Pulmonology

Question 1

What is the USPSTF recommendation for lung cancer screening?

Answer 1

annual low-dose CT ages 55-80 only if 30 pack year history or more

• can stop screening after pt stopped smoking for 15 years

Question 2

What levels do you follow in sarcoid patients

Answer 2

ACE levels - to follow disease activity

Question 3

mainstay in sarcoid patients

Answer 3

corticosteroids

Question 4

Most common causative organism in community acquired pneumonia in adults

Answer 4

strep pneumo

Question 5

Most common causative organism in community acquired pneumonia in children age 4 mo to 4 years

Answer 5

RSV and other viruses

Question 6

Most common causative organism in community acquired pneumonia in children ages 5-18

Answer 6

mycoplasma and other atypical organisms

Question 7

What criteria can you use to determine if pt at high risk for drug-resistant pneumonia?

Answer 7

BIRP
B: broad spectrum antibiotic within the last 3 months
I: immunosuppression
R: resident of NH or poor functional status
P: prior hospitalization within past 3 mo

Question 8

What antibiotics should you use in the follow CAP case?:

outpatient, previously healthy, no risk for drug resistance

Answer 8

Macrolides (SOR A) or Doxycycline (SOR B)

Question 9

What antibiotics should you use in the follow CAP case?:

Outpatient with comorbidities or recent antibiotics

Answer 9

Respiratory fluroquinolone (SOR A): moxi, gemi, levo

Or

Beta-lactam + macrolide (SOR A): amox/clav

Question 10

Indications for PCV13 vaccine

Answer 10

Adults > 19 with CSF leaks, cochlear implants, functional asplenia, sickle cell, immunosuppression

All adults > 65 who have not previously received a dose of PCV13 need one dose

Question 11

Indications for PPSV23 vaccine

Answer 11

single dose at age > 65 years

single dose:
- cardiac, liver, diabetes, lung disease, smoker, cochlear implants or CSF leak, resident of chronic care institution

2 doses 5 years apart:

• CKD
• asplenia, sickle cell disease
• immunocompromised

Question 12

How to give both pneumococcal vaccines in Age 2-18

Answer 12

after last dose of PCV13 give one dose of PPSV23

Question 13

How to give both pneumococcal vaccines in age 19-64 at high risk

Answer 13

give PCV13 first followed by PPSV23 at least 8 weeks later

Question 14

How to give both pneumococcal vaccines in age > 65 yo

Answer 14

Give PCV 13 first followed. by PPSV23 1 year later

Question 15

When is a tuberculin skin test positive at > 5 mm

Answer 15

• HIV seropositive
• recent TB contact
• CXR shows prior inactive TB
• immunosuppressed patients

Question 16

When is a tuberculin skin test positive at > 10 mm

Answer 16

• DM
• ESRD
• cancer
• recent immigrant
• high prevalence area
• long term care facility
• inmate
• IV drug use
• children < 4 yo
• works in TB lab

Question 17

When is a tuberculin skin test positive at > 15 mm

Answer 17

any person with known risk factors even if prior BCG vaccination

Question 18

Treatment of active TB

Answer 18

RIPE

• Rifampin
• Isoniazid
• Pyrazinamide
• Ethambutol

Question 19

Treatment of Latent TB

Answer 19

Isoniazide for 6-9 months

rifampin for 4 months

Question 20

Which fungal lung infection would you suspect in the following setting:

Immunocompromised

Answer 20

aspergillosis

candidiasis

Question 21

Which fungal lung infection would you suspect in the following setting:

Missisipi/ohio valley

Answer 21

histoplasmosis and blastomycosis

Question 22

Which fungal lung infection would you suspect in the following setting:

Southwest

Answer 22

Coccidiomycosis