma

80
Q

most malignant lung nodules are located in which lung fields

A

upper

81
Q

2 Pyrazinamide SE to think of

A

hyperuricemia, photosensitivity rash

82
Q

noncaseating granuloma. think what dx?

A

sarcoidosis

83
Q

for suspected sarcoidosis, order what unusual lab? expected result?

A

ACE level. elevated

84
Q

pneumoconiosis with “eggshell” calcifications

A

silicosis

85
Q

pneumoconiosis with calcified plaques along diaphragm or lateral wall

A

asbestosis

86
Q

Outpatient cap with comorbidities

A

Augmentin OR 2nd gen cephalosporin
+
Macrolide

OR

FQ

87
Q

3 tx for moderate acute asthma exacerbation

A

Saba, sama, systemic steroid

88
Q

Tx for severe asthma exacerbation that is not responding to tx

A

IV Mg sulfate

89
Q

Lights criteria looks at amounts of what 2 things

A

Pleural protein and LDH

90
Q

2 MCC of ARDS

A

Sepsis, severe PNA

91
Q

MCC of hemoptysis

A

bronchitis

92
Q

CAP tx for outpatient with DM

A

[augmentin OR cefpodoxime] + [macrolide OR doxy]

93
Q

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
A

PE

94
Q

which type of COPD has a barrel chest?

A

emphysema

95
Q

which vaccine is recommended for revax in immunocompromised pts: PCV13 or PPSV23?

A

PPSV23

96
Q

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

A

Diffuse nodular densities

97
Q

Which of the following medications is most likely to cause acute tubular necrosis?

Trimethoprim-sulfamethoxazole (Bactrim)

Acetaminophen

Cephalothin (Kefzol)

Gentamicin

A

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
Q

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

A

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
Q

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?

A

bronchiolitits, hospitalisation

100
Q

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

A

The insidious onset of symptoms, the interstitial infiltrate on chest x-ray, and elevated cold hemagglutinin titer make this diagnosis the most likely.

101
Q

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

A
  1. 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
Q

A patient taking bleomycin (Blenoxane) should be monitored for which of the following side effects?

Optic neuritis

Hyperuricemia

Encephalopathy

Pulmonary fibrosis

A

Pulmonary fibrosis

Clin Med (14 decks)

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