MTB 2 CK - Pulmonary Flashcards Preview

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

Flashcards in MTB 2 CK - Pulmonary Deck (65):
1

Best initial test in asthma

PEF or ABG; CXR is normal

2

Most accurate test in asthma

PFT

3

Asthma mgmt in stepwise fashion

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

4

COPD mgmt in stepwise fashion

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

5

Severity of an asthma exacerbation is quantified by

decreased PEF, ABG (increased A-a gradient)

6

treatment of acute asthma exacerbation

O2, albuterol, steroids

7

indications for home O2 use

PaO2

8

best initial test in COPD

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

9

most diagnostic test in COPD

PFT

10

improves mortality in COPD

smoking cessation
O2 therapy
influenza & pnuemococcal vaccine

11

etiology of acute bronchitis

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

12

treatment of acute exacerbation of chronic bronchitis

macrolides, cephalosporins, amoxillin/clavulanic acid, quinolones

13

what causes increased DLCO

asthma

14

what causes decreased DLCO

emphysema

15

most accurate test in bronchiectasis

high resolution CT

16

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

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

17

Most accurate test for Cystic Fibrosis

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

18

define CAP

pneumonia occuring before hospitalization or within 48 hours of admission

19

common pathogen associated with COPD

hemophilus influenza

20

common pathogen associated with viral infection

staph aureus

21

common pathogen associated with alcoholism or diabetes

klebsiella pneumonia

22

common pathogen associated with poor dentition

anaerobes

23

common pathogen associated in young, healthy patients

atypical organisms: mycoplasma, chlamidya, legionella
(not visible on gram stain, not culturable on standard blood agar)

24

common pathogen associated with birds

chlamydia psittaci

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