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Step 2 CK > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

best initial test in acute asthma exacerbation?

A

PEF or ABG

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2
Q

What is the most accurate diagnostic test for asthma when the patient is asymptomatic?

A

20% decrease in FEV1 with use of methacholine or histamine as they provoke bronchoconstriction and an increase in bronchial secretions

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3
Q

What is the best indication of the severity of an asthma exacerbation?

A 
Respiratory Rate
(pulse ox will not show hypoxia until point of resp failure) 
(O2 sat can be maintained >90% by hyperventilating)
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4
Q

how to quantify severity of asthma attack?

A

PEF

ABG

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5
Q

Treatment for asthma exacerbation

A

oxygen
albuterol
steroids
Mag (only in acute severe episodes not responsive to albuterol)

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6
Q

Best initial test to diagnose COPD

A

chest x-ray

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7
Q

why is their an increase in TLC in COPD

A

increase in residual volume

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8
Q

how do you define full reversibility to bronchodilators in obstructive airway disease?

A

> 12% or 200ml increase in FEV1

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9
Q

CBC findings and EKG findings that might be seen with COPD

A

CBC: increase in hct from chronic hypoxia

EKG: right atrial hypertrophy and right ventricular hypertrophy. afib. MAT

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10
Q

most effective symptomatic therapy in COPD?

A

tiotropium, ipratropium

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11
Q

when all medical therapy is insufficient for COPD, what do you do?

A

refer for transplant

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12
Q

single most common cause of bronchiectasis?

A

cystic fibrosis

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13
Q

key to the diagnosis of bronchiectasis?

A

recurrent episodes of very high volume purulent sputum production.

can have hemoptysis
weight loss
anemia of chronic disease
crackles
dyskinetic cilia syndrome
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14
Q

best initial test and most accurate test to diagnose bronchiectasis?

A

high-resolution CT scan

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15
Q

Treatment for bronchiectasis

A

specific microbio diagnosis is preffered since mycobacterium avium intracellulare can be found

chest physiotherapy
rotate antibiotics

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16
Q

Asthmatic patient with recurrent episodes of brown-flecked sputum and transient infiltrates on c-xray

A

allergic bronchopul aspergillosis

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17
Q

treatment for ABPA?

A

Oral steroids for severe cases (inhaled dont work)

Itraconazole for recurrent episodes

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18
Q

PFTS for CF?

A

mixed obstructive and restrictive. and decreased diffusing capacity for CO

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19
Q

COPD pneumonia pathogen?

A

H.flu

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20
Q

Recent viral infection -> pneumonia. pathogen?

A

S. aureus

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21
Q

Hoarseness and pneumonia?

A

Chlamydia pneumonia

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22
Q

animals at time of giving birth. vets. farmers. type of pneumonia?

A

coxiella burnetii

23
Q

when can you consider a sputum gram stain “adequate”?

A

more than 25 wbcs and fewer than 10 epithelial cells

24
Q

Diagnostic test for PCP pneumo?

A

bronchoalveolar lavage

25
Q

diagnostic test for coxiella burnetti?

A

rising serology titers

26
Q

legionella diagnostic test

A

urine antigen, culture on charcoal-yeast extract

27
Q

treatment for pneumonia in a prev healthy, no comorbidity, mild symptoms, no abx in past 3 months?

A

azithromycin or clarithromycin or doxycycline

28
Q

treatment for pneumo if patient has comorbidities or abx in past 3 months?

A

levofloxacin or moxiflox

29
Q

single factor reasons to hospitalize a patient with pneumonia?

A
  1. hypoxia
  2. hypotension
  3. resp > 30, PO2<60, pH <7.35
  4. BUN > 30, Na <130, gluc > 250
  5. HR > 125
  6. confusion
  7. temp > 104
  8. Age > 65 or other comorbidities
30
Q

CURB 65`

A 
(0-1 point = home)
2 or more = admit
confusion
uremia
resp distress
BP low
age >65
31
Q

dangerous side effect of imipenem?

A

can cause seizures. cleared renally

32
Q

best abx for lung abscess coverage?

A

clinda or penicillin

33
Q

if you get negative sputum stain for PCP testing, what should u do next?

A

bronchoscopy

34
Q

If LDH is normal, can the pneumonia be due to PCP?

A

on the test- do NOT answer PCP

35
Q

how do you define severe PCP pneumonia? what should you add for coverage?

A

PO2 <70 or A-a gradient >35

add steroid

36
Q

If bactrim is not acceptible for PCP treatment use?

A

clinda and primaquine- (also contraindicated in G6PD)
or
pentamidine

37
Q

If there is a rash or neutropenia from TMP-SMX in prophylactic treatment of PCP - use?

A

atovaquone or dapsone-> (also contraindicated in G6PD)

38
Q

all of TB drugs cause hepatotoxicity. but do not stop them unless transaminases rise to - ?

A

3-5X upper limit of normal

39
Q

when are steroids helpful in TB?

A

reduce risk of constrictive pericarditis in those with pericardial involvement. decrease neuro comp with TB meningitis.

40
Q

pyrazinamide and streptomycin are contraindicated in?

A

pregnant patients

41
Q

SE of pyrazinamide

A

hyperuricemia

42
Q

If first PPD is negative in a patient with first time screen?

A

Need another test to rule out false-negative

43
Q

Does previous BCG vaccine have any effect on recommendations for positive PPD?

A

NO- still must take isoniazid for 9 months

44
Q

when you have a high suspicion for malignancy of a solitary pulm lesion- what should u do?

A

resect it. dont biopsy (high chance of false negative)

45
Q

bronchoalveolar lavage shows an elevated level of helper cells in?

A

sarcoidosis

46
Q

drug of choice for sarcoid?

A

prednisone

47
Q

Cxray in PE usually show? most common abnormality?

A

(usually normal in PE)

atelectasis, wedge shaped infarct

48
Q

most common EKG abnormality seen for PE?

A

tachy, nonspecific ST changes

49
Q

most common wrong answer “the most common PE EKG findings”?

A

S1Q3T3

50
Q

when should V/Q be first diagnostic test for PE?

A

pregnancy

51
Q

when is direct thrombin inhibitor the answer for PE?

A

HIT (fondaparinux can be used)

52
Q

Is ASA ever the answer for PE?

A

no

53
Q

Treatment of idiopathic Pulm htn?

A

prostacyclin analogues: (PA vasodilators): epoprostenol, treprostinil

endothelin antagonist: bosentan

phosphodiesterase inhibitor: sildenafil

Step 2 CK (26 decks)

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