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STEP 2 Medicine
Pulmonary/Respiratory Rx notes
| Question | Answer |
|---|---|
| What is the 1st LOT for severe COVID-19 patients on supplemental oxygen? | Dexamethasone combined with Tocilizumab |
| What condition is treated with Dexamethasone + Tocilizumab? | COVID-19 |
| What is the best TX for GAS pharyngitis? | Penicillin |
| What test shall be done prior to treating GAS-pharyngitis with antibiotics? | Rapid Strep Antigen test |
| What pathogen is the MCC of COPD exacerbations? | S pneumoniae |
| What is the pathology of acute silicosis? | Inhalation of crystalline silica dust --> fibrosis of airways |
| What are the CXR imaging findings of silicosis? | Bilateral centrilobular nodular opacities, focal ground glass opacities, and patchy areas of consolidation |
| What is a common cause of benign pulmonary nodules? | Hamartomas |
| How are lung Hamartomas distinguished? | Heterogenous appearance that includes fat, cartilage, bone and connective tissue |
| What vessel-associated condition is commonly seen with COVID-19 complication? | Venous thromboembolism |
| What DOC (type) for VTE therapy? | LMWH or unfractionated heparin |
| What is the MC DX in pt with pleuritic chest pain in setting of SOB? | Pneumothorax |
| What are physical exam signs pointing to Pneumothorax? | ↓ chest excursion and breaths sounds along with hyperresonance |
| What are common risk factors for developing a Pneumothorax? | Subpleural blebs, smoking, asthenic body habitus, and situations with ↑↑↑ transpulmonary pressure |
| What type of actions are commonly seen to cause a ↑↑↑ in transpulmonary pressure? | Diving and military flying |
| What is a common PCP in HIV patient complication? | Pneumothorax |
| What is the most likely DX of an HIV patient with sudden onset of chest pain and normal Troponin levels? | Pneumothorax |
| What is viral rhinosinusitis? | Virally induced inflammation of the nasal cavity and the paranasal sinuses |
| What is the primary pharmacotherapy of symptomatic acute rhinosinusitis? | Intranasal saline, antipyretics, analgesics and intranasal glucocorticoids |
| What is an important or key CXR finding of Pleural effusion? | Blunting of the costophrenic angle |
| What is the best INITIAL study to test/evaluate a pleural effusion? | Ultrasound |
| What is Pulmonary Langerhans Cell Histiocytosis? | Cystic lung disease commonly seen in male smokers |
| How is PLCH commonly presented? | Spontaneous pneumothorax and chronic progressive SOB |
| What are the CT-scan findings associated with PLCH? | Upper-lobe cysts and nodules w/out lower lobe or basilar involvement |
| What is the MCC of CAP? | Pneumococcus infection, especially by Strep Pneumonia |
| Which tests are used to confirm Strep-induced CAP? | Cultures of blood or sputum and antigen testing in urine |
| Interrupted breathing during sleep and classified as central or obstructive. Most likely DX? | Sleep Apnea |
| When is Home Sleep testing an appropriate option to DX OSA? | Uncomplicated pts. with a high pretest probability for moderate to severe OSA |
| What is the best option for testing in DX OSA in pt with comorbidities? | In-lab polysomnography |
| What Blood-gas imbalance is seen in early sepsis? | Respiratory alkalosis |
| What are some common causes of acute respiratory alkalosis? | Sepsis, pain, hypoxemia, and anxiety (panic) |
| What is the best treatment option for chronic mucocutaneous candidiasis? | Clotrimazole |
| Which antifungal is commonly used in treatment of mucocutaneous candidiasis? | Clotrimazole |
| What does ABPA stand for? | Allergic Bronchopulmonary Aspergillosis |
| When should ABPA be suspected in a patient? | Poorly controlled asthma with IgE>> 1,000, absolute eosinophil >500, and sensitization evidence to Aspergillus fumigatus, + central bronchiectasis |
| What is the imaging findings of ABPA? | Central bronchiectasis |
| What are significant findings of RA + pleural effusion? | Low glucose, Low pH (acidosis), ↑↑ LDH, and ↓ complement levels |
| What are some indications or clues pointing to young pt with Pulmonary Arterial HTN? | - Enlarged pulmonary artery on CT, - Prominent precordium - ↑↑ JVP - Significant bilateral leg edema All with 6 months of exertional dyspnea |
| What is the NBSM in pt with PAH? | Echocardiogram |
| What is evaluated with an echocardiogram in PAH pt? | Left heart disease, RV dilation, and RA dilation |
| What is the initial step in management of Asthma exacerbation? | Bronchodilators (albuterol), with Ipratropium and conjunction w/ systemic corticosteroids |
| How would a pt with acute asthma exacerbation be present clinically? | Significant respiratory distress with a HX of asthma and normal imaging results |
| What is the gold standard test to DX Pulmonary Arterial HTN? | Right heart catheterization |
| What are S/S of PAH? | Dilated RV on U/S, ↓DLCO, normal spirometry, and Hx of progressive fatigue and exertional dyspnea, + leg edema |
| How is OSA characterized? | Repetitive upper airway narrowing or occlusion during sleep |
| What is the best and the initial treatment option for OSA? | Nasal C-PAP |
| What type of lung cancer is associated w/ LEMS? | Small Cell Lung Carcinoma |
| What is the best TX for LEMS? | Adress the underlying malignancy |
| What are the classic CT findings of Idiopathic Pulmonary Fibrosis (IPF)? | Fibrosis, honeycombing, and traction bronchiectasis |
| What are common anti-fibrotic drugs used to TX IPF? | Pirfenidone and Mintedanib |
| A pt on Pirfenidone or Mintedanib, maybe DX with what condition? | Idiopathic Pulmonary Fibrosis |
| What is the associated profile of restrictive lung disease? | Everything ↓↓, except for a normal/↑ FEV1: FVC ratio |
| Which lobe is most commonly affected by cysts in Lymphoid Interstitial Pneumonia? | Lower lobe predominantly |
| What are some common pulmonary cystic diseases? | 1. Lymphoid Interstitial Pneumonia 2. Lymphangioleomyomatosis (LAM) 3. Pulmonary Langerhans Cell Histiocytosis 4. Birt-Hogg-Dube syndrome |
| What is seen on BX of LIP? | Non-necrotizing granulomas |
| What autoimmune condition is often associated with LIP? | Sjogren syndrome |
| Which pulmonary cystic disease affects both, upper and lower lobes? | Lymphangioleiomyomatosis (LAM) |
| What are common associations of LAM? | - TB, HMB (+), VEGF>800 - Renal angiomyolipoma - Spontaneous pneumothorax |
| Which lobe is predominantly affected by Pulmonary Langerhans Cell Histiocytosis? | Upper lobe |
| What are (+) stains or markers in Pulmonary Langerhans Cell Histiocytosis? | CD1a and S-100 (+) |
| What is the most significant histologic finding on EM of Pulmonary Langerhans Cell Histiocytosis? | Birbeck nodules |
| Which lung lobes are mostly affected by cysts of Birt-Hogg-Dube syndrome? | Lower lobe and base |
| Which pulmonary cystic condition is associated with Folliculin gene mutation and Fibrofolliculomas? | Birt-Hogg-Dube syndrome |
| What is the most reliable imaging option for the paranasal sinuses in case of sinusitis? | CT |
| What is the treatment option for most Coccidioidomycosis patients? | Supportive care only |
| What are two of the main risk factors for COPD? | Long-term exposure to cigarette smoke and environmental dust |
| ↓↓↓ FEV1: FVC ratio. Obstructive vs Restrictive | Obstructive |
| What is the appropriate pharmacotherapy for eosinophilic asthma refractory to corticosteroids? | Mepolizumab |
| MOA of Mepolizumab | Monoclonal antibody that targets the eosinophils |
| What are S/S of Pulmonary contusion? | Sever hypoxia, ↑ HR, and unilateral ↓ breath sounds |
| What is recommended USPST guideline for 60 yo male with a 32 pack-year smoking HX? | Low-dose CT of the chest for lung cancer screening |
| What is the minimum time range to consider smoking not a current elevated risk for lung cancer? | Quit smoking over 15 years at least |
| What does USPST stand for? | United States Preventive Services Task Force |
| What is the 1st LOT for ESBL Klebsiella? | Carbapenems |
| What are common Carbapenems? | Ertapenem, Imipenem, and Meropenem |
| What is Checkpoint Inhibitor Pneumonitis? | Common adverse effect associated with immunotherapy |
| What anti-cancer drugs are associated with Checkpoint Inhibitor Pneumonitis? | Pembrolizumab, Ipilimumab, and Nivolumab |
| What is another way to refer to Checkpoint Inhibitor pneumonitis? | Immune-related adverse event |
| What is the MOA of Theophylline? | Inhibits phosphodiesterase --> ↓cAMP hydrolysis --> bronchodilation |
| Theophylline directly inhibits the actions of: | Adenosine |
| What are adverse effects associated with Theophylline? | N/V, cardiac arrhythmias, and seizures |
| What are the 3 main causes of Transudate? | Cirrhosis, Nephrotic syndrome, and CHF |
| What are some causes for an exudate? | Bacterial infection, pancreatitis, Malignancy, PE, CVD |
| What is the etiology of an exudate? | ↑pleural vascular permeability |
| What is the exudate Light criteria in terms of protein and serum ratio? | Pleural protein> serum protein > 0.5 |
| What is the pleural LDH/Serum LDH ratio for an exudate according to Light criteria? | > 0.6 |
| What diagnostic findings for Berylliosis? | (+) serum and bronchoalveolar lavage beryllium lymphocyte proliferation test |
| What are jobs commonly associated with Beryllium exposure? | Electronic manufacturing, machine building, aerospace work, shipyard work, and mining |
| What are two common risk factors for development of COPD? | Exposure to tobacco smoke and α1-antitrypsin deficiency |
| What is the MC associated arrhythmia seen with COPD? | Multifocal Atrial Tachycardia (MAT) |
| What are the drugs associated in treating acute COPD exacerbations? | ß-agonists, muscarinic antagonists, and systemic corticosteroids +/- adjunctive treatments |
| How is ARDS clinically presented? | Rapid-onset hypoxic respiratory failure after trauma |
| Which criteria is used to DX ARDS? | Berlin criteria |
| What are the imaging findings of ARDS? | Diffuse infiltrates on CXR |
| What is the management of ARDS? | Focused on LUNG-PROTECTIVE ventilation with high PEEP for alveolar recruitment, + low plateau pressure to prevent barotrauma, and low tidal volumes per ideal body weight to prevent alveolar overdistension |
| What is the purpose of Low Tidal Volumes per ideal body weight in TX of ARDS? | Prevent alveolar overdistension |
| What is the intended purpose of using high PEEP in ARDS management? | Alveolar recruitment |
| How is 99% of histoplasmosis cases presented? | Asymptomatic |
| Histoplasmosis is: | Yeast with budding mycelial forms and spores on respiratory photomicrograph |
| What is seen in CXR of Histoplasmosis pt? | Nodular opacities |
| How many steps are noted for progressive treatment of Asthma? | 6 steps |
| What is "step 1" treatment of intermittent asthma? | Short-acting ß2-agonists (albuterol) |
| What are the common symptoms associated with intermittent asthma? | ≤ 2 days/weeks Nighttime awakenings ≤ 2x/month No interference with DOL FEV1/FVC >85% |
| What are symptoms of Mild persistent asthma? | > 2 days/week but not daily Nighttime awakenings 3-4x/month Minor limitations ADLs FEV1/FVC normal |
| What are the symptoms associated with Moderate persistent asthma? | Daily Nighttime awakenings >1x week, not nightly Some limitations of ADLs FEV1/FVC reduced 5% |
| What are the symptoms of Severe persistent asthma? | Throughout the day Nighttime awakenings 7x/week Severe limitations ADLs FEV1/FVC reduce >5% |
| How is mild persistent asthma treated? | Low-dose inhaled glucocorticoid |
| What are the TX options for Moderate persistent asthma? | 1. Low-dose inhaled glucocorticoid + Long-acting ß2-agonist, or, 2. Medium-dose inhaled steroid |
| What is the TX option for Severe persistent asthma? | Medium-dose inhaled steroid + LABA |
| What is the step 5 treatment regimen for asthma? | High-dose inhaled glucocorticoid + LABA + Omalizumab (if pt has severe allergies) |
| What is the step 6 treatment therapy for asthma? | High-dose inhaled glucocorticoid + LABA + oral systemic glucocorticoid, and add Omalizumab if pt has severe allergies |
Created by:
rakomi
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