Pulmonology

Question 1

> 12% increase in FEV1 after bronchodilator tx indicates…

Answer 1

Asthma

Question 2

FEV1:FVC < 80% indicates…

Answer 2

asthma

Question 3

Asthma would show a ____ FEV1 and ______ FEV1:FVC ratio

Answer 3

decreased

Question 4

3 staples of asthma…

Answer 4

inflammation
hyperresponsiveness
reversible obstruction

Question 5

Steps 1-6 of asthma Tx…

Answer 5

1: SABA
2: low dose ICS
3: low dose ICS + LABA + SABA
4: medium dose ICS + LABA
5: High dose ICS + LABA
6: high dose ICS + LABA + PO Steroids

Question 6

cough > 5 days lasting 2-3 weeks

Answer 6

bronchitis

Question 7

COPD = chronic cough that is productive of phlegm occurring on most days for _____ months of the year for ______ or more consecutive years

Answer 7

3 months

2+ years

Question 8

3 hallmarks of COPD…

Answer 8

cough

sputum production

dyspnea

Question 9

Dx of COPD (4)

Answer 9

PFTs

CXR

alpha antitrypsin

ABGs

Question 10

PFTs in COPD show FEV1/FVC ratio…

Answer 10

< 0.7

Question 11

CXR findings in COPD

Answer 11

perivascular markings

Question 12

CBC findings in COPD…

Answer 12

increased H & H due to chronic hypoxia

Question 13

Tx for mild COPD…

Answer 13

SABA

Question 14

Tx for moderate/severe COPD

Answer 14

LABA +/- ICS

Question 15

Inahler of choice for COPD…

Answer 15

ipratropium

Question 16

single most important medication and lifestyle factor for COPD

Answer 16

Oxygen and smoking cessation

Question 17

2 mandatory vaccines for COPD

Answer 17

pneumococcal, flu

Question 18

Pt p/w:

Recurrent PNA
constitutional sxs
Hx of smoking

Answer 18

small cell lung CA

Question 19

4 complications associated with small cell lung cancer

Answer 19

SVC syndrome

phrenic nerve palsy

recurrent laryngeal nerve palsy

horner syndrome

Question 20

which lung CA complication?

obstruction of SVC by a mediastinal tumor, facial fullness, facial and arm edema, dilated veins over the anterior chest, arms, face; JVD

Answer 20

SVC syndrome

Question 21

which lung CA complication?

hemidiaphragmatic paralysis…

Answer 21

phrenic nerve palsy

Question 22

which lung CA complication?

p/w hoarseness

Answer 22

recurrent laryngeal nerve palsy

Question 23

which lung CA complication?

invasion of the cervical sympathetic chain by apical tumor → unilateral facial anhidrosis (no sweating), ptosis, miosis

Answer 23

horner syndrome

Question 24

which lung CA complication?

proximal muscle weakness/fatigue, diminished DTRs, paresthesias (lower extremity

Answer 24

eaton-lambert syndrome

Question 25

Which lung CA? ``` Central mass, very aggressive 99% smokers 15% of cases do not respond to surgery mets at presentation ```

Answer 25

small cell

Question 26

Diagnostics for lung CA

Answer 26

CXR Contrast CT Bx

Question 27

This diagnostic is used to diagnose central tumors

Answer 27

fiber-optic bronchoscopy

Question 28

Which lung CA diagnostic? suspicious masses, highly accurate for peripheral lesions

Answer 28

transthoracic needle bx

Question 29

3 types of non-small cell lung CA

Answer 29

SCC Large Cell adenocarcinoma

Question 30

Which lung CA? most common (peripheral mass) 35-40% of cases of lung cancer Associated with smoking and asbestos exposure Location: Periphery Paraneoplastic syndrome: Thrombophlebitis

Answer 30

adenocarcinoma

Question 31

Which lung CA? fast doubling rates - responds to surgery rare (only 5%) Location: Periphery 60% Paraneoplastic syndrome: Gynecomastia

Answer 31

Large cell

Question 32

Which lung CA? hemoptysis 25-35% of lung cancer cases Location: central mass Paraneoplastic syndrome: hypercalcemia Elevated PTHrp

Answer 32

squamous cell

Question 33

Tx for non-small cell lung CA...

Answer 33

surgery

Question 34

Which lung CA association? shoulder pain horner's syndrome brachial plexus compression

Answer 34

pancoast tumor

Question 35

MC cause of CAP...

Answer 35

S. pneumo

Question 36

Patient presents with: fever then gradual onset of cough SOB on exertion sweats/chills/rigors chest discomfort

Answer 36

CAP

Question 37

Outpatient CAP tx if no recent use of Abx w/in 90 days...

Answer 37

azithromycin 500 mg dose 1, then 250 mg x 4 days or Doxycycline 100mg PO BID x 5 days

Question 38

Outpatient CAP tx if Abx last 90 days, Age > 65, immunosuppression, comorbid illness

Answer 38

Moxifloxacin 400 mg PO daily, levofloxacin 750 mg PO daily x 5 days OR azithromycin + beta lactam

Question 39

ICU CAP tx if no recent use of Abx w/in 90 days...

Answer 39

Azithromycin or respiratory FQ (moxifloxacin, levofloxacin) plus Antipneumococcal β-lactam: cefotaxime, ceftriaxone

Question 40

Inpatient CAP tx if Abx last 90 days, Age > 65, immunosuppression, comorbid illness

Answer 40

IV macrolide plus IV β lactam (HD ampicillin 1-2 g q 4-6 h or Cefotaxime 1-2 g q 4-12 h or Ceftriaxone 1-2 g q 12-24 h)

Question 41

Inpatient CAP tx if no recent use of Abx w/in 90 days...

Answer 41

IV levofloxacin 750 mg daily or IV ciprofloxacin 400 mg q 8-12 h

Question 42

Pt. p/w: fatigue, productive cough, night sweats, weight loss, post-tussive rales

Answer 42

TB

Question 43

Dx of TB...

Answer 43

sputum Cx

Question 44

CXR of TB...

Answer 44

cavitary lesions, ghon complex in apex of lungs

Question 45

Bx of TB

Answer 45

caseating granuloma

Question 46

Tx of TB: (+) PPD, CXR Neg

Answer 46

Isoniazid x 9 mo

Question 47

Tx of TB: (+) PPD and CXR

Answer 47

4 drugs x 8 weeks (RIPE) then RI x 16 weeks

Question 48

SFx of isoniazid and what can help prevent?

Answer 48

peripheral neuropathy prevent with pyridoxine 25-50 mg QD

Question 49

SFx of Pyrazinamide

Answer 49

hyperuricemia, caution Gout

Question 50

SFx of ethambutol

Answer 50

optic neuritis red-green blindness ((E = eye changes)

Question 51

What should be monitored during TB treatment?

Answer 51

serum creatininte

Question 52

TB prophylaxis for household members?

Answer 52

INH x 1 year