pulmonary with Kelly

Question 1

Ominous signs in asthma

Answer 1

paradoxical chest/abd movement

inability to maintain recombancy

absent breath sounds

cyanosis

Question 2

Asthma

Answer 2

thick causes plugging

the epitheial basement membrane gets thick

Question 3

What PFTs are important in Asthma

Answer 3

Pulmonary Function Tests:

peak flows at home

FEV1, FVC, FEF

Question 4

What level FEV1 is less than what ____% of predicted requires admission?

Answer 4

less than 30% of predicted, admit

Question 5

If you treat an asthmatic in the ER for an hour and their FEV1 doesn’t increase to at least 40% of predicted, what should you do?

Answer 5

admit

Question 6

CXR of asthmatic shows

Answer 6

hyperinflation

Question 7

steps wise approach to outpatient management of asthma

Answer 7

1) SABA: short acting beta adrenergic (albuterol, rescue and before you exercise)
2) inhaled corticosteroids (pulmicort) (this helps prevent chronic changes that the inflammation causes, not for symptoms, daily maintenance, wash out your mouth)
3) SABA for symptom breakthrough, albuterol (rescue inhaler)
4) LABA long acting beta adrenergic, salmeterol. NOT rescue inhalers.

*5) anticholinergic *On the test, atrovent IS used in asthma for secretions

*6) antiluekotriane: monolukast

Question 8

inpatient mangement of asthma

Answer 8

inhaled: alupent/albuterol (proventil) are sympathomimetics
corticosteroids: methylprednisone IV (in the hospital)

parenteral (IV) sympathomimetics: SQ epi

anticholingergic to dry secretions: atrovent

Question 9

status asthmaticus

Answer 9

severe acute asthma, unremitting, poorly controlled, life threatening

Question 10

Asthma, COPD, emphysema, chronic bronchitis

are they obstructive or restrictive?

Answer 10

obstructive

Question 11

How long do you have to have productive cough for dx of chronic bronchitis?

Answer 11

3 consecutive months for two consecutive years

Question 12

Emphysema is characterized by:

Answer 12

mild clear sputum

barrel chest

old

thin

increased lung capacity

alveoli abnormal permanent enlargement

Question 13

CXR for chronic bronchitis

Answer 13

hyperinflation

possible bulea or blebs

normal AP diameter

Question 14

COPD CXR

Answer 14

flattened diaghragm

Question 15

PFTs for restrictive:

TLC total lung capacity

RV remaining volumes after maximal expiration

FRC functional residual capacaity

Answer 15

in restrictive disease all these are low

restrictive disease: pulmonary fibrosis, pulmonary sarcoidosis (connective tissue where it shouldn’t be)

acute: ARDS, PNA,

Question 16

If you see extrapulmonary TB you should consider

Answer 16

HIV

Question 17

Definitive diagnostic test for TB

Answer 17

culture x3

Question 18

TB CXR

Answer 18

honeycomb appearance R upper lobe

upper lobes

Question 19

4 differentials for night sweats

Answer 19

menopause

TB

HIV/AIDS

endocarditis

lymphoma

Question 20

acronym for TB meds

they are ripe for treatment

Answer 20

Rifampin

INH isoniazid (monitor LFTs)

Pyrazinamide

ethambutal (changes red/green color perception, and visual acuity)

Question 21

If you are treating pulmonary TB, how often do you get cultures?

Answer 21

every week for first 6 weeks

then monthly until cultures are negative

Question 22

If you have positive cultures after three months of TB treatment consider

Answer 22

drug resistance

Question 23

Patient with HIV gets treated for TB for how long?

Answer 23

9 months

Question 24

TB treatment lasts a total of how many months?

Answer 24

6 months

*9 months for HIV

Question 25

Most common organism with CAP?

Answer 25

strep pneumoniae

Question 26

Lung consolidation is PNA, you can't clear the ronchi with a caugh

Answer 26

lung consolidation

Question 27

Treatment for CAP, consider two things:

Answer 27

how old they are (60) if they have been on abx recently

Question 28

CAP in healthy \<60, not been on ABX

Answer 28

azythromycin (macrolide) \*new black blox warning for QT prolongation

Question 29

If CAP patient with other commorbidities and \>65 y/o.

Answer 29

levaquin -floxacins (flouroquinalones)

Question 30

CAP \>65 not doing well on levaquin, now admit

Answer 30

ADD A BETALACTAM start on betalactam cextriaxone unasyn cefetaxime plus continue outpatient (levaquin)

Question 31

If you admit CAP

Answer 31

betalactam + azithromycin or levaquin \*if PCN allergic hold betalactam and give aztreonam

Question 32

Most common causitive organisms in HAP?

Answer 32

strep + staph (gram positive) H flu (gram negative)

Question 33

What is the most common caustive agent in VAP?

Answer 33

pseudomnas \*treat with antipseudamonal beta lactam \*zosyn, cefepime, imipenem

Question 34

Thoracentesis with colored fluid, high protein, high LDH

Answer 34

exudates pressure problem\* due to inflammation (lupus) infection (TB/PNA) malignancy

Question 35

Thoracentesis clear, normal protein, normal LDH

Answer 35

transudates heart failure, liver failure

Question 36

In the elderly, does the vital capacity increase or decrease?

Answer 36

it decreases because of increased residual volume increases

Question 37

What is the only mid-diastolic murmur?

Answer 37

mitral stenosis

Question 38

Acute L sided HF what heart sound?

Answer 38

S3

Question 39

CXR for CHF

Answer 39

kerley B lines | (increased interstitial markings)

Question 40

What drug is used to treat HTN in pregnancy, can also be used to treat parkinsons?

Answer 40

central alpha 2 agonist methyldopa

Question 41

Papilledema

Answer 41

swelling of the optic disk with blurred margins \*found in HTN emergency

Question 42

Oral drugs in HTN urgency

Answer 42

clonidine captopril loop durectics