pulmonary

Question 1

pt with increased RR, hyperresounane upon assessment as well as pulses paradoxes , what do you suspect

Answer 1

asthma

Question 2

pulsus paradoxus

Answer 2

seen in asthma
SBP decreases with inhalation

Question 3

hyperresonance

Answer 3

air trapping
asthma / COPD

Question 4

when is hospitalization recommended for asthma

Answer 4

FEV1 does not improve after bronchodilator
peak flow <60/liters/min or does not improve after treatment

Question 5

expected finding of asthma in chest xray

Answer 5

hyperinflation

Question 6

stepwise approach for managing asthma

Answer 6

step 1 - SABA (albuterol, levalbuterol)
Step 2 - ICS *budesonide, fluticasone, triamcinolone)
Step 3- ICS + LABA (salmeterol,)
step 4- medium ICS + LABA
step 5 - high dose ICS + LABA

Question 7

how does levalbuterol work

Answer 7

by stimulating enzymes that convert adenosine triphosphate to cyclic-3, cAMP, which in turns relaxes bronchial smooth muscle

Question 8

what is advair

Answer 8

fluticasone + salmeterol (LABA)

Question 9

what is symbicort

Answer 9

formoterol + budesonide (LABA)

Question 10

if a pt does not respond to SABA and ICS what other medication may you administer

Answer 10

magnesium sulfate

Question 11

55 y/o female with progressive cough complains of clear sputum and has an increased chest A-P diameter , what do you suscpect

Answer 11

emphysema

Question 12

40 y/o female presents with copious purulent sputum and mild dyspnea, xray reveals hyperinflation and normal AP diameter -what do you supect

Answer 12

chronic bronchitis

Question 13

normal FEV1

Answer 13

70

Question 14

typical FEV1 of COPD

Answer 14

low , below 70 due to reduced expiratory airflow

Question 15

normal TLC
FRC
RV

Answer 15

TLC - 4000-11000
FRC - (functional residual capacity) -1.7-3.5L
RV (residual volume) -1-1.2L

Question 16

what are the FRC and RV of a COPD

Answer 16

increased

Question 17

what test is definitive diagnosis of TB

Answer 17

culture of M. tuberculosis x 3

small homogeneous infiltrate in upper lobe by XRAY

Question 18

TB medication regimen

Answer 18

RIPE

r- rifampin
I- isoniazid
p - pyrazinamide
e - ethambutol

if isolate proves susceptible to INH and RIF then fourth drug may be dropped

Question 19

tx time of TB in HIV

Answer 19

9 months

Question 20

tx time for healthy person with TB

Answer 20

three drugs 2 months, then 4 more months of INH and RIF

Question 21

what test do you monitor weekly when under going TB tx

Answer 21

liver function studies

Question 22

what should people be tested for if taking ethambutol

Answer 22

red -green color perception

Question 23

most common agent of CAP

Answer 23

strep. pneumoniae

Question 24

postive TB test for HIV infected perison

Answer 24

5mm

Question 25

postive TB test for immigrants or health care workers

Answer 25

10mm

Question 26

postive TB test for general population

Answer 26

15mm

Question 27

screening tool to predict morbidity and mortality in patients with CAP

Answer 27

PORT score patient outcomes research team /pneumonia severity index (PSI)

Question 28

how many categories make up PORT score

Answer 28

twenty - (-10 for women)

Question 29

what class of PORT requires ICU

Answer 29

>130, Class V, high risk mortality

Question 30

pt has PORT score of III what should you do for admission

Answer 30

brief inpatient, score 71-90 low risk

Question 31

pt has PORT score of <70, how should you manage

Answer 31

outpatient , class I-II

Question 32

CURB-65 Criteria

Answer 32

score for pneumoia C-confusion U- BUN >19 RR - RR >=30 SBP - SBP<90 DBP <60 Age- >=65 low risk - 0-1 (go home) moderate risk - 2 *brief inpatient high risk - >=3 Hospital admission

Question 33

VAP medication mtg

Answer 33

Vanco + Zosyn OR Cefepime or Meropenem + levofloxacin/cipro

Question 34

s/s of pneumothorax

Answer 34

hyperresonance on affected side diminished breath sounds affected side mediastinal shift toward unaffected side

Question 35

tx for sarcoidosis

Answer 35

corticosteroid

Question 36

s/s of sarcoidosis

Answer 36

progressive dyspnea even with oxygen nonproductive cough rales / velcro crackles

Question 37

chest tube placement for pneumothorax

Answer 37

4th/5th ICS , mid axillary line

Question 38

most common cause of VAP

Answer 38

pseudomonases

Question 39

leading cause of in hospital death

Answer 39

PE

Question 40

test to dx PE in stable patients

Answer 40

VQ scan

Question 41

vent changes for ARDS

Answer 41

decrease TV 4-6 ml/kg IBW

Question 42

what do you order for PE when VQ is indeterminate

Answer 42

pulmonary angiography

Question 43

this vent setting has preset TV and number of breaths

Answer 43

assist control

Question 44

these diseases are characterized by reduced volumes ( low TLC, FRC, RV)

Answer 44

restrictive disease- morbid obesity, sarcoidosis, pulmonary fibrosis

Question 45

exudate fluid has waht

Answer 45

one or more: fluid protein to serumm protein >0/5 LDH ratio >0/6 LDH > 2/3 upper limit of normal serum LDH

Question 46

you see localized infiltrate of right middle lobe, what do you suspect

Answer 46

aspiration pneumonia

Question 47

how do you manage pulmonary shunting on vent

Answer 47

Increase PEEP

Question 48

how is pulmonary htn dx

Answer 48

2d echo

Question 49

how is pulmonary HTN confirmed

Answer 49

right heart Cath