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Step 2 > Pulm > Flashcards

Pulm Flashcards

1
Q

Name all 6 steps of asthma treatment

A

1) inhaled SABA (albuterol)
2) Add a long term control agent (ICS > Cromolyn/Nedocromil, Theophylline, LTE modifiers)
3) Add a LABA (Salmeterol) or increase the ICS dose
4) Max dose ICS + add a LABA
5) Add omalizumab if there is an increased IgE level
6) Add an oral steroid (prednisone)

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2
Q

What are the side effects of ICS?

Concern with Zafirlukast?

A

Dysphonia + oral candidiasis

Hepatoxic + churg Strauss association

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3
Q

What is the best indication of asthma severity?
How do you quantify the severity of an attack? (2 tests)
How do you treat?

A

RR
Decreased PEF + ABG with increased Aa gradient
O2 + albuterol + steroid bolus –> intubate if no response

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4
Q

What is the cause of COPD in a young non smoker?
What is the best initial test for COPD?
Most accurate test?

A

A1ATD
CXR
PFT

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5
Q

What COPD treatments improve mortality?
What COPD treatments improve Sx?
What do you give COPD pts who do not respond to albuterol?

A

Quit smoking + O2 + flu/pneumo vaccines
SABA, Anticholinergics (Tiotropium), steroids, LABA, rehab
Anticholinergics –> ICS

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6
Q

What is the most effective agent for COPD?

What is the COPD treatment when medals therapy fails?

A

Anticholinergics

Refer for transplant

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7
Q

How do you treat acute exacerbation of chronic bronchitis?
What are first line agents?
What are second line?

A

Abx Against Spneumo/Hflu/Moraxella
Macrolides/cephalosporins/Augmentin/Quinolones
Doxy/Bactrim

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8
Q 
What is bronchiectasis?
What is the most common cause?
What is the classic Sx?
What is the initial test?
Accurate test?
A 
Permanent chronic dilation of large bronchi
CF
Buckets of sputum
CXR
High res CT
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9
Q

Who gets ABPA?
How does it present?
How do you treat acutely?
How do you treat chronically?

A

Almost always asthmatics or atopic disorder patients
Brown flecked sputum
Oral steroids if severe
Itraconazole

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10
Q

What is the most common cause of death in CF?
What are the affected and unaffected parts of the pancreas?
What is the most accurate test to diagnose?
How do you treat?

A

Lung disease
Islets spared, beta cell decline later in life
Increased sweat chloride test
Abx + inhaled rhDNase + inhaled bronchodilators

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11
Q

What is the most common infectious cause of death in the US?
What is the most common organism?
What are 3 ways to distinguish this from bronchitis?
What 5 organisms cause nonproductive cough?
What is the best initial tests?

A 
Pneumonia
S pneumo
Dyspnea + high fever + abnormal CXR
Mycoplasma/virus/coxiella/pneumocystis/chlamydia
CXR + sputum gram stain/culture
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12
Q 
What are som specific diagnostic tests for Mycoplasma?
Chlamydophila pneumonia?
Legionella?
Chlamydia psittaci?
Coxiella?
PCP?
A 
PCR/cold agglutins/serology
Rising serologic titers
Urine antigen/Charcoal yeast culture
Rising titers
Rising titers
Bronchoalveolar lavage
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13
Q

What drives initial therapy for pneumonia?

How is outpatient treatment done?

A

Severity of disease

Macrolide or doxy –> Levo or Moxifloxacin if sick or Abx in past 3 months

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14
Q

When would you hospitalize for pneumonia?
What is the inpatient treatment?
How do you treat an infected pleural effusion or empyema?

A

CURB65: confused/uremia/RR/BP low/age>65
Levo/moxie or Ceftriaxone + azythromycin
Chest tube for suction

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15
Q

What is the best initial test for acute exacerbation of asthma?
What is the most accurate test?
What is the most accurate if the patient is asymptomatic?
How much does FEV1 increase with albuterol/decrease with Methacholine or His?
How is the diffusion capacity for CO affected?

A 
PEF or ABG
PFTs
Methacholine challenge test
12% and 200mL --> 20%
Increase
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16
Q

When do you receive the pneumococcal vaccines?
What are weird reasons to get it early?
What do you do for those who got it early?

A

65 PCV13 –> 6-12 months later PSV23
Asplenia/heme CA/CSF leak or cochlear implant/immunosuppressed
2nd dose given 5 years after 1st dose

17
Q

What is the concerning pathogen in HAP?
What is not acceptable HAP treatment?
What are 3 treatments?

A

Gram negatives
Macrolides
Cefepime/Cefatadime or Pip/Tazo or Carbapenems

18
Q

What are 5 tests for VAP?

What is the treatment?

A

Tracheal aspirate > BAL > protected brunch specimen > VAT > open lung biopsy
3 drug combo: antipseudomonal beta lactam + 2nd antipseudomonal (aminogylcocide or quinolone) + MRSA agent (Vanc or linezolid)

19
Q

What pseudomonas drug can cause seizures?

A

Imipenem

20
Q

What is the best initial test for lung abscess?
What is more accurate?
What is most accurate?

A

CXR
CT
Lung biopsy

21
Q 
What is the best initial test for PCP?
What is the most accurate test?
What is also very specific?
What lab test makes PCP unlikely?
How is PCP treated?
What do you add if it is severe?
What if the 1st line becomes toxic?
A 
CXR or ABG
BAL
Sputum stain
Normal LDH
TMP/SMX
Steroids (pO2 35)
Clinda + primaquine or Pentamidine
22
Q

What is the first line PCP prophylaxis?
What if there is a reaction?
What are the 2 main reactions?

A

TMP/SMX
Atovaquone or dapsone
Rash or neutropenia

23
Q

What do you do if you have a negative sputum stain for TB?
What is the most accurate test?
What is never the right test if the patient is symptomatic?

A

Do it again! 3 times total
Pleural biopsy
PPD

24
Q

What are the 4 TB treatments?
How long are they used?
What are their side effects?

A

Rifampin - 6 months - red color secretions
INH - 6 months - peripheral neuropathy (prevent with B6)
Pyrazinamide - 2 months - hyperuricemia (no tx unless Sx)
Ethambutol - 2 months (or not at all if sensitive to other 3) - optic neuritis/color vision/renal failure

25
Q

What are glucocorticoids used for with regards to TB?

A

Decrease risk of constrictive pericarditis

Decrease risk of neuro complications if meningitis

26
Q

What does 2 stage testing mean with TB?

What do you do to treat positive PPD and negative CXR?

A

For the first PPD, you need a 2nd 1-2 weeks later

INH + B6 for 9 months (yearly screening CXR if in healthcare)

27
Q

If you have an intermediate probability lesion, what is the most appropriate next step?
What is a side effect of those?

A

Bronchoscope (central )or TT needle biopsy (peripheral)

Pneumothorax

28
Q

What are 4 features of pulmonary fibrosis?
What is the initial test?
More accurate?
Most accurate?
Which pneumoconiosis responds to steroids?

A 
Dyspnea on exertion/rales/loud P2/finger clubbing
CXR
High res CT
Lung biopsy
Berylliosis
29
Q

What condition is present in 95% of sarcoidosis?
What is most accurate for sarcoidosis?
What is the treatment?

A

Hilar adenopathy
Lymph node biopsy
Prednisone

30
Q

What is the best initial tests for PE (3)?
What is the next step?
What is the most common EKG finding?
What is the suggestive ABG finding?
What is the next step when findings suggest PE?
What is the best confirmation test in pregnancy?

A 
CXR + EKG + ABG
CTA (spiral CT)
Sinus tach with nonspecific ST-T changes
Hypoxia + RespAlk
Start therapy
V/Q
31
Q

What is the reason to use an IVC filter for PE?
When do you use thrombolytics?
When do you use direct thrombin inhibitors?
When do you use ASA?

A

Contraindications to anticoagulants/recurrent emboli/RV dysfunction
HypoTN/acute RV dysfunction
HIT
Never!

32
Q

What is the initial test for pulm HTN?
What is the accurate test?
What are 3 in initial medication options?
What is a cure?

A

CXR/CT
Swan Ganz/Right heart catheter
PGI analogues (epoprostenol, iloprost, beraprost)/endothelin antagonists (bosentan, ambrisentan)/PGE inhibitors (sidenafil)
Lung transplant

33
Q

What is the definition of ARDS?

What is the treatment?

A

pO2/FIO2 ratio

Step 2 (13 decks)

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