Respiratory

Question 1

excess tracheobronchial mucus production resulting in a productive cough that occurs for at least 3 months a year for 2 or more consecutive years

Answer 1

chronic bronchitis

Question 2

abnormal dilatation of terminal airspaces w/ destruction of the alveolar septa

Answer 2

emphysema

Question 3

airway condition that is reversible and there is no associated w/ smoking

Answer 3

asthma

Question 4

what is associated w/ the panacinar form of emphysema

Answer 4

alpha 1 antitrypsin deficiency

Question 5

what type of emphysema is smoking associated w/

Answer 5

centrilobular

Question 6

What type COPD has marked V/Q mismatch?

Answer 6

chronic bronchitis

Question 7

late findings of COPD- chronic bronchitis

Answer 7

weight gain
lethargy
cyanosis

Question 8

how does emphysema typically present

Answer 8

minimal cough/ scant amounts of thin sputum
dyspnea w/ exertion
weight loss (caynosis is rate)

Question 9

lungs sounds w/ chronic bronchitis

Answer 9

coarse rhonchi and wheezes

Question 10

lung sounds w/ emphysema

Answer 10

hyperresonant
decreased breath sounds
increased A-P chest diamester
lowered diaphragms

Question 11

the volume of air that can be exhaled going from maximal inhalation to maximal exhalation

Answer 11

Forced vital capacity (FVC)

Question 12

the volume of air exhaled in 1 second, starting a maximal inhalation

Answer 12

forced expiratory volume in 1 second (FEV1)

Question 13

what is a normal FEV1/FVC

Answer 13

0.75-0.80

Question 14

what is stage I of COPD?

Answer 14

FEV/FVC 80% predicted

Question 15

what stage of COPD is FEV1 30%

Answer 15

Stage III- Severe

Question 16

what stage of COPD is FEV1 50%

Answer 16

Stage II-Moderate

Question 17

what vaccines do people with COPD need?

Answer 17

yearly influenza vaccines

pneumococcal vaccine

Question 18

first line med for COPD

Answer 18

tiotropium bromide

Question 19

COPD patients with PAO2<90% can benefit from what?

Answer 19

continuous supplemental oxygen

Question 20

How is TB spread?

Answer 20

respiratory route- droplets formed by coughing , usually requries several months of close contact

Question 21

Risk factors for TB

Answer 21

older age
low socioeconomic status
recent immigration from 3rd world country
HIV positive

Question 22

symptoms of TB

Answer 22

fever, chills, night sweats
anorexia
fatigue
cough 
hemoptysis (advanced dz)

Question 23

pulmonary findings w/ tb

Answer 23

dullness w/ decreased fremitus or distanct hollow breath sounds

Question 24

M. tuberculosis stains positive in a what stain?

Answer 24

acid-fast

Question 25

what is considered a positive TB skin test in someone form a low-risk group

Answer 25

>15 mm

Question 26

what is considered a positive TB test in a moderate risk individual (recent immigration, IV drug user)

Answer 26

>10 mm

Question 27

what is considered a positive TB test in an HIV-infected individual or patients w/ organ transplants receiving >15 mg of prednisone a day

Answer 27

>5 mm

Question 28

first line drugs for TB

Answer 28

``` isoniazid (INH) fiampin pyrazinamide ethambutol streptomycin ```

Question 29

chemoprpolyaxis fo recent skin test onverters

Answer 29

daily INH

Question 30

what is the vaccine for TB that is not recommended for routine use in the US

Answer 30

BCG vaccine (live attenuated strain of Mycobacterium bovis)

Question 31

what is a whole blood test for the diagnosis of latent TB?

Answer 31

QuantiFERON-TB Gold

Question 32

after how many weeks of treatment are TB patients usually noninfectious

Answer 32

2 weeks

Question 33

TB med that produced red-orange discoloration of body fluids

Answer 33

rifampin

Question 34

TB med that can cause red-green color blindness

Answer 34

ethambutol

Question 35

Diagnosis of cystic fibrosis

Answer 35

elevated sweat chloride >60 on 2 occcasions

Question 36

what organ systems does CF mainly affect

Answer 36

lungs | pancreas

Question 37

Pulmonary manifestations of CF

Answer 37

persistent, productive cough hyperinflation of the lung fields PFTs consistent w/ obstructive airway dz clubbing seen in moderate disease states

Question 38

what causes most cases of acute bronchitits?

Answer 38

viruses

Question 39

what suggests acute bronchitis

Answer 39

presitence of cough for mroe than 5 days , and cough generally persists up to 2-3 weeks

Question 40

Is fever common in acute bronchitits?

Answer 40

No, it suggests either influenza or pneumonia

Question 41

Indications for chest x-ray w/ acute cough

Answer 41

pulse >100/ min respiratory rate >24 temp >38

Question 42

how should acute bronchitits be treated?

Answer 42

symptomatic treatment- NSAIDs

Question 43

what differs pneumonia from bronchitits?

Answer 43

pneumonia patients more liekly to have high fever, experience dyspnea and shills, ahve chest pains

Question 44

If symptoms of a URI persist for more than a week what abx can be started for 10-14 days?

Answer 44

amoxicillin or TMP/SMX

Question 45

ABX to give for outpatient CAP <60

Answer 45

erythromycin Azithromycin Doxycycline (less expensive)

Question 46

For patients >60 what are good abx choices for pneumonia

Answer 46

Fluoroquinolone (ex- levofloxacin) | 2nd gen cephalosporin