PULMONARY

COPD

100

What are the cardinal signs? 

Progressive, gradual dyspnea and cough 

200

What is the gold standard for diagnosis? What is the result that would indicate COPD? 

Spirometry 

FEV1/FVC <70% 

300

If Mary Ann was hospitalized last year for her COPD, what COPD group would you classify her? What medication would she be on? What would you include in her treatment plan? 

E

LABA+LAMA 

(add ICS if eso >300 OR recurrent hospitalizations) 

PULM REHAB FOR ALL E+B PATIENTS 

400

Recall GOLD grades 1-4 & what they indicate 

What is the MRC scale and CAT assessment used for? 

1: mild, FEV1 >80%

2:mod, FEV1 50-80% 

3: severe, FEV1 30-80%

4: very severe, <30%

MRC- dyspnea rating 

CAT- symptom rating 

500

What is used in the treatment for COPD exacerbations and why? 

SABA- immediate relief and airway opening

PO steroid- reduced inflammatory response and mucus production

Azithromycin x5 days- treat underlying cause/ prevent infection 

ASTHMA

100

What are the cardinal signs of asthma? 

Wheezing, Dyspnea, Cough, Chest Tightness 

200

Describe the Atopic Triad & Hygiene Hypothesis 

Atopic Triad: asthma, allergic rhinitis, atopic dermatitis 

Hypothesis: early exposure to animals/ kids/ farm life and little abx use results in reduced risk for asthma 

300

Describe typical PFT results for asthma. 

Pre: REDUCED- FVC, FEV1, ratio

       INCREASED- TLC

Post: Normalized numbers 

         KEY FINDING: significant improvement in FEV1 & change % > 10-15

400

What is the patho behind asthma? 

REVERSIBLE airway obstruction 

bronchial inflammation, edema, and constriction 

500

If 15 year old Lucy's asthma is persistent, moderate How often is she having symptoms? How often is using her rescue? What treatment step/ treatment plan would you initiate according to GINA guidelines? 

Daily symptoms 

Waking up at least once a week 

Daily rescue use 

Step 3: SMART: Daily low dose ICS-Formoterol & PRN ICS-Formoterol 

PNA

100

What are the likely pathogens for pediatric age ranges: 3-11 weeks, 3months- 5 years, 5-18 years? 

3-11 weeks: chlamydial 

3mon-5 year: viral (RSV)

5-18 years: mycoplasma, strep PNA

200

Causative Agents for typical vs atypical PNA

typical: #1 = strep PNA, staph aureus, klebsiella, morazella cat., H influenzae 

Atypical: #1 = mycoplasma, legionella, chlamydia, fungi, oral anaerobes, viral 

300

What is the gold standard for diagnosis and differentiating PNA? 

Staining w/ culture and sensitivity 

400

What is the CURB 65 criteria? Interpret the scores.

What is the treatment for CAP?

CURB65: determines outpt vs inpt treatment for PNA needed (confusion, BUN, RR, blood pressure, >65) 

No comorb/MRSA/pseudo: amoxicillin OR doxy OR zpack 

w/ comorb: augmentin or cephalo PLUS zpack or doxy 

OR monotherapy with fluoroquinolone (-floxacins) 

500

If Juan is a 50 year old male on HD and who has had the PCV15 vaccine 4 years ago is he due for another vaccine? 

YES. 

Preferred: PCV20 or PCV 21

If they have had PCV 15 -> give PPSV23

If they have no had 20, 21 or 15+23 -> give 20 or 21. 

Spread by 1 year 

CROUP PERTUSSIS INFLUENZA

100

What is "whooping cough"? what are the symptoms? how long does it last? how do we treat (what abx is #1 choice)? tell me about the vaccines. 

Pertussis bacterial infection 

high pitch cough on inhalation 

duration: weeks to months 

tx: supportive, azithromycin (macrolides) 

Tdap = texting = older than 11 years (2 doses)

Dtap = younger than 11 (5 doses) 

200

What are the s/s of RSV

wheezing 

tachypnea 

cough 

fever

 nasal congestion 

300

What does Epiglottitis look like? What are we going to do for these patients? 

enlarged red

frothy mucous 

stridor, drooling, cyanosis, fever, malaise 

-> ER, need abx and airway protection 

400

What are the signs and symptoms of influenza? What complications can arise? Tell how you would treat. 

s/s: DRY COUGH, fever, chills, malaise, body aches, sore throat 

Complications: viral PNA, croup, COPD exacerbation, reye syndrome 

Tx: symptoms, antivirals (48 hrs onset, prophylactic, high risk for deterioration) 

500

What is the gold standard for diagnosing pertussis? 

NP swab culture (best within 1st two weeks of symptom onset) 

Extras

100

What is the difference between spirometry and plethysmography? 

spirometry: VENTILATED gas measurement 

Plethysmography: ALL gas measurement 

200

Describe peak flow meter zones and expected readings. What should the patient do for each zone? 

Green: >80% -> maintain treatment plan 

Yellow: 50-80% -> caution, increased checking, notify provider, take as needed 

Red: <50% -> ER 

300

What is RAST?

radioallergosortbent test for FOOD

serum blood test of IgE

does NOT tell you how severe reaction may be 

400

Tell me what I would see on CXR for... 

Bronchitis (acute vs chronic) 

Emphysema 

Typical PNA

Atypical PNA

TB 

Bronchitis acute- negative, chronic- peribronchial thickening & increased lower lobe markings 

Emphysema- hyperinflation (diaphragm flat, small cardiac silhoutte) 

Typical: dense homogenous, lobar infiltrates (lower lobes)

Atypical: diffused, patchy interstitial infiltrates 

TB: unilateral, cavities, upper lobes, hilar lymphodenopathy 

500

Describe the following for Croup 

Causes, Signs and Symptoms, Duration, Tx, and who is most likely to get it

cause: viral infection (flu, rsv, parainflu)

s/s: low BARKY cough, Seal bark 

duration: day 3-5 is worst, cough lasts 2 weeks 

tx: supportive - cool mist, tylenol, fluid (steroids MAYBE)

Group at increased risk: boys, 6 month- 3 years old