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USMLE Step 2 CK > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Symptoms worse at night, nasal polyps, sensitivity to aspirin

A

asthma

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2
Q

best initial test in acute asthma exacerbation

A

PEF or ABG

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3
Q

most accurate test for asthma

A

PFTs

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4
Q

characteristic PFTs in asthma

A

Decreased FEV1 (more so), decreased FVC, and decreased FEV1/FVC, increased DLCO

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5
Q

result of albuterol challenge in asthma

A

increased FEV1 >12% or 200 ml

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6
Q

result of methacholine challenge in asthma

A

Decreased FEV1 >20%

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7
Q

increased IgE in asthma is associated with

A

allergic bronchopulmonary aspergillosis

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8
Q

tx of asthma

A

inhaled SABA (albuterol)

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9
Q

tx of asthma if albuterol is insufficient

A

add low dose corticosteroid

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10
Q

tx if IgE positive asthma

A

omalizumab

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11
Q

if SABA and corticosteroid are insufficient to treat asthma then

A

add LABA and/or increase corticosteroid

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12
Q

if all other medical therapies are ineffective in asthma then

A

add oral steroids (prednisone)

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13
Q

adverse effects of systemic steroids

A

osteoporosis, cataracts, adrenal suppression and fat redistribution, Hyperlipidemia, hyperglycemia, acne, hirsuitism, thinning of skin, striae, easy bruising

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14
Q

adverse effects of inhaled steroids

A

dysphonia, oral candidiasis

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15
Q

indicators of severity in acute asthma attack

A

RR, decreased PEF, ABG with increased Aa gradient

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16
Q

asthma predisposes to

A

pneumothorax

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17
Q

tx of acute asthma exacerbation

A

oxygen, albuterol, steroids

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18
Q

most common cause of COPD

A

tobacco, destroys elastin

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19
Q

COPD in young non smoker

A

alpha 1 antitrypsin deficiency

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20
Q

best initial test for COPD

A

x ray (increased AP, flattened diaphragm)

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21
Q

most accurate test for COPD

A

PFT

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22
Q

characteristic PFTs in COPD

A

↓ FEV1, ↓ FVC, ↓ FEV1/FVC (<70%)
↑TLC (↑ residual volume)
↓ DLCO (emphysema, not chronic bronchitis)

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23
Q

CBC finding in COPD

A

increased hematocrit

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24
Q

cardiac findings in COPD

A

RA, RV hypertrophy, A fib or MAT, pulmonary HTN

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25
Q

when do you give oxygen in COPD

A

If pO2 <90%

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26
Q

tx that decrease mortality in COPD

A

smoking cessation, influenza and pneumoccocal vaccines, oxygen

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27
Q

tx if COPD not controlled with albuterol

A

inhaled anticholinergics (tiotropium, ipratropium) → inhaled steroid

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28
Q

Most common cause of acute exacerbations of chronic bronchitis

A

infections

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29
Q

most common cause of bronchiectasis

A

cystic fibrosis

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30
Q

Recurrent episodes of very high volume purulent sputum production, dyspnea, and wheezing

A

bronchiectasis

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31
Q

best initial test for bronchiectasis

A

x ray (tram tracks)

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32
Q

most accurate test for bronchiectasis

A

CT

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33
Q

tx for bronchiectasis

A

chest physiotherapy (cupping, clapping), rotate antibiotics (1 weekly each mo)

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34
Q

population that gets allergic bronchopulmonary aspergillosis

A

Almost exclusively in asthmastics with atopic disorders

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35
Q

Recurrent episodes of brown flacked sputum and transient infiltrates of x ray

A

allergic bronchopulmonary aspergillosis

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36
Q

tx of allergic bronchopulmonary aspergillosis

A 
oral steroids (prednisone) if severe.  Inhaled steroids are NOT effective
Itraconazole for recurrent episodes
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37
Q

tx for cystic fibrosis

A

antibiotics, inhaled recombinant human deoxyribonuclease, albuterol, pneumococcal and influenza vacccines

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38
Q

organism: CAP in COPD

A

H influenza

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39
Q

organism: CAP after recent viral infection

A

staph aureus

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40
Q

organism: CAP in alcoholic or diabetic

A

klebsiella

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41
Q

Currant jelly sputum, hemoptysis from necrotizing disease

A

klebsiella

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42
Q

organism: CAP with poor dentition

A

anaerobes

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43
Q

Foul smelling sputum “rotten eggs”

A

anaerobes

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44
Q

orgnaism: CAP in young healthy adult

A

mycoplasma pneumoniae

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45
Q

Dry cough, rarely severe, bullous myringitis

A

mycoplasma pneumoniae

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46
Q

dx of mycoplasma pneumoniae

A

PCR, cold agglutins, serology, special culture media

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47
Q

organism: CAP with horseness

A

chlamydia pneumoniae

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48
Q

dx of chlamydia pneumoniae

A

rising serologic titers

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49
Q

organism: CAP from ventillation

A

legionella

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50
Q

organism: CAP with GI (abdominal pain, diarrhea), or CNS (HA, confusion)

A

legionella

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51
Q

dx or legionella

A

urine antigen, culture on charcoal-yeast extract

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52
Q

organism: CAP with bird exposure

A

chlamydia psittaci

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53
Q

dx of chlamydia psittaci

A

rising serologic titers

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54
Q

organism: CAP with birthing animal exposure

A

coxiella burnetti

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55
Q

dx of coxiella burnetii

A

rising serologic titers

56
Q

dx of PCP

A

bronchoalverolar lavage

57
Q

best initial test in CAP

58
Q

organisms in CAP, bilateral intersitital infiltrates, with dry productive cough

A

Mycoplasma, viruses, coxiella, PCP, chlamydia

59
Q

next step in all new pleural effusions

A

thoracentesis

60
Q

LDH >60%, protein >50%, WBC >1000, or pH <7.2

A

exudate = infection or CA = empyema

61
Q

outpatient CAP tx in Previously healthy or no antibiotics for past 3mo and mild symptoms

A

Macrolide (azithromycin or clarithromycin) OR doxycycline

62
Q

outpatient CAP tx in Comorbidities or antibiotics in past 3 mo

A

Fluoroquinolones (levofloxacin or moxifloxacin)

63
Q

in patient CAP tx

A

Fluoroquinolones (levofloxacin or moxifloxacin) OR ceftriaxone and azithromycin

64
Q

rule for hospitalization in pneumonia

A

if >2: CURBS65 = confusion, uremia, respiratory distress, BP low, age >65

65
Q

tx of hospital acquired pneumonia

A

antipseudomonal cephalosporins (cefepime or ceftazidime) or antipseduomonal penicillin (piperacillin/tazobactam) or carbapenems (imipenem, meropenem, or doripenem)

66
Q

most accurate test for ventilator associated pneumonia

A

open lung biopsy

67
Q

tx for ventilator associated pneumonia

A 
Antipseudomonal beta lactam:
antipseudomonal cephalosporins (cefepime or ceftazidime) or antipseduomonal penicillin (piperacillin/tazobactam) or carbapenems (imipenem, meropenem, or doripenem)
AND
Second antipseudomonal agent:
Aminoglycoside (gentamicin, tobramycin, or amikacin) or fluoroquinolone (ciprofloxacin or levofloxacin)
AND
MRSA agent:
Vanco or linezolid
68
Q

adverse effect of imipenem

69
Q

which lobe: aspiration pneumonia when lying flat

A

upper lobe

70
Q

best initial test for lung abscess

71
Q

most accurate test for lung abscess

72
Q

tx for lung abscess

A

clindamycin or penicillin

73
Q

best initial test for PCP

A

x ray or ABG

74
Q

most accurate test for PCP

A

bronchoalverolar lavage

75
Q

what is always elevated in PCP

76
Q

negative sputum stain in PCP, next best dx test?

A

bronchoscopy

77
Q

best initial tx for PCP

78
Q

prophylactic tx for PCP when TMP/SMZ causes rash

A

atovaquone or dapsone

79
Q

dapsone contraindicated in

A

G6PD deficiency

80
Q

primaquine contraindicated in

A

G6PD deficiency

81
Q

tx of PCP when TMP/SMX is toxic

A

clindamycin and primaquine or pentamidine

82
Q

what do you add to tx of PCP in severe disease

83
Q

best initial test for TB

84
Q

test to exclude TB

A

sputum stain and culture for acid fast bacilli x3

85
Q

most accurate test for TB

A

pleural biopsy

86
Q

tx for TB

A

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

RIPE for 2 mo, then d/c ethambutol and pyrazinamide. Continue rifampin and isoniazid for 4 more mo = 6 mo total

87
Q

if pericardial involvement of TB meningitis add what to tx

A

glucocorticoids

88
Q

adverse effects of rifampin

A

red color to secretions (benign)

89
Q

adverse effects of isoniazid

A

peripheral neuropathy (use pyridoxine to prevent)

90
Q

adverse effects of pyrazinamide

A

hyperuricemia, only tx if symptomatic.

91
Q

adverse effects of ethambutol

A

optic neuritis/color vision – decrease dose in renal failure

92
Q

which TB drug is contraindicated in pregnancy

A

pyrazinamide

93
Q

positive PPD in high risk

94
Q

positive PPD in medium risk

95
Q

positive PPD in no risk

96
Q

next step when positive PPD

A

x ray and 9 mo of isoniazid, even if prior BCG

97
Q

what test is equivalent to PPD and has no cross reaction with BCG

A

Interferon gamma release assay (IGRA)

98
Q

management of lung nodule with intermediate probability of malignancy

A

bronchoscopy for central lesions, transthoracic biopsy for peripheral lesions

99
Q

most common adverse effect of transthoracic biopsy

A

pneumothorax

100
Q

causative drugs of interstitial lung disease

A

bleomycin, busulfan, amiodarone, methylsergide, nitrofurantoin, cyclophosphamide

101
Q

byssinosis d/t

102
Q

bagassosis d/t

A

moldy sugar cane

103
Q

best initial test for interstitial lung disese

104
Q

most accurate test for interstitial lung disease

A

lung biopsy

105
Q

characteristic PFTs in interstitial lung disease

A

restrictive disease. FEV1/FVC is normal, DLCO decreased

106
Q

tx for interstitial lung disease

A

prednisone

107
Q

best initial test for sarcoidosis

108
Q

most accurate test for sarcoidosis

A

lymph node biopsy

109
Q

bronchoalverolar lavage in sarcoidosis shows

A

helper cells

110
Q

tx for sarcoidosis

A

prednisone

111
Q

what is elevated in sarcoidosis

A

ACE - granulomas make Vit D

112
Q

most common finding on x ray in PE

A

atelectasis

113
Q

most common finding on EKG in PE

A

non specific ST/T wave changes

114
Q

most common finding on ABG in PE

A

hypoxia and respiratory alkalosis (high pH, low pCO2)

115
Q

best initial test for PE

A

x ray, EKG, ABG

116
Q

if x ray abnormal and suspect PE then next dx test?

117
Q

V/Q is superior to spiral CT for PE when

118
Q

most accurate test for PE

A

angiography

119
Q

adverse effects of angiography for PE

A

allergy, renal toxicity, and death

120
Q

best initial tx for PE

A

heparin and warfarin (INR 2-3)

121
Q

alternative tx to heparin in PE

A

fondaprinux

122
Q

hampton hump and westermark sign suggest

123
Q

when do you use thrombolytics for PE

A

when hemodynamically unstable or acute RV dysfunction

124
Q

when are direct acting thrombin inhibitors (argatroban, lepirudin) used in PE

125
Q

pulmonary HTN is

126
Q

best initial tests for pulmonary HTN

A

x ray and CT

127
Q

most accurate test for pulmonary HTN

A

swan ganz cath

128
Q

prostacyclin analogue tx for pulmonary HTN

A

epoprostenol, treprostinil, iloprost, beraprost

129
Q

endothelin antagonist tx for pulmonary HTN

130
Q

phosphodiesterase inhibitor tx for pulmonary HTN

A

sildenafil

131
Q

what slows progression of pulmonary HTN

132
Q

only cure for pulmonary HTN

A

lung transplant

133
Q

x ray findings in ARDS

A

white out with air bronchograms

134
Q

ARDS definition

A

pO2/FIO2 <300

135
Q

tx of ARDS

A

mechanical ventilation with 6ml/kg tidal volume

136
Q

if FIO2 >50% in ARDS then

A

add PEEP and Maintain plateau pressure <30cm of water

137
Q

are steroids beneficial in ARDS

USMLE Step 2 CK (11 decks)

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