Adult - Respiratory II

Question 1

What are the five conditions which may cause significant night sweats?

Answer 1

TB
menopause
AIDS
lymphoma
endocarditis

Question 2

What are the signs and symptoms of TB?

Answer 2

majority of people are ASYMPTOMATIC
if present:
weight loss
night sweats
low grade fever
cough

Question 3

What is the typical cough progression in TB?

Answer 3

dry cough progressing to productive and sometimes blood tinged

Question 4

What are the two tests definitively diagnostic for TB?

Answer 4

culture

CXR - small, homogenous infiltrate in upper lobes

Question 5

Is TB reportable?

Answer 5

yes

Question 6

What is INH?

Answer 6

the abbreviation for isoniazid

Question 7

What is the medication regimen for TB?

Answer 7

RIPE
R - Rifampin
I - Isoniazid (INH)
P - Pyrazinamide 
E - Ethambutol

Question 8

When can the 4th drug in the TB regimen be dropped?

Answer 8

if the isolate is fully suceptible to RIF and INH

Question 9

How long are the drugs given in TB?

Answer 9

INH and RIF for at least 6 months

pyrazinamide for 2 months

Question 10

How is TB therapy monitored?

Answer 10

Weekly sputum smears and cultures for the first 6 weeks

Then monthly until negative cultures documented

Question 11

Continued positive TB cultures after what time frame would raise the suspicion of drug resistance?

Answer 11

3 months

Question 12

What baseline studies should be obtained prior to starting TB drug therapy?

Answer 12

LFTs
CBC
serum creatinine

Question 13

What lab work must be monitored weekly while on INH?

Answer 13

LFTs

Question 14

What needs to be monitored in people taking ETHAMBUTOL?

Answer 14

visual acuity

red-green color perception

Question 15

PPD reading of 5 mm considered positive in what populations?

Answer 15

HIV patients
contacts of a known cause
those with typical TB presentation on CXR

Question 16

PPD reading of 10 mm considered positive in what populations?

Answer 16

immigrants
high risk groups
health care workers

Question 17

PPD reading of 15 mm considered positive in what populations?

Answer 17

all others

those not in any high prevalence groups

Question 18

FVC
stands for -
defined -
significant in -

Answer 18

forced vital capacity

volume forcefully expelled after max inspiration

significant in OBSTRUCTIVE diseases

Question 19

FEV1
stands for -
defined -
significant in -

Answer 19

forced expiratory volume in 1st second

volume expelled in 1st second of FVC maneuver

significant in OBSTRUCTIVE diseases

Question 20

FEF 25-75
stands for -
defined -
significant in -

Answer 20

forced expiratory flow in middle 50%

max mid-expiratory airflow rate

significant in OBSTRUCTIVE diseases

Question 21

PEFR
stands for -
defined -
significant in -

Answer 21

peak expiratory flow rate

max rate achieved in FVC maneuver

significant in OBSTRUCTIVE diseases

Question 22

TLC
stands for -
defined -
significant in -

Answer 22

total lung capacity

volume in lungs after max inspiration

significant in RESTRICTIVE diseases

Question 23

FRC
stands for -
defined -
significant in -

Answer 23

functional residual capacity

volume left after passive exhalation

significant in RESTRICTIVE diseases

Question 24

RV
stands for -
defined -
significant in -

Answer 24

residual volume

volume remaining after max exhalation

significant in RESTRICTIVE diseases

Question 25

What are the PFTs which reflect AIRFLOW RATE?

Answer 25

FVC FEV1 FEF 25 - 75 PEFR

Question 26

What are the PFTs which reflect VOLUMES?

Answer 26

TLC FRC RV

Question 27

Which type of PFTs are decreased in obstructive diseases?

Answer 27

the airflow rate measures

Question 28

Which type of PFTs are decreased in restrictive diseases?

Answer 28

the volume measures

Question 29

What are examples of OBSTRUCTIVE diseases?

Answer 29

asthma | COPD

Question 30

What are examples of RESTRICTIVE diseases/conditions? (6)

Answer 30

``` pneumonia pleural effusion pulmonary fibrosis lobectomy morbid obesity pregnancy ```

Question 31

What is a pleural effusion?

Answer 31

a buildup of fluid between the lungs and chest cavity in the pleural space

Question 32

Clear fluid in pleural effusion is called what?

Answer 32

transudate

Question 33

Cream colored fluid in pleural effusion is called what?

Answer 33

exudate -- contains protein

Question 34

Pus found in pleural effusion is called what?

Answer 34

empyema

Question 35

Blood in pleural effusion is called what?

Answer 35

hemorrhagic

Question 36

What is the typical Xray finding in pleural effusion?

Answer 36

loss of costophrenic angle to blunting or shadows | no shark fins

Question 37

What is the difference between pleural effusion and infiltrate?

Answer 37

pleural effusion is fluid between the lung and chest wall in the pleural space infiltrate is a general term meaning an abnormal substance that accumulates gradually within cells or body tissues

Question 38

What is atelectasis?

Answer 38

collapse of all or part of the lung - develops when alveoli become deflated

Question 39

What is tactile fremitus?

Answer 39

"99" - ulnar surfaces of hands on back increased in consolidation (pnumonia) decreased in pleural effusion