PULMO

Question 1

The most common infectious cause of acute exacerbation of bronchitis

Answer 1

Respiratory viruses

Respiratory viruses such as influenza A and B, parainfluenza, respiratory syncytial virus, and coronavirus have all been attributed to acute bronchitis.

Question 2

Chronic Bronchitis

Answer 2

Productive cough for 3 months each year for 2 consecutive years, often with dyspnea and partially reversible airway obstruction.

Question 3

Acute exacerbation of Chronic Bronchitis

Answer 3

Change in the characteristic of a productive cough that has lasted for more than 3 months for 2 consecutive years

Question 4

Hallmarks of upper respiratory cough syndrome previously termed “postnasal drip.”

Answer 4

Rhinorrhea and repetitive throat clearing

Question 5

Fever is common in patients with ________________ and is less common with ________________

Answer 5

Fever is common in patients with viral respiratory illnesses and is less common with pertussis infection

Question 6

Acute Bronchitis

Answer 6

cough of at least 5 days duration and can persist up to 20 days

Question 7

risk factor for penicillin resistance

Answer 7

Immunosuppression from alcoholism or
cancer

Question 8

Poor prognostic factors in Elderly

Answer 8

fever greater than 38.3◦C
leucopenia
immunosuppression
gram-negative or staphylococcal infection
cardiac disease
bilateral infiltrates

Question 9

Chronic alcoholism

Answer 9

S. aureus
S. pneumoniae
Klebsiella pneumoniae
Pseudomonas aeruginosa

Question 10

distinguishing a chronic obstructive pul- monary disease (COPD) exacerbation from congestive heart failure (CHF)

Answer 10

B-type natriuretic peptide level

Question 11

ACUTE COUGH

Answer 11

<3 weeks

Associated with self-limited URTI or bronchial infection

URTI: rhinitis, sinusitis, pertussis
LRTI: bronchitis, pneumonia
Allergic reaction
Asthma
Environmental irritants
Transient airway hyperresponsiveness
Foreign body

Question 12

Hallmark of acute bronchitis

Answer 12

PRODUCTIVE COUGH

Question 13

SUBACUTE COUGH

Answer 13

3-8 weeks

postviral airway inflammation with bronchial hyperresponsiveness
mucus hypersecretion
upper airway cough syn- drome (postnasal discharge),
asthma

Question 14

Most likely cause of subacute cough

Answer 14

Postinfectious cough

Question 15

CHRONIC COUGH

Answer 15

> 8 weeks

Question 16

MCC of Chronic cough

Answer 16

(1) smoking, often with chronic bronchitis; (
2) upper airway cough syndrome (formerly postnasal discharge);
(3) asthma;
(4) gastroesophageal reflux; and
(5) angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker therapy

Question 17

Feeling of difficult, labored, or uncomfortable breathing “Shortness of breath,” “breathlessness,” or “not getting enough air”

Answer 17

Dyspnea

Question 18

Rapid breathing

Answer 18

Tachypnea

Question 19

Dyspnea in the recumbent position

Answer 19

Orthopnea

Question 20

Orthopnea that awakens the patient from sleep

Answer 20

Paroxysmal nocturnal dyspnea

Question 21

Dyspnea associated with lying on one side (lateral decubitus position) but not the other side
Patient lies on the side of the more affected lung where gravity increases blood flow to the worse lung and reduces it to the better lung

Answer 21

Trepopnea

Question 22

Dyspnea in the upright position
Results from:
Loss of abdominal wall muscular tone
Right-to-left intracardiac shunting (patent foramen ovale)

Answer 22

Platypnea

Question 23

Hyperventilation; minute ventilation in excess of metabolic demand

Answer 23

Hyperpnea

Question 24

Combined the subjective sensation of dyspnea with signs indicating difficulty breathing

Answer 24

Respiratory distress

Question 25

Occurs when the lungs and ventilatory muscles cannot move enough air in and out of the alveoli to adequately oxygenate arterial blood and eliminate carbon dioxide

Answer 25

Ventilatory or respiratory failure

Question 26

excludes heart failure

Answer 26

BNP (<100 picograms/mL) or NT pro-BNP (<300 picograms/mL)

Question 27

Treatment of Hiccups

Answer 27

SWIF the hiccups Sugar Water Ice Foreign body *Swallow a teaspoon of sugar *Drink water quickly *Sip ice water *Remove foreign body from ear

Question 28

approved for treatment of intractable hiccups

Answer 28

Chlorpromazine

Question 29

Pleural fluid (ml) required to be detectable on an upright chest xray

Answer 29

150-200ml

Question 30

limit therapeutic thoracentesis acute drainage to 1.0 – 1.5 L to prevent

Answer 30

Reexpansion pulmonary edema

Question 31

Light Criteria

Answer 31

1 or more = EXUDATE PROTEIN (P/S) = >0.5 LDH (P/S) = >0.6 LDH (P>S) = >2/3 ****Serum albumin difference: >1.2g/dl or 12g/L

Question 32

HIGH Protein (Transudative vs Exudative)

Answer 32

Exudative

Question 33

LOW Protein (Transudative vs Exudative)

Answer 33

Transudative

Question 34

Massive or severe hemoptysis

Answer 34

100 mL to >1000 mL per 24 hours Midpoint value: 600 mL per 24 hours

Question 35

most commonly affected in hemoptysis

Answer 35

BRONCHIAL ARTERIES

Question 36

Intubation in Hemoptysis

Answer 36

Larger-diameter ET to allow for bronchoscopy Affected lung is in a dependent position to prevent spilling of blood into the unaffected side Preferentially intubate the main bronchus of the unaffected lung

Question 37

Visualization of the more peripheral and upper lobes NOT provide optimal suctioning and does NOT allow for local treatment

Answer 37

Fiberoptic bronchoscopy

Question 38

Cannot fully view the upper lobes and peripheral lesions Greater suctioning ability than fiberoptic bronchoscopy

Answer 38

Rigid bronchoscopy

Question 39

Tamponade the bronchus of the AFFECTED lung

Answer 39

FORGARTY CATHETER

Question 40

Most effective treatment of massive hemoptysis

Answer 40

bronchial artery embolization

Question 41

Most common pathogen causing pneumonia in alchoholics

Answer 41

S. Pneumoniae

Question 42

Most common cause of acquired immune deficiency AIDS-related death in pregnant women

Answer 42

Pnemocystis Pneumonia

Question 44

Acute pulmonary infection in a patient who is not hospitalized or residing in a long-term care facility ≥14 d before presentation

Answer 44

Community-acquired pneumonia

Question 45

New infection occurring ≥48 h after hospital admission

Answer 45

Hospital-acquired pneumonia

Question 46

New infection occurring ≥48 h after endotracheal intubation

Answer 46

Ventilator-acquired pneumonia

Question 47

Healthcare–associated pneumonia

Answer 47

Patients hospitalized for ≥2 d within the past 90 d Nursing home/long-term care residents Patients receiving home IV antibiotic therapy Dialysis patients Patients receiving chronic wound care Patients receiving chemotherapy Immunocompromised patients

Question 48

Rust-colored; gram-positive encapsulated diplococci

Answer 48

Streptococcus pneumoniae

Question 49

Purulent; gram-positive cocci in clusters Patchy, multilobar infiltrate; empyema, lung abscess

Answer 49

Staphylococcus aureus

Question 50

Brown “currant jelly”; thick, short, plump, gram-negative, encapsulated, paired coccobacilli Upper lobe infiltrate, bulging fissure sign, abscess formation

Answer 50

Klebsiella pneumoniae

Question 51

Gram-negative coccobacilli

Answer 51

Patchy infiltrate with frequent abscess formation

Question 52

Short, tiny, gram-negative encapsulated coccobacilli Gradual onset, fever, dyspnea, pleuritic chest pain; especially in elderly and COPD Patchy, frequently basilar infiltrate, occasional pleural effusion

Answer 52

Haemophilus influenzae

Question 53

Multiple patchy nonsegmented infiltrates, progresses to consolidation, occasional cavitation and pleural effusion Few neutrophils and no predominant bacterial species

Answer 53

Legionella pneumophila

Question 54

Gram-negative diplococci found in sputum Diffuse infiltrates Indolent course of cough, fever, sputum, and chest pain; more common in COPD patients

Answer 54

Moraxella catarrhalis

Question 55

Patchy subsegmental infiltrates Few neutrophils, organisms not visible

Answer 55

Chlamydophila pneumoniae

Question 56

Interstitial infiltrates (reticulonodular pattern), patchy densities, occasional consolidation Few neutrophils, organisms not visible

Answer 56

Mycoplasma pneumoniae