Pulmonary

Front 1

what is a side effect of inhaled steroids

Back 1

oral candidiasis, sore throat, hoarse voice

Front 2

side effects of beta 2 agonists

Back 2

palpitations, tachycardia (in patients w/ CAD can cause MI)

Front 3

exercised induced asthma, are given what treatment?

Back 3

inhaled beta 2 agonists 10-20 minutes prior to exercise and cromolyn sodium which is a mast cell stabilizer (only use it for prophylaxis)

Front 4

in children that have exercise-induced asthma what do you give them

Back 4

give them montelukast everyday a leukotriene modifier

Front 5

pt comes w/ asthma exacerbation. if they've moved into a new apartment or basement. or purchased a new pet. what are the likely trigger?

Back 5

molds and pets can trigger asthma

Front 6

COPD patient w/ PaO2 on RA c/o exertional shortness of breath during sports. what do you do?

Back 6

check PaO2 or O2 saturation, SaO2 is <88 or PaO2<55 then they should be on oxygen during exertion

Front 7

COPD patient w/ PaO2 of 65 c/o daytime sleepiness, early morning HA, nocturnal restlessness. what do you do?

Back 7

check oxygen saturation during sleep. if <88 prescribe O2 during sleep.

Front 8

pt w/ COPD given oxygen, repeat ABG shows increase PaO2 w/ increased PaCO2, patient becomes drowsy and confused. what's the likely cause of change of mental status?

Back 8

hypercapnia. develop b/c too much oxygen used. in COPD exacerbation can't give too much oxygen because it decreases ventilatory drive and they don't blow out enough. could have used BiPap

Front 9

emphysema pt known to have alpha-antitrypsin. what do you do?

Back 9

supplement alpha 1 antitrypsin

Front 10

emphysema pt known to have alpha-antitrypsin. what is he at increased risk for?

Back 10

liver cirrhosis and hepatocellular carcinoma

Front 11

pt is having a cough for 1 week. complains of abdominal pain or chest pain w/ cough. O/E BP 120/70, HR=88, T=37 C, lungs are clear, abdomen is soft and non-tender. what do you do?

Back 11

reassure and give tylenol or decongestant

Front 12

45 y.o. male w/ recurrent attack cough w/ copious foul smelling purulent sputum and recurrent hemoptysis. has h/o of PNA. crackles are present at the lung base. CXR shows thick bronchial wall. what's the diagnosis and how do you confirm?

Back 12

Bronchiectasis, confirm w/ HR CT. a high resolution scan of the chest. h/o of PNA or TB is common for this disease.

Front 13

A young adult w/ bronchiectasis is due to what disease?

Back 13

cystic fibrosis

Front 14

treatment of bronchiectasis. what if there's hemoptysis.

Back 14

augmentin (amoxicillin-claluvunate) or bactrim or tetracycline w/ chest physiotherapy w/ postural drainage. if they have massive hemoptysis can do bronchial artery embolization or surgical resection

Front 15

10 y.o. male having recurrent cough w/ productive sputum > 3x/year. also c/o diarrhea, w/ foul smelling stool, has mild abdominal pain. which of the following test will confirm diagnosis?

Back 15

sweat chloride test.

Front 16

10 y.o. male having recurrent cough w/ productive sputum > 3x/year. also c/o diarrhea, w/ foul smelling stool, has mild abdominal pain. which of the following test will confirm diagnosis? once diagnosis is confirmed what is the treatment for diarrhea

Back 16

sweat chloride test for cystic fibrosis. treat diarrhea w/ pancreatic enzymes.

Front 17

pre-term infant presents w/ tachypnea, grunting, nasal flaring, and cyanosis w/in first 3 hours of life. CXR shows this finding? what's the diagnosis.

Back 17

hyaline membrane disease. surfactant deficiency as evident by ground glass appearance of CXR

Front 18

a mother planned for elective C-section, had it done one week before the due date. newborn is tachypneic (>60 breaths/min), has nasal flaring, mild cyanosis, CXR has vascular prominence and fluid in the fissure. what's the diagnosis?

Back 18

transient tachypnea of the newborn

Front 19

transient tachypnea of the newborn develops because process of clearing lung fluid begins at term and continues during labor. catecholamine surge during labor also enhances clearing of lung fluid. how do you treat it?

Back 19

give the baby oxygen.

Front 20

h/o choking in a child who came w/ coughing wheezing and has h/o choking. CXR is negative. what's the diagnosis?

Back 20

foreign body aspiration.

Front 21

child w/ h/o cough for last few days. O/E has wheezing or right lung. CXR shows hyperexpansion of the right lung. no foreign body is present. what's the likely diagnosis?

Back 21

foreign body aspiration.

Front 22

a pt w/ fever weight loss, cough, w/ expectoration of foul smelling, purulent sputum, has poor dental hygeine. on CXR has infiltrative in dependent lung zone RLL.

Back 22

aspiration PNA secondary to anaerobic organism, give clindamycin or metronidazole.

Front 23

young patient w/ fever, cough, productive sputum, CXR shows streaks of infiltrates. what's the diagnosis?

Back 23

mycoplasma pneumonia

Front 24

pt w/ PNA w/ diarrhea plus CNS symptoms. what's the diagnosis? what's the investigation? treatment?

Back 24

Legionella PNA. urine for legionella antigen. treat w/ macrolide (azitrhromycin_

Front 25

IVDA came w/ symptoms of cough, productive sputum fever, chills. on examination crackles are present. CXR has bilateral lower lobe infiltrate w/ air fluid levels. what's the organism causing this infections?

Back 25

staph aureus

Front 26

after influenza pt has PNA what's the organism

Back 26

staph aureus

Front 27

pt has a 2 cm pulmonary nodule on chest xray. what's the appropriate next step?

Back 27

compare to old CXR

Front 28

pt w/ h/o heavy smoking comes c/o shoulder and arm pain. what next test will you do?

Back 28

CXR to rule out pancoast tumor

Front 29

pt w/ h/o smoking c/o right-sided ptosis, myosis, anhydrosis, planned for CXR. what do you expect to see on CXR.

Back 29

right upper lobe mass. horner's syndrome.

Front 30

HIV patient exposed to an active TB pt, PPD is negative, what do you?

Back 30

start the INH

Front 31

HIV patient exposed to an active INH resistant TB pt, PPD is negative, what do you?

Back 31

give rifampin for 4 months

Front 32

a pregnant pt is PPD positive what do you do?

Back 32

postpone treatment until delivery except in HIV positive patients or someone who has recently converted after known TB contact.

Front 33

identify this CXR abnormality and which disease it is common in

Back 33

calcification of periphery of hilar lymph node ie egg shell calcification. common in silicosis!

Front 34

pt w/ exertional shortness of breath, dry cough, CXR has reticular infiltrates, CT shows reticular opacities, PFT shows restrictive lung disease, what's the next step in management?

Back 34

fiberoptic broncoscopy and transbronchial biopsy. though this does not confirm diagnosis. you need an open lung biopsy for that.

Front 35

a pt is intubated after 5 days you evaluate the patient and he does not seem to be extubated sooner. what is the most important thing to do in the management.

Back 35

Do a tracheostomy to avoid laryngeal injury

Front 36

Intubated pt who is 60 kg, tidal volume used in 350, RR is 14, on 100% oxygen is still desaturating. what adjustments would you like to do?

Back 36

increase the tidal volume to 600 ml b/c it is supposed to be 10-12 ml/kg.

Front 37

pt w/ ARDS 50 kg, intubated, tidal volume used is 350 ml, RR is 20, pt is on 100% oxygen, whenever you try to decrease oxygen, the pt starts to desaturate. what do you next?

Back 37

add PEEP b/c tidal volume and RR are OK.

Front 38

pt is recently intubated became hypotensive, tachycardic, tachypneic. what's the diagnosis? how do you correct it?

Back 38

patient has developed auto PEEP. how do you correct increase inspiratory flow rate time and increase expiratory time.