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Step 2 > Pulmonary 1 (Step up son) > Flashcards

Pulmonary 1 (Step up son) Flashcards

1
Q

What is an A-a gradient? What is the normal range?

A

Alveolar [O2] - arterial [O2]

Normal is 5-15mmHg

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2
Q

What causes an increased A-a gradient?

A

Things that would decrease arterial [O2]

Right to left shunt (mixes deoxygenated into oxygenated)
PE (decreased pulmonary capillary perfusion --> less blood can become oxygenated)
Pulmonary edema (increased barrier to diffusion)
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3
Q

What are two scenarios in which a person would have decreased arterial [O2], but a ‘normal’ A-a gradient?

A

Things that would decrease Alveolar [O2]

Hypoventilation
High altitudes

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4
Q

How is Alveolar [O2] determined? what is the normal range?

A

150mmHg - arterial [CO2] = ~110mmHg

arterial [CO2] via ABG (usually ~40mmHg)

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5
Q

How is arterial [O2] determined? what is the normal range?

A

ABG

90-100mmHg

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6
Q

What viruses typically cause the common cold?

A

Rhinovirus
Coronavirus
Adenovirus

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7
Q

Why do you treat strep throat if it is often self limited?

A

To prevent RHD

Does NOT help to prevent poststrep glomerulonephritis

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8
Q

A patient comes in complaining of sore throat, ear pain, and a fever. You try to look at the throat, but he won’t open his mouth very wide, but you get a glance and see that one tonsil is larger than the other and the uvula is pointing away from the larger tonsil. What is the concern? How is it treated?

A

Peritonsillar abscess

IV Abx and I&D…tonsillectomy after resolution

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9
Q

What are the common causes of acute sinusitis? How is it treated?

A

Strep pneumo
H. influ
Moraxella catarrhalis
Viral infection

Amoxicillin x 2wks

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10
Q

What is a possible complication of acute sinusitis if untreated?

A

Meningitis

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11
Q

When is sinusitis deemed ‘chronic’? What causes chronic sinusitis? How is it treated?

A

Sinus symptoms for 3+ months

Obstruction + anaerobic infection

Amoxicillin x 6-12wks +/- surgery

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12
Q

Patient comes in with a fever and the entire workup is negative. Blood, CSF, urine, CXR, no GI symptoms…nothing. What else could be considered?

A

Sinus CT…could show fluid levels and/or opacification

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13
Q

A nonsmoker comes in with a productive cough, fever, and wheezing. What does she have? What is likely causing it?

A

Acute bronchitis

Virus (most likely)
Mycoplasma pneumonia (Dx: Cold agglutinin titer Tx: tetracycline, fluoroquinolone, or macrolide)
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14
Q

A smoker comes in with an acute bronchitis. What is the likely cause? What else could cause it?

A

Viral is most likely

Strep pneumo and H. influ are also common

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15
Q

What is the most common cause of pneumonia in kids?

A

Viral (nonproductive cough…self-limited)

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16
Q

What is the most common cause of pneumonia in adults?

A

Strep pneumo (productive cough…beta-lactam or macrolide)

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17
Q

Which bacteria commonly infect sickle cell patients?

A

Strep pneumo
H. influ
Klebsiella

18
Q

What is a common cause of pneumonia in COPD patients?

A

H. influ (slow onset…beta-lactam or TMP-SMX)

19
Q

Patient has “currant jelly” sputum. What is the likely bug? What risk factors could the patient have?

A

Klebsiella (cephalsporin AND aminoglycoside [gentamicin, trobramycin])

Increased risk of aspiration (alcoholic)
Prolonged hospitalization
Sickle cell disease

20
Q

What type of pneumonia are cystic fibrosis patients at increased risk of contracting? Who else is more likely to contract?

A

Pseudomonas (fluoroquinolone, aminoglycoside, or 3rd gen cephalosporin)

Chronically ill (nosocomial)
Immunocompromised
21
Q

What type of bacteria causes pneumonia in neonates/infants?

A

Group B Strep (beta-lactam)

22
Q

Who is at increased risk of contracting enterobacter pneumonia? How is it treated?

A

Old people in hospitals

TMP-SMX

23
Q

A young adult comes in with a mild pneumonia and a rash. What should be checked? How should it be treated?

A

Cold agglutinin test (+ = mycoplasma pneumonia)

Macrolide (azithromycin, clarithromycin, erythromycin)

24
Q

A patient comes in with a slowly progressing pneumonia with some GI and CNS symptoms. What is the likely bug? What was the likely exposure?

A

Legionella (macrolides; fluoroquinolone)

Aerosolized water (air conditioner)

25
Q

A patient has frequent, recurrent sinusitis and a slowly progressive pneumonia. What is the likely bug?

A

Chlamydophila pneumonia (doxy, macrolide)

26
Q

A patient comes back from traveling to SW US and now 1-3 weeks later has mild pneumonia symptoms. What is a possible cause?

A

Coccidiodomycosis…a dimorphic fungi (amphotericin B or fluconazole)

27
Q

A patient has been spelunking and now 1-3 weeks later has mild pneumonia symptoms. What is a possible bug?

A

Histoplasmosis…often dx with serology; cx takes ~6wks (itraconazole)

28
Q

A patient came back from central america 3-12 weeks ago and now has mild pneumonia symptoms. What is a possible bug?

A

Blastomycosis…yeast (itraconazole)

29
Q

Patient comes because he has had bad night sweats and hemoptysis. CXR shows apical fibronodular infiltrates. What does this guy have? What is the treatment?

A

Reactivated TB

RIPE (Rifampin, Isoniazid [INH], Pyrazinamide, Ethambutol) followed by Rifampin and INH for a total of 6 months…give B6 (pyridoxine) to counteract INH competition for neurotransmitter synthesis

30
Q

There are 12 common causes of ARDS. What are they? (HINT: they all start with letters in ARDS)

A 
A:
     Aspiration
     Acute pancreatitis
     Air embolism
     Amniotic embolism
R:
     Radiation
D:
     Drug overdose
     Diffuse lung disease
     DIC
     Drowning
S:
     Shock
     Sepsis
     Smoke inhalation
31
Q

What is seen on ABG with ARDS? Pulmonary Wedge Pressure? PaO2:FiO2?

A

ABG: Respiratory alkalosis (pH > 7.45; PaCO2 500)

32
Q

How is ARDS treated?

A 
In ICU 
On ventilator:
     PEEP
     Increased inspiratory times
     FiO2 to keep sats >90%
Treat underlying cause
Keep fluid volume low (prevent pulmonary edema)
Extracorporeal Membrane Oxygenation (ECMO) may be necessary
33
Q

Besides clinical symptoms and frequency of medication use, what else is used to classify asthma? What is seen on PFTs with asthma?

A

Peak Expiratory Flow Rate (PEFR)

Decreased FEV1, but not as decreased as FVC, and normal/elevated diffusion

34
Q

A normal CO2 is seen during an asthma exacerbation. Is this normal?

A

NO…indicates impending respiratory failure

Increase beta-agonists and supplemental O2, and be prepared to ventilate

35
Q

A smoker comes in and says that they have probably had a productive cough for at least 3 months during each of the last two years. What can this person be diagnosed with?

A

Chronic bronchitis (continuum with emphysema as COPD)

36
Q

What is the reasoning behind the term “blue bloater”?

A

Chronic bronchitis –> cor pulmonale –> cyanosis (blue) and peripheral edema (bloated)

37
Q

What is the reasoning behind the term “pink puffer”?

A

Emphysema –> pursed lip breathing (pink) and dyspnea + barrel chest (puffing/puffed)

38
Q

Besides the possible clinical differences that differentiate chronic bronchitis and emphysema (blue bloater vs pink puffer), what can more definitively distinguish the two?

A

Diffusion capacity D(Lco)
Normal with chronic bronchitis
Decreased with emphysema

39
Q

What is one way a CXR can help differentiate common emphysema (caused by smoking) from alpha1-antitrypsin deficiency emphysema?

A

Normal –> centrilobular distribution

Alpha1-antitrypsin deficiency –> panlobular distribution

40
Q

Bronchiectasis occurs secondary to chronic airway obstruction. What is seen on radiology with bronchiectasis?

A

CXR: Multiple cysts and bronchial crowding
CT: bronchial dilation, wall thickening, and wall cysts

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