Pulmonology

Question 1

Asthma, definitions of

good control

partial control

poor control

Answer 1

good control : no problem

partial control : one or two of these

poor control : three or more of these

1. day time symptom >2 days/week
2. SABA inhaler >2 times/week
3. any limitation of activities
4. night time Sx or Sx on waking

Question 2

Asthma adult

stepped up management

Answer 2

1. SABA as needed
2. low dose ICS + SABA as needed
3. low dose combination regular preventer + reliever as needed

• budesonide/formoterol low dose ; maintenance-and-reliever therapy
• ICS/LABA combination low dose : maintenance

4. higher dose combination regular prevent + reliever as needed

Question 3

Asthma children age 1-5

when to consider inhaled steroid or montelukast?

Answer 3

consider :

mild flare-ups (managed by SABA) every 6-8 weeks

Indicated :

any moredate or sever flare-ups in the last 6 months

Question 4

<30 yo, no contact with TB patients, positive tuberculin test. CXR clear, no symptoms.

Dx and Management?

Answer 4

latent tuberculosis.

Tx

1. Isoniazid for 6-12 months

isoniazid 9 months (5mg/kg daily)

+

pyridoxine (Vit B6) 25mg daily

2. Isoniazid + rifampin for 3 months

Question 5

bronchiectasis, lobar pneumonia

green sputum

what species to cover with what Abx?

Answer 5

Think Pseudomonas aeruginosa.

Admit the patient!

• Ticarcillin + clavulanate
• Pipieracllin + Tazobactam
• Cefotaxime
• ceftriaxone
• Gentamicin

Question 6

cough, fever, arthralgia, malaise,

bilateral hilar lymphadenopathy on chext X ray

rash on legs

Dx?

Answer 6

sarcoidosis