Pulm

Question 1

Pleural Fluid Analysis:

exudative?

Answer 1

fluid protein/serum protein > 0.5
fluid lactate dehydr > 2/3 UL of normal OR
fluid/serum lactate dehydr > 0.6

Question 2

What leukocyte value implies transudative process?

Answer 2

<1000

Question 3

What does a predominance of neutrophils in pleural fluid suggest?

Answer 3

an acute inflammatory or infectious process

Question 4

What is pleural fluid glucose level of <60 most commonly caused by?

Answer 4

TB, parapneumonic effusion, malignant effusion, or rheumatoid disease

Question 5

What is normal pleural fluid pH?

Answer 5

7.6-7.66

Question 6

What does pleural fluid of <7.2 indicate?

Answer 6

complicated parapneumonic effusions (empyema), esophageal rupture, rheumatoid and TB pleuritis, malignant pleural disease, systemic acidosis, paragonimiasis, lupus pleuritis, or urinothorax.

Question 7

What kind of pleural effusion is seen in malignancy?

Answer 7

exudative w/ predominance of lymphocytes!

Question 8

How to distinguish TB from bacterial effusion?

Answer 8

TB has predominance of lymphocytes

Question 9

What 2 characteristics of pleural effusions indicate a poor prognosis for a pt?

Answer 9

low glucose and pH

Question 10

How to tell the difference between a pleural effusion and lobar consolidation on exam?

Answer 10

decreased fremitus in pleural effusion. increased fremitus in consolidation.

Question 11

What is atopy?

Answer 11

excema

Question 12

how to induce asthma?

Answer 12

Ach-agonist: methylcholine

Question 13

How to rescue pt with asthma?

Answer 13

albuterol- beta agonists

Question 14

Asthma stabilizers?

Answer 14

nedocromyl/cromolyn. Only for athletic asthma when certain of cause

Question 15

Bronchodilator response in COPD?

Answer 15

• response of FEV1/FVC to less than 70% of predicted

- FEV1 can be relatively preserved in mild disease

Question 16

Which lung disease should be considered in pts with tuberous sclerosis?

Answer 16

lymphangioleiomyomatosis

Question 17

The following findings in a young woman with dyspnea should prompt consideration of what condition? spontaneous pneumothorax, chylothorax, CXR that shows hyperinflation

Answer 17

lymphangioleiomyomatosis

Question 18

What findings on CXR are present in cryptogenic organizing pneumonia (COP)?

Answer 18

alveolar opacification almost always bilateral and show varied distribution. migrate to diff lung regions.

Question 19

COP is the idiopathic form of what?

Answer 19

bronchiolitis obliterans organizing pneumonia (BOOP)

Question 20

What gram positive rod causes meningitis in babies/elderly?

Answer 20

Lysteria monocytogenes

Question 21

How do you treat lysteria monocytogenes meningitis?

Answer 21

Ampicillin or Penicillin G. Use Bactrim in peeps allergic to penicillin

Question 22

What gram positive diplococci causes meningitis in babies/elderly?

Answer 22

strep pneumo

Question 23

How to treat presumed strep pneumo meningitis?

Answer 23

ceftri and vanc until sensitivities come back

Question 24

What type of meningitis is associated with HSV2 genital infection?

Answer 24

aseptic meningitis

Question 25

What sx are associated with aseptic meningitis?

Answer 25

recurrent episodes of fever, vomiting, and photosensitivity

Question 26

Leuk count in bacterial meningitis?

Answer 26

1000-5000

Question 27

What type of leuks found in bacterial meningitis?

Answer 27

predominance of neutrophils

Question 28

What glucose level ass w/ bacterial meningitis? CSF to plasma glucose ratio?

Answer 28

= to 40. = to 0.4

Question 29

Rash ass w/ acute HIV infection?

Answer 29

diffuse maculopapular eruption across chest, face, back, and UEs. could also affect palms and soles.

Question 30

What disease has sx of recurrent painful oral & genital apthous ulcers, skin lesions, and uveitis, along with neurologic manifestations in 25% of pts?

Answer 30

Behcet's disease

Question 31

What leuk level ass. with Behcet's disease?

Answer 31

<100 cells

Question 32

What 2 agents are appropriate to administer within 48 hrs of ischemic stroke onset if pts don't meet criteria for thrombolytic therapy?

Answer 32

325 mg aspirin and dipyridamole

Question 33

What is time window AFTER SYMPTOM ONSET in acute ischemic stroke to see a benefit from rTPA admin?

Answer 33

4.5 hours

Question 34

What is time window AFTER HOSPITAL ARRIVAL in ischemic stroke to see a benefit from rTPA admin?

Answer 34

1 hour (withhold antiplatelet agents for 24 hours post)

Question 35

What's the word for when the muscles you use for speech are weak or you have difficulty controlling them? comes with slurred/slowed speech

Answer 35

dysarrthria

Question 36

What scoring system to eval peeps with probable TIA for admission?

Answer 36

``` A- >60 yo B- BP > 140/90 C- clinical sx (hemiparesis) D^2- duration, presence of DM >3 --> hospital admission ```

Question 37

BP level required before thrombolytic therapy for stroke administered?

Answer 37

185/110 (180/105 goal for 24 hrs after that)

Question 38

What is it called when damage to posterior parietal cortex causes individual to have difficulty with the motor planning to perform tasks or movements when asked?

Answer 38

apraxia

Question 39

What is the name for the reflexive rolling upwards of the globe during eye closure?

Answer 39

bell phenomenon

Question 40

How to treat bell palsy?

Answer 40

prednisone, 40 mg/day, pref initiated in first 72 hrs

Question 41

What glucose level w/ 2-hour glucose tolerance test is diagnostic for impaired glucose tolerance?

Answer 41

140-199

Question 42

What glucose level w/ 2-hour glucose tolerance test is diagnostic for diabetes?

Answer 42

>200

Question 43

What test to perform in pts with acute/progressive neuropathy or polyradiculoneuropathy, and also in pts with severe weakness, sensory loss, or absent DTRs?

Answer 43

LP to R/O guillain barre and chronic inflamm polyradiculopathy; also infectious viral causes

Question 44

What does CSF look like in Guillain barre?

Answer 44

normal cell count, elevated CSF protein

Question 45

Initial tx for essential tremor?

Answer 45

"lifestyle modifications"

Question 46

Pharmacologic management of essential tremor?

Answer 46

beta-blockers, anti-convulsants like primidone

Question 47

Pharmacologic order of operations in status epilepticus?

Answer 47

IV lorazepam --> fospheny-->phenobarb if the others don't work. Can substitute Valproate for fospheny, but has infusion rate limitations and longer onset of action