Pulmonary

Question 1

What is the time period for an acute cough and what are some typical causes?

Answer 1

< 3 weeks

post-infection, viral

Question 2

What is the time period for a subacute cough and what are some typical causes?

Answer 2

3 - 8 weeks

pertussis, eosinophilic bronchitis

Question 3

What is the time period for chronic cough and what are some typical causes?

Answer 3

> 8 weeks

bronchitis, asthma, COPD, GERD, TB, ACEI, allergic rhinitis, fibrosis, lung CA

Question 4

What are the most common causes of cough?

Answer 4

upper airway cough syndrome (PND)
asthma
GERD
laryngopharyngeal reflux

Question 5

What are some social history factors you would be especially concerned about for chronic cough?

Answer 5

smoking history
employment exposure
incarceration

Question 6

What is the typical clinical picture of a patient with a spontaneous pneumothorax? (risk factors)

Answer 6

tall, lean males
FHx
> 40 yo unlikely

Question 7

What are some signs and symptoms for a spontaneous pneumothorax?

Answer 7

SOB at rest
acute dyspnea
ipsilateral pleuritic CP
tachycardia and hypotension are common but not always present

Question 8

What are some things you would find on PE of a spontaneous pneumothorax?

Answer 8

diminished breath sounds

hyperresonance to percussion

Question 9

What would you see on a CXR of a patient with a spontaneous pneumothorax?

Answer 9

visceral pleural line

Question 10

What is the treatment for spontaneous pneumothorax?

Answer 10

supplemental O2 x 6 hours

aspiration of air with chest tube or needle decompression

Question 11

What is commonly the cause of tension pneumothorax?

Answer 11

trauma, MVC

Question 12

what are signs and symptoms that are more common to see in a tension pneumothorax rather than spontaneous?

Answer 12

hypotension and hypoxia

Question 13

What are some things you would find on exam of a patient with tension pneumothorax?

Answer 13

absent breath sounds on ipsilateral side
tracheal deviation
hyperresonance to percussion
JVD, tachy

Question 14

What would you see on CXR of a patient with tension pneumothorax?

Answer 14

mediastinal shift to contralateral side

Question 15

Treatment of tension pneumothorax:

Answer 15

needle decompression 2nd ICS, 14 - 16” cath

Question 16

What is the #1 complication of COPD?

Answer 16

upper airway infection

Question 17

What is the technical diagnosis for COPD?

Answer 17

emphysema + chronic bronchitis, cough and sputum production for at least 3 months in each of 2 consecutive years

Question 18

Risk Factors: 80% of COPD patients are _______.

Answer 18

smokers

Question 19

How might Hgb and Hct values differ in a patient with COPD?

Answer 19

elevated Hgb and Hct (chronic hypoxia)

Question 20

What is the GOLD guideline diagnostic for COPD?

Answer 20

FEV1/FVC < 0.7

Question 21

What are the FEV1 values (% predicted) for GOLD criteria?

Answer 21

Gold 1: FEV1 >= 80

Gold 2: FEV1 50 - 79

Gold 3: FEV1 30 - 49

Gold 4: FEV < 30

Question 22

What is the recommended first choice for pharmacologic therapy for a patient with COPD in category A (low risk, less symptoms)?

Answer 22

SABA (albuterol sulfate)
or
SAMA (ipratropium)

Question 23

What is the recommended first choice for pharmacologic therapy for a patient with COPD in category B (low risk, more symptoms)?

Answer 23

LABA (salmeterol/formoterol)
or
LAMA (tiotropium)

Question 24

What is the recommended first choice for pharmacologic therapy for a patient with COPD in category C (high risk, less symptoms)?

Answer 24

ICS (beclomethasone, fluticasone, mometasone) + LABA or LAMA

Question 25

What is the recommended first choice for pharmacologic therapy for a patient with COPD in category D (high risk, more symptoms)?

Answer 25

ICS + LABA and/or LAMA

Question 26

What is the gold standard for evaluating a patient with asthma?

Answer 26

peak flow expiratory rate

FEV1/FVC < 80% or + > 12% increase of FEV1 with bronchodilator

Question 27

What are the rules of two for asthma patients? (if yes to any of these, Rx adjustment)

Answer 27

quick relief inhaler > 2x/week
awake at night > 2x/month
refill quick-relief inhaler > 2x/year

Question 28

How are asthma exacerbations managed?

Answer 28

1. O2
2. SABA (3 tx every 20 - 30 min with ipratropium if severe)
3. systemic corticosteroids
4. consider IV MgSO4 or heliox

Question 29

What is the stepwise treatment approach for asthma patients?

Answer 29

1. SABA
2. low dose ICS
3. low dose ICS + LABA
4. medium dose ICS + LABA
5. high dose ICS + LABA
6. high dose ICS + LABA + oral corticosteroids

Question 30

What is the CURB-65 Score for PNA?

Answer 30

score gives you a suggested site-of-care for PNA patients

C = confusion
U = blood urea nitrogen >= 20 mg/dL
R = RR >= 30
B = systolic BP < 90 or diastolic BP <= 60
65 = age >= 65

0 - 1 = outpatient
2 = short inpatient / supervised outpatient
3 = inpatient
4 - 5 = inpatient / ICU

Question 31

How should you treat PNA in patients that were previously healthy with no risk factors for drug-resistant S. pneumoniae ?

Answer 31

macrolide

Question 32

How should you treat PNA in the presence of comorbidities (chronic heart, lung, liver, renal dz, DM, alcoholism, etc.)
or in a PNA patient with the use of antimicrobials within the previous 3 months
or other risk factors for drug-resistant S. pneumoniae?

Answer 32

macrolide + beta lactam
or
respiratory FQ (levofloxacin)