Pulm

Question 1

Spontaneous Pneumothorax

- treatment

Answer 1

• stable and >3 cm or symptomatic : needle aspiration

- persistent leak: tube thoracostomy

Question 2

Foreign body aspiration

- Classic triad of sx

Answer 2

1. coughing
2. diminished breath sounds
3. wheezing

Question 3

Foreign body aspiration

- mgmt

Answer 3

removal with rigid bronchoscopy

Question 4

Acute asthma exacerbation

- mgmt

Answer 4

• O2 and inhaled bronchodilators/anticholinergics (beta agonist, ipratroprium)
• systemic glucocorticoids
• if still sx: 2 grams IV mg
• then consider intubation

Question 5

RSV

- RF for developing lower respiratory tract infection

Answer 5

• down syndrome
• significant asthma
• chronic pulm disease
• immunocompromised
• institutionalized

Question 6

RSV

- RF for increased risk of bronchiolitis

Answer 6

• born <36 weeks gestation
• cardiopulmonary dz
• older siblings
• second hand smoke exposure

Question 7

RSV

- treatment

Answer 7

• Nonsevere: nasal suctioning, hydration

- Severe: ? bronchodilator, heated humidified high-flow nasal cannula, CPAP, intubation

Question 8

Pneumonia

- PE

Answer 8

• increased tactile fremitus
• diminished lung sounds
• bronchial lung sounds
• crackles
• egophany

Question 9

Pneumonia

- XR findings

Answer 9

• patchy lung infiltrate

- lung consolidation

Question 10

Pneumonia

- CAP treatment

Answer 10

• doxycycline or macrolide

- abx in 3 months or comorbidities: augmentin + macrolide or doxy

Question 11

Aspiration pneumonia

- prevention for those at risk (stroke, etc.)

Answer 11

• thickened fluids
• feeding upright
• proper oral hygiene to reduce oral bacteria present
• don’t rush feeding time

Question 12

Pulmonary nodule

• dx first line
• dx next steps

Answer 12

• CXR

- CT without contrast

Question 13

Solitary pulmonary nodule

- size

Answer 13

• <3 cm

> 3 cm is considered pulmonary mass

Question 14

Most common cause of hemoptysis

Answer 14

bronchitis

Question 15

TB

- dx

Answer 15

• screening with PPD

- definitive with positive acid-fast bacillus sputum stain

Question 16

TB

- mgmt

Answer 16

• 2 months 4 drugs

- 4 months 2 drug (isoniazid and rifampin)

Question 17

What vitamin is co-administered with isoniazid to reduce risk of peripheral neuropathy?

Answer 17

Pyridoxine (B6)

Question 18

Legionella pneumonia

- mgmt

Answer 18

Abx: azithromycin, levofloxacin, doxy

Question 19

Bordetella pertusus

- what kind of bacteria

Answer 19

gram-negative coccobacillus

Question 20

Blastomycosis

- describe

Answer 20

• Widespread, systemic pyogranulomatous infection due to the inhalation of fungal Blastomyces dermatitidis and Blastomyces gilchristii.
• midwest and souther US

Question 21

Blastomycosis

- three most common clinical presentations

Answer 21

• Pneumonia (MC)
• Skin - verrucous lesions, irregular border, gray/violet color (looks like squamous cell)
• Osteomyelitis

Question 22

Blastomycosis

- dx

Answer 22

• culture
• histopathology
• serologic testing
• PCR

Question 23

Blastomycosis

- tx

Answer 23

• amphotericin B

- Itraconazole

Question 24

Who should be tested for lung cancer

Answer 24

• Adults 55-80
• 30 year hx smoking who currently smoke or quit within last 15 years
• dc screening once has not smoked in 15 years or health problem that diminishes their life expectancy

Question 25

Pneumocystis jirovecii pneumonia | - mgmt

Answer 25

Bactrim

Question 26

PCV13 | - recommended for whom?

Answer 26

- children <2 - adults >=65 - 2-64 with issues

Question 27

PPSV23 | - recommended for whom

Answer 27

- Adults >=65 (one year after PCV13) - Children >2 with RF for pneumonia - 19-64 who smoke, chronic disease

Question 28

Coin in trachea | - appearance on XR

Answer 28

AP: sliver

Question 29

Coin in esophagus | - appearance on XR

Answer 29

AP: circle

Question 30

Histoplasmosis | - location

Answer 30

- Ohio and Mississippi river valleys | - spelunkers, caves, bat and bird droppings

Question 31

Histoplasmosis | - clinical

Answer 31

- usu asx - disseminated infection in immunocompromised - primary infection: flu like - chronic infection: TB like

Question 32

Histoplasmosis - Dx - Tx

Answer 32

- culture | - itraconazole, amphotericin B

Question 33

Nosocomial PNA - org to consider - abx

Answer 33

- pseudomonas | - imipenem, gentamicin, vancomycin

Question 34

Outpatient CAP | - pharm

Answer 34

Macrolide or doxy

Question 35

CAP with chronic dz, immunocompromised, abx in last 3 months | - pharm

Answer 35

- Resp FQ | - Beta-lactam + macrolide/doxy

Question 36

HAP Pharm - no multi drug resistance RF - yes multi drug resistance RF - MRSA RF

Answer 36

- beta-lactam, ertapenem, resp FQ - antipseudomonal beta-lactam or carbapenem + resp FQ - add vanc

Question 37

Coccidioidomycosis | - location

Answer 37

SW USA (arizona, New Mexico, central/souther CA, western TX)

Question 38

Coccidioidomycosis | - clinical

Answer 38

- acute pulm infection - CP, cough, dyspnea, hemoptysis, fever, fatigue - hilar and mediastinal lymphadenopathy - HA, pharyngitis, arthralgia, erythema nodosum

Question 39

Coccidioidomycosis | - mgmt

Answer 39

- azoles

Question 40

Lung abscess | - RF

Answer 40

- aspiration - reduced level of consciousness (etoh, drugs, general anesthesia, head trauma) - dysphagia

Question 41

Lung Abscess | - sx

Answer 41

- indolent that develop over weeks/months - fever, cough, SOB, foul smelling sputum - systemic sx (night sweats, weight loss)

Question 42

Lung abscess | - imaging

Answer 42

- XR: pulm infiltrates with cavity and air fluid level | - CT for more detail

Question 43

Lung abscess | - dx

Answer 43

- imaging | - sputum gram stain/culture

Question 44

lung abscess | - mgmt

Answer 44

- ampicillin-sulbactam - carbapenem - betalactam allergy: clindamycin