UW 2

Question 1

Invasive aspergiolsis - risk factors

Answer 1

immune

Question 2

invasive aspergillosis - findings

Answer 2

1. triad of fever, chest pain, hemoptysis
2. pulm nodules with halo
3. positive cultures
4. positive cell wall biomarkers (galactomannan, betal D glucam

Question 3

invasive aspergillosis -management

Answer 3

voriconazole +/- caspofungin

Question 4

chronic pulmonary aspergilosis - risk factors

Answer 4

lung disease/damage (cavitary TB)

Question 5

chronic pulm aspergilosis - findings

Answer 5

1. more than 3 months: weight loss, hemoptysis, fatique
2. cavitary lesion +/- funfus ball
3. positive aspergillus IgG seology)

Question 6

Chronic pulm aspergilosis - management

Answer 6

resect aspergilloma (if possible)

2. azole (vorizonazole)
3. embolization (if severe hemoptysis)

Question 7

tumors of the mediastinum - location

Answer 7

anterior: thymoma, thyroid, teratoma, lymphoma
middle: bronchogenic cysts
posterior: neurogenic, esoph leiomyomas

Question 8

hospitalized vs ventilator acquired pneumonia - definition

Answer 8

hosptial: 48 or more hours after admission
ventilator: 48 or more hours after intubation

Question 9

Acute exacerbation of COPD - management

Answer 9

1. O2 (target 88-92)
2. inhaled bronchodilators
3. systemic glucocrticoids (β2 or anticholinerg)
4. antibiotics if at least 2 of dyspnea, more frequent cough, change in colore or volume of sputum)
5. oselramivir if evidence of flu
6. noninvasive (+) pressure ventilation
7. intubation

Question 10

pulm nodule sorrounded by ground glass

Answer 10

invasive aspergilosis (halo sign)

Question 11

causes of obstructive pattern (and their DLCO)

Answer 11

asthma: normal/increaed
emphysema: decreasd
chronic bronchitis: normal

Question 12

causes of increased DLCO

Answer 12

1. asthma
2. morbit obesity
3. polycythemia
4. pulm hemorrhage

Question 13

increased PCWP is an indicator of

Answer 13

LA pressure

Question 14

lung problems - PCWP?

Answer 14

not affected

Question 15

asbesotis exposure - when develop disease

Answer 15

after 20 years of initial exposure

Question 16

aspiration syndromes - types and mechansim

Answer 16

pneumonia: parenchyma infection, anaerobes microves
pnemonitis: parenchyma infl, aspiration of gastric acid

Question 17

aspiration syndrome - types and clinical features

Answer 17

1. pnemonia: daus after aspiration, fever, cough, sputum. CXR infiltrates, can progress to abscess
2. pneumonitis: hours after event, from asymptomatic to resp distress, CXR infiltrates (1 or both lower lobes)

Question 18

aspiration syndrome - types and management

Answer 18

pneumonia: clindamycin or b lactam + lactamase inh
pneumonitis: supportive (no antibiotics)

Question 19

negative pressure pulm edema

Answer 19

when a atient has upper airway obstruction that results in large negative intrathoracic pressure (due to inspiration against obstruction)

Question 20

the 3 MCC of clubbing

Answer 20

1. Lung ca
2. Cystic fibrosis
3. R –> L cardiac shunts

Question 21

Clubbing in COPD

Answer 21

copd does not cause

if there is, search for ca

Question 22

TB endemic areas

Answer 22

Mexico, philippnes, china, vietnam, india, Dominican Republic, Haiti

Question 23

management of PE if more than 4 wells

Answer 23

first antigoagulant, and after diagnostic tests

Question 24

classic ECG in PE

Answer 24

prominent S in lead I, Q in lead III, and inverted T in head III (S1Q3T3)

Question 25

management after Wells criteria

Answer 25

1. PE likley --> CT pulm angiography --> if (-) is excluded, if (+) is confirmed 2. PE unlikely --> D dimers -->: if more more than 500 --> CT pulm angiography, if less excluded

Question 26

Modified Wells criteria

Answer 26

- 3 points: Clinical signs of DVT, alternate diagnosis is less likley - 1.5 points: previous PE or DVT, herat rate more than 100, Recent surgery or immobilazation - 1 point: hemoptyisis, cancer MORE THAN 4 --> LIKELY 4 OR LESS --> UNLIKELY

Question 27

fat embolism - time after event

Answer 27

12-78 h

Question 28

pulm contusion - symptoms can be worsen by

Answer 28

fluid overvolume

Question 29

COPD indications for O2 at home

Answer 29

1. resting PaO2 55 or lower 2. SaO2: 88 or less 3. Those with RHF or HCT higher than 55 should be started if Pao2 lower than 60 or Sao2 lower than 90

Question 30

the 3 MCC of chronic cough are

Answer 30

1. upper airway cough syndrome (postnasal drip_ 2. asthma 3. GERD

Question 31

POSTNASAL SYNDROME

Answer 31

caused by rhinosinus conditions including allergic, perennial nonallergic and vasomotor rhinitis --> mechanical stimulation of cough reflex treatment: chlorpheniramine

Question 32

COPD exacerbation - when to give antibiotics

Answer 32

if 2/3 of: 1. increaed dyspnea 2. increased cough (more frequent o sever 3. sputum production (change in color or volume)

Question 33

anaphylaxis - IV vs IM epinephrine?

Answer 33

IM --> if no response --> IV | NO IMMEDIATELY IV DUE TO SE (arrhythmia)

Question 34

the most effective way to differentiate asthma from COPD

Answer 34

spirometry before and after administration of a bronchodilator (usually albuterol)

Question 35

COPD - factors that decrease mortality

Answer 35

1. smoking cessation 2. Long term supplemental 02 decreases mortality if: - SpO2 under 88% - SpO2 under 89% + RHF or erythrocytosis (HCT more than 55)

Question 36

solitary pulm nodule - definition

Answer 36

round opacity up to 2 cm in diameter within and surrounded by pulm parenchyma by convention: no pleural effusion, adenopathym atelectasis

Question 37

solitary pulm nodule - DDX

Answer 37

1. 1ry lung Ca 2. Metastatic ca 3. Benigh infect granulomas (TB, histopl, other fungus) 4. Benign neolasm (lipomas, hamartomas, fibroma) 5. vascular (AV malformation)

Question 38

Solitary pulm nodule on routine chest X-ray - management

Answer 38

previous chest x-ray: - stable over 2-3 years --> no further testing - No previous imaging or possible nodule growth --> CT: 1. Benign features --> serial CT scans 2. High suspicious for malignancy --> surgery 3. indeterminate or suspicious for malignancy --> biopsy or PET

Question 39

high risk vs low risk for solitary pulm nodule

Answer 39

low: smaller than 0.8 cm, younger than 40, never skomed or smoking cessation more than 15 years, smooth margins high: larger than 2 cm, older than 60, current smoker or cessation less than 5 years before, corona radiata or spiculated margins

Question 40

Causes of recurrent pneumonia

Answer 40

1. involving same region: local airway obstruction, aspiration --> CT 2. involving different regions of lung: immunoddef, sinopulm disease, noninfectious (Vasculitis, etc)

Question 41

antitryps def - smoking

Answer 41

COPD 10 years earlier compare to nonsmoking

Question 42

empiric treatment of CAP

Answer 42

1. outpatient:macrolide or doxycycline (healthy) resp quinolone or beta lactam + macrolide (comorbitities) 2. inpatients: quinolone (IV) or betal lactam + macrolide 3. ICU: beta lactam + macrolide or quinolne + beta lactam

Question 43

resp quinolones

Answer 43

levo-, moxifloxacin

Question 44

CURB-65

Answer 44

``` Confusion Urea more than 20 Respiration more than 30 Blood pressure lessthan 90/60 Age 65 or more ```

Question 45

CURB-65 interpretation

Answer 45

0-1: low mortality --> outpatient 1-2 intermediate --> likley inpatient 3-4 urgent inpatient --> possibly ICU if socre more than 4

Question 46

initial drug in stable PE in patient with RF

Answer 46

``` unfractionated heparin (if severe: GFR lower than 30) (the others are contraindicated) ```

Question 47

SIADH - treatment

Answer 47

Fluid restrition (best initial) +/- salt tablets hypertonic (3%)saline for severe - DEMECLOCYCLINE ONLY IF THE OTHERS FAIL

Question 48

PE - Aa gradient

Answer 48

increased

Question 49

anemia - Aa gradient

Answer 49

low

Question 50

dead space ventilation?

Answer 50

air in non-perfused areas

Question 51

subacute vs chronic cough

Answer 51

subacute: 3-8 wks chronic: more than 8 wks

Question 52

evaluation of subacute or chronic cough

Answer 52

evaluate and treat as indicated (stop ACEi, H1 for upper airway cough, OFT for asthma, PPI for GERD) --> if no improvement --> Cest X-ray - parenchymal disease, purulent sputum, immune, no specific etiology --> chest x-ray

Question 53

atelectasi - PCO2

Answer 53

low

Question 54

upper airway obstruction - graph

Answer 54

decrease the airflow rate during insipration and expiration --> flattening both the top and bottom of the flow - volume loop

Question 55

FRC in ankylosing spond

Answer 55

normal or increased due to fixation of a rib in the inspiratory position