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USMLE step2 > pulmonary > Flashcards

pulmonary Flashcards

1
Q

increase on A-a gradient causes

A 
CORRECT WITH O2(V/Q mismatch)
-airway disease(asthma,COPD)
-interstitial lung disease
-alveolar disease(Atelectasis,pneumonia,pulmonary edema)
-pulmonary vascualr disease
DONNOT CORRECT WITH O2
-right-left shunt
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2
Q

ARDS Dx

A
  • PaO2/FiO2 ratio below 300
  • acute onset respiratory distress
  • BILATERAL pulmonary infiltrates on CXR
  • respiratory failure not completely explainend by heart failure
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3
Q

goal oxygenation on ARDS

A

PaO2>55mmHg or SaO2>88%

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4
Q

tidal volumes mechanical ventilation onARDS

A

4-6cc/Kg

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5
Q

pulmonary hypertention

A

> 25mmHG

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6
Q

Malignant lung nodule

A 
New or enlarging lesions
>2cm
irregular calcifications or absent
age>45
smoker
irregular margins
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7
Q

samters triad

A

asthma
aspirine intolerance
nasal polyps

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8
Q

Obtructive pulmonary Disease

A

FEV/FVC less than 80%

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9
Q

mild persistent asthma and tx

A

> 2 weekly NOT DAYLY
2 nights 7Month
low dose steroid
PRN shorts acting beta agonist

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10
Q

Moderate persistent asthma dn tx

A 
DAYLY 
>1 night/week
med dose corticosteroid
Long actint B agonist
PRN short acting
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11
Q

severe persistent

A

coninual episodes
high dose steroid, oral steroir
long acting B agonist
PRN short acting

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12
Q

improves COPD survival

A
  • smoking cessation and O2

- influenza and pneumococcal vaccination

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13
Q

O2 inditacion for COPD

A

hypoxemia
right heart failure
polycythemia

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14
Q

medications contribute to interstitial lung disease

A 
AMIODARONE(foamy macrophages)
busulfan
nitrofurantoin
blomycin
radiation
long term O2 concentration
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15
Q

antifibrotic agent for interstitial lung disease

A

pirfenidone

nintedanib

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16
Q

Löfgren syndrome

A

sarcoidosis type:
bilateral hilar adenopathy
erythema nodosum
arthritis

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17
Q

silicosis related infection

A

TB

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18
Q

pneumonia types

A

CAD(S-pneumo)
HAP(gram-negative bacilli)
VAP

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19
Q

lung abscess treatmetn

A

clinda or penicillin

20
Q

empyema lab finds

A
  • LDH above 60% of serum level.
  • Protein above 50% of serum level.
  • White cell count above 1000
  • Ph
21
Q

best initial test in acute exacerbation os asthma

A

peak expiratory flow(its decreased)

22
Q

when to intubate a asthma patient

A

respiratori acidosis( increased PCO2)

23
Q

patient with obstrutive patern
increased DLCO=
low DLCO=

A
  • increased DLCO=asthma

- low DLCO=emphysema

24
Q

best initial test for chronic COPD

A

chest x ray

25
Q

most accurate test for COPD

26
Q

indication for O2 in COPD

A
  • PO2 less o equal to 55mmHg
  • Saturation less o equal 88%
  • 60mmhg and 90 % when there is HTN,high HCT or cardiomyopathy
27
Q

single most common cause of bronchiectasis

A

cystic fibrosis

28
Q

best initial step for bronchiectasy

A

chest x-ray

most accurate:high resolution CT

29
Q

antibiotics for COPD,bronchiectasy and cystic fibrosis

A

macrolides, cefalosporins,amoxi/clav,quinolones)

30
Q

atypical pnuemonia(non visible on gram stain and not culturable on standard blood agar)

A
  • Mycoplasma
  • Chlamydophila
  • Legionella
  • Coxiella
  • viruses
31
Q

CURB 65

A

-confusion
-BUN more than 20
-Respiratori distress
-BP low
-age65
CURB MORE THAN 2= HOSPITALIZATION
CURB MORE THAN4= ICU

32
Q

treatment of Hospital-acquired pneumonia

A

antipseudomonal B lactam

33
Q

ventilator associated pneumonia treatmetn

A

combine 3 drugs

  • antipseudomonal b lactam
  • second antipseudomonal
  • MRSA(vanco or linezolid)
34
Q

most accurate test for PCP

A

broncheoalveolar lavage

35
Q

PCP treatmen in TMP allergi

A

2 LINE:clida + primaquine

3 LINE: pentaminidine

36
Q

PCP profilaxis

A
  • TMP/SMX

- if allergic give ATOVAQUONE OR DAPSONE

37
Q

single most accurate test for pulmonary TB

A

pleural biopsy

38
Q

PPD for health workers

A

yearly and the cut point its 10mm

39
Q

dysnea, loud p2 , fine ryales , and clubbing fingers

A
  • pulmonary fibrosis
  • idiopathic
  • radiation
  • drugs:amiodarone,bleomycin,nitrofurantoin,busulfan,
40
Q

restrictive patern FPT and decrease DLCO

A

pulmonary fibrosis

41
Q

firts initial test for pulmonar embolous

A

WHEN THE HISTORY ITS CLEAR GIVE HEPARIN FIRTS

  • chest X ray(hampton pump, and westermark sign)
  • EKG(right axis deviation, RV hypertrophy and RBBB)
  • ABG(respiratory alkalosis)
42
Q

criteria for exudative effusion

A
  • pleural/serum protein more than 0.5

- pleural/serum LDH more than 0.6

43
Q

best prognosis indicator of COPD

44
Q

anti TB medicantion contraindicated in pregnancy

A

Pyrazinamide

45
Q

abnormal calcificaiton in solitary pulmonary nodude

A

-stippled,spiculated,eccentric

46
Q

rapid shallow breathing index(respiratory rate/tidal volume)=

A

-under 100

patient its ready to be extubated

USMLE step2 (21 decks)

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