Lungs

Question 0

What are the s/s of acute bronchitis?

Answer 0

Cough preceded by URI sx, no findings of pneumonia. No consolidation on CXR. Treat with supportive therapy, rest, hydration, stop smoking. Abx only in elderly or immunocompromised.

Question 1

What is an acute inflammation of the large airways? Risk factor?

Answer 1

Bronchitis, smoking

Question 2

This is an infection and inflammation of the smaller airways. What is the most common cause?

Answer 2

Acute bronchiolitis. Caused by RSV.

Question 3

Presentation of a child with bronchiolitis?

Answer 3

Diffuse wheezing, fever, cough, hyperinflation, crackles, nasal flaring. Child looks sick.

Question 4

Treatment for bronchiolitis?

Answer 4

Supportive, bronchodilator, ribavirin.

Question 5

Hallmark signs of influenza?

Answer 5

Toxic appearance but exam normal.

Question 6

What medication do you avoid giving for flu and why?

Answer 6

ASA, Reye’s syndrome.

Question 7

What are some predisposing factors for pneumonia?

Answer 7

Smoking, DM, alcoholism, malnutrition, cancer, immunosuppression

Question 8

Pneumonia in smokers, COPD?

Answer 8

S. Pneumonaie, h. Flu.

Question 9

Most common cause for CAP? Community acquired pneumonia.

Answer 9

Strep pneumonaie.

Question 10

Pneumonia in nursing home resident?

Answer 10

S. Pneumonaie, h. Flu, TB.

Question 11

Pneumonia and alcoholic?

Answer 11

S. Pneumonaie, klebsiella.

Question 12

Pneumonia and bats?

Answer 12

Histoplasmosis

Question 13

Pneumonia and birds?

Answer 13

Cryptococcus

Question 14

Young healthy adult with pneumonia?

Answer 14

Mycoplasma.

Question 15

Cystic fibrosis and pneumonia?

Answer 15

Pseudomonas

Question 16

Pneumonia in IV drug user?

Answer 16

Staph aureus, TB.

Question 17

Pneumonia in HIV?

Answer 17

Pneumocystis

Question 18

Water source of pneumonia?

Answer 18

Legionella

Question 19

Lobar pneumonia is caused by what?

Answer 19

Bacteria

Question 20

Interstitial pneumonia is caused by?

Answer 20

Viral or mycoplasma.

Question 21

Nodular pneumonia caused by?

Answer 21

Fungus. Or metastatic dz.

Question 22

Describe an infiltrate on CXR.

Answer 22

Opaque consolidation that you can still see the landmarks.

Question 23

Describe a pleural effusion on CXR.

Answer 23

Fluid in plural space. Loss of landmarks and borders. Caused by CHF, pneumonia, malignancy.

Question 24

Treatment of CAP with no comorbidities?

Answer 24

Out patient tx with microlides (azithromycin) or fluroquinolones.

Question 25

CAP with comorbidities?

Answer 25

Treat inpatient with ceftriaxone plus macrolide.

Question 26

Pneumonia with altered mental status.... CVA or drugs think....

Answer 26

Aspiration pneumonia. Common on RLL. Treat wiTh amoxicillin, fluroquinolones.

Question 27

Most common cause of HAP?

Answer 27

Gram negative rods.

Question 28

What is RSV?

Answer 28

Common cause of bronchiolitis in kids.

Question 29

Antiviral Amantadine.

Answer 29

Treats influenza A, can cause seizure.

Question 30

Rimantadine?

Answer 30

Treats influenza A.

Question 31

Zanamivir?

Answer 31

Influenza A and B treatment. Competes with neuraminidase. Bronchospasm side effect.

Question 32

Oseltamivir or tamiflu.

Answer 32

Treats influenza A and B.

Question 33

Ribavirin.

Answer 33

Treats influenza A, B, hepatitis A, B, C. No PREGNANCY

Question 34

Gold standard for testing TB?

Answer 34

Acid fast bacillus culture.

Question 35

PPD positive at >5 mm induration?

Answer 35

HIV, contact with active TB patients, organ transplants, immunosupressed.

Question 36

PPD positive at > 10 mm induration?

Answer 36

High risk countries, IV drug users, prison/nurse/homeless shelter workers. High risk patients. Children over 4 in high risk setting.

Question 37

Normal positive PPD size?

Answer 37

15 mm induration.

Question 38

Positive PPD. What next?

Answer 38

CXR, if abnormal AFB smears and culture.

Question 39

Gohn complex?

Answer 39

Calcified lymph node on CXR in TB.

Question 40

Positive PPD but no active disease?

Answer 40

Treat with INH and vitamin B 6 x 9 months.

Question 41

Mechanism of action of INH, side effects.

Answer 41

Bactericidal, inhibits synthesis of mycolic acid. SE hepatitis, peripheral neuropathy.

Question 42

Mechanism of action and side effects of rifampin.

Answer 42

Bactericidal, inhibits RNA ploymerase. Hepatitis, orange body fluids, pseudomembranous colitis.

Question 43

The characteristics of asthma?

Answer 43

Obstruction of airflow, bronchial hyper reactivity, inflammation of airways.

Question 44

Mild intermittent asthma:

Answer 44

< 2 times per month

Question 45

Mild persistent asthma:

Answer 45

> 2 times per week and nocturnal sx > 2 times per month

Question 46

Moderate persistent asthma:

Answer 46

Daily, nocturnal > 6 per month

Question 47

Severe persistent asthma:

Answer 47

Continuous and nocturnal frequently

Question 48

Step 1 asthma treatment?

Answer 48

SABA prn

Question 49

Step 2 asthma tx?

Answer 49

sABA + low dose ICS

Question 50

Step 3 asthma tx?

Answer 50

Low dose ICS + long acting BA

Question 51

Step 4 asthma tx?

Answer 51

Medium dose ICS + LABA

Question 52

Step 5 asthma tx?

Answer 52

High does ICS + LABA plus allergy Meds

Question 53

A patient presents with acute onset of chest toughness, SOB, cough. Tachycardia, tachypnea, cyanosis, accessory muscle use and NO wheezing. Dx? Tx?

Answer 53

Status asthmaticus. Tx with oxygen, bronchodilators every 2 hrs, IV corticosteroids, mechanical ventilation.

Question 54

Dx of chronic bronchitis.

Answer 54

Cough on most days for at least 3 months of the year for 2 consecutive years.

Question 55

Patient with chronic bronchitis is a.....

Answer 55

Blue bloater.

Question 56

Chronic bronchitis may have signs of?

Answer 56

Right heart failure or cor pulmonale.

Question 57

Treatment Of chronic bronchitis?

Answer 57

Stop smoking. Ipatropium bromide, albuterol, theophylline, steroids.

Question 58

What is emphysema?

Answer 58

Enlarged air space due to destruction of alveolar septa.

Question 59

Describe a pink puffer?

Answer 59

Thin, pursed lip breathing, barrel chest, tachypnea, decreased breath sounds. Hyperinflation of X-ray.

Question 60

This is abnormal and persistent dilation of major bronchi and bronchioles.

Answer 60

Bronchiectasis.

Question 61

Bronchiectasis is related to what in the history?

Answer 61

Destructive changes from infection. TB, fungal, CF, pneumonia.

Question 62

Patient presents to clinic with SOB, hemoptysis, and foul smelling sputum.

Answer 62

Bronchiectasis

Question 63

Signet sign on CT which is the test of choice?

Answer 63

Bronchiectasis

Question 64

90 % of this originate from DVT.

Answer 64

PE

Question 65

Risk factors for PE?

Answer 65

Hypercoag state, pregnancy, OCP, surgery, a fib, trauma.

Question 66

Patient presents with pleuritic chest pain, dyspnea and tachypnea?

Answer 66

Pulmonary embolism

Question 67

Common EKG finding in PE?

Answer 67

S1Q3T(inverted)3

Question 68

Gold standard for PE and test of choice?

Answer 68

Angiography, spiral or helical CT

Question 69

PE and hemodynamically stable. Ok for coag. Tx?

Answer 69

LMWH and warfarin x 7 days then warfarin x 6 months.

Question 70

PE and hemodynamically stable coag contraindicated?

Answer 70

Inferior vena cava filter

Question 71

PE and unstable? Tx?

Answer 71

Thrombolytics

Question 72

PE and unstable but coag contraindicated? Tx?

Answer 72

Pulmonary embolectomy

Question 73

Most common cause of pulmonary hypertension?

Answer 73

COPD

Question 74

What causes the leading number of cancer deaths?

Answer 74

Lung cancer

Question 75

No small cell cancer includes:

Answer 75

Adenocarcinoma, squamous cell, large cell.

Question 76

Risk factors for lung cancer?

Answer 76

Smoking, asbestos exposure, uranium arsenic chromium nickel exposure, hx of COPD,

Question 77

This starts in the central bronchi and mets to nodes. May have associated hypercalcemia.

Answer 77

Squamous cell carcinoma.

Question 78

Definitive dx test for carcinoma?

Answer 78

Biopsy

Question 79

Most common type of lung cancer?

Answer 79

Adenocarcinoma.

Question 80

This cancer appears at the periphery and mets to distant organs.

Answer 80

Adenocarcinoma

Question 81

Clinical sx of this lung cancer include lymphadenopathy, Hepatomegaly, clubbing.

Answer 81

Adenocarcinoma

Question 82

This is the most aggressive type of lung cancer. It arises in the peribronchial tissue located centrally.

Answer 82

Small cell carcinoma.

Question 83

What is paraneoplastic syndrome and which lung cancer is it related to?

Answer 83

Can cause SIADH, Cushing's syndrome, etc. small cell carcinoma. No clubbing noted.

Question 84

This is a round oval, sharp lesion up to 3 cm in the lung.

Answer 84

Solitary pulmonary nodule. 25% are primary cancer, 10% are mets. Coin lesion.

Question 85

Benign solitary pulmonary nodule means....

Answer 85

Has not enlarged in 2 years.

Question 86

Treatment of solitary pulmonary nodule?

Answer 86

Exploratory thoractomy or thorascopy

Question 87

This is a low grade malignant neoplasm that is slow growing. Patient presents with hemoptasis, cough, wheezing, flushing and diarrhea. Dx? Tx?

Answer 87

Carcinoid tumor. CT for dx. Treatment is surgery. Resistant to chemo and radiation.

Question 88

Horner traveled to the coast with his lung cancer.

Answer 88

Yep

Question 89

This cancer invades other tissues leading to other sx. May present with mass in apex of lung, shoulder pain, and Horner syndrome.

Answer 89

Pancoast tumor.

Question 90

What is Horner syndrome?

Answer 90

Dropping of eyelids, decreased sweating, pupil contraction. Due to invasion of paraveterbral sympathetic chain.

Question 91

Treatment of pancoast tumor?

Answer 91

Surgery, RT and chemo may make it smaller prior to surgery.

Question 92

What is a transudate pleural effusion caused by?

Answer 92

Leaky vessels.

Question 93

What causes an exudate pleural effusion?

Answer 93

Inflammatory process.

Question 94

Three most common causes of pleural effusion?

Answer 94

CHF, infection, malignancy

Question 95

CXR findings and treatment of pleural effusion?

Answer 95

Blunting of the costophrenic angles, loss of land marks. Thoracentesis is treatment.