pulmonary

Question 1

increase on A-a gradient causes

Answer 1

CORRECT WITH O2(V/Q mismatch)
-airway disease(asthma,COPD)
-interstitial lung disease
-alveolar disease(Atelectasis,pneumonia,pulmonary edema)
-pulmonary vascualr disease
DONNOT CORRECT WITH O2
-right-left shunt

Question 2

ARDS Dx

Answer 2

• PaO2/FiO2 ratio below 300
• acute onset respiratory distress
• BILATERAL pulmonary infiltrates on CXR
• respiratory failure not completely explainend by heart failure

Question 3

goal oxygenation on ARDS

Answer 3

PaO2>55mmHg or SaO2>88%

Question 4

tidal volumes mechanical ventilation onARDS

Answer 4

4-6cc/Kg

Question 5

pulmonary hypertention

Answer 5

> 25mmHG

Question 6

Malignant lung nodule

Answer 6

New or enlarging lesions
>2cm
irregular calcifications or absent
age>45
smoker
irregular margins

Question 7

samters triad

Answer 7

asthma
aspirine intolerance
nasal polyps

Question 8

Obtructive pulmonary Disease

Answer 8

FEV/FVC less than 80%

Question 9

mild persistent asthma and tx

Answer 9

> 2 weekly NOT DAYLY
2 nights 7Month
low dose steroid
PRN shorts acting beta agonist

Question 10

Moderate persistent asthma dn tx

Answer 10

DAYLY 
>1 night/week
med dose corticosteroid
Long actint B agonist
PRN short acting

Question 11

severe persistent

Answer 11

coninual episodes
high dose steroid, oral steroir
long acting B agonist
PRN short acting

Question 12

improves COPD survival

Answer 12

• smoking cessation and O2

- influenza and pneumococcal vaccination

Question 13

O2 inditacion for COPD

Answer 13

hypoxemia
right heart failure
polycythemia

Question 14

medications contribute to interstitial lung disease

Answer 14

AMIODARONE(foamy macrophages)
busulfan
nitrofurantoin
blomycin
radiation
long term O2 concentration

Question 15

antifibrotic agent for interstitial lung disease

Answer 15

pirfenidone

nintedanib

Question 16

Löfgren syndrome

Answer 16

sarcoidosis type:
bilateral hilar adenopathy
erythema nodosum
arthritis

Question 17

silicosis related infection

Answer 17

TB

Question 18

pneumonia types

Answer 18

CAD(S-pneumo)
HAP(gram-negative bacilli)
VAP

Question 19

lung abscess treatmetn

Answer 19

clinda or penicillin

Question 20

empyema lab finds

Answer 20

• LDH above 60% of serum level.
• Protein above 50% of serum level.
• White cell count above 1000
• Ph

Question 21

best initial test in acute exacerbation os asthma

Answer 21

peak expiratory flow(its decreased)

Question 22

when to intubate a asthma patient

Answer 22

respiratori acidosis( increased PCO2)

Question 23

patient with obstrutive patern
increased DLCO=
low DLCO=

Answer 23

• increased DLCO=asthma

- low DLCO=emphysema

Question 24

best initial test for chronic COPD

Answer 24

chest x ray

Question 25

most accurate test for COPD

Answer 25

PFT

Question 26

indication for O2 in COPD

Answer 26

- PO2 less o equal to 55mmHg - Saturation less o equal 88% - 60mmhg and 90 % when there is HTN,high HCT or cardiomyopathy

Question 27

single most common cause of bronchiectasis

Answer 27

cystic fibrosis

Question 28

best initial step for bronchiectasy

Answer 28

chest x-ray | most accurate:high resolution CT

Question 29

antibiotics for COPD,bronchiectasy and cystic fibrosis

Answer 29

macrolides, cefalosporins,amoxi/clav,quinolones)

Question 30

atypical pnuemonia(non visible on gram stain and not culturable on standard blood agar)

Answer 30

- Mycoplasma - Chlamydophila - Legionella - Coxiella - viruses

Question 31

CURB 65

Answer 31

-confusion -BUN more than 20 -Respiratori distress -BP low -age65 CURB MORE THAN 2= HOSPITALIZATION CURB MORE THAN4= ICU

Question 32

treatment of Hospital-acquired pneumonia

Answer 32

antipseudomonal B lactam

Question 33

ventilator associated pneumonia treatmetn

Answer 33

combine 3 drugs - antipseudomonal b lactam - second antipseudomonal - MRSA(vanco or linezolid)

Question 34

most accurate test for PCP

Answer 34

broncheoalveolar lavage

Question 35

PCP treatmen in TMP allergi

Answer 35

2 LINE:clida + primaquine | 3 LINE: pentaminidine

Question 36

PCP profilaxis

Answer 36

- TMP/SMX | - if allergic give ATOVAQUONE OR DAPSONE

Question 37

single most accurate test for pulmonary TB

Answer 37

pleural biopsy

Question 38

PPD for health workers

Answer 38

yearly and the cut point its 10mm

Question 39

dysnea, loud p2 , fine ryales , and clubbing fingers

Answer 39

- pulmonary fibrosis * idiopathic * radiation * drugs:amiodarone,bleomycin,nitrofurantoin,busulfan,

Question 40

restrictive patern FPT and decrease DLCO

Answer 40

pulmonary fibrosis

Question 41

firts initial test for pulmonar embolous

Answer 41

WHEN THE HISTORY ITS CLEAR GIVE HEPARIN FIRTS - chest X ray(hampton pump, and westermark sign) - EKG(right axis deviation, RV hypertrophy and RBBB) - ABG(respiratory alkalosis)

Question 42

criteria for exudative effusion

Answer 42

- pleural/serum protein more than 0.5 | - pleural/serum LDH more than 0.6

Question 43

best prognosis indicator of COPD

Answer 43

FEV

Question 44

anti TB medicantion contraindicated in pregnancy

Answer 44

Pyrazinamide

Question 45

abnormal calcificaiton in solitary pulmonary nodude

Answer 45

-stippled,spiculated,eccentric

Question 46

rapid shallow breathing index(respiratory rate/tidal volume)=

Answer 46

-under 100 | patient its ready to be extubated