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step 2 ck > PULMONARY > Flashcards

PULMONARY Flashcards

1
Q 
tactile fremitus and percussion findings for:
1 consolidation/pna
2 pleural effusion
3 pneuothorax
4 emphysema
5 atelectasis
A 
1 increased TF, dull to P
2 decreased TF, dull to P
3 decreased TF, hyperresonant to P
4 same as 3
5 decreased TF, dull to P
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2
Q

best initial test for acute asthma exxacerbation?

most accurate?

A

peak expiratory flow or ABG

most accurate = PFTs (decreased FEV1/FVC ratio)

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3
Q

if asx, best test to evaluate asthma is

A

methacholine challenge (20% decrease in FEV1)

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4
Q

if asthma, PFT will show an increase of ____ in response to albuterol

A

> 12%

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5
Q

stepwise asthma treatment

6 steps

A

1 inhaled SABA (albuterol)
2 low dose ICS (beclomathasone, budenoside, fluticasone) OR cromolyn/theophylline/leukotriene mods
3 add LABA (salmeterol, formeterol) OR increase ICS
4 increase ICS to maximum and cont LABA + SABA
5 add omalizumab
6 oral corticosteroids (prednisone)

**never use LABA first or alone

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6
Q

tx of acute asthma attack

A

oxygen
albuterol
steroids

if they dont respnd, intubate

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7
Q

young patient and nonsmoker who has air trapping and copd picture. think

A

alpha 1 antitrypsin deficiency

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8
Q

best initial test for copd is

most accurate?

A

cxr
look for increased ap diameter and flattened diaphragm/air trapping

most accurate is PFTs = FEV1 and FVC decreased, FEV1/FVC <70%, increased TLC, incomplete improvement with albuterol (not reversible)

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9
Q

copd treatment

1) things that improve mortality and delay progression
2) improves sx but no change in progression or mortality
3) no benefit

A

1 - smoking cessation, oxygen therapy, and flu/pneumococcal vaccines

2 - albuterol (SABA), anticholinergics (ipratropium, tipropium), steroids, LABA (salmeterol), and pulmonary rehab

3 cromolyn, leukotriene mods (monteleukast)

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10
Q

criteria for oxygen use in copd

A

pO2 below 55 or ox sat below 88%
OR
signs of right sided heart failure or elevated hematocrit with pO2 <60 or sat <90%

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11
Q

cxr for bronchiectasis

most accurate test?

A

thickened dilated bronchi, tram tracks

most accurate test is high res CT

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12
Q

allergic bronchopulmonary aspergillosis
mech?
dx?
tx?

A

hypersensitivity of the lungs to fungal antigens (patient with asthma and atopy)

brown flecked sputum and infiltrates on cxr

dx: peripheral eosinophilia, skin test reactivity to aspergillus ag, serum IgE elevated, CXR/CT infiltrates

tx: oral prednisone (inhaled DOES not work for ABPA)
+ itraconazole orally for recurrent cases

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13
Q

most accurate test for CF is

A

increased sweat chloride test (cl>60)

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14
Q

CF treatment

A

routine abx (inhaled aminoglycosides)
recombinant human deoxyribonuclease
bronchodilators (albuterol)
vaccinations (pneumococcal and influenza)

lung transplant when unresponsive to above therapy

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15
Q

CAP is defined as

A

pna occuring before hospitalization or within 48 hours of admission

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16
Q

what organism is associated with CAP with reference t contaminated water or ventilation?

A

legionella

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17
Q

pneumonia presentations:
1 hemoptysis and currant jelly sputum
2 foul sputum “rotten eggs”
3 dry cough, rarely severe, bullous myringitis
4 GI upset (n/v, diarrhea) or CNS (ha/confusion)
5 AIDS with <200 cd4

A 
1 klebsiella
2 anaerobes
3 mycoplasma pneumoniae
4 legionella
5 pneumocytis (PCP)
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18
Q

best initial test (but not most accurate) for pna?

A

cxr

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19
Q

4 pneumonia orgs not visible on gram stain

A

coxiella
chlamydia
legionella
mycoplasma

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20
Q

sputum gram stain is “adequate” if ….

A

there are more than 25 white blood cells and less than 10 epithelial cells

21
Q

how to diagnose legionella?

A

urine antigen
or
culture on charcoal yeast agar

22
Q

outpatient vs inpatient tx for CAP

A

outpatient is macrolide (azithromycin or clarithromycin) or doxycycline
—if comorbidities do resp fluoroquinolone (levo or moxi)

inpatient is levo or moxi OR ceftriaxone + azithromycin

23
Q

exudate/empyema is suggested by what labs

A

LDH >60% of serum
protein >50% of serum
pH <7.2

24
Q

do healthcare workers need pneumococcal vaccine?

A

NO

25
Q

every 65+ should receive the ___ followed by ___ 6-12 months later

A

pcv13

23pneumococcal

26
Q

health care associated pneumonia defined as

A

pna developing more than 48 hours after admission or after hospitalization in past 90 days

often gram - (e coli or pseudomonas)

27
Q

treatment for healthcare associated pna

A

NOT macrolines (azithro)

need to treat for gram - bacilli
use: antipseudomonals

cefepime or ceftazidine OR pip/tazo OR imipenem/meropenem

28
Q

tx for ventilator associated pna

A 
3 drug therapy
antipseudomonal beta lactam (piptazo, ceftazidime)
\+
aminoglycoside or fluoroquinolone
\+
vanc or linezolid
29
Q

most accurate test for PCP is

when to do it?

A

BAL

if sputum stain is negative in an aids patient
(if sputum is +, no need to do the BAL)
also if LDH is normal, it cant be PCP!

30
Q

ppx for PCP?
tx?

if cant tolerate ?

A

both are tmp-smx

add steroids if pO2 <70 or A-agradient >35

tmp smx can cause rash/bone marrow suppression….can change to clinda + primaquine OR pentamidine
choose pentamidine if patient has G6PD

31
Q

tb treatment

A

RIPE for 2 months..then just RI for 4 more

32
Q

patient with abnrmal CXR or symptoms suggestive of tb should get what next done?

A

sputum acid fast testing x3

33
Q

if screening ppdis + and cxr -, tx?

A

9 months isoniazid + pyridoxine

34
Q

best initial step in all lung lesions/nodules is…

if it is enlarging…

A

compare to old cxr

biopsy it

35
Q

cryoglobulinemia is associated with hx of what disease?

presentation?

A

hep C

palpable purpura + hepatosplenomegaly + proteinuria and hematuria

36
Q

drugs that can cause pulmonary fibrosis?

A 
amiodarone
bleomycin
busulfan
cyclophosphamide
nitrofurantoin
37
Q 
types of pneumoconioses based one xposure
1 coal
2 sandblasting, mining, tunneling
3 shipyard, insulation
4 cotton
5 electronics manufacturing
6 moldy sugar cane
A 
1 coal workers pneumoconiosis
2 silicosis
3 asbestosis
4 byssinosis
5 berylliosis
6 bagassosis
38
Q

pulmonary fibrosis presents with

A

loud P2
clubbing of fingers
dyspnea, worse w exertion
rales/crackles

39
Q

PFTs of ILD (restrictive)

A

everything decreases proportionately

FEV1/FVC will be normal
DLCO is decreased

40
Q

tx for ILD

A

prednisone

41
Q

sarcoidosis
presentation?
dx?
tx?

A

cxr showsbilateral hilar adenopathy, noncaseating granulomas, hypercalcemia (granulomas make vitamin D)

cxr is best initial test
LN biopsy is most accurate test
PFTs will show restrictive picture (normal ratio)

tx with prednisone if symptomatic

42
Q

mc abnormality on ekg for PE

A

nonspecific ST-T wave changes

43
Q

adverse effects of angiography?

A

allergy, renal toxicity, death

44
Q

PE treatment

A

heparin bridge + warfarin (inr 2-3)

45
Q

when is an IVC filter the tx?

A

cant use anticoagulation (GI or brain bleeding)

recurrent emboli while on anticoagulation

RV dysfunction with enlarged RV

46
Q

when to use thrombolytics?

A

hemodynamically unstable

acute RV dysfunction

47
Q

If patient has HIT, switch from heparin to…

A

fondaparinoux

48
Q

most accurate test for pulm htn?

A

right heart (swan-ganz) cath

49
Q

who do you screen for lung cancer?

A

55-80 yo with 30 pack year hx, quit less than 15 years ago

annual low dose ct scan

step 2 ck (16 decks)

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