pulmonology

Question 1

tx influenza

Answer 1

zanamivir 10mg BID x 5 days if within first 24 hrs

Question 2

fatigue, WL, fever, night sweats, productive cough. next step for dx?

Answer 2

three consecutive morning sputum specimens, light microscope to look for acid-fast bacilli on smear, chest xray to look for pulmonary opacities

Question 3

TX TB for non-HIV pts

Answer 3

I, R, P, E for 2 months then I and R 2-3x/wk for 4 months

Question 4

tx tb for HIV

Answer 4

treat with same but for at least 9 months and watch for drug resistance

Question 5

what if drug resistant TB?

Answer 5

try streptomycin

Question 6

tx latent TB

Answer 6

isoniazid for 9 mon, rifampin and pyrazinamide for 2 months,

Question 7

monitoring labs in TB treatment

Answer 7

serum bilirubin and hepatic enzymes, urea nitrogen, CBC and creatinine, audiometry if steptomycin issued

Question 8

shaking chills, high fever, pleuritic chest pain, cough with purulent rust colored sputum. CXR shows LLL infiltrate

Answer 8

pneumococcal pneumonia

Question 9

injection drug use pneumonia organism

Answer 9

staph aureus

Question 10

periodontal disease causitive organism

Answer 10

anaerobs

Question 11

erythema nodosum

Answer 11

TB, chlamydia species

Question 12

erythema multiforme organism

Answer 12

m pneumonia, histoplasma capsulated

Question 13

bullous myringitis pneumonia

Answer 13

mycoplasma

Question 14

aspiration pneumonia organism

Answer 14

aerobic and anaerobic streptococci, bacteroides, staph aureus

Question 15

HIV pneumonia

Answer 15

pneumocystis jiroveci

Question 16

contaminated water pneumonia

Answer 16

legionella

Question 17

elderly, smokers pneumonia

Answer 17

h influenza

Question 18

cystic fibrosis pneumonia

Answer 18

pseudomonoas

Question 19

alcoholics/diabetics pneumonia

Answer 19

klebsiella, stap aureus and DRSP

Question 20

children and young adults

Answer 20

mycoplasma and chlamydia

Question 21

most common pneumonia

Answer 21

strep pneumo

Question 22

exposure to bats or birds

Answer 22

histoplasma

Question 23

viral pneumonia sxs

Answer 23

non productive cough, gradual onset and prodrome, wheezing, low grade temp, conjunctivities, HA/malaise

Question 24

TX pneumocystis jiroveci

Answer 24

bactrim

Question 25

tx CA pneumonia

Answer 25

azithro, clarythro, doxy-- | axmoil if 6mo-5yo

Question 26

tx HA pneumonia

Answer 26

beta lactam plus macrolide plus quinolone IV

Question 27

peribornchial infiltrative densities

Answer 27

bronchopneumonia

Question 28

diffuse patchy densities in perihilar area

Answer 28

viral pneumonia

Question 29

most common neoplasm of lung?

Answer 29

metastisis! common from colon.

Question 30

most common neoplasm of lung?

Answer 30

metastasis! common from colon.

Question 31

paraneoplastic syndrome

Answer 31

endocrine--SIADH, hypercalcemia, cushings, hypoglycemia, hyperthyroid hematologic--erythrocytosis, coagulopathy, thrombophlebitis neuro--neuropathy etc...derm...fever

Question 32

pulm nodule benign features

Answer 32

central calcifications, stable over past 2 years, heavy calcium pattern

Question 33

spiculated nodule on CXR

Answer 33

adenocarcinoma

Question 34

cavity histoplasmosis satellite nodule

Answer 34

coccidiomycosis

Question 35

females/never smoker/peripherally located NSCC

Answer 35

adenocarcinoma

Question 36

hilar adenopathy, hemoptysis, centrally located

Answer 36

SCC

Question 37

rapid doubling time, central and peripheral masses

Answer 37

large cell carcinoma

Question 38

tumor of bronchial origin that typically begins centrally with hilar and mediastinal abnormalities

Answer 38

small cell carcionma

Question 39

triad for asthma

Answer 39

cough SOB and wheeze

Question 40

peak flow zone green

Answer 40

>80%

Question 41

peak flow zone yellow

Answer 41

50-80%

Question 42

peak flow zone red

Answer 42

less than 50% GO TO ER

Question 43

peak flow zone red

Answer 43

less than 50% GO TO ER

Question 44

reduced PO@ and elevated pCO2

Answer 44

chronic bronchitis

Question 45

decreased P02 and normal or decreased PCO2

Answer 45

emphysema

Question 46

stage 1 COPD treatment

Answer 46

SABA prn

Question 47

stage 2 COPD tx

Answer 47

SABA prn plus SA or LA anticholinergic such as ipatropium bromide or tiotropium LA (spiriva), long activing beta 2 agonist, theophylline

Question 48

stage 3 or severe COPD tx

Answer 48

pulmonary rehab, corticosteroid such as beclomethasone puffs

Question 49

tx exacerbations

Answer 49

add anticholinergic if not on one already, IV solumedrol, oral corticosteroid, NIPPV with checking ABGs, abx only if patient has worsening cough/sxs, increased sputum or is immunocompromised

Question 50

O2 therapy requirements

Answer 50

paP2 less than 55%, SaO2 less than 88%

Question 51

insomnia treatment

Answer 51

sleep hygiene first. benzos, zolpidem, trazodone

Question 52

pathyphys of obstructive sleep apnea

Answer 52

loss of normal pharyngeal muscle tone allows pharynx to collapse during inspiration

Question 53

"bull neck"

Answer 53

OSA

Question 54

dx OSA

Answer 54

polysomnography

Question 55

tx OSA

Answer 55

weight loss, avoid alcohol/hypnotic meds, nasal CPAP at night. can do surgery if all else fails

Question 56

tetrad narcolepsy

Answer 56

brief sleep attacks during any activity, cataplexy (sudden loss of muscle tone), sleep paralysis (flaccidity of muscles with full conciousness between sleep and awake), ypnagogic hallucinations

Question 57

tx narcolepsy

Answer 57

dextroamphetamine sulfate stimulant, Modafinil

Question 58

enuresis tx

Answer 58

bell when pad wets, imipramine, desmopressin spray

Question 59

obstructive lung disease

Answer 59

airway narrowing, restrict air movement and cause air trapping.

Question 60

etiologies of obstructive lung disease

Answer 60

ABCT: asthma, bronchiectasis, CF or COPD, trachial or bronchial obstruction

Question 61

restrictive lung disease

Answer 61

loss of lung compliance, increased lung stiffness and decreased lung expansion.

Question 62

etiologies of restrictive lung diseases

Answer 62

AIN'T: alveolar (edema, hemorrhage, pus) Interstitial or inflammatory (sarcoid), Neuromuscular (myasthenia, myopathy, phrenic nerve palsy), Thoracic Wall (ascites, pregnancy, obesity, ankylosing spondylitis