Pulmonology

Question 1

Asthma is confirmed with an increase FEV1 of ___ after inhaled bronchodilators

Answer 1

> 12 percent

Question 2

Best initial therapies for asthma exacerbation are

Answer 2

Inhaled bronchodilators (albuterol)
Bolus of steroids (methyl prednisolone)
Inhaled ipratropium
Oxygen
Magnesium

Question 3

Persistent respiratory acidosis is an indication

Answer 3

intubation and mechanical ventilation

Question 4

___ are never to be used alone in asthma!

Answer 4

Long-acting beta agonists (aka salmeterol or formeterol)

Question 5

Non acute asthma order of medications:

Answer 5

inhaled bronchodilator (albuterol)
Inhaled steroid
Inhaled long acting beta agonist
Oral steroid as last resort

Question 6

Ipratropium and tiotropium act by ___ so they are useful in COPD

Answer 6

inhibiting muscarinic receptors on respiratory mucosae (drying up goblet cells and decreasing mucus)

Question 7

For COPD patient with mild respiratory acidosis, answer ___ or ___ and move clock forward half hour. This could spare the patient from intubation

Answer 7

CPAP or BiPAP

Question 8

Labs to do in outpatient setting of COPD include

Answer 8

CBC
EKG
CMP
ABG
CXR

Question 9

The PFT values that will be increased in COPD are

Answer 9

total lung capacity and residual volume

Question 10

Two vaccines that are important for COPD patients are

Answer 10

pneumococcal 13 to start then 23 a year later and influenza

Question 11

Only send patient home with long-term home oxygen if PO2 is < ___ or sats are less than ___

Answer 11

55; 88

Question 12

What two interventions lower mortality in COPD?

Answer 12

Smoking cessation

Continuous home oxygen therapy

Question 13

COPD = BICARBONATE ____

Answer 13

INCREASE

this is because chronic respiratory acidosis increases the new bicarbonate generation at the distal tubule of the kidney

Question 14

High volume of sputum, fever, hemoptysis =

Answer 14

Bronchiectasis

Question 15

What UTI antibiotic is associated with lung fibrosis?

Answer 15

Nitrofurantoin

Question 16

What will EKG show in interstitial lung disease?

Answer 16

pulmonary hypertension

right atrial and right ventricular hypertrophy

Question 17

FEV1/FVC ratio will be ___ in ILD

Answer 17

normal or increased

Question 18

The only form of ILD that definitely responds to steroids is ___ because it is a granulomatous disease

Answer 18

berylliosis (electronics factory)

Question 19

What two meds slow the progression of idiopathic pulmonary fibrosis?

Answer 19

Pirfenidone and nintedanib

Question 20

Unlike ILD, there are systemic findings in

Answer 20

BOOP/COP (Bronchiolitis obliterans organizing pneumonia or cryptogenic organizing pneumonia)
-also, no occupational exposure in history

Question 21

Physical findings in pulmonary hypertension include

Answer 21

Loud P2
Tricuspid regurgitation
Right ventricular heave
Raynaud’s Phenomenon

Question 22

Diagnose pulmonary hypertension with

Answer 22

Transthoracic echocardiogram (TTE) 
-shows RVH and big right atrium

Question 23

Most accurate test for pulmonary HTN is

Answer 23

right heart catheterization (Swan-Ganz catheterization ) with increased pulmonary artery pressure

Question 24

Treat pulmonary HTN with

Answer 24

bosentan, ambrisentan, or macitentan (endothelin inhibitors)

Question 25

Epoprostenol is a prostacyclin analog that also can treat

Answer 25

pulmonary HTN

Question 26

Lungs are ___ in PE

Answer 26

CLEAR

CXR will most likely be normal too

Question 27

ABG in PE will show

Answer 27

increased A-a gradient and mild respiratory ALKALOSIS

Question 28

Right heart strain + Hypotension =

Answer 28

Thrombolytics treatment indicated (PE)

-Heparin

Question 29

The gold standard for PE diagnosis is

Answer 29

CT angio (95% specific and sensitive)

Question 30

The best use for D-dimer testing is in a patient with

Answer 30

very low probability of PE but you still want to rule it out

Question 31

Keep an eye out for questions about PE that have

Answer 31

CONTRAINDICATIONS TO ANTICOAGULATION! (i.e. hematomas, brain bleeds, etc)

Question 32

Patients who are hemodynamically unstable (hypotensive) and have a PE should receive

Answer 32

thrombolytics!

Question 33

Thoracentesis fluid show (alsos high protein and high LDH. What is it?

Answer 33

Cancer or infection

Question 34

Thoracentesis fluid shows low protein and low LDH, what is it?

Answer 34

Congestive failure

Question 35

What tests should be ordered on pleural fluid?

Answer 35

Gram stain/culture
Acid-fast stain
Total protein (also order serum)
LDH (also order serum)
pH
Glucose
Cell count w/ diff
Triglycerides

Question 36

A kinda badass solution to recurrent pleural effusion that can’t be corrected is

Answer 36

Pleurodesis, or use of talcum powder or bleomycin to cause the pleura to stick to the chest wall. Life Hack!

Question 37

Central sleep apnea is treated by

Answer 37

avoiding alcohol and sedatives

Question 38

Acetazolamide is an inhibitor of ___ an enzyme needed to reabsorb ___ that has been filtered in the glomerulus

Answer 38

carbonic anhydrase; bicarb

-results in respiratory acidosis which can help drive respiration

Question 39

Asthma + brown mucous plugs + peripheral eosinophilia and elevated IgE =

Answer 39

allergic bronchopulmonary aspergillosis (ABPA)

Question 40

Treat ABPA with

Answer 40

oral steroids, NOT inhaled steroids!

for refractory disease, you can use itraconazole

Question 41

Do not treat ARDS with

Answer 41

steroids

Question 42

What does PEEP do?

Answer 42

It keeps the alveoli open! More surface area available for gas exchange!

Question 43

Wedge pressure will only be high in

Answer 43

cardiogenic shock (it will be low in hypovolemia and septic shock)

Question 44

Cardiac output on Pulm artery catheterization will only be high in cases of

Answer 44

septic shock (low in hypovolemia and cardiogenic shock)

Question 45

The respiratory fluoroquinolones are

Answer 45

levofloxacin and moxiflocacin

used for outpatient pneumonia (as are macrolides)

Question 46

Inpatient pneumonia should be treated with

Answer 46

Ceftriaxone and azitrhomycin OR a fluoroquinolone as a single agent

Question 47

Ventilator associated pneumonia should be treated with

Answer 47

Imipenem or meropenem, pip/tazo, cefepime
gentamicin
AND vancomycin or linezolid

Question 48

What is an adverse effect of pyrizanimide for TB?

Answer 48

Hyperuricemia (gout!)

Question 49

Adverse effect of ethambutol for TB?

Answer 49

Optic neuritis

Question 50

PPD is positive at 5mm in people who are

Answer 50

close contacts
steroid users
HIV-positive

Question 51

PPD is positive at 10mm in people who are

Answer 51

homeless, immigrants, prisoners, alcoholics, healthcare workers, and other high risk groups

Question 52

PPD is positive at 15mm for

Answer 52

Everyone with no other risks