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

MTB 2 CK - Pulmonary Flashcards

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
Q

common pathogen associated with animals at the time to giving birth, veteniarians, farmers

A

coxiella

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26
Q

What findings are suggestive of empyema on pleural fluid?

A

LDH > 60% of serum LDH
protein > 50% of serum protein
WCC > 1000/uL or pH

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27
Q

What is the only infection for which BAL reveals diagnosis

A

pneumocystic pneumonia

28
Q

Diagnostic test for mycoplasma penumonia

A

PCR, cold agglutinin, serology, special culture media

treat empirically

29
Q

Diagnostic test for chlamidophilia pneumonia

A

rising serologic titers

treat empirically

30
Q

Diagnostic test for Legionella

A

urine Ag, culture on charcoal yeast extract

31
Q

Diagnostic test for chlamidya psittaci

A

rising serologic titers

32
Q

Diagnostic test for coxiella burnetti

A

rising serologic titers

33
Q

Diagnostic test for PCP

A

BAL

34
Q

OPT treatment for CAP

A

Macrolide or Doxycycline

If comorbidities present, Fluoroquinolones

35
Q

IPT treamtent for CAP

A

Fluoroquinolone or ceftriaxone + azithromycin

36
Q

Reasons to hospitalize

A

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
Q

indications for a pneumonococcal vaccine (23PPV)

A

Age > 65

Under age

38
Q

Define HAP

A

pneumonia acquired 48+ hrs after admission to hospital or after hospitalization in last 90 days

39
Q

organism associated with HAP and mgmt

A

organisms: Gm- bacilli (E. coli, pseudomonas)
antipsedomonals: cefepine, ceftazidime, zosyn, imipenem, meropenem

40
Q

what is the initial diagnostic test for VAP

A

tracheal aspirate

41
Q

what is the most diagnostic test for VAP

A

open lung biopsy

42
Q

how to treat VAP

A

3 drugs:

  1. antipsedomonal b-lactam (cefepine, ceftazidime, zosyn, imipenem, meropenem)
  2. 2nd antipseudomonal: aminoglycoside, fluoroquinolone
  3. MRSA agen: vancomycin, linezolid
43
Q

How do you diagnose lung absecess

A

lung biopsy (not culture sputum– always contaminated)

44
Q

treatment for lung abscess

A

clindamycin or penicillin

45
Q

what is the most likely diagnosis for pt with AIDS presenting with DOE, dry cough, fever, CD4

A

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
Q

most diagnostic test for TB

A

pleural biopsy
if symptomatic -> TREAT!
if asyptomatic -> PPD’

47
Q

Positive TB if induration > 5mm

A
  1. immunocompromised: HIV+, glucocorticoid users, organ transplant recipients
  2. close contact of active TB (especially children)
  3. abnormal calcification on CXR
48
Q

Positive TB if induration > 10mm

A 
recent immigrants (past 5 years)
close contact: prisoners, healthcare workers with patient contact, close contacts of someone else
49
Q

How do you treat TB with positive PPD?

A

Isoniazid (+B6) 9 months

50
Q

Most common adverse effect of a transthoracic biopsy

A

Pneumothorax

51
Q

Manage a solitary pulmonary finding on CXR

A
  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
Q

Pneumoconiosis: sillicosis

A

sandblasting, rock mining, tunneling

53
Q

Pneumoconiosis: asbestosis

A

shipyard workeres, pipe fitting, insulators

54
Q

Pneumoconiosis: byssinosis

A

cotton

55
Q

Pneumoconiosis: berylossis

A

electronic manufacture
(See granulomas on CXR)
Tx: steroids

56
Q

Pneumoconiosis: bagassosis

A

moldy sugar cane

57
Q

most accurate test in sarcoidosis

A

lymph node biopsy

58
Q

best initial tests if suspecting pulmonary embolism

A

CXR, ECG, ABG
CXR: atelectasis
ECG: nonspecific ST-T wave changes
ABG: hypoxia, respiratory alkalosis

59
Q

Next best step in management if suspecting PE?

A

IV UFH
start warfarin at the same time
IVC when anticoags contraindicated, recurrent embolism, RV dysfunction

60
Q

msot accurate test if suspecting PE

A

angiography

61
Q

in PE, when are thrombolytics the right answer

A

hemodynamically unstable, acute RV dysfunction

62
Q

how does transient tachypnea of newborn present?

A

mild-moderate respiratory distress from birth -> 2-3 days
CXR: perihilar lymphatic streak, fluid in fissures
Neonates IMPROVE with supplemental oxygen

63
Q

how do you treat PCP?

A

1 bactrim

if allergic -> atovoquone

64
Q

how do you treat TB positive on smear?

A

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
Q

MGMT of COPD Exacerbation

A 
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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