Pulmonology

Question 1

Causes of sinusitis

Answer 1

Viral
Strep pneumo
H influ
Moraxella

Question 2

Increased risk of bacterial sinusitis

Answer 2

Asthma
Allergic rhinitis
Recent barotrauma
Prolonged NG tube

Question 3

Chronic sinusitis

Answer 3

> 3 mos
usu d/t obstruction or anaerobes
increased risk w/diabetes d/t mucormycosis
tx w/6-12wks abx, surg for obst, tx allergies

Question 4

Viral Pneumonia

Answer 4

Cause: PAIR viruses and CMV
Pts: most common pna in children
Sx: Non-productive cough
Tx: self-limited

Question 5

Strep Pneumo Pneumonia

Answer 5

Pts: most common pna in adults
        inc risk w/SCD
Sx: productive cough
Tx: b-lactams, macrolides
      (Ctx/Azithro)

Question 6

H. influ Pneumonia

Answer 6

Pts: COPD
inc risk w/SCD
Sx: slower onset
Tx: b-lactams, bactrim

Question 7

Staph Pneumonia

Answer 7

Pts: nosocomial
immunocompromised
Sx: abscess formation
Tx: b-lactams

Question 8

Klebsiella Pneumonia

Answer 8

Pts: alcoholics
       aspiration
       prolonged inpt
       SCD
Sx: currant-jelly sputum
Tx: cephalos, aminoglycosides
      (Amp/Gent)

Question 9

Mycoplasma Pneumonia

Answer 9

Pts: young adults
Sx: less severe
      \+ cold agglutinin test
Tx: macrolides
      (Azithro)

Question 10

Pseudomonas Pneumonia

Answer 10

Pts: chronically ill
       immunocompromised 
       CF
       nosocomial 
Sx. rapid onset 
Tx: fluoroquinolones, aminoglycosides, cephalos
      (Cipro, Gent, Ctx)

Question 11

Legionella Pneumonia

Answer 11

Pts: aerosolized water (AC)
Sx: slow onset 
       nausea, diarrhea
       confusion, ataxia
Tx: macrolides, fluoroquinolones 
      (Azithro, Cipro)

Question 12

Chlamydia Pneumonia

Answer 12

Pts: very young
        elderly
Sx: slow onset
       often sinusitis
Tx: doxycycline, macrolides

Question 13

GBS Pneumonia

Answer 13

Pts: neonates, infants
Sx: resp distress
Tx: b-lactams

Question 14

Enterobacter Pneumonia

Answer 14

Pts: nosocomial
elderly
Sx: classic sx
Tx: bactrim

Question 15

Fungal Pneumonia

Answer 15

Pts: travelers
Sx: less severe
subacute
Tx: ampho, ketoconazole

Question 16

Causes of Fungal PNA

Answer 16

Coccidiomycosis: southwest US
Histoplasmosis: caves
Blastomycosis: Central America

Question 17

Pneumocystis Pneumonia

Answer 17

Pts: AIDS
Sx: slow onset
GI symptoms
Tx: bactrim

Question 18

Bacterial Bronchitis

Answer 18

Increased risk if smoker

Strep pneumo, H influ

Question 19

CAP: Neonatal

Answer 19

GBS
E. coli
Klebsiella
Staph aureus
Strep pneumo

Question 20

CAP: Infant-5yo

Answer 20

RSV
Strep pneumo
Mycoplasma
Chlamydia

Question 21

CAP: 5-20yo

Answer 21

Strep pneumo
Mycoplasma
Chlamydia
RSV

Question 22

CAP: 20-40

Answer 22

Mycoplasma
Strep pneumo
Viral
Chlamydia

Question 23

CAP: 40-60yo

Answer 23

Strep pneumo

Mycoplasma

Question 24

CAP: >60yo

Answer 24

Strep pneumo
H influ
Chlamydia
Staph aureus
RSV

Question 25

HAP: Neonatal

Answer 25

Staph aureus GBS Klebsiella RSV

Question 26

HAP: Infant-5yo

Answer 26

Staph aureus Klebsiella RSV

Question 27

HAP: 5-20yo

Answer 27

Staph aureus Klebsiella RSV

Question 28

HAP: 20-40yo

Answer 28

Strep pneumo Viral Staph aureus

Question 29

HAP: 40-60yo

Answer 29

Strep pneumo H influ Staph aureus Enterobacter

Question 30

HAP: >60yo

Answer 30

Strep pneumo H influ Staph aureus Enterobacter

Question 31

PPD Test

Answer 31

Positive if: >5mm and HIV, close contact w/infected person, TB findings on cxr >10mm and homeless, immigrant, IVD use, chronically ill, HCW, recent incarceration, received BCG w/in 1yr >15mm always positive, including h/o BCG >1yr ago

Question 32

TB Treatment

Answer 32

Initial Multi-drug Regimen: rifampin + isoniazid + pyrazinamide + ethambutol After Improvement: Isoniazid + Rifampin x6-9mos Prophylaxis: isoniazid x6mos *always give Vitamin B6 w/INH to prevent peripheral neuritis

Question 33

Causes of ARDS

Answer 33

``` Sepsis Trauma Drowning PE Lung infection/disease Aspiration Drug OD Shock Radiation Smoke Inhalation ```

Question 34

PE Risk Factors

Answer 34

Hypercoaguability: inherited, pregnancy, OCP's, cancer, smoking Hypomobility: fracture, surgery, travel, obesity History: prior PE or DVT Hypovolemia: dehydration Hyperhomocysteinemia

Question 35

Asthma Severity

Answer 35

Mild Intermittent: - sx 80% Mild Persistent: - sx >2/wk, noc >2/mo - peak flow >20% variation over time Moderate Persistent: - sx daily, noc >1/wk - peak flow 60-80% Severe Persistent: - sx nearly constant, noc nearly nightly - peak flow rarely >70% - FEV1 usu <60%

Question 36

Asthma Meds: inhaled short-acting b-agonists

Answer 36

Albuterol, Ventolin, Proventil