Pulmonology

Question 1

Asthma Diagnosis

• improvement in FEV1 by ___% after bronchodilator
• Decrease in FEV1 by ___% after metacholine challenge
• DLCO: Increased to unchanged for mild-moderate, low for severe asthma

Answer 1

12, 20

Question 2

Acute management of Asthma

1) Nebulized Ipatropium/Albuterol
2) _________
3) Magnesium
4) Intubate if worsening respiratory acidosis

Answer 2

Methylprednisone

Question 3

Backbone of asthma management ______

Answer 3

Steroids

SABA, Steroid inhaler, LABA + Steroid inhaler

LABA substitute: Theophylline, Cromolyn, Leukotriene (Montelukast)

Question 4

Salvage asthma therapy includes

1) Oral steroids
2) ________ (IL-5 Inhibitor)
3) ________ (Anti IgE)
4) Bronchial Thermoplasty

Answer 4

Mepolizumab

Omalizumab

Question 5

Loud P2 sound is a sign of ______

Answer 5

Pulmonary hypertension

Question 6

Backbone of COPD management_____

Answer 6

SABA/LABA

SABA –> LABA—> LABA+Steroid /LAMA (tiotropium)

Question 7

For OSA, apnea defined as greater than ______ seconds

Answer 7

10

Question 8

_____ is a treatment for OSA, causes a metabolic acidosis which produces respiratory drive

Answer 8

Acetazolamide (causes bicarb leeching at level of renal tubule, resulting in acidosis)

Question 9

_____ is a treatment for central OSA, CNS respiratory stimulant

Answer 9

Medroxyprogesterone

Question 10

A1 antitrypsin results in _____ emphysema

Answer 10

pan-acinar

Question 11

____, ____, ____ drugs associated with pulmonary fibrosis

Answer 11

Bacterim, nitrofurantoin, bleomycin

Question 12

ILD 2 treatment philosophies

1) Steroids for acute flare, transition to _____
2) Cyclophosphamide
3) Next generation medication _______, nintedanib

Answer 12

AZT

Pirfenidone

Question 13

_____ is like an ILD flare , fevers/chills, cough, myalgia

Most accurate biopsy

Answer 13

BOOP , Lung biopsy

Because BOOP is a flare, it will respond to steroids, standard ILD mostly does not

Question 14

Extra pulmonary manifestations of ______ include, uveitis, 7th nerve palsy, erythema nodosum, restrictive cardiomyopathy, ACE, CD4:CD8 ratio, non-caseating granuloma,

Tx: ______

Answer 14

Sarcoid

Steroids

Question 15

Most accurate test for pulmonary HTN diagnosis_____

Answer 15

R heart cath: swan ganz

Question 16

Chronic therapies for primary pulmonary hypertension

1) Bosentan
2) _______
3) Riociguat

Answer 16

Epoprostenol, Selexipag (prostacyclin agonist)

Question 17

Treatment for chronic thrombo-embolic PE______

Answer 17

Riociguat

30% of PE originate in pelvic veins, wont be visualized on DVT scan LE

Question 18

Most accurate test for PE______

Answer 18

Angiogram, although never done

Question 19

T/F : PPI increases risk of HAP

Answer 19

True, natural defense against bacterial organisms suppressed

Question 20

______ pneumonia associated with farm exposure, birth of an animal

Answer 20

Coxiella

Question 21

Standard of care for TB is ____ months of RIPE

Answer 21

6 months

Question 22

Standard of care for TB is ____ months of RIPE

Answer 22

6 months

Question 23

____ is a side effect of ethambutol, _____ is a side effect of Pyrazinamide

Answer 23

optic neuritis, hyper uricemia

Question 24

PPD Cutoff

1) Normal Person: _____mm
2) At Risk Groups (nurse, physician, jail)____mm
3) HIV(+)/Steroid/TNF_____

Answer 24

15mm

10mm

5mm

Question 25

Latent TB Treatment 1) Isoniazid monotherapy ______ Even if BCG vaccine with positive skin test, treat the patient as normally would

Answer 25

9 months

Question 26

____ is a serious, bronchioectasis like pneumonia common among atopy/asthma patients treated with ______

Answer 26

ABPA, oral steroids + itraconazole; never use inhaled steroids

Question 27

People with HIV and _____ are at risk of MAC pneumonia

Answer 27

COPD Dx: requires serial sputum (+) not just 1, and clinical symptoms Tx: Azithromycin/Rifampin/Ethambutol

Question 28

_____ is a MAC species causing cavitary lung lesions

Answer 28

Kansaii

Question 29

_____ is a skin, soft tissue version of MAC, que: colonized denta lines

Answer 29

Abscessus, Fortuitum

Question 30

For asthma, you see a patient with the following what would you add on : 1) High peripheral eosinophils (IL-5) _____ 2) High peripheral IgE______ 3) COPD____

Answer 30

mepolizumab Omalizumab Tiotropium (anti muscarinic: anti secretion, pro dilation)

Question 31

The caveats to VQ scan 1) ______ 2) ______

Answer 31

Have to have a normal CXR before doing it A high probability result dosent mean anything, 15% may still have PE

Question 32

The caveats to VQ scan 1) ______ 2) ______

Answer 32

Have to have a normal CXR before doing it A high probability result dosent mean anything, 15% may still have PE

Question 33

Treatment of hemodynamically unstable PE_______

Answer 33

Thrombolysis

Question 34

Treatment of hemodynamically unstable PE_______

Answer 34

Thrombolysis

Question 35

Urine tests for pneumonia ____, _____

Answer 35

Pneumococcus, legionella

Question 36

RIPE: Rifampin, Isoniazid (6 months), Pyrazinamide, Ethambutol (2 months), stop if liver enzymes>____times the limit

Answer 36

5

Question 37

T/F TB during pregnancy requires >6 months treatment

Answer 37

True

Question 38

A more rapid growing mycobacterium species that my cause cavitary lesions in a immunodeficiency-competent host_____

Answer 38

M. Kansaii