Pulmonology

Question 1

Mild intermittent asthma

Answer 1

PRN albuterol

Question 2

Mild persistent asthma

Answer 2

PRN albuterol + low dose ICS +/- montelukast +/- cromolyn

Question 3

Moderate persistent asthma

Answer 3

PRN albuterol + mod dose ICS +/- Long acting B2 agonist +/- montelukast +/- coromolyn

Question 4

Severe persistent asthma

Answer 4

PRN albuterol + high dose ICS + long acting b2 agonist + PO steroids +/- montelukast +/- theophylline

Question 5

COPD category A (GOLD 1 or 2 with mild or infrequent sxs)

Answer 5

Albuterol, ipratropium

Question 6

COPD category B (GOLD 2 or 3 with moderate to severe sxs)

Answer 6

Albuterol, B2 agonist or anticholinergic (tiotropium, ipratropium)

Question 7

COPD category C (GOLD 3 or 4 with mild or infrequent sxs)

Answer 7

Short acting bronchodilator (albuterol), long acting bronchodilator, inhaled steroid

Question 8

COPD category D (GOLD 3 or 4 with moderate to severe sxs)

Answer 8

Short acting bronchodilator (albuterol), long acting bronchodilator, inhaled steroid, +/- theophylline, home )2 if pulse <88%, +/- Phosphodiesterase 4 inhibitor (roflimilast)

Question 9

emphysema treatment

Answer 9

smoking cessation
fast acting beta agonist, inhaled anticholinergics, ICS
Home O2 if indicated
a1-antitrypsin if has syndrome
lung transplant in select pts

Question 10

chronic bronchitis treatment

Answer 10

azithromycin, levofloxacin, amox/clavulanate

Question 11

bronchiectasis treatment

Answer 11

pulm hygiene (hydration, sputum removal)
chest physiotherapy
abx when sputum production increases
inhaled B2 agonsits and steroids may reduce sxs
resection of severely diseased reagions of lung indicated for hemm, substantial sputum production or inviability

Question 12

non small cell lung cancer tx

Answer 12

surgical resection if localized, radiation, chemo

Question 13

small cell lung cancer tx

Answer 13

chemo

Question 14

malignant mesothelioma

Answer 14

surgery (pleurectomy, decortication), radiotherapy, chemo

Question 15

laryngeal cancer

Answer 15

partial or total larygnectomy, radx, chemo

Question 16

Idiopathic pulm fibrosis tx

Answer 16

pirfenidone, nintedanib, sildafenil, steroids, abx, lung transplant

Question 17

Sarcoidosis tx

Answer 17

steroids, cytotoxic drugs +/- lung transplantation

Question 18

Good pasture syndrome tx

Answer 18

plasmapheresis, corticosteroids, immunosuppresive agents

Question 19

granulomatosis with polyangiitis

Answer 19

corticosteroids, methotrexate, cyclophosphamide, rituximab, plasma exchange

Question 20

PE treatment in unstable pt

Answer 20

thrombolysis (tPA, streptokinase, urokinase)

Question 21

PE treatment in stable pt

Answer 21

Start with LMWH (enoxaparin), unfractionated hep or fondaparinux
switch to warfarin, a direct Xa inhibitor (ribaroxaban, apixaban, edoxaban) or dabigatran (direct thrombin inhibitor)

Question 22

vasodilators used in pulm HTN

Answer 22

CCB (nifedipine)
Endothelin receptor antagonists (ambisentan, bosentan)
Cyclic GMP phosphodiesterase inibitors (sildafenil, tadafinil)
Prostanoids (iloprost, treprostinil)

Question 23

Pulm Edema tx

Answer 23

NO LIP
Nitrates
Oxygen (if hypoxic)
Loop diuretics
Inotropic (dobutamine, milrinone- not first line)
Positioning (sit on edge of bed to pool fluid in legs)

Question 24

plerual effusion tx

Answer 24

thoracentesis, chest tube

Pleurodesis if recurrent

Question 25

PTX tx

Answer 25

<15%: supplemental O2 and monitor >15%: chest tube recurent PTX may need pleruodesis

Question 26

tension PTX tx

Answer 26

needle decompression at 2nd or 3rd intercostal space in midclavicular line

Question 27

Strep phayngitis (strep throat) tx

Answer 27

B lactam abx (penicillin, amoxicillin) if pt gets a head to toe rash after giving amox, the dx was EBV

Question 28

ludwigs angina

Answer 28

abx and I&D of infected area. Protect the airway

Question 29

Peritonsillar abscess

Answer 29

needle aspiration, I&D, abx

Question 30

Mononucleosis

Answer 30

supportive. No non contact sports for 3 weeks. No contact sports for 4 weeks (bc of splenomegaly)

Question 31

viral influenza

Answer 31

Zanamivir or oseltamivir if started within 48 hours of sxs

Question 32

sinusitis

Answer 32

nasal irrigation, analgesics, oral decongestants, Inhaled steroids, amox/clavulanate, doxy, levofloxacin

Question 33

acute bronchitis

Answer 33

supportive care, abx therapy is rarely needed!

Question 34

CAP in neonates

Answer 34

admit | ampicillin + gentamicin or vanc +gent

Question 35

CAP in children

Answer 35

outpt amox or amox/clav for typical presentation azithromycin for atypical presentation or penicillin allergy

Question 36

CAP in adults + outpt and healthy pt w/no abx use in the last 3 weeks

Answer 36

azithromycin or doxy alone

Question 37

CAP in adults + outpt and unhealthy pt OR use of abx in the last 3 weeks

Answer 37

``` B lactam (amox or cefuroximine) AND macrolide (azithro) Levo or moxi ```

Question 38

CAP in adults + inpt

Answer 38

B lactam AND macrolide (ceftriaxone + azithro) | Levo or moxi

Question 39

CAP in adults + ICU

Answer 39

B lactam AND either macrolide or levo/moxi

Question 40

coccidiodes immitis

Answer 40

(desert/dust storm) | itraconazole or fluconazole

Question 41

histoplasma capsulatum

Answer 41

(mississippi and ohio river valleys, soild contaminated with bird droppings, spelunking) itraconazole

Question 42

Cyrptococcus neoformans

Answer 42

(worldwide, soil contaminated with pigeon or chicken droppings. A/w immunocompromised) Fluconazole

Question 43

Blastomycosis dermatiditis

Answer 43

(SE, South central, midwest, canada) | Amphotericin B or itraconazole

Question 44

Paracoccidiodes brasiliensis

Answer 44

(central and south america) | Itraconazole

Question 45

Pneumocystis jirovecci (PCP) pneumonia

Answer 45

``` 21 days of abx: - TMP SMX (IV or PO) - Pentimidine (IV) - Primaquine PO and Clinda IV or PO Add steroids if - pO2 <70 on room air - A/a gradient >35 ```

Question 46

Latent TB tx

Answer 46

Isoniazid qd for 9 months OR Rifapentine and Isoniazide once weekly for 3 months

Question 47

Active TB tx

Answer 47

2 months of: Rifamipin, Isoniazid (with B6), Pyrazinamide, Ethambutol followed by 4 months of: rifampin and isoniazid (with B6)

Question 48

ARDS tx

Answer 48

ICU mechanical ventilation wiht low tidal volumes and adequate PEEP Conservative fluid management Prone positioning (improves oxygenation) Prevent fever, minimize anixety and pain, limit respiratory mm use transfuse blood only if Hgb <7 bc transfusion may increase risk of death

Question 49

Induction agents used with in tubation (sedatives and paralytics)

Answer 49

sedatives: etomidate, proprofal, midazolam, ketamine Paralytics: succinylcholine, roccuronium