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A. AMC - MCQ MATEO 2024 > RESPIRATORIO > Flashcards

RESPIRATORIO Flashcards

1
Q

COP.
Chronic Bronchitis definition:

A

cough for 3 months in each of 2 consecutive years

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2
Q

Enphysema and bronchitis x ray findings

A

hyperinflated lungs
flattened hemi-diaphragms **

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3
Q

Diagnosis of COPD is confirmed by:

A

spirometry
FEV1/FVC ratio < 0.7 and not reversible after admnistration of bronchodilator

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4
Q

COPD

Managment of stable COPD =
general + drugs

A
  1. smoking cessation
  2. regular excersise
  3. pulmonary rehabilitation
  4. pneumococal vacc and anual influenza vacc
  5. SABA
    2.SABA + LABA OR LAMA
  6. SABA + LABA + ICS
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5
Q

Most important intervention to prevent and limit lung damage in COPD

A

stop smoking

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5
Q

Comorbilities of COPD ( 6)
COACHD

A

cardiovascular
osteoporosis
anxiety disorders
Cor pulomanle ( common)
HTP
diabetes

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6
Q

indications for hospitalizacion for COPD

A
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7
Q

Is sputum culture recomended for exacerbations of COPD? why?

A

NO, positive is not indicative of infection. 50% are colonixed by HI , MC, SP/

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8
Q

COPD EXACERBATION MANAGEMENT - drugs

A

1) SABA
o
1) terbutaline
o
IPATROPIUM CONTRAINDICATED IF TAKES A LAMA

if doesnt respond 5 DAY COURSE SYSTEMIC CORICOSESTORIDS.

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9
Q

COPD EXACERBATION MANAGEMENT - oxygen

A

administrar oxigeno para mantener O2 88-92%

si no funciona non invasive ventilation

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10
Q

COPD EXACERBATION MANAGEMENT + signs of infection - drugs

A

amoxciilina
o
doxiciclina

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11
Q

TRIADA DE SAMSTERS

A

ASTHMA
ASPIRINA SENSIVITY
NASAL POLIPOS

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12
Q

TRIADA DE ATOPIA

A

ASTHMA
RINITIS ALERGICA
ATOPIC DERMATITIS

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13
Q

ASTHMA - espirometria dx valores de reversivilidad

A

FEV1 > 200ml o 12% de baseline

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14
Q

ASTHMA - best dx test

A

spirometry

fev1/fv reduced

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15
Q

ASTHMA - guidelines spacer in sever asthma:

A

<35kg <6 anos
6 puff salbutamol
2 patropium
> 6 anos
12 puff salbutamol
4 ipatropium

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16
Q

Cystic Fibrosis- inheritance

A

autosomal recessive inheritance
25% affected
50% carrier
25% unaffected

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17
Q

cystic fibrisis clinic - respiratory, GIT, reproductive, general

A
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18
Q

Cystic Fibrosis- dx ?

Cystic Fibrosis- most important test? gold standar

A

heel prick test (screening after birth)

sweat chloride test (>60 sodium chloride)

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19
Q

Cystic Fibrosis- managment

A
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20
Q

Bronchiectasis - image

A
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21
Q

When to suspect bronchiectasis

A
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22
Q

Bronchiectasisas - gold standar?
.

A

high resolution CT

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23
Q

Bronchiectasisas - MX - cuando dar ATB?

A

if >3 exacerbtions a year

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24
Q

Bronchiectasisas - MX

A
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25
Q

Bronchiectasisas - empirical ABX exacerbation

A

Non severe
- amoxicilina
severe - P aureginosa
- ceftriazona
-cefotaxime
-amoxicilina _ clavunato IV
severe + P aureginosa
- ceftazidime IV
- pip taz IV
-gentamicina IV
-tobramycina IV

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26
Q

-ILD investigation

A
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27
Q

ILD symptoms

A

INSPIRATORY CREPITATION
clubbing fingers

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28
Q

ILD MX

A

supportive
corticosteroids
lung transplantation

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29
Q

ILD - most common IPF (idiopatic pulmonary fibrosis)

A

no therapy

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30
Q

SARCOIDOSIS what is it? diffentiate with what from TB

A

abnormal nodules, granulomas appears in body tissue.

Manoux test

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31
Q

Sarcoidosis symptoms:
GRUELING nemotecnia

A

sob, chest pain, wheeze, fever, cough, malaise, arthitis, night sweats. SIMILAR TB

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32
Q

Sarcoidosis FEATURES MNEMOTECNIC GRUELING

A

IMAGE

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33
Q

Sarcoidosis TX

A

Usually spontaneous resolution
if not or worst or EYE , SNC involvement =
prednisolona

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34
Q

Sarcoidosis 2 types

A
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35
Q

extrinsic allergic alveolitis

A
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36
Q

extrinsic allergic alveolitis

A
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37
Q

extrinsic allergic alveolitis -question

A
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38
Q

allergic bronchopulmonary aspergillosis - predomintaly in pts with ?

A

asthma 1-2%
CF 10-20 %

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39
Q

allergic bronchopulmonary aspergillosis - dx

A

+ve skin test for aspergillus

blood: ige levels, eosinophilia

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40
Q

allergic bronchopulmonary aspergillosis - complication

A

bronquiectasia

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41
Q

allergic bronchopulmonary aspergillosis - question

A
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42
Q

DRUG INDUCED ILD

A
43
Q

most common pathogen

A

in comunity , pte has been in hospital <48 horas

S P

44
Q

atypical microorganisms

A

mycoplasman pneumonie
hamofilus influenza
legionella
chlamydophilia

45
Q

CAP symptoms and signs

A
46
Q

hospital admision red flags CAP

A
47
Q

CRB-65 AND CURB 65

A
47
Q

CAP dx

A

acute respiratory symptoms + fever + new infiltrate on C-XR (dx)

48
Q

CAP TX en caso de hipersensibilidad a penicilina?

A

moxifloxacina 400 mg orally, and
iv whenre high severity tx

49
Q

Empirical rx for Pseudo. A. in CAP

A

cefepime ‘O’ pip taz
+
azotrimicina IV

(shock SEPTICO)=
+ gentamicina IV

50
Q

CAP TREATMENT

A
51
Q

CAP - pneumonia in children hospitalizacion :

A
52
Q

CAP - Neonatos etiologia ?
primeras 72 horas:
>72 h:
>1 mes :

A

1) maternal flora, streptococus grupo B and E choli
2) haemophilus influenzae
3) 70% viral. (30% streptococ pneumonie and mycoplasma pneumoniae=school aged*)

53
Q

CAP children TX - mild and severe

A

mild to moderate

  • amoxicilina 25mg/kg
    +
    azitromicina/ claritromicina / doxiciclina si (atypical bacteria sospecha)

severe
- cefotaxime IV / ceftriaxona IV

54
Q

atypical pneumonia -mycoplasma dx

A

serum mycoplasma AG

55
Q

atypical pneumonia -LEGIONELLA dx

A

ac cooling systems
sputum culture GOLD STANDAR
hiponatrmia
urine - alternative, rapido al dia siguiente de los sintomas detectbale x semanas

56
Q

atypical pneuumonia tx

A
57
Q

legionella question

A
58
Q

Hospital acquired pneumonia definition?

A

hospital> 48 horas

59
Q

Hospital acquired pneumonia most common patogen

A

s. pneumoniae

60
Q

Hospital acquired pneumonia investigations

A

blood and sputum samples
- uncomon pathogens in inmunocompromised
CXR

61
Q

HAP EMPIRICAL TX

A

LOW MODERATE
-AMOXI+CLAV orally
- - Hipersensibilidad penicilinas (moxifloxacino)

HIGH SEVERETY HAP
- PIP TAX
- Hipersensibilidad penicilinas (ciprofloxacino IV) + vancomicina
o meropenem

62
Q

Lung abscess - most comon cause adults and children

A

adults: oral bacteria (periodontal, paranasal sinusitus, swealling disordes, GER , vomiting frecuunetly from alcohol abuse. anaeorobic bacteria and microanarophilici streptocco

children: neumonia stafilicocos o s aureus

63
Q

Lung abscess- INVestigations

A

Blood culture - 3 sets before ATB
sputum gram stain and culture - Blood culture - before ATB
CT

64
Q

images chest xray and CT scan

A
65
Q

lung abscess - pte does not improve in 7 or 10 days ->

A

may need drainage procedure or surgery.

66
Q

Empyema is a collection of pus in pleural cavity . most comon causative organism:

A

DM/alcohol abuse/ GORD : gram negative bacteria

66
Q

lung abscess TX ATB

A
67
Q

Empyema images - CT mos ideal for DX an TX

A
68
Q

Empyema tx

A

ATB mismos que CAP/HAP
DRENAJE = tube thoracostomy (confirm with rx o CT)
(thoractomia last resource)

69
Q

Tb. most common cause of PUO. investigations and gold test?

A

1) sputum testing
microscopia AFB stain (rapido)
cultivo (semanas)
2) IGRA - quantiferon GOLD TEST
3) mantoux test (false positve in BCG vacc)

70
Q

TB. IGRA advantage and disadvantage

A

advantage: unaffected by previous BCG vacc

disadvantage: not < 2 years, prefered TST to detect it
( - cannot exclude TB ,
+ is suggestive)

71
Q

TB- mantoux test - PPD . AREAS values

A
72
Q

TB- most comon finding in RX?

A

cavity infiltrate upper lobbe
hiv upper or lower lobes

73
Q

image TB

A
74
Q

algoritmo TB- manejo

A
75
Q

TB tratamiento antibiotico

A
76
Q

COPD ESPIROMETRIA IMAGEN

A
77
Q

ASSESING SEVERITY ACUTE ASHTMA IN CLINICAL SETTINGS

A
78
Q

ASTHMA MANAGMENT ACCORDING TO EPISODES TABLE

A
79
Q

CYSTIC FIBROSIS SUMMARY

A
80
Q
A
81
Q
A
82
Q
A
83
Q
A
84
Q
A
85
Q
A
86
Q

Pulmonary HTN definition

A

Pulmonary HTN is when the mean arterial pressure >25 mmHg(Normal = 15 mmHg)

87
Q

Pulmonary HTN & Cor pulmonale SIGNS

A

RHF signs:
*Raised JVP
*Positive hepato-jugular reflux
*Peripheral edema
*Hepatomegaly
*Loud P2 (Pulmonary HTN)
*Flow murmur –holosystolic murmur of tricuspid insufficiency
*S4
*Parasternal heave

88
Q

Pulmonary HTN/ Cor pulmonale -Investigations & Rx:

A
89
Q

Normal pH

A

7.35-7.45

90
Q

Normal PaCO2

A

35-45 mmHg

91
Q

Normal HCO3

A

22-26 meq/L

92
Q

Unprocessed raw cotton + bacterial endotoxin

A

Byssinosis
doesn’t cause COPD

93
Q

FEV1/FVC ratio

A

0.75-0.85

94
Q

List of restrictive diseases

A
  • pulmonary fibrosis
  • pneumothorax
95
Q

FEV1/FVC ratio > 0.85

A

Restrictive airway disease

96
Q

FEV1/FVC ratio < 0.75

A

Obstructive airway disease

97
Q

Residual lung volume increased :

A

obstructive disease

98
Q

Residual lung volume decreased

A

restrictive disease

99
Q

CURB-65 Score

A

– Confusion of new onset.
– Urea greater than 7 mmol/l.
– Respiratory rate of 30 breaths per minute or higher.
– Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg
or less.
– Age 65 or older

CURB-65 score equal or >3, an
inpatient treatment for community acquired pneumonia is necessary.

100
Q

Difference between crackles associated with alveolar fluid vs interstitial lung disease .

A

Egophony

Crackles (or rales) are predominantly heard during inspiration and are considered a sign of alveolar or interstitial lung disease. A variety of diseases cause crackles including pneumonia, pulmonary edema, and any cause of interstitial lung fibrosis. Some clinicians attempt to distinguish between the “wet” crackles of pulmonary edema or pneumonia compared to the “dry” crackles of interstitial lung disease. However, this is not a reliable finding. A better way to differentiate between the alveolar and interstitial causes of crackles is to test for the presence of egophony. When alveolar filling is present, the “EEE” sound will be heard as a “AH” sound; however, in interstitial lung disease the “EEE” sound will be preserved. Whispered pectoriloquy will also be intensified in alveolar filling processes, but not interstitial lung disease.

The lack of breath sounds is important to note, but can be caused by many factors including severe bullous lung disease, emphysema, pneumothorax, or pleural effusion.

101
Q

Primary spontaneous pneumothorax CRITERIA

A

*No respiratory finding on exam except those related to the pneumothorax
*There is no history of lung disease
*Thereisnochest- Xrayfind ingotherthanthoserelatedtothe pneumothorax
*The patient is young<or=50
*There is no significant history of smoking

102
Q

PNEUMOTHORAX

Diagnostic testing: WHICH IS BEST INITIAL AND MOST ACCURATE TEST?

A

Chest radiograp –> Bestinitial test

Computed tomography(CT) ->MOST ACCURATE

103
Q

PNEUMOTHORAX

The differential diagnoses of pleuritic pain include the following 5Ps:

A

1Pulmonary embolism
2Pericarditis
3Pneumonia
4Pneumothorax
5Pneumomediastinum

104
Q
A

A. AMC - MCQ MATEO 2024 (16 decks)

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