D\'s Pulm Step 2

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Author:
JCremer
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29316
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D\'s Pulm Step 2
Updated:
2010-08-08 13:56:33
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USMLE Step
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Pulmonology
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  1. CAP pt clinic tx
    Z pack
  2. CAP at hospital
    Rocephin & azithromycin
  3. Nosocomial vent pneumonia (pseudomonas)
    3rd gen cephalosporin & fluoroquinolone (cipro, levaquin)
  4. Nosocomial atypical pneumonia
    Erythromycin or azithromycin
  5. Aspiration pneumonia
    Clindamycin or vanc
  6. Fungal pneumonia
    Amphotericin B
  7. Diagnostic features of peritonsilar abscess:
    Infxn b/t tonsil & pharyngeal constrictors

    • Severe sore throat
    • Fever
    • Hot potato voice
    • Deflection of uvula
    • Trismus
    • Drooling
  8. Treatment of peritonsilar abscess
    • Needle aspiration or I & D
    • Pain meds
    • Amoxicillin/clavulunate x 10
    • Or
    • Clindamycin x 10 days
  9. Viral Influenza high amount of
    Arthralgia and myalgia
  10. Sinusitis most common effects what sinus?
    Maxillary
  11. Treatment for acute bacterial sinusitis
    • Symptoms: nasal saline irrigation, anagesic, decongestant
    • Intranasal glucocorticoid
    • Antibiotic:
    • 1st-amoxillin
    • 2nd-cephalosporin or bactrim
  12. Treatment of chronic bacterial sinusitis
    • Oral steriods
    • Oral antibiotics (clinda or augmentin)
    • Intranasal saline irrigation
    • Intranasal steriods indefinitely


    • If allergies: antihistamine, antileukotriene, allergy immunotherapy
    • If polyps refractory: surgery
    • If allergic fungal sinusitis: sinus sx & prolonged steriods
  13. Complications of sinusitis
    • Meningitis
    • Abscess
    • Orbital infxn
    • Osteomyelitis
  14. Allergic fungal rhinosinusitis
    • Chronic rhinosinusitis
    • Opacified thick allergen mucin
  15. Newborn tx for PNA
    • Amp & Gent
    • +\- Vanc (if MRSA)
    • Erythromycin (if chlamydia)
  16. PCP treatment
    • Bactrim or pentamide
    • Prednisone
  17. Xray/lab for PCP
    • CXR: diffuse, bilateral, interstital infiltrates
    • CD4: <200
    • LDH: >220
  18. Differential for ground glass opacitied
    • Interstital pna
    • PCP pna
    • Pulmonary edema
    • Pulmonary hemorrhage
    • Hypersensitivity pneumonitis
    • RDS
  19. PNA atypical/walking & tx
    Mycoplasma

    Macrolides (azithromycin, erythromycin, clarithromycin)
  20. PNA in alcoholic & treatment, currant jelly sputum
    Klebsiella

    Cephalosporin & aminoglycosides (gentamycin, tobramycin)
  21. PNA pt with hx of bat & bird droppings & treatment
    Histoplasmosis

    Amphotericin B or ketoconazole
  22. Q fever, livestock
    Coxiella burnetti
  23. PNA with air conditioners & tx
    Legionella

    Macrolides or fluoroquinolones
  24. MCC PNA kid <1 yr
    RSV
  25. Woolsorters disease
    Antrax
  26. Pontiac fever
    Legionella
  27. Gram + cocci in clusters
    Staph aureua
  28. Gram + cocci in pairs
    Strep pneumo
  29. Gram - rods in 80 yr old
    E coli
  30. Gram + cocci in neonate
    Group B strep
  31. Gram - rod in neonate
    E coli
  32. How do you dx active TB
    • Sputum AFB
    • Sputum culture for TB
    • Bronch with BAL or biopsy
  33. Treatment of TB
    RIPE (2mos)RI(4 more mos)
  34. Asysmptomatic + PPD: immunocompromised, IVDA, <35 yrs, close contact with TB, indigent treat?
    Prophylactically with INH & B6
  35. ARDS tx
    • Underyling cause
    • Vent- low TV & adequate PEEP
    • Fluids with goal CVP 4-6, furosemide, albumin
    • Prone
  36. PCWP ARDS vs 
    •  18- 
    •  18- ARDS
  37. 4 criteria for ARDS
    • PCWP 18
    • B Pulm infiltrated (edema)
    • PaO2/FiO2 200
    • Symptoms if respiratiry distress
  38. Mild intermittent asthma: Symptoms & meds
    • <2 day/wk or
    • <2 nights/mo

    Prn albuterol
  39. Mild persistent asthma: Symptoms & meds
    • 3-6 day/wk
    • 3-4 nts/mo

    • Prn albuterol
    • Low dose INH Steriod
    • +/- singular
    • +/- cromolyn
  40. Moderate persistent asthma: Symptoms & meds
    • Daily daytime episode
    • >1nt/wk

    • Prn albuterol
    • mod dose INH steriod
    • +/- long acting b2 agonist
    • +/- Singular
    • +/- Theophylline
  41. Severe persistent asthma Symptoms & meds
    • Continuois day episodes
    • Frequent night episodes

    • Prn albuterol
    • + high dose INH steriod
    • + long acting B2 agonist
    • + po steriod
    • +/- singular
    • +/- theophylline
  42. COPD staging
    • 0: chronic cough-nml spiro
    • 1: mild FEV1/FVC  70%
    • FEV 80%
    • 2: mod FEV1 50-80%
    • 3: severe FEV1 30-50%
    • 4: very severe FEV1  30%
  43. COPD tx by staging
    • 0:  risk factors & flu vac.
    • 1: above & short bronchodil
    • 2: above & long bronchodil
    • 3: above & INH steriods
    • 4: above & theo & home O2
  44. Home O2 for COPD if
    • 1. Pulse Ox  88%
    • 2. Pulmonary HTN
    • 3. Periph Edema
    • 4. Polycythemia
  45. SE theophylline
    • Hypotension
    • Sz
    • Tachycardia
  46. Tx theophylline OD
    • BB/verapamil
    • Benzo
    • Phenytoin
    • Dialysis
  47. Define COPD
    Prod cough for 3 mo's of yr for  2 yrs
  48. CXR/CT tram tracking, multiple cysts & bronchial crowding, dilation of bronchi
    Bronchiectasis
  49. Honeycomb lung
    Idiopathic pulmonary fibrosis
  50. Serum markers for interstitial fibrosis
    • SP-A
    • SP-B
    • MCP-1
    • KL-6
  51. Lung cancer with  ACTH
    Small Cell

    Cushings
  52. Lung cancer with  PTH related peptide
    Squamous Cell

    Hypercalcemia
  53. Lung cancer with ADH
    Small cell

    SIADH: hyponatriemia
  54. Lung cancer with antibodies to presynaptic Ca channels
    Small cell

    Lambert eaton
  55. Initial treatment for small cell lung cancer
    Chemo
  56. Initial treatment for non small cell lung cancer
    Surgery then chemo
  57. Treatment for idiopathic pulmonary fibrosis
    • Steriods
    • Azathioprine (cyclophosphamide)
    • Mucomyst
  58. Pneumoconiosis with progressive fibrosis
    Coal worker or silicosis
  59. Pneumoconiosis with Inc risk of TB
    Silicosis
  60. Pneumoconiosis with working with electronics & Inc cancer risk
    Berylliosis
  61. Pneumoconiosis with malignant mesothelioma & bronchogenic carcinoma
    Asbestosis
  62. Chronic sinusitis, hemolysis, hematuria
    Wegeners
  63. Treatment of sarcoidosis
    • Seld resolving
    • Steriods if chronic
  64. Lab of sarcoidosis
    •  ACE
    •  Ca
    • Hypercalciuria
    •  ALP
    • ESR
    •  WBC
    •  DLCO
  65. PE on EKG
    • S1Q3Q3
    • Sinus tachycardia-MC
  66. Studies for PE
    • CT with contrast if CI
    • V/Q scan
  67. Gold standard for PE
    Pulmonary angiogram
  68. ABG of PE
    Respiratory Alkalosis
  69. Best way to dx DVT
    Compressive venography-US
  70. Pulmonary Edema CXR
    • Fluid throughout lungs
    • Cephalization of vessels
    • Kerley B lines
  71. Indications for Chest Tube in Empyema
    • pH  7.2
    • Glucose 30
  72. Treatment of PTX
    • Small: 15% O2 only
    • Larger: 15% Chest Tube
    • Tension: immediate needle decompression & chest tube
    • Reccurent: pleurodesis
  73. Hemothorax causes, radio, treatment
    Causes: trauma, malignancy, TB, pulmonary infarction

    CXR: like pleural effusion, blunting of costophrenic angles

    Treat: O2, CT, underlying cause
  74. Drugs that make CSA worse
    • Opiods
    • Anti-histamine
    • EtOH
  75. Treatment of OSA
    • Wt loss
    • Stop sedatives
    • CPAP
    • Sx-tonsils, polyps, trach
  76. Treatment CSA
    • Stimulants
    • Azetazolamide
    • Theophylline
    • CPAP
    • Phrenic nerve pacemaking
  77. Croup cause, symptoms, radiology, treatment
    Parainfluenza

    Barking seal cough, inspiratory stridor, worse 

    Steeple sign 

    • Supportive
    • Epinephrine
    • Steriods: INH
  78. Epiglottis cause, symptoms, radio, treatment
    H. Influenza

    Dsyphagia, sniffing dog, muffled voice, hot potato voice

    Thumb print sign

    Calm, intubate, antibiotics

    Pen/vanc/clinda & 3 gen cephalosporin
  79. Bronchiolitis cause, symptoms, CXR, treatment
    RSV > parainfluenza

    Respiratory distress, wheezing, mild URI, nasal flaring, tachypnea, grunting, retractions

    Hyperinflated lungs

    • Hydrate
    • Albuterol or racemic epi
    • Steriods
    • Ribavirin
  80. Lungs mature at what time?
    35 wks
  81. 2 ways to determine lung maturity:
    • L:S ratio of 2
    • + phosphatidyl glycerol
  82. RDS vs transient tachypnea of newborn:
    RDS:  lung volumes, diffuse ground glass infiltrate, air bronchograms

    TTN:  lung volumes, flat diaphragms, prominent vasc markings, fluid in interlobular fissures
  83. Meconium aspiration consequences
    • Pulmonary HTN
    • Asthma
  84. Sweat chloride test in CF
    >60 Cl-
  85. Treatment of Cystic Fibrosis
    • DNase: decrease viscosity
    • CPT: clear secretions
    • Bronchodilators:
    • NSAIDs:
    • Antibiotics: pulm infxn
    • Pancreatic enzyme:
    • Vit: K, A, D, E
  86. What antibiotics give to CF fir pseudomonas
    • Azithromycin
    • Fluroquinolones ok here

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