Pulmonology

Question 1

Two interventions show to decrease COPD mortality

Answer 1

Supplemental oxygen and smoking cessation

Question 2

Centor criteria

Answer 2

Symptom based grading system that helps determine likelihood of Strep pharyngitis

(Score of 3 or more indicates further testing for rapid antigen detection)

Fever
Tonsillar exudates
Tender anterior cervical lymphadenopathy
Absence of cough
Add 1 pt for age <15; subtract 1 pt for age >44

Question 3

Strep pharyngitis vs. infections mono

Answer 3

Strep:
Acute onset sore throat, headache, n/v, abdominal pain, odynophagia, lack of cough, tender cervical lymphadenopathy

Mono:
1-4wk prodromal period, hepatomegaly, splenomegaly, posterior cervical lymphadenopathy

Question 4

Strep pharyngitis vs. infections mono

Answer 4

Strep:
Acute onset sore throat, headache, n/v, abdominal pain, odynophagia, lack of cough, tender cervical lymphadenopathy

Mono:
1-4wk prodromal period, hepatomegaly, splenomegaly, posterior cervical lymphadenopathy

Question 5

Intermittent asthma

Answer 5

Rule of <2's
Symptoms &amp; use of albuterol < 2days/wk
< 2 night time awakening per month
No interference with normal activity
FEV1> 80%

Tx: SABA prn

Question 6

Mild persistant asthma

Answer 6

Rule of >2's
Symptoms and albuterol use > 2days/wk
3-4 night awakenings/ month
Minor interference with normal activity
FEV1 > 80%

Requires 2 or more oral glucocorticoids in a year

Tx: low ICS + SABA (prn)

Question 7

Moderate persistent asthma

Answer 7

Rule of often:
Symptoms and SABA use daily
Night  > 1x/wk but not nightly
Some interference with normal activity
60% < FEV1 < 80%

Tx: low dose ICS + LABA + SABA (prn)

Question 8

Severe persistant asthma

Answer 8

Rule of daily’s
Symptoms and SABA use throughout the day
Night time symptoms up to 7X/ wk
FEV1 < 60%

Tx: medium or high doses of CIS + LABA + SABA (prn)

Question 9

Sleep apnea risk factors

Answer 9

Obesity
Anatomic abnormalities
Family history
Sedative use
Hypothyroidism
Smoking

Question 10

Sleep apnea presentation

Answer 10

Daytime somnolence
Snoring or choking at night
Morning headaches
Poor concentration
Decreased libido

Question 11

Treatments to diminish symptoms of viral URI

Answer 11

Decongestants
Analgesics
Antipyretics

Question 12

Treatment for bacterial sinusitis

Answer 12

amox-clav
doxycycline
levofloxacin or moxifloxacin

Question 13

Asthma diagnosis

Answer 13

Spirometry shows reduced FEV1/ FVC

Methacholine challenge yield 20% decrease in FEV1 after administration

Question 14

CURB-65

Answer 14

Determines whether a patient should be hospitalized for pneumonia

C: confusion
U: BUN > 19mg/mL
R: respiratory rate > 30/min
B: BP<90/60
65: Age > 65

Pts with scores of 2 or more should be hospitalized

Question 15

Acid-base disturbance in COPD

Answer 15

Hypercapnia (and hypoxemia)- causes chronic respiratory acidosis and compensatory chronic metabolic alkalosis

Question 16

Strep pharyngitis

Answer 16

May present with:

• tonsillar erythema and exudates
• swollen uvula
• anterior cervical lymphadenopathy
• petechiae on the palate
• scarlatiniform rash