Respiratory > step 2 > Flashcards

step 2 Flashcards

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1
Q

management of mucormycoses infection

A

diabetic with nasal black eschar with bleeding
- amphotericin B + surgical debridement

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2
Q

patient with active tB, most accurate diagnostic test

A

mycobacterium culture of sputum

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3
Q

treatment for active TB

A

rifampicin, isoniazide, pyrazinamide, ethambutal for 6 months followed by isoniazid + rifampicin for 4 months

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4
Q

treatment for latent TB

A

isoniazid + rifampicin/rifapentine for 3 months or rifampicin for 4 months

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5
Q

side effects of the following medications;
- rifampicin
- isoniazid
- ethambutol
- pyrazinamide

A

rifampicin - liver impairment, orange urine
isoniazid - hepatitis, peripheral neuopathy, lupus like syndrome
ethambutol - optic neuritis
pyrazinamide - hyperuricaemia or hepatitis

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6
Q

what medication should you co-prescribe when giving isoniazid

A

pyridoxine (B6) to prevent peripheral neuropathy

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7
Q

mycobacterium avium can occur in HIV patients with a CD4 count of what

A

< 50

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8
Q

patients not on highly active anti retroviral therapy for HIV should recieve what prophylaxis against mycobacterium

A

azithromycin

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9
Q

antibiotics for mycobacterium avium infection

A

macrolide + ethambutol +/- rifabutin

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10
Q

what might be present on labs of a patient with PJP infection

A

elevated LDH
elevated beta-D-glucan

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11
Q

would should be added to treatment regimen in a patient with PJP and Pa02 < 70 or A-a gradient >35

A

steroid taper to reduce inflammation and improve mortality

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12
Q

alternative abx regimen (from co-trim) in severe PJP

A

pentamidine or primaquine + clindamycin

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13
Q

best initial treatment for anthrax

A

ciprofloxacin or doxycycline + 1 or 2 other antibiotics
14 days if inhalation or cutaneous of the head, face, neck
7-10 days if other cutaneous locations

if cutaneous anthrax - post exposure prophylaxis with ciprofloxacin to prevent inhalation anthrax should be continued for 60 days

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14
Q

describe centor criteria for acute pahryngitis

A

if 4 -5 points then start abx
if 2-3 then rapid antigen test

fever
pustular tonsils
tender anterior cervical lymphadenopathy
lack of cough
age 3-14 yrs

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15
Q

complication of retropharyngeal abscess presenting with fever, chest pain and dyspnoea

A

necrotizing mediastinitis
treat with surgical drainage

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16
Q

what is ludwig angina

A

rapidly progressive cellulitis of the submanidibular space that may cause airway compromise from oedema
presnets with red, warm mouth, dysphagia, drooling and fever
caused by polymicrobials in the setting of poor dental hygiene
treat with IV abx and airway management

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17
Q

light criteria for pleural effusion

A

pleural protein + serum protein > 0.5
pleural LDH + serum LDH >0.6
pleural LDH > 2/3 upper limit normal

if 1 or more criteria met = exudate

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18
Q

causes of exudate pleural effusion

A

meets 1 or more light criteria
caused by increased vascular permeability
- infection
- malignancy
- autoimmune
- drugs
- haemothorax, chylothorax
- left side: pancreatitis, esophageal rupture
- right side: meigs syndrome, endometriosis

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19
Q

causes of transudate pleural effusion

A

doesnt meet any light criteria

increased in hydrostatic pressure or PCWP;
- heart failure
- ESRF
- PE (early)

decrease in oncotic pressure
- nephrotic syndrome
- cirrhosis

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20
Q

how would pleural effusion present on physical examination

A

dullness to percussion
reduced breath sounds
reduced vocal resonance

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21
Q

PH transudate vs exudate pleural effusion

A

transudate 7.4 - 7.55
exudate < 7.4

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22
Q

CXR confirms left sided pleural effusion measuing 4cm. what is the next step?

A

thoracentesis
required if new effusion and is >1cm
not required if bilateral or signs of CHF

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23
Q

features of complicated parapneumonic effusion and empyema vs simple parapneumonic effusion

A

simple parapneumonic effusion: PH > 7.2, glucose normal/increased, clear fluid

complicated: PH < 7.2, glucose decreased, no positive culture , cloudy

empyema: PH < 7.2, glucose decreased, growth of sputum culture, purulent

complicated and empyema require drainage

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24
Q

what size of pnuemothorax requires only observaion and 02

A

2cm or less

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25
diagnostic criteria for OSAS
apnoea-hyponea index (AHI) AHI >5 with symptoms AHI >15 regardless of symptoms
26
1st line treatment for OSAS
weight loss + CPAP
27
STOP-BANG survery
survey used to assess the risk of OSAS snoring tiredness observed stopped breathing at night pressure (bp) bmi >35 age >60 neck circumference >40cm gender (male)
28
1st line treatment for nasal polyps
oral steroids intranasal steroids are not as effective
29
1st line management for anterior and posterior epistaxis not responding to first aid measures
anterior = cauterization nasal packing if source of bleeding cannot be visualised posterior = balloon catheter alternatively foley catheter
30
patient develops fever, hypotension and rash after nasal packing
toxic shock syndrome
31
multiple warty lesions in the upper airway
recurrent respiratory papilomatosis
32
what is recurrent respiratory papilomatosis
rare disease caused by HPV causing warty growths in the upper airway juvenille risk factors: first born, vaginal delivery, mothers age < 20yrs adult form: oral sex hoarsness, episodic chocking, voice change, cough, dyspnoea, foreign body sensation, inspiratory wheeze, stridor treatment: multiple debulking surgical removals, noncurative but may obtain remission after several years malignant transformation to SCC can occur
33
male smoker presents with pnuemonthorax and CXR shows upper lobe cysts and nodules ?diagnosis
pulmonary langerhan cell histocytosis - male smokers - progressive SOB - affects upper lobe without basilar involvement - cysts and nodules - pnuemothoraces
34
management of langerhan cell histocytosis
1st line: smoking cessation if cysts persist then steroids can be useful
35
feature of langerhan cell histocytosis on sputum microscopy
birbeck granules stain positive for S100 and CD1a
36
adenosine deaminase level in TB
adenosine deaminase levels are an important marker in TB - elevated
37
1st step in investigation of OSAS
home sleep study if uncomplicated and high probability of diagnosis in-lab test if complicated +/or lower probability
38
signs/sympotms of theophylline toxicity
theophylline has a narrow therapeutic range and so toxicity can occur; - nausea, vomiting - diarrhoea - arrythmias i.e. AF - hypoglycaemia - hypokalaemia - headache
39
what severity of symptoms warrants step 2 and 3 in asthma management step-wise approach
step 2 (SABA + ICS) - few nighttime wakenings 2-3x per month - symptoms few times per week - minor limitations step 3 (SABA + LABA + IC) - daily symptoms - night time wakenings >1x per week - some limitations
40
common arrythmia found in lung disease such as COPD
multifocal tachycardia
41
as part of ARDS, what is the Pa02/Fi02 and what does this indicate
Pa02/Fi02 < 300 Pa02 is their 02 Fi02 is the supplemental 02 they are receiveing (i.e. if on 40% 02, the Fi02 would be 0.4)
42
management of meconium aspiation syndrome
if signs of respiratory distress then positive pressure CPAP if this fails then intubation
43
management of SVC syndrome
radiotherapy if severe then stent placement or intubation
44
treatment for pnuemonia if penicillin allergy
respiratory flouroquinolone such as moxifloxacin
45
lymphoid interstitial pnuemonia (LIP) risk factors, presentation and investigations
commonly seen in female patients with autoimmune conditions i.e. sjogrens CXR/CT shows bilateral lower lobe opacities, cysts and ground glass appearance biopsy shows non-necrotizing granulomas with plasma cells, lymphocytes and giant cells treat with steroids can transform into lymphoma
46
in moderate-severe PJP what can be added to the management in combination with iv ABX
steroids
47
recurrent sinus infection, recurrent pneumonia, bronchiectasis and splenomegaly + FHx of similar presentation, sweat chloride negative. what is the most likely diagnosis
common variable immunodeficiency confirm with serum immunoglobulin testing
48
antibiotic of choice if pneumonia is caused by extended-spectrum beta lactamase organism such as klebsiella
carbapenem i.e. meropenam note: cephalosporin i.e. ceftriaxone can be used for klebsiella if no beta-lactamase activity
49
indications for thoracotomy with haemothroax
immediate draineg fo 1000-1500ml blood or continuation of blood > 200ml/hr
50
what indicates a posititive purified protein derivative test
purified protein derivative test is for TB positive if induration > 10mm
51
in a patient who is intubated, how can the settings be changed to reduce PaC02
increase tidal volume and/or respiratory rate
52
in a patient who is intubated, how can the settings be changed to increase Pa02
increase PEEP and/or Fi02 (fraction of inspired 02)
53
indication for omalzumab in asthma management
if elevated IgE >30
54
management for ventillator-support pneumonia
abx to cover gram negative incl pseudomonas + MSRA i.e. vanc (MSAR cover) + cefepime (pseudomonas cover)
55
parameters on right heart catheterization suggestive of PAH
mean pulmonary artery pressure >20 PCWP < 15 pulmonary vascular resistance > 2 wood units
56
most common pathogen of infections in CF in younger vs older patients
younger patients - staph aureus older patients - pseudomonas
57
when should itraconazole be avoided
patient has congestive heart failure
58
patient has chest pain, dyspnoea and 02 requirement with signs of heart failure and hypertension. ?diagnosis ? management
hypertensive emergency can lead to flash pulmonary oedema 1st line: loop diuretics 2nd line: nitroglycerin
59
1st line treatment for COVID in the outpatient setting for high risk individual
nirmatrelvir-ritonavir - nirmatrelvir is a protease inhibitor against Mpro - ritonavir is a strong PY450 inhibitor
60
criteria for yearly lung cancer screening and the investigation of choice
low dose CT chest - 20-pack-year history - stopped recently or within the past 15 years - 40-80yrs
61
02 sats suggesting hospital admission for bronchiolitis
< 92%
62
what infection can present similarly to sarcoidosis
histoplamsosis both present with granulomatous inflammation, lymphadenopathy and calcified nodules
63
1st line management for hypersensitivity pneumoconiosis (i.e. bird fanciers lung')
avoidance of anigens
64
intubated patient with plateau pressure of 14mmHg and peak pressure of 35mmHg. ?cause
high pressures are due to either decreased lung compliance or airway resistance airway resistance causes a large difference in plateau and peak pressures decreased compliance causes relatively similar plateau and peak pressures
65
patient has cough, SOB and chest pain. No signs of heart failure. negative bronchoalveolar lavage. CT shows ground glass opacities. ?diagnosis
inflammatory pneumonitis treat with steroids
66
respiratory symptoms for > 1 week but < 3 weeks that doesnt respond to abx, bronchoalveolar lavage negative and eosinophil dominant. ?diagnosis
hypersensitivity pneumonitis treat with steroids
67
what type of lung cancer is associated with gynaecomastia
large cell lung cancer (NSCLC) rare, least common NSCLC
68
underlying mechanism of the cause of hypoxia that is easily corrected with 02 supplementation
V/Q mismatch i.e. pneumonia intrapulmonary shunt i.e. PE wouldnt easily correct
69
pnuemonia caused by gram negative non-lactose fermenting organism
pseudomonas
70
patient presents with few months history of worsening dyspnoea. PFT normal except for isolated low DLC0. ?diagnosis
pulmonary hypertension presents with isolated diffusion capacity for carbon monoxide
71
best initial treatment for type 3 pulmonary hypertension caused by COPD
bronchodilators + oxygen therapy systemic vasodilators i.e. sildenafil are not used if pulmonary HTN due to chronic lung disease as it will cause vasodilatation in poorly ventilated areas making V/Q mismatch worse
72
what type of shock does PE cause and how
obstructive shock thrombus in pulmonary artery causes back up of blood in right ventricle = increased afterload the right heart isnt able to accomodate for increased pressure leading to RV failure. the decreased flow to the left heart = decreased output = shock
73
PPD induration > 5mm is considered positive TB test in what patients
exposure to people with active TB HIV immunosuppression
74
PPD induration >10mm is considered positive TB test in what patients
immigrant from endemic area working/ living in high risk environment i.e. hospital, care homes homeless IV drug abuse diabetes or CKD
75
PPD induration >15mm is considered positive TB test in what patients
all patients
76
60 year old patient with hx diabetes is exposed to someone with TB. PPD test induration 8mm. is triple therapy with abx required
yes if in contact with someone with positive TB then considered positive PPD test if induration >5mm (if diabetes only then would be positive if PPD > 10mm)
77
describe the Fleschnier criteria for low risk patients with pulmonary nodules
low risk = no risk factors; - nodule <4mm = no f/u - nodule 4-6mm = CT in 12 months, if stable no other f/u - nodule 6-8mm = initial CT in 6 months then if stable repeat at 18-24 months - nodule >8mm = CT at 3,9,12 months. consider PET +/or biopsy
78
treatment for PCP if sulpha allergy
atovaquone primaquine-clindamycin trimethoprim-dapsone pentamidine
79
indication for prone positioning in a patient with ARDS
Fi02 > 60% and Pa02/Fi02 <150
80
treatment of croup
mild: oral dexamethasone moderate/severe: nebulized racemic epinephrine + dexamethasone
81
sweat chloride test result that rules out CF
if sweat chloride test < 29 CF unlikely
82
treatment for COVID-19 if in hospital and doesnt require supplemental 02
Remdesivir avoid dexamethasone in these patients
83
treatment for COVID-19 if in hospital and requires low supplemental 02
Remdesivir + dexamethasone
84
treatment for COVID-19 if in hospital and is requiring increasing amounts of supplemental 02
oral Baricitinib or IV tacilizumab plus either Remdesivir or dexamethasone (Baractinib used in < 18yrs)
85
treatment for COVID-19 if in hospital and requires mechanical ventillation or ECMO
dexamethasone + oral Baricitinib or Tocilizumab (Baracitinib used in < 18yrs)
86
AHI of mild, moderate and severe OSAS
apnoea hypopnoea index 5-15 mild 16-30 moderate >30 severe
87
biologic option for severe asthma if IgE 20 and eosinophils elevated
IgE < 30 so omalizumab not indicated with elevated eosinophils the biologic options include to anti-eosinophillic drugs; - dupilumab (inhibit IL-4) - benralizumab (inhibit IL-5) - reslizumab (inhibit IL-5)
88
treatment for influenza in pregnancy
pregnancy i a high risk group for influenza infection treat with oseltamivir
89
when symptoms are controlled in asthma, when can medication be stepped down
when sympotms have been well controlled for 3 months
90
causes of ground glass appearance on chest CT
pulmonary oedema i.e. CHF viral pneumonia i.e. COVID mycoplasma pneumonia organizing pneumonia sillicosis e-cigarettes or vaping use
Respiratory
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