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USMLE Step Two > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

common cause of pneumonia in immunocompromised patients

A

PCP

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2
Q

most common cause of atypical/walking pneumonia

A

mycoplasma pneumoniae

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3
Q

common causative agent for pneumonia in alcoholics

A

klebsiella

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4
Q

can cause an interstitial pnuemonia in bird handlers

A

chlamidya psitacci

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5
Q

often the cause of pnuemonia in a patient with a history of exposure to bats

A

histoplasma

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6
Q

cause of pneumonia in a patient who has recently visited california, new mexico, or west texas

A

coccidiomycoses

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7
Q

pnuemonia associated with “current jelly” sputum

A

klebsiella

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8
Q

pneumonia associated with Q fever

A 
coxiella burnetti
(interstitial pneumonia)
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9
Q

pneumonia acquired from air conditioners

A

legionella

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10
Q

most common cause of pnuemonia in children 1 year old or younger

A

RSV

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11
Q

most common cause of pnuemonia in neonate

A

GBS and E coli

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12
Q

most common cause of pneumonia in children and young adults

A

mycoplasma pneumonia

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13
Q

common cause of pneumonia in patients hospitalized or with other health probelms

A

klebsiella pneumoniae

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14
Q

most common cause of viral pneumonia

A

RSV

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15
Q

life-threatening pneumonia causes wool-sorter’s disease

A

bacillus anthracis

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16
Q

common bacterial cause of COPD exacerbation

A

haemophilus influenzae

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17
Q

common pneumonia in ventilator patients and those with cystic fibrosis

A

pseudomonas

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18
Q

pontiac fever

A

legionella

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19
Q

pneumonia gram + cocci in clusters

A

staph aureus

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20
Q

pneumonia gram + cocci in pairs

A

strep pneumoniae

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21
Q

pneumonia gram - rods in 80 year old

A

e. coli

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22
Q

pneumonia gram + cocci in nenonate

A

GBS

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23
Q

pneumonia gram - rods in neonate

A

e. coli

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24
Q

size of induration for positive reading in patient who is HIV-positive

A

5 mm

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25
Q

size of induration for positive reading in patient who had close contact with TB-infected patient

A

5 mm

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26
Q

size of induration for positive reading in patient who has signs of TB seen on CXR

A

5 mm

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27
Q

size of induration for positive reading in patient in homeless patients

A

10 mm

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28
Q

size of induration for positive reading in patient in immigrants from developing nations

A

10 mm

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29
Q

size of induration for positive reading in patient with IV drug abuse

A

10 mm

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30
Q

size of induration for positive reading in patient in chronically ill patients

A

10 mm

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31
Q

size of induration for positive reading in patient in health care workers

A

10 mm

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32
Q

size of induration for positive reading in patient with recent incarceration

A

10 mm

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33
Q

size of induration for positive reading in patient that does not fit into other category

A

15 mm

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34
Q

how is diagnosis of active TB made

A

sputum acid fast stain
sputum culture for TB
bronchoscopy with bronchoalveolar lavage or biopsy

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35
Q

how can PCWP distinguish between ARDS and cardiogenic edema

A

< 18 in ARDS

> 18 in cardiogenic

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36
Q

differential diagnosis of ground-glass infiltrates on CXR

A 
interstitial pneumoniae
PCP
pulmonary edema
pulmonary hemorrhage
hypersensitivity pneumonitis (from methotrexate)
heroine, cocaine
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37
Q

normal A-a gradient

A

5 - 15 mmHg

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38
Q

what causes a high A-a gradient

A

pulmonary embolism
pulmonary edema
ARDS

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39
Q

emperic treatment for pnuemonia in a 2 month-old

A

macrolide

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40
Q

empierc treatment for pnuemonia in a 2 year-old

A

amoxicillin or ampicillin

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41
Q

treatment for atypical pneumonia

A

macrolide

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42
Q

next step in work-up of patient with a solitary pulmonary nodule

A

compare to previous CXR

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43
Q

definition of chronic bronchitis

A

> 3 months of symptoms per year for at least 2 years

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44
Q

when do patients with chronic COPD qualify for home O2

A

pulse ox < 88%, pulmonary hypertension, peripheral edema, or polycythemia

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45
Q

type of lung cancer associated with cushing’s syndrome

A

small cell lung cancer

46
Q

type of lung cancer associated with hypercalcemia

A

squamous cell lung cancer

47
Q

type of lung cancer associated with SIADH and hyponatremia

A

small cell lung cancer

48
Q

lung cancer with antibodies to presynaptic calcium channels

A

small cell lung cancer

49
Q

initial treatment for small cell lung cancer

A

chemotherapy

50
Q

initial treatment for localized non-small cell lung cancer

A

surgical resection followed by chemotherapy

51
Q

what factors make pulmonary nodule more likely to be malignant

A 
> 2 cm
> 45
irregular margins
smoker
irregular calcifications
52
Q

outpatient management for mild persistent asthma

A

low-dose inhaled corticosteroid
adjunct montelukast if necessary

short-acting beta agonist for exacerbations

53
Q

radiologic findings in idiopathic pulmonary fibrosis

A

honeycomb lung

54
Q

treatment for idiopathic pulmonary fibrosis

A

steroids, azathioprine, and n-acetylcysteine
may substitute cyclophosphamide for azathioprine but greater incidence of side effects
lung transplant

55
Q

pnuemoconiosis with progressive fibrosis

A

silicosis and coal mining

56
Q

pneumoconiosis with increased risk of TB

57
Q

pneumoconiosis associated with working with electronics and increased cancer risk

A

berylliosis

58
Q

pneumoconiosis with malignant mesothelioma and bronchogenic carcinoma

A

asbestosis

59
Q

patient w/chronic FEV1 of 40%

A

inhaled corticosteroid, long-acting beta-agonist, annual influenza vaccine

60
Q

diagnosis and treatment: chronic sinusitis, hemoptysis, and hematuria

A

wegener’s granulomatosis

steroids + cyclophosphamide

61
Q

diagnosis and treatment: anti-glomerular basement membrane antibodies

A

goodpasture’s syndrome

plasmapheresis, steroids, additional immunosuppressive agents

62
Q

smoker with rapid onset JVD, facial swelling, and altered mental status

A

superior vena cava syndrome

63
Q

pathologies with decreased DLCO (decreased diffusion capacity at alveoli-arterial interface)

A

ARDS (alveoli filled with fluid)

emphysema (fibrotic destruction of alveoli)

64
Q

diagnostic distinction between bronchitis and emphysema

A

bronchitis: normal DLCO
emphysema: decreased DLCO (fibrotic destruction of alveoli)

65
Q

easier way to determine oxygen diffusion at alveolar-arterial interface instead of measuring DLCO

A

A-a gradient

66
Q

vaccines for patients with COPD

A

influenza vaccine annually
pneumococcal vaccine every 5 years
haemophilus influenza vaccine once

67
Q

what kind of oxygen do you give patients with COPD

A

low-flow via nasal cannula

do not want to reduce hypoxic drive

68
Q

genetic disorders associated wit bronchiectasis

A

cystic fibrosis, kartagener’s syndrome

69
Q

how to monitor heparin dosage after PE

A

titrate PTT to 1.5-2.5 times normal

70
Q

pulmonary embolism treatment

A

heparin x 5 days, cross over to warfarin x 3-6 months

71
Q

criteria for labeling pleural fluid as exudative

A

pleural LDH > 0.6 serum LDH

pleural protein > 0.5 serum protein

72
Q

drug of choice for inpatient management of pneumonia

A

levofloxain, moxifloxacin

for nosocomial penumonia, add vancomycin to cover MRSA

73
Q

drug of choice for outpatient management of pneumonia

A

azithromycin, doxycycline

74
Q

test to differentiate between asthma and COPD

A

FEV1 with and without bronchodilator

DLCO

75
Q

which test on pleural fluid is most helpful in determining need for chest tube placement in parapneumonic effusion

A

pH: low pH (< 60 also is an indication for thoracostomy

76
Q

aspirin sensitivity syndrome

A

pseudo-allergic reaction caused by prostaglandin/leukotriene imbalance in susceptible individuals

treatment: avoid NSAIDs and use leukotriene receptor antagonists

77
Q

mobile cavitary mass in lung with intermittent hemoptysis

A

aspergillosis

78
Q

physical exam in lung consolidation

A

bronchial breath sounds (full inspiration and expiration), dullness to percusion, and increased fremitus

bronchial breath sounds have a full expiratory phase

79
Q

physical exam in pleural effusion

A

decreased breath sounds, dullness to percussion, decreased fremitus and transmitted airway sounds

80
Q

physical exam in emphysema

A

hyper-resonant to percussion, breath sounds are vesicular, intensity of sound is decreased, wheezing may be present

81
Q

physical exam in pneumothorax

A

hyper-resonance on percussion, decreased breath sounds

82
Q

physical exam in interstitial lung disease

A

lungs are resonant on percussion, vesicular breath sounds, fine crackles heard at the end of inspiration

83
Q

normal A-a gradient

84
Q

how to calculate PAO2 from PaCO2

A

PAO2 = 150 mmHg - (1.2)PaCO2

85
Q

most common bacterial cause of bronchitis in nonsmokers

A

mycoplasma pneumoniae

86
Q

most common cause of bronchitis in smokers

A

streptococcus pneumonia

haemophilus influenzae

87
Q

bacterial pneumonia associated with abscess formation

A

staphylococcus aureus

88
Q

mechanism of aspiration pneumonia

A

impaired gag reflex

89
Q

pneumonia associated with young adults

A

mycoplasma pneumoniae

90
Q

pneumonia associated cold-agglutinin test

A

mycoplasma pneumoniae

91
Q

pneumonia in cystic fibrosis

A

pseudomonas

92
Q

pneumonia associated with nausea, diarrhea, confusion, hyponatremia

A

legionella

93
Q

treatment for coccidio pneumonia

A

amphotericin B, ketoconazole

94
Q

treatment for legionella pneumonia

A

macrolides, fluoroquinolones

95
Q

treatment for pseudomonas pneumonia

A

fluoroquinolones, aminoglycosides, 3rd generation cephalosporins

96
Q

treatment for mycoplasma pneuominae

A

macrolides

97
Q

treatment for klebsiella pneumonia

A

cephalosporins and aminoglycosides

98
Q

lung cancer: cavitary lesions, direct extension to hilar lymph nodes

A

squamous cell lung cancer

99
Q

lung cancer: wide metastases, can be caused by asebestos, pleural effusions show increased hyaluronidase

A

adenocarcinoma

100
Q

lung cancer: rapidly growing, early distant metastases

A

small cell lung cancer

101
Q

lung cancer: late distant metastases, early cavitation

A

large cell carcinoma

102
Q

treatment for idiopathic pulmonary fibrosis

A

corticosteroids +/- azathioprine
n-acetylcysteine
lung transplant

103
Q

treatment for sarcoidosis

A

self-resolving in most cases

otherwise, corticosteroids, cytotoxic drugs, or lung transplant

104
Q

gold standard for measuring pulmonary artery pressures

A

cardiac catheterization

105
Q

predictors of ventilator weaning success

A 
maximal inspiratory pressure < 30 cmH2O
vital capacity > 10 mL/kg
minute ventilation < 10 L/min
PaO2/FiO2 ratio > 200
frequency:tidal volume ratio < 100 breaths/min/L
106
Q

treatment for croup

A

aerosolized epinephrine and inhaled corticosteroids

107
Q

pathogen in croup

A

paraindluenzae virus

108
Q

barking cough, inspiratory stridor

109
Q

drooling, soft stridor

A

epiglottitis

110
Q

epiglottitis treatment

A

antibiotics 7-10 days

111
Q

RSV bronchiolitis treatment

A

racemic epinephrine, corticosteroids, beta-agonists

ribavirin in severe cases

112
Q

what ratio is important for evaluating for respiratory distress in the newborn

A

lecithin:sphingemyelin ratio

USMLE Step Two (17 decks)

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