Pulmonary

Question 1

Pertussis treatment

Answer 1

Macrolide- azythromycin

Question 2

Older adults with CAP, sicker- what pathogen? How would you treat?

Answer 2

Strep pneumo
B-lactam ie amoxicillin or doxycycline

Question 3

Younger patients with community acquired pneumo- what pathogen and how to treat?

Answer 3

-Atypical pathogens ie. mycoplasma pneumo or chlamydiphilia pneumo
- macrolide ie. azythromycin or doxy

Question 4

Patients with CAP and other comorbid conditions- what pathogen?
Treatement?
If pregnant or CI?

Answer 4

Drug resistant strep pneumo
Resp quinalone- ie. moxi/levofloxacin
Preg- macrolide + beta lactam ie. azythromycin + amoxicillin

Question 5

Three meds used to treat CAP

Answer 5

Macrolide- azythromycin
Resp qinalones- moxi/levo
Beta lactams- amoxicillin +/- clav

Question 6

Diagnostic criteria COPD spiro?

Answer 6

FEV1/FVC <0.7

Question 7

Stages of COPD

Answer 7

4 stages

1- FEV1 > 80%
4- FEV1 < 30%

4 = worst

Question 8

SABA onset and duration

Answer 8

Onset 10 mins- duration 4-6h

Question 9

LABA onset and duration

Answer 9

10-20 mins
Last 12h

Question 10

Steroid treatment of COPD exacerbation

Answer 10

Prednisone 40mg PO OD x 5 d

Question 11

Side effects of anti cholinergics saying-

Answer 11

Oh this drug it makes me pink
Sometimes I can’t think, or even blink
I can’t see
I can’t pee
I can’t spit
I can’t shit

Question 12

What COPD meds do you avoid in ppl with BPH

Answer 12

Antocholinergics ie SAMA/ LAMA

Question 13

Long term side effects of inhaled steroids x2

Answer 13

Increased risk of cataracts - annual eye exams
Increased r/o Osteopenia

Question 14

Normal upper and lower lobe breathe sounds

Answer 14

Upper- vesicular- soft and low
Lower- bronchial- louder

Question 15

Name the condition-
Increased breathe sounds
Increased tactile Fremitus
Percussion- dull

Answer 15

Consolidation ie. lobar pneumonia

Question 16

Name the condition-
Decreased/ absent breathe sounds
Decreased tactile fremitus
Percussion- dull

Answer 16

Pleural effusion
Mediastinal shift away from effusion (if large)

Question 17

Name the condition-
Decreased or absent breathe sounds
Decreased tact frem.
Hyper resonance- percuss

Answer 17

Pneumothorax
Mediastinal shift aware from the tension pneumo

Question 18

Name the condition-
Decreased or absent breathe sounds
Decreased tat frem.
Dullness on percuss

Answer 18

Atelectasis ie. mucus plugging
Mediastinal shift towards the atelctasis.

Question 19

Who qualifies for lung cancer screening?
What is the screening test?

Answer 19

Low dose CT of chest.

Ppl aged 50-80
> / = 20 pack year history and current smoker/ quit within 15 yrs

Stop screening if have quit for >15 yrs

Question 20

Chronic bronchitis definition

Answer 20

Coughing with excessive mucus for > 3 months for 2 consecutive yrs

Question 21

Treatment step wise approach for COPD x 4

Answer 21

SABA +/- SAMA prn
LAMA
LAMA + LABA
LAMA + LABA + ICS

Question 22

Albuterol med class

Answer 22

SABA

Question 23

Salmetrol med class

Answer 23

LABA

Question 24

Formoterol Med Class

Answer 24

LABA

Question 25

Levalbuterol med class

Answer 25

SABA

Question 26

Vilanterol med class

Answer 26

LABA

Question 27

Ipratropium med class

Answer 27

SAMA

Question 28

Tiotropium med class

Answer 28

LAMA

Question 29

Umeclidinium pwder med class

Answer 29

LAMA

Question 30

COPD pt failing on SABA- what do you add?

Answer 30

SAMA

Question 31

COPD pt failing on SABA + SAMA- what’s next?

Answer 31

LABA or LAMA
Then combo them for next step
Keep PRN SABA

Question 32

Rescue med inhaler class?

Answer 32

SABA

Question 33

Gold standard definitive test for CAP?

Answer 33

X-ray- repeat in 6 weeks to document clearing

Question 34

If treating a pt with CAP who has antibiotics within last 3 months- treat with what?

Answer 34

Doxycycline or levofloxacin

Question 35

Young person with CAP- treatment?

Answer 35

Think atypical pathogen
and treat with azythromycin or doxycycline

Question 36

Older person with CAP- treatment?

Answer 36

Think S.Pneumo - treat with beta-lactam or doxycycline

Question 37

If DRSP CAP is suspected- treatment is?

Answer 37

Resp Quinalonee ie. moxifloxi or levofloxi

Question 38

CURB 65 ?

Answer 38

Confusion
BUN elevated
Resp > 30
BP <90/60
65 yrs or older
Score >1 == hospitalize

Question 39

Top 2 bacteria in CAP

Answer 39

S. Pneumo
H. Influenza

Question 40

2 Top bacteria in Atypical Pneumonia

Answer 40

Mycoplasma pneumo
Chlamydia pneumo

Question 41

Suspect pertussis after pt experiences what?

Answer 41

Coughing for >2-3 weeks
Or failed on abx and is getting worse

Question 42

Duration and treatment of common cold?

Answer 42

Duration of symptoms 4-10 days
Treatment is supportive care

Question 43

CXR shows cavitations and adenopathy and granule as in the hill of the lungs—-?

Answer 43

Reactive TB

Question 44

Present in younger children and elderly
-milia seed on CXR

Answer 44

Military TB

Question 45

Quad therapy- rifampin + ethambutol + pyrazinamide + INH
Treatment of what disease?
How long for?

Answer 45

TB
2 months of intensive treatment
18 weeks continuation phase treatment

Question 46

Positive PPD TB test

Answer 46

< 10mm
Induration at site

Question 47

ICS + LABA Combo names x 2

Answer 47

Advair- fluticasone + salmeterol

Symbicourt- budesonide + formoterol

Question 48

Step 3 Asthma criteria
Treatment-

Answer 48

FEV1 60-80%
Nightly awakenings 1/wk (not nightly)
Tx- low-dose ICS + LABA

Question 49

1st line treatment for severe asthma exacerbation

Answer 49

Epinephrine injection

Question 50

Two medications that cause interstitial lung disease

Answer 50

Amiodarone and methotrexate