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MTB STEP 2 (R) > MTB 2 CK - Pulmonary > Flashcards

MTB 2 CK - Pulmonary Flashcards

(65 cards)

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1
Q

Best initial test in asthma

A

PEF or ABG; CXR is normal

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2
Q

Most accurate test in asthma

A

PFT

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3
Q

Asthma mgmt in stepwise fashion

A
  1. SABA 2. intranasal steroids 3. LABA+/- Cromolyn 4. maximize dose of ICS and LABA 5. Theophylline 6. Omalizumab if high IGE
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4
Q

COPD mgmt in stepwise fashion

A
  1. SABA 2. Anti-cholinergics (ipratroprim) 3. ICS 4. LABA 5. pulmonary rehab
    mast cell stabilizers, theophylline are USELESS In COPD
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5
Q

Severity of an asthma exacerbation is quantified by

A

decreased PEF, ABG (increased A-a gradient)

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6
Q

treatment of acute asthma exacerbation

A

O2, albuterol, steroids

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7
Q

indications for home O2 use

A

PaO2

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8
Q

best initial test in COPD

A

CXR (increased AP diameter, air trapping -> flat diaphragms)

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9
Q

most diagnostic test in COPD

A

PFT

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10
Q

improves mortality in COPD

A

smoking cessation
O2 therapy
influenza & pnuemococcal vaccine

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11
Q

etiology of acute bronchitis

A

20-80% by viruses; bacteria = strep pneumo, H. influenza, Moraxella catarrhalis

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12
Q

treatment of acute exacerbation of chronic bronchitis

A

macrolides, cephalosporins, amoxillin/clavulanic acid, quinolones

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13
Q

what causes increased DLCO

A

asthma

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14
Q

what causes decreased DLCO

A

emphysema

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15
Q

most accurate test in bronchiectasis

A

high resolution CT

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16
Q

What is ABPA? How does it present? How do you treat?

A

Allergic Bronchopulmonary Aspergillosis
hypersensitivity of lungs to fungal antigents
Px w/ brown sputum, infiltrates on CXR
Dx: eosinophilia, AB to aspergillus, high IgE
Tx: ORAL steroids, itraconazole

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17
Q

Most accurate test for Cystic Fibrosis

A

increased sweat chloride test (with pilocarpine -> inc. sweating -> Cl > 60 meq/L is diagnostic)

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18
Q

define CAP

A

pneumonia occuring before hospitalization or within 48 hours of admission

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19
Q

common pathogen associated with COPD

A

hemophilus influenza

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20
Q

common pathogen associated with viral infection

A

staph aureus

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21
Q

common pathogen associated with alcoholism or diabetes

A

klebsiella pneumonia

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22
Q

common pathogen associated with poor dentition

A

anaerobes

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23
Q

common pathogen associated in young, healthy patients

A

atypical organisms: mycoplasma, chlamidya, legionella

not visible on gram stain, not culturable on standard blood agar

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24
Q

common pathogen associated with birds

A

chlamydia psittaci

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25
common pathogen associated with animals at the time to giving birth, veteniarians, farmers
coxiella
26
What findings are suggestive of empyema on pleural fluid?
LDH > 60% of serum LDH protein > 50% of serum protein WCC > 1000/uL or pH
27
What is the only infection for which BAL reveals diagnosis
pneumocystic pneumonia
28
Diagnostic test for mycoplasma penumonia
PCR, cold agglutinin, serology, special culture media | treat empirically
29
Diagnostic test for chlamidophilia pneumonia
rising serologic titers | treat empirically
30
Diagnostic test for Legionella
urine Ag, culture on charcoal yeast extract
31
Diagnostic test for chlamidya psittaci
rising serologic titers
32
Diagnostic test for coxiella burnetti
rising serologic titers
33
Diagnostic test for PCP
BAL
34
OPT treatment for CAP
Macrolide or Doxycycline | If comorbidities present, Fluoroquinolones
35
IPT treamtent for CAP
Fluoroquinolone or ceftriaxone + azithromycin
36
Reasons to hospitalize
CURB 65 confusion, uremia (BUN>30), resp rate > 30/min, BP 65. IPT if score greater than 2 ICU if score greater than 4
37
indications for a pneumonococcal vaccine (23PPV)
Age > 65 | Under age
38
Define HAP
pneumonia acquired 48+ hrs after admission to hospital or after hospitalization in last 90 days
39
organism associated with HAP and mgmt
organisms: Gm- bacilli (E. coli, pseudomonas) antipsedomonals: cefepine, ceftazidime, zosyn, imipenem, meropenem
40
what is the initial diagnostic test for VAP
tracheal aspirate
41
what is the most diagnostic test for VAP
open lung biopsy
42
how to treat VAP
3 drugs: 1. antipsedomonal b-lactam (cefepine, ceftazidime, zosyn, imipenem, meropenem) 2. 2nd antipseudomonal: aminoglycoside, fluoroquinolone 3. MRSA agen: vancomycin, linezolid
43
How do you diagnose lung absecess
lung biopsy (not culture sputum-- always contaminated)
44
treatment for lung abscess
clindamycin or penicillin
45
what is the most likely diagnosis for pt with AIDS presenting with DOE, dry cough, fever, CD4
PCP Best initial test: CXR or ABG (hypoxia, inc. A-a gradient) Elevated LDH levels Best diagnostic test: BAL Tx: TMP/SMX. if severe, add steroids to decrease mortality (pO2 35). 2nd line = Pentamidine or Clindamycin + Primaquine If rash from Bactrim: Arovaquome or Dapsone
46
most diagnostic test for TB
pleural biopsy if symptomatic -> TREAT! if asyptomatic -> PPD'
47
Positive TB if induration > 5mm
1. immunocompromised: HIV+, glucocorticoid users, organ transplant recipients 2. close contact of active TB (especially children) 3. abnormal calcification on CXR
48
Positive TB if induration > 10mm
``` recent immigrants (past 5 years) close contact: prisoners, healthcare workers with patient contact, close contacts of someone else ```
49
How do you treat TB with positive PPD?
Isoniazid (+B6) 9 months
50
Most common adverse effect of a transthoracic biopsy
Pneumothorax
51
Manage a solitary pulmonary finding on CXR
1. Compare with old CXR Look for features of benign/malignant 2. PET CT 3. FNA or Bronchoscopy to get sample/cytology VATS is more specific thatn all other forms of testing
52
Pneumoconiosis: sillicosis
sandblasting, rock mining, tunneling
53
Pneumoconiosis: asbestosis
shipyard workeres, pipe fitting, insulators
54
Pneumoconiosis: byssinosis
cotton
55
Pneumoconiosis: berylossis
electronic manufacture (See granulomas on CXR) Tx: steroids
56
Pneumoconiosis: bagassosis
moldy sugar cane
57
most accurate test in sarcoidosis
lymph node biopsy
58
best initial tests if suspecting pulmonary embolism
CXR, ECG, ABG CXR: atelectasis ECG: nonspecific ST-T wave changes ABG: hypoxia, respiratory alkalosis
59
Next best step in management if suspecting PE?
IV UFH start warfarin at the same time IVC when anticoags contraindicated, recurrent embolism, RV dysfunction
60
msot accurate test if suspecting PE
angiography
61
in PE, when are thrombolytics the right answer
hemodynamically unstable, acute RV dysfunction
62
how does transient tachypnea of newborn present?
mild-moderate respiratory distress from birth -> 2-3 days CXR: perihilar lymphatic streak, fluid in fissures Neonates IMPROVE with supplemental oxygen
63
how do you treat PCP?
1 bactrim | if allergic -> atovoquone
64
how do you treat TB positive on smear?
RIPE x2 months, RI x4 months Add 3 months of treatment if patient has: osteomyelitis, milliary TB, meningitis, pregnancy/other situations in which pyrazinamide is not used
65
MGMT of COPD Exacerbation
``` Oxygen (Target >88%) Inhaled Bronchodilators Systemic Glucocorticoids Abs NPPV Tracheal intubation if no improvement on NPPV ```

MTB STEP 2 (R) (12 decks)

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