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INTERNAL MEDICINE - PLE TOPNOTCH 2020 > PULMONOLOGY > Flashcards

PULMONOLOGY Flashcards

1
Q

Define massive hemoptysis

A

blood loss of 400 mL in 24 hours or 100- 150 mL expectoration at one time.

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2
Q

What is the major risk factor for asthma?

A

Atopy

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3
Q

Give the TB treatment category and regimen.

Retreatment of Rifampicin susceptible PTB and EPTB (except CNS, Bones, Joints)

A

Category II

2 HRZES / 1 HRZE / 5 HRE

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4
Q

Give the TB treatment category and regimen.

Retreatment of Rifampicin susceptible CNS, Bone or Joints TB

A

Category IIa

2 HRZES/ 1 HRZE/ 9 HRE

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5
Q

Atypical pathogens for CAP

A

Mycoplasma, Chlamydia and Legionella

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6
Q

Duration of acute cough and differentials

A

Acute <3weeks

Acute = RTI, Aspiration, inhalation of noxious substances

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7
Q

DOC for Low risk CAP with no co-morbids.

A

Amoxicillin

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8
Q

What is the most common risk factor for COPD?

A

Tobacco smoking

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9
Q

Define hypopnea

A

> 30% reduction in airflow for at least 10s during sleep that is accompanied by either a > 3% desaturation or an arousal.

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10
Q

Pneumothorax that occurs in the presence of disease. Most are due to chronic obstructive pulmonary disease.

A

Secondary Pneumothorax

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11
Q

Predicts mortality in CAP

A

Streptococcus pneumoniae

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12
Q

Choroidal tubercle on eye examination is pathognomonic of __________

A

Miliary TB

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13
Q

Pneumothorax that occurs in the absence of underlying lung disease. This is almost exclusive in smokers

A

Primary Pneumothorax

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14
Q

What is the preferred screening test for Latent TB infection in resource- limited setting (alternative is Interferon gamma release assay or IGRA)

A

TST

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15
Q

most hepatotoxic TB drug

A

Pyrazinamide

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16
Q

give examples of LONG ACTING MUSCARINIC ANTAGONISTS (LAMA)

A
  • Tiotropium
  • Glycopyronium
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17
Q

Pott’s disease (Skeletal TB) commonly affects _____

A

lower thoracic and upper lumbar in adults.

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18
Q

gold standard for diagnosis of OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAHS)

A

overnight polysomnogram (PSG)

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19
Q

Give examples of LONG ACTING BETA AGONIST

A
  • Formoterol
  • Indacaterol
  • Vilanterol

*LABA is not given without ICS.

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20
Q

WHEN DO YOU SUSPECT PNEUMOCYSTIS PNEUMONIA?

A

Patient with AIDS (with CD4 count of <200/uL) presenting with fever without respiratory symptoms, to mild, persistent, dry cough, to significant hypoxemia and respiratory compromise.

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21
Q

What is the Most common cause of pleural effusion

A

LV heart failure

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22
Q

Classic symptoms of COPD

A

o Dyspnea – progressive over time

o Chronic cough

o Chronic sputum production

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23
Q

Stay in hotel or on cruise ship in previous 2 weeks. Think of what organism?

A

= think of Legionella!

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24
Q

Duration and differentials for chronic cough

A

> 8 weeks

Chronic = Asthma, GERD, Post nasal Drip, ACEi

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25
Q

TB drug assoc with Autoimmune thrombocytopenia

A

Rifampicin

26
Q

TB drug associated with Peripheral neuropathy

A

Isoniazid

Give Vitamin B6

27
Q

Enumerate the CLASSIFICATION OF SEVERITY OF AIRFLOW LIMITATION SEVERITY IN COPD (BASED ON POST-BRONCHODILATOR FEV1)

28
Q

What is the most accurate test in the diagnosis of asthma?

A

Pulmonary function test or spirometry.

It will show a decrease in FEV1 to FVC ratio.

29
Q

Clubbing is NOT a sign of COPD. True or false.

30
Q

Duration and differentials of Subacute cough

A

3-8weeks

Subacute = Post-viral tussive syndrome

31
Q

Give the TB treatment category and regimen.

• New Pulmonary TB

• New Miliary TB

• New EPTB (except CNS, Bones, Joints)

A

Catergory I

2 HRZE / 4HR

32
Q

The tuberculin skin test cannot be used to diagnose active PTB. True or false.

33
Q

Give the TB treatment category and regimen.

CNS TB, TB of Bones or Joints

A

Category Ia

2 HRZE / 10HR

34
Q

Type of pneumothorax that occurs without antecedent trauma to the thorax

A

Spontaneous pneumothorax

35
Q

Enumerate evidence of variable expiratory airflow limitation

A

o Reduced FEV 1 /FVC ratio (<0.7)

o Reduced FEV 1 that increases by >12% (and by at least 200 ml from baseline) post bronchodilator

o Reduced FEV 1 that increases by >12% (and by at least 200 ml from baseline) after 4 weeks on steroid trial

o Decrease in FEV1 by 20% with methacholine or histamine

36
Q

HOW TO RISK STRATIFY COMMUNITY ACQUIRED PNEUMONIA?

37
Q

flow-volume loop appearance of asthma

A

reduced peak expiratory flow and atypical scalloped appearance indicating widespread airflow obstruction.

38
Q

SHORT ACTING MUSCARINIC ANTAGONIST (SAMA)

A

Ipratropium

39
Q

Direct sputum smear microscopy (DSSM)

A

o Primary diagnostic method

o Two (2) sputum specimens

o Same day (spot-spot) strategy collected 1-hour apart

o Confirmed if at least one (1) is positive

40
Q

Egg-shell calcification on CXR

41
Q

recommended treatment for lung abscess

A

Clindamycin IV or Beta-lactam with BLIC IV

42
Q

most common extrapulmonary TB

A

TB lymphadenitis

43
Q

First line agent for Acute severe asthma (life threatening)

44
Q

What is the most accurate test for the diagnosis of COPD?

A

Pulmonary function test

45
Q

The most common allergens to trigger asthma are _____

A

Dermatophagoides species (dust mites)

46
Q

The first evidence of response to treatment of CAP

A

resolution of fever within a week and decreasing WBC count within 2-4 days.

47
Q

TB drug associated with Visual impairment (optic neuritis, decreased color perception)

A

Ethambutol

48
Q

What is the target oxygen saturation for COPD?

49
Q

Anti-IgE drug against asthma

A

Omalizumab

Omalizumab is an IgG against IgE. Decreasing IgE decreases activation and release of mast cells. This drug is reserved for patients who are not controlled on maximal doses of inhaler therapy.

50
Q

What form of TB is considered most infectious?

A

Cavitary pulmonary disease and Laryngeal TB

51
Q

What should be the result of the serum and pleural fluid protein gradient to consider transudative effusion?

A

>31 g/L (3.1 g/dl)

52
Q

Differentiate transudate vs exudate using light’s criteria. Give examples.

53
Q

Give examples of LOW DOSE ICS

A
  • fluticasone
  • budesonide
  • mometasone
  • triamcinolone
  • beclometasone
  • ciclesonide
54
Q

TB drug assoc with Asymptomatic hyperuricemia

A

Pyrazinamide

55
Q

Define Apnea.

A

cessation of airflow > 10s during sleep accompanied by persistent respiratory effort (obstructive) or absence of respiratory effort (central)

56
Q

What to consider if pleural fluid glucose is < 60mg/dl?

A
  • Malignancy
  • Bacterial infections
  • Rheumatoid arthritis
57
Q

the most common cause of CAP

58
Q

What is the best initial test for TB?

A

Gene X-pert MTB/Rif

59
Q

When do you start supplemental oxygen in COPD?

A
  • pO2 <55 / sat <88%
  • pO2 <60 / sat <90% if with signs of pulmonary hypertension or right heart failure
60
Q

Give examples of SHORT ACTING BETA AGONISTS (SABA)

A
  • Salbutamol
  • albuterol
  • terbutaline
61
Q

When when will you consider doing an invasive procedure in the presence of pleural effusion?

A

In INCREASING order of importance:

  1. Loculated pleural fluid
  2. Pleural fluid pH <7.20
  3. Pleural fluid glucose <3.3mmol/ L (<60mg/dL)
  4. Positive Gram stain or culture of the pleural fluid
  5. Presence of gross pus in the pleural space - most important
62
Q

Sudden dyspnea enlarged hemithorax with no breath sounds, hyperresonance to percussion and shift of mediastinum to contralateral side

A

think of tension pneumothorax!

INTERNAL MEDICINE - PLE TOPNOTCH 2020 (10 decks)

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