Pulm

Question 1

Exudate vs transudate

Answer 1

Pleural effusion

Exudate in cancer or infxn, high protein and ldh

Transudate in CHF, low protein and ldh

Question 2

Cap vs hap tx

Answer 2

Cap usually pneumococcus but tx for gram pos, gram neg, and atypical with macrolide, resp quin (levo Or moxi), and doxy

Hap and vap cover for gnr (eg cefepime, pip/tazo, carbapenem for gnr + quinolone or gent for gnr + vanc or linez for mrsa)

Question 3

How to give pneumococcal vax

Answer 3

13, then 23 polyvalent (one year later if routine 65yo, 8 weeks if earlier dt immunocomp, smoker, copd etc)

Question 4

Tb drugs and AEs

Answer 4

• rifampin 6 mo, orange secretions
• isoniazid 6 mo, periph neuropathy (b6)
• pyraz 2 months, hyperuricemia
• ethamb 2 mo, optic neuritis

All can cause liver tox

Question 5

ABPA test and tx

Answer 5

Test is asp skin test and serum ige
Tx is oral steroid and itracon

Question 6

Sarcoidosis tx

Answer 6

If asx, no tx
Else 12-24 months oral steroids and most cases resolve without recurrence

Question 7

Obstructive vs restrictive lung disease

Answer 7

Obstructive - asthma, copd, air trapping, low fev1/fvc
Restrictive - eg ild, can’t fill lungs, low TLC but normal fev1/fvc

Question 8

Gene therapy for cf

Answer 8

Ivacaftor (restore fxn of cftr)

Question 9

Vent settings that affect ventilation vs oxygenation

Answer 9

Vent (look at co2 and ph) - tidal volume (keep low to prevent barotrauma) and RR

Oxygenation - peep (opens collapsed alv) and fio2 (too high causes o2 toxicity)

Question 10

Copd exacerbation tx

Answer 10

Prednisone po, albuterol, ipratropium, o2, ctx or amp with azithro or resp fluoroquin for cap

Question 11

Common lobes for aspiration pna

Answer 11

Right lower and middle

Question 12

PE management

Answer 12

• if hds, ac or if ci Ivc filter
• if hypotn and low bleed risk, thrombolysis. If high bleeding risk, intracranial tumor etc or thrombolysis doesn’t work, do embolectomy