Pulm

Question 1

self-limited upper airway infxn
cough > 5 days
myalgia + low fever
prolonged expiration

Answer 1

acute bronchitis
MC viral
bacterial - pertussis, mycoplasma, chlamydia
tx: supportive

Question 2

kid < 2 w/ wheezing

Answer 2

bronchiolitis (RSV)
nasal suction
\+/- bronchodilator
steroids
Ribavirin

Question 3

HIGH fever
sore throat out of proportion to phayngititis
odynophagia, muffled voice

Answer 3

epiglotitis
stridor, tripoding, retractions
“thumb sign”
tx: rocephin + vanc

Question 4

inspiratory stridor worse at night
low grade fever
abrupt barking cough

Answer 4

croup
parainfluenza
“steeple sign”
tx: glucocorticoids, epi

Question 5

single-stranded RNA
high fever + chills + myalgia
winter months

Answer 5

flu
can cause atypical pneumonia in pts w/ pre-existing dz
rapid flu - low sensitivity, high specificity
tx: neuroaminidase inhibitors (tamiflu, zanamivir kids > 7)

Question 6

cough > 14D
no fever
post-tussive vomit
whoop

Answer 6

pertussis: gram- coccobacillus
tx: macrolide

Question 7

bacterial causes PNA

Answer 7

s pneumo
h flue
klebsiella
m cat

Question 8

atypical causes PNA

Answer 8

legionella
mycoplasma
chlamydia

Question 9

fungal PNA southeast US

Answer 9

blastomycosis

Question 10

fungal PNA San Joaquin Valley/California

Answer 10

caoccidiodes

Question 11

fungal PNA Mississippi River Valley

Answer 11

histoplamsa

Question 12

MCC PNA COPD

Answer 12

Haemophilus

Question 13

MC PNA w/ exposure to birds

Answer 13

chlymdia psittaci

Question 14

MC PNA post viral infxn or IV drug use

Answer 14

S aureus

Question 15

CXR typical vs atypical PNA

Answer 15

typical - lobar

atypical - interstitial

Question 16

outpt tx PNA

Answer 16

macrolide

doxycycline

Question 17

outpt tx PNA recent abx or chronic dz

Answer 17

levofloxacin, moxifloxacin

amoxicillin + azith

Question 18

inpt tx PNA non-ICU

Answer 18

levo, moxi

amoxicillin + azith or doxy

Question 19

inpt tx PNA ICU

Answer 19

levo, moxi + azith

Question 20

tx PNA + allergy to PCN

Answer 20

levo + aztreonam

Question 21

obligate intracellular acid fast bacillus

cavitary lesions in lung apices

Answer 21

TB

sputum smear AFB, confirm w/ PCR

Question 22

BCG vaccine testing

Answer 22

interferon gamma release assay (IGRA)

Question 23

tx latent TB w/ negative CXR

Answer 23

isoniazid x 9mon

Question 24

skin flushing + exposive diarrhea + PNA/coughing/hemoptysis

Answer 24

carcinoid tumors
check 5HIAA urine
serum tumor marker chromogranin A
tx: antidiarrhea, avoid trytophan foods

Question 25

humoral hypercalcemia of malignancy

Answer 25

squamous cell makes PTH-related protein

Question 26

lung mass vs nodule

Answer 26

mass > 30mm serial CT chest scans Fleishener guidelines determines CT follow up

Question 27

reversibility on PFT

Answer 27

improves by 12% AND increases by 200mL

Question 28

gold staging

Answer 28

mild: FEV1> 80 moderate: FEV1 50-80 severe: FEV1 30-50 very severe: FEV1 < 30

Question 29

when to use O2

Answer 29

sats below 88% or desats on 6 min walk test

Question 30

tx COPD

Answer 30

mild: SABA moderate: anti-cholinergic (tiotropium) severe: inhale steroid very severe: lung transplant/O2

Question 31

3 hallmarks of asthma

Answer 31

outflow obstruction bronchial hyper-reactivity inflammation of airway

Question 32

tx asthma

Answer 32

SABA --> ICS --> ICS + LABA --> higer dose ICE/LABA --> steroid

Question 33

permanent and abnormal dilation of bronchial walls from chronic infxn/inflamation

Answer 33

bronchiectasis

Question 34

CT = tram tracks | chronic cough

Answer 34

tx: guiafinesin, CPT

Question 35

autosomal recessive chronic cough, clubbing pancreas cysts = malabsorption/constipation infertility in men

Answer 35

CF pilocarpine sweat test tx: CPT, digestive enzymes, insulin

Question 36

ssx pleural effusion

Answer 36

fullness to percuession diminished breath sounds decreased tactile fremitus DOE/orthopnea, PND

Question 37

transudate vs exudate cause effusion

Answer 37

``` transudate = high hydrostatic forces or low oncotic pressure exudate = capillary permeability s/t inflammation ```

Question 38

light's criteria

Answer 38

P/S protein > 0.5 P/S LDH > 0/6 LDH > 2/3 upper normal limit for serum

Question 39

unilateral CP hyper-resonance tachy SOB

Answer 39

pneumo

Question 40

``` sx 6mon-2 years progressive SOB non-productive cough velcro-like crackles clubbing ```

Answer 40

idiopathic pul fibrosis CXR = honeycombing + reticulonodular infiltrates tx: O2, steroids - nor real good txl mean survivial 3-7 years

Question 41

caused by build up of mineral dust in the lungs

Answer 41

pneumoconiosis

Question 42

pleural plaquex on CXR

Answer 42

asbestos

Question 43

egg shell calcifications on CXR

Answer 43

silicosis

Question 44

skin lesions + granulomas + hypercalcemia

Answer 44

berylliosis | tx: steroid

Question 45

diffuse lung injury PaO2/FiO2 < 300 bilateral infiltrates respiratory infiltrates not explained by cardiac failures

Answer 45

ARDS | causes: PNA, aspiration, inhalation injuries, sepsis, pancreatitis, drug OD

Question 46

tx ARDS

Answer 46

low TV, high PEEP