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USMLE Step 2 > pulm > Flashcards

pulm Flashcards

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USMLE® Step 1 flashcards
1
Q

when do you NOT tap a pleural effusion

A

too small ( <1 cm)
loculated
CHF

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2
Q

exudative effusion assoc with…..

A

malignancy
TB
PNA

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3
Q

asthma diagnosis with PFTs

A

FEV1 inc by 12% with albuterol (200 ml inc)

FEV1 dec by 20% with methacholine

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4
Q

TLC is inc in COPD because of…..

A

inc in residual volume

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5
Q

how would you treat an asthma and COPDer not controlled on albuteral differently?

A

asthma –> ICS

COPD –> anticholinergic (ipratropium, tiotropium) –> ICS

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6
Q

most likely presentation of bronchiectasis

A
  • recurrent episodes of very high volume purulent sputum production
  • mostly related to CF

MUST be dx with CXR or CT –> “tram tracks”= thickened bronchi

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7
Q

bugs not gram stainable in PNA

A

mycoplasma
chlamydophila
legionella
coxiella

**also generally assoc with DRY COUGH and BILATERAL infiltrates

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8
Q

PNA tx for previously healthy/ no recent abx use?

A

macrolide or doxy

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9
Q

PNA tx for comorbidities or abx in last 3 months?

A

resp FQ –> levo or moxi

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10
Q

how can you use vitals to quikcly differentiate croup from epiglotitis?

A

croup= dec O2 sat (if mild, give steroids; if severe, give raecemic epi)

epiglottitis= impending dec O2 sat

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11
Q

management of epiglottitis

A

INTUBATE

  • -> ceftriaxone 7-10 days
  • —–> rifampin for close contacts
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12
Q

empiric therapy for retropharyngeal abcess

A

iv amp sul

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13
Q

MOST COMMON CAUSE OF CAP INCLUDING HIV PATIENTS (WITH GOOD CD4 COUNT)

A

strep pneumo

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14
Q

ludwigs angina

A

rare, often fatal, soft tissue neck infx (cellulitis)

predisposing factors: otodontic infx and diabetes

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15
Q

when should you get a PET for lung nodule?

A

> 1cm

pulm nodules are evaluated with Chest CT!! no xray.

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16
Q

most common lung cancer in smokers

A

Squamous

sCuamous cell –> Ca!!

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17
Q

what skin finding can be associated with mycoplasma PNA

A

erythema multiforme

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18
Q

positive PPD with negative chest xray?

A

9 months INH

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19
Q

when do you do sx tx in croup vs racemic epi?

A

racemic for moderate to severe –> stridor at rest, retractions

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20
Q

most common bugs in bacterial rhinosinusitis

A

h flu

strep pneumo

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21
Q

pavalizumab

A

monoclonal RSV antibody that supplies passive immunity to AT RISK babies (premies with BPD)

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22
Q

pseduomonas is a grem negative rod?

A

yes

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23
Q

hyponatremia, patchy bilat cxr, diarrhea?

A

legionella

tx with FQ or macrolide

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24
Q

tissue dense upper lobe mass seen on CXR that can be moved with change in position?

A

chornic pulmonary aspergilloma that has seeded in an old TB cavity

+galactomannin test

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25
Q

erythromycin in infants less than one?

A

can cause hypertrophic pyloric stenosis

***ie use azithromycin for pertussis

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26
Q

Pleural effusion: ADA, Triglycerides

A

TB, chylothorax

27
Q

three things that can acutely change plateau pressure in ICU?

A

pneumo (deep sulcus sign on CXR)

pulm edema

abdominal compartment syn

28
Q

what are CURB65 criteria

A 
Confusion
Urema (BUN>30)
Resp distress
BP (systolica < 90)
>65 yo
29
Q

define HAP

A

PNA 48 hours after admission or with in 90 days of hospitalization

more likely to be GNR rods!! –> e coli, PSA

30
Q

best antibiotics for lung abscess

A

clinda, pen

31
Q

PCP PNA

  • dx
  • tx
  • alt tx
A

dry cought, bilat infiltrates in patient with CD4 <200

-dx: LDH is always elevated!!

tx: TMP/SMX
- –> add steroids if severe
- ——–> use atovaqonue, dapsone or clinda/ primaquine if sulfa allergy
* *cannot use dapsone in G6PD

32
Q

what are adverse effects of TB tx?

A

rifampin –> red body secretions (benign)
isoniazid –> peripheral neuropathy (use pyridoxine)
pryainamie –> hyperuricemia (tx if symptomatic)
ethambutol –> optic neuritis/ color vision (decrease dose in renal failure)

***they all raise LFTs! only d/c if 3-5x upper limit of normal

33
Q

most approp next step in the high risk or “intermediate” pulm nodule

A

high risk= resect!!

intermediate –> sputum cytology, bronchoscopy (central), transthoracic needle bx (peripheral)

34
Q

pres and work up for restrictive lung dz

A

look for PE signs like loud P2
clubbing of the fingers

high resolution CT scan is better than Xray but lung bx is the best

35
Q

in ILD, granulomas are seen in bx of…..

A

berylliosis (assoc with electronics)

tx with steroids!! this is the most likely pneumoconiosis to respond (albeit just a little)

you can also try azathioprine

36
Q

sarcoidosis can present with and is best treated by?

A

SOB with non productive cough

  • erythema nodosum and lymphadenopathy!!
  • parotid enlargment
  • faicla palsy
  • heart block, restrictive cardiomyopathy
  • CNS
  • uveitis

tx with prednisone

37
Q

indicatoins for IVC filter

A
  • CI to to use of anticoagulants (CNS bleed, GI bleed)
  • reccureent emboli on NOAC
  • RV dysfunciotn on echo
38
Q

indications for thrombolytics in PE?

A

hemodynamically unstable

acute RV dysfunction

39
Q

parameters sufficient for lobectomy in lung cancer?

A

FEV1 >1.5L
DLCO >60% of predicted

consider wedge resection if above are below cut offs

40
Q

unilateral foul smelling nasal discharge with no other sx in a young child

A

foreign body

41
Q

order of surgical W’s

A

w1nd (12-48 hours)

wa2er (day 3 UTI)

wound

walking (7-10 days)

42
Q

order of mechincal ventilation vs surgery in CDH

A

intubate, stabilize, operate at 24-48 hours

43
Q

in V/q mismatch, Aa grad…….

in alveolar hypovent, Aa grad…..

A

increase!

stays the same

44
Q

signs and sx of hemothorax

A

dullness to percussion, tracheal dev to other side, tachy, hypotension, FLAT neck veins

45
Q

initial steps to take in hemoptysis

A

place bleeding lung in dependent position

–> bronch to locate/ stop bleed

46
Q

penetrating trauma with object still in place:

A

surgery

47
Q

60% of patients with flail chest who are NOT responding to O2 supplement

A

intubate –> PPV!

PPV has a splint effect on the flail segment, and pain prevents deep adequate resps

48
Q

diffuse patchy infiltrate on CXR after blunt trauma to chest that gets WORSE with fluids

A

pulmonary contusion –> damaged vasculatre

49
Q

physical location of croup

A

narrowing of subglottic larynx

50
Q

how to tell OHS from OSA

A

elevated bicarb!! with diurnal hypercapnia and resp acidosis suggests that the problem is chronic

51
Q

explain mech for cor pulomale

A

in COPD, chronic hypoxia leads to hypoxic vasoconstriction which increases PVR and overtime leads to R heart failure

52
Q

lung disease pattern seen in diffuse systemic sclerosis?

A

restrictive! decreased diffusion capacity

53
Q

asbestosis

A

shipyard workings
FIRST BRONCHOGENIC CARCINOMA
then mesothelioma

54
Q

first step in management of RDS in neonate

A

CPAP to inc peep!!

if that fails, intubate and give surfactant

55
Q

magnesium in asthma?

A

only used in acute exacerbations after several FAILED rounds of albuterol while you wait for steroids to kick in

it helps relax muscles and reduce vasoscpasm

56
Q

samter’s triad

A

astham/bronchosinusitus + nasal polyps + ASPIRIN!!! ghat causes a PSEUDO allergic (pseudo type 1 hypersensitivity)

57
Q

hypercalcemia in SqCC of the lung?

A

paraneoplastic syndrome –> PTHrP –> inc PTH –> inc Calcium, decreased phosphate

**this is the only paraneoplastic syn assocaited with SQUAMOUS. the others are assoc with small cell

58
Q

non allergic asthma

A

gnerally presents >age 40, triggered by viral illnesses and exercise

probably in a COPD like picture

59
Q

infant that turns blue with feeding and pink when crying?

A

think choanal atresia (bony or membranous obstruction of nasal passages) –> can only breathe through their mouth

bilateral presents immediately!!

unilateral can come in childhood

60
Q

when does surfactant completely develop?

A

34 weeks –> on CXR, see diffuse reticular opacities with air bronchograms

61
Q

non smoker women are most likely to get what cancer

A

adenocarcinoma

62
Q

describes correlations of glucose levels in pleural effusions

A

> 60= normal

30-60= TB, malignant effusion, etc

<30= empyema or rheumatoid pleurisy

63
Q

paraneoplastic syndrome of SMALL cell lung cancer

A

SIADH
ACTH
Lambert Eaton
Cerebellar degeneration

64
Q

diagnostic confirmation of sarcoidosis is with…?

A

lung bx showing non caseating granulomas

USMLE Step 2 (18 decks)

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