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Internal Med > Pulm > Flashcards

Pulm Flashcards

1
Q

Pleural Fluid Analysis:

exudative?

A

fluid protein/serum protein > 0.5
fluid lactate dehydr > 2/3 UL of normal OR
fluid/serum lactate dehydr > 0.6

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2
Q

What leukocyte value implies transudative process?

A

<1000

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3
Q

What does a predominance of neutrophils in pleural fluid suggest?

A

an acute inflammatory or infectious process

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4
Q

What is pleural fluid glucose level of <60 most commonly caused by?

A

TB, parapneumonic effusion, malignant effusion, or rheumatoid disease

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5
Q

What is normal pleural fluid pH?

A

7.6-7.66

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6
Q

What does pleural fluid of <7.2 indicate?

A

complicated parapneumonic effusions (empyema), esophageal rupture, rheumatoid and TB pleuritis, malignant pleural disease, systemic acidosis, paragonimiasis, lupus pleuritis, or urinothorax.

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7
Q

What kind of pleural effusion is seen in malignancy?

A

exudative w/ predominance of lymphocytes!

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8
Q

How to distinguish TB from bacterial effusion?

A

TB has predominance of lymphocytes

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9
Q

What 2 characteristics of pleural effusions indicate a poor prognosis for a pt?

A

low glucose and pH

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10
Q

How to tell the difference between a pleural effusion and lobar consolidation on exam?

A

decreased fremitus in pleural effusion. increased fremitus in consolidation.

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11
Q

What is atopy?

A

excema

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12
Q

how to induce asthma?

A

Ach-agonist: methylcholine

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13
Q

How to rescue pt with asthma?

A

albuterol- beta agonists

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14
Q

Asthma stabilizers?

A

nedocromyl/cromolyn. Only for athletic asthma when certain of cause

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15
Q

Bronchodilator response in COPD?

A
  • response of FEV1/FVC to less than 70% of predicted

- FEV1 can be relatively preserved in mild disease

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16
Q

Which lung disease should be considered in pts with tuberous sclerosis?

A

lymphangioleiomyomatosis

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17
Q

The following findings in a young woman with dyspnea should prompt consideration of what condition? spontaneous pneumothorax, chylothorax, CXR that shows hyperinflation

A

lymphangioleiomyomatosis

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18
Q

What findings on CXR are present in cryptogenic organizing pneumonia (COP)?

A

alveolar opacification almost always bilateral and show varied distribution. migrate to diff lung regions.

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19
Q

COP is the idiopathic form of what?

A

bronchiolitis obliterans organizing pneumonia (BOOP)

20
Q

What gram positive rod causes meningitis in babies/elderly?

A

Lysteria monocytogenes

21
Q

How do you treat lysteria monocytogenes meningitis?

A

Ampicillin or Penicillin G. Use Bactrim in peeps allergic to penicillin

22
Q

What gram positive diplococci causes meningitis in babies/elderly?

A

strep pneumo

23
Q

How to treat presumed strep pneumo meningitis?

A

ceftri and vanc until sensitivities come back

24
Q

What type of meningitis is associated with HSV2 genital infection?

A

aseptic meningitis

25
Q

What sx are associated with aseptic meningitis?

A

recurrent episodes of fever, vomiting, and photosensitivity

26
Q

Leuk count in bacterial meningitis?

A

1000-5000

27
Q

What type of leuks found in bacterial meningitis?

A

predominance of neutrophils

28
Q

What glucose level ass w/ bacterial meningitis? CSF to plasma glucose ratio?

A

= to 40. = to 0.4

29
Q

Rash ass w/ acute HIV infection?

A

diffuse maculopapular eruption across chest, face, back, and UEs. could also affect palms and soles.

30
Q

What disease has sx of recurrent painful oral & genital apthous ulcers, skin lesions, and uveitis, along with neurologic manifestations in 25% of pts?

A

Behcet’s disease

31
Q

What leuk level ass. with Behcet’s disease?

A

<100 cells

32
Q

What 2 agents are appropriate to administer within 48 hrs of ischemic stroke onset if pts don’t meet criteria for thrombolytic therapy?

A

325 mg aspirin and dipyridamole

33
Q

What is time window AFTER SYMPTOM ONSET in acute ischemic stroke to see a benefit from rTPA admin?

A

4.5 hours

34
Q

What is time window AFTER HOSPITAL ARRIVAL in ischemic stroke to see a benefit from rTPA admin?

A

1 hour (withhold antiplatelet agents for 24 hours post)

35
Q

What’s the word for when the muscles you use for speech are weak or you have difficulty controlling them? comes with slurred/slowed speech

A

dysarrthria

36
Q

What scoring system to eval peeps with probable TIA for admission?

A 
A- >60 yo
B- BP > 140/90
C- clinical sx (hemiparesis)
D^2- duration, presence of DM
>3 --> hospital admission
37
Q

BP level required before thrombolytic therapy for stroke administered?

A

185/110 (180/105 goal for 24 hrs after that)

38
Q

What is it called when damage to posterior parietal cortex causes individual to have difficulty with the motor planning to perform tasks or movements when asked?

A

apraxia

39
Q

What is the name for the reflexive rolling upwards of the globe during eye closure?

A

bell phenomenon

40
Q

How to treat bell palsy?

A

prednisone, 40 mg/day, pref initiated in first 72 hrs

41
Q

What glucose level w/ 2-hour glucose tolerance test is diagnostic for impaired glucose tolerance?

A

140-199

42
Q

What glucose level w/ 2-hour glucose tolerance test is diagnostic for diabetes?

A

> 200

43
Q

What test to perform in pts with acute/progressive neuropathy or polyradiculoneuropathy, and also in pts with severe weakness, sensory loss, or absent DTRs?

A

LP to R/O guillain barre and chronic inflamm polyradiculopathy; also infectious viral causes

44
Q

What does CSF look like in Guillain barre?

A

normal cell count, elevated CSF protein

45
Q

Initial tx for essential tremor?

A

“lifestyle modifications”

46
Q

Pharmacologic management of essential tremor?

A

beta-blockers, anti-convulsants like primidone

47
Q

Pharmacologic order of operations in status epilepticus?

A

IV lorazepam –> fospheny–>phenobarb if the others don’t work. Can substitute Valproate for fospheny, but has infusion rate limitations and longer onset of action

Internal Med (6 decks)

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