1.4 Pulmunology

Question 1

what does the PFT in asthma show

Answer 1

↓ FEV1/FVC (both decrease)

↑ TLC

↑ RV

Reversibility with albuterol: ↑ FEV1 > 12%

Bronchial hyperresposiveness: ↓ FEV1 >20% (methacoline)

Question 2

what diagnostic tool do you use ot test for asthma in a patient that is asymptomatic?

Answer 2

methocoline bronquial hyperresponsiveness

↓ FEV1 >20%

Question 3

adverse effect of ICS

Answer 3

dysphonia

oral candidiasis

Question 4

adverse effects of zafirlukast

Answer 4

hepatotoxicity

Chrug-Strauss Syndrome

Question 5

what vaccines are given in all asthma and COPD patients?

Answer 5

influenza

pneumococcal

Question 6

severe asthma exacerbation (LAB)

Answer 6

PEF: decreased

ABG: increased A-a

Question 7

when is magnesium used in an acute asthma flare?

Answer 7

after several rounds of albuterol do not work (waiting for the corticosteroids to begin to work)

Question 8

shortness of breath, young, non-smoker

most likely cause?

Answer 8

anpha-1 antitrypsin deficiency

Question 9

treatment of COPS that decreases mortality

when to use them

Answer 9

1. smoking cessation
2. oxygen therapy

• pO2 <55 / sat <88%
• pO2 <60 / sat <90%
  
  • pulm HTN
  • High HCT
  • cardiomyopathy

Question 10

Most common/resistant organisms that infect CF patients?

Answer 10

nontypable H. influenzae

Pseudomonas aerruginosa

Staph. aureus

Burkhorlderia capacia

Question 11

pneumonia that is accompanied by a dry (nonproductive) cough

Answer 11

1. virus
2. pneumocystis
3. mycoplasma
4. coxiella
5. chlamydia

Question 12

what is the best initial test for all respiratory infections?

Answer 12

chest x-ray

Question 13

organisms that cause atypical pneumonia

Answer 13

mycoplasma

chalmydophila

legionella

coxiella

viruses

Question 14

criteria for empyema

Answer 14

LDH >60% of serum

Protein >50% of serum

WBC >1000

pH <7.2

+ gram stain/culture / frank pus

Question 15

🌟 reasons to hospitalize a patient with pnemonia

Answer 15

CURB 65

Confusion

Uremia

Respiratory distress

BP low

Age > 65

Question 16

empiric therapy for CAP

Answer 16

macrolides

comorbidities or ATB in past 3 months: flouroquinolones

inpatient treatment: IV flouroquinolones

/ ceftriaxone+ azithromycin

Question 17

empiric therapy for HAP

Answer 17

antipseudomonal drugs (gram-eg bacilli)

cefepime, ceftazidime

piperaciline/tazobactam

imipenem, meropenem

Question 18

why can’t you use daptomycin in the lung

Answer 18

inactivated by surfactant

Question 19

adverse effect of imipenem

Answer 19

at toxicity levels can cause seizures

excreted by kidney, kidney failure = toxicity

Question 20

risks for large-volume aspiration

Answer 20

stroke with loss of gag reflex

seizures

intoxication

endotracheal intubation

Question 21

in what part of the lungs does aspiration pneumonia happen

Answer 21

upper lobe when lying flat

Question 22

🚩 pt with AIDS presenting dyspnea, dry couch and fever

Answer 22

pneumocystis pneumonia

P. jiroveci

Question 23

most common adverse effects of TMP/SMP

Answer 23

rash

bone marrow supression

Question 24

🚩 bite cells

what drug is contraindicated

Answer 24

G6PDH deficiency

primaquine, dapsone

Question 25

TB risk factors

Answer 25

immigrants (past 5 yrs) healthcare provider prisoners close contacts with TB alcoholics HIV hematologic malignancy DM

Question 26

in what cases is the tx for tuberculosis extended \>6m?

Answer 26

1. osteomyelitis 2. miliary tb 3. meningitis 4. pregnancy 5. cavitary lesions

Question 27

what drugs are contraindicated for a pregnant woman with TB?

Answer 27

pyrazinamide and streptomycin

Question 28

lunch cancer screening indications

Answer 28

30 pack-year tobacco history age \>55 chest CT

Question 29

🚩 velcro sounding crackles

Answer 29

interstitial lung disease (pulm. fibrosis)

Question 30

🚩 hiliar adenopathy on chest x-ray in a healthy african american woman

Answer 30

Sarcoidosis

Question 31

🚩 Dyspnea, normal chest x-ray, hypoxia with respiratory alkalosis

Answer 31

pulmonary embolism

Question 32

when should you treat PE with IVC filter

Answer 32

1. contraindication to the use of anticoagulants 2. recurrent emboli (while on therapy) 3. right ventricular dysfunction

Question 33

when should you tret a patient with PE with thrombolytics

Answer 33

1. hemodynamically unstable 2. acute right ventricle dysfunction

Question 34

what is the treatment in a patient with PE that has heparin-induced thrombocytopenia?

Answer 34

fondaparinux