Pulmonary

Question 1

Pulsus paradoxus of greater than 12 mmHg is seen in asthma or COPD?

Answer 1

Asthma

Question 2

What do you hear when you percuss over the gastric air bubble?

Answer 2

Tympany

Question 3

Hospitalization is recommended if FEV1 is below what in asthma?

Answer 3

Below 30% predicted value

Question 4

Hospitalization is recommended if peak flow is below what in asthma?

Answer 4

Below 60 liters/min

Question 5

What will you see on the CXR of a pt with acute asthma?

Answer 5

Hyperinflation

Question 6

What is the preferred step 1 agent in asthma, and what is an example of one?

Answer 6

SABA - ex. is albuterol

Question 7

How do SABAs work?

Answer 7

Stimulate enzymes that convert adenosine triphosphate to cAMP

Question 8

What is the preferred step 2 agent in asthma?

Answer 8

Low-dose inhaled corticosteroids

Question 9

What is the step 3 in asthma management?

Answer 9

Low dose inhaled corticosteroid + LABA

Question 10

What are two combined inhaled corticosteroid + LABA combos used in asthma?

Answer 10

Advair and Symbicort

Question 11

What is Advair a combo of?

Answer 11

Fluticasone and salmeterol

Question 12

What is Symbicort a combo of?

Answer 12

Formoterol and budesonide

Question 13

What is the indication for IM epi?

Answer 13

Stridor or resp distress 2/2 anaphylaxis

Question 14

What is chronic bronchitis defined as?

Answer 14

Productive cough for 3 or more months in at least 2 consecutive years

Question 15

What is emphysema defined as?

Answer 15

Abnormal, permanent enlargement of the alveoli

Question 16

COPD/emphysema will show what on CXR?

Answer 16

Low, flat diaphragm 2/2 air trapping

Question 17

What two drugs are the mainstay of COPD tx?

Answer 17

Inhaled ipratropium bromide or sympathomimemetics

Question 18

What is a major pulmonary disease that causes night sweats?

Answer 18

TB

Question 19

How is the definitive diagnosis of TB made?

Answer 19

Culture of M. tuberculosis x 3

Question 20

What is seen on CXR in TB?

Answer 20

Small homogenous infiltrates in upper lobes of CXR

Question 21

What does a PPD for a pt with TB?

Answer 21

Just that they were exposed to TB

Question 22

What should you do if pt has a positive PPD and neg CXR?

Answer 22

Offer 6 months INH

Question 23

What 4 drugs are given for TB?

Answer 23

Isoniazid, rifampin, pyrazinamide, ethambutol

Question 24

How long should someone be on TB treatment, at minimum?

Answer 24

6 months

Question 25

How long should someone with HIV be treated for TB?

Answer 25

9 months

Question 26

What is a major complication of INH (isoniazid)?

Answer 26

Hepatotoxicity

Question 27

Pts taking ethambutol should be tested for what?

Answer 27

Visual acuity and red-green color perception

Question 28

The general population is considered PPD positive at what size reaction?

Answer 28

15 mm

Question 29

Immigrants from high risk areas or health care workers are considered PPD positive at what size reaction?

Answer 29

10 mm

Question 30

HIV infected persons are considered PPD positive at what size reaction?

Answer 30

5 mm

Question 31

What is the most common agent that causes CAP?

Answer 31

S. pneumoniae

Question 32

What are three treatment choices for low severity, outpatient CAP?

Answer 32

Amoxicillin, doxycycline, or macrolide

Question 33

What is the tx for inpatient CAP caused by psuedomonas?

Answer 33

Zosyn or meropenem or cefepime + aminogylcoside/azithromycin

Question 34

What is HAP defined as?

Answer 34

PNA that occurs at greater than 48 hours of admission

Question 35

What is VAP defined as?

Answer 35

PNA that occurs more than 48--72 hours after intubation

Question 36

What is the most common causative organism for VAP?

Answer 36

Pseudomonas

Question 37

Is fremitus increased or decreased in PTX?

Answer 37

Decreased

Question 38

Is fremitus increased or decreased in PNA?

Answer 38

Increased

Question 39

At what landmark is needle decompression for a PTX done?

Answer 39

2nd intercostal space, mid clavicular line

Question 40

At what landmark is a chest tube placed for PTX?

Answer 40

4th or 5th ICS, mid axillary line

Question 41

What is the mainstay therapy for sarcoidosis?

Answer 41

Corticosteroids

Question 42

What study should be performed in all clinically stable pts with suspected PE?

Answer 42

VQ scan

Question 43

If VQ scan is indeterminate for PE but you suspect pt has a PE, what is the next step?

Answer 43

Pulmonary angiography

Question 44

Hypoxemia is defined as what on an ABG?

Answer 44

PaO2 <80 mm Hg

Question 45

What will you see on an ABG in PE?

Answer 45

Hypoxemia and hypocapnia

Question 46

What is the hallmark feature of ARDS?

Answer 46

Refractory hypoxemia

Question 47

How much TV should a pt with ARDS have?

Answer 47

6-8kg of ideal body weight

Question 48

How much PEEP should a pt with ARDS have?

Answer 48

At least 10 cm H2O

Question 49

If you put a pt on a vent and ABG shows resp acidosis, what should you do?

Answer 49

Increase ventilation rate

Question 50

If you put a pt on a vent and ABG shows resp alkalosis, what should you do?

Answer 50

Decrease ventilation rate

Question 51

If your pt is vented and starts breathing on their own, you switch from assist control to what?

Answer 51

SIMV (synchronized intermittent mandatory ventilation)

Question 52

What is the difference between assist-control and SIMV?

Answer 52

In assist control, if the pt initiates a breath on his own, the vent delivers preset TV. In SIMV, if the pt initiates a breath, they pull whatever tidal volume they can

Question 53

If you have a pt on assist-control and they start breathing on their own and you don't switch them to SIMV, what will develop?

Answer 53

Respiratory alkalosis (from overbreathing)

Question 54

An exudate has higher what than a transudate?

Answer 54

Protein and/or LDH