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Risk factors for COPD
- Smoking
- Alpha-1 antitrypsin deficiency
Decreased breath sound, increased AP diameter, cachetic and non-cyanotic breather. Dx?
- Emphysema
Gold standard to dx COPD
- PFT with obstructive pattern
Criteria to consider Chronic Bronchitis
- Productive cough x3 mo/yr x2 yr
3 cardinal sisx in Chronic Bronchitis
- chronic cough
- sputum production
- dyspnea
EKG rhythm associated with COPD
- Multifocal atrail tachy
Indication of O2 in COPD
- Condition
- O2 sat
- PaO2 level
- Cor Pulmonale
- O2 sat < 88%
- PaO2 < 55 mmHg
Gold Stand for CF
- Sweat Chloride test
common cause of bronchiectasis
- CF
- Recurrent lung infx - Pseudomonas, H. Influenzae
- Test of choice & Gold standard for Bronchiectasis
- CT scan
- PFT
Samter's TRIAD
- Asthma
- Nasal Polyps
- ASA/NSAID sensitivity
Atopic's TRIAD
- Asthma
- Atopic dermatitis
- Allergic rhinitis
Dx tool of asthma in office setting
- PFT with reversible obstruction
- Methacholine challenge follow by bronchodilator challenge with FEV1 increase > 12%
how to assess asthma exacerbation severity?
- Peak expiratory flow rate
- discharge pt if PEFR > 70%
Beta agonist side effect (albuterol, salmeterol, formoterol)
- Tachycardia,arrhythmias
- Muscle tremors
- CNS stimulation
Supplement for someone who is on long-term corticosteroid
- Calcium
- Vit D
Bilateral hilar lymphadenopathy on C-Xray
- Sarcoidosis
Erythema nodosum, lupus pernio, maculapapular rash
Uveitis
joint pain
bilateral hilar LAD
- Sarcoidosis
Sarcoidosis
- Restrictive or obstructive pattern on PFT
- Restrictive
Lab - increased ACE level. dx
- sarcoidosis
Most accurate dx for sarcoidosis
- Tissue biopsy - non-caseating granulomas
Caseating vs Non-caseating granulomas
- Caseating = TB
- Non-caseating = Sarcoidosis
Cystic fibrosis vs pulmonary fibrosis
- Cystic fibrosis = over secretion of the lungs d/t abnormal chloride/water transport
- Pulmonary fibrosis = progressive scarring of the lungs
Occupation: Quarry work with granite. sandblasting. What pneumoconiosis?
- Silicosis
Round nodular opacity in the upper lobes. What Pneumoconiosis
- Silicosis
Work in Aerospace, electronics. What pneumoconiosis?
- Berrylliosis
Construction in old building, ship yards, insulation. What pneumoconiosis?
- Asbestosis
Which region of lungs involved in Asbestosis?
- Lower lobes
What lung dz associated with Asbestosis
- Bronchogenic carcinomas
Contradiction to Flu vax
- pt with GBS
- Infatn < 6m of age
Vax schedule for DTaP
- 2-4-6 mo, 15-18 mo, 4-6 yr
- 5 doses
cause of epiglottitis is unvax pt
- H. Influenzae
cause of epiglottitis in vax pt
- GAS --> S. pneumoniae
Gram + diplococci. what pathogen for PNA
- S. pneumoniae
gram (+) cocci in cluster. what pathogen for PNA
- S. aureus
Common pathogen for HAP
- Pseudomonas, MRSA
Criteria to dx for HAP
- Sisx of PNA onset AFTER 48hr of hospital stay
Criteria to dx for CAP
- Sisx of PNA onset BEFORE 48hr of hospital stay
Risk factor for Histoplasmosis
- Inhalation of what?
- HIV with what CD4 count?
- Inhalation of soil with bird or bat dropping
- HIV with CD4 count < 150
Risk factor for PCP
- HIV with what CD4 count
- CD4 < 200
Where is the location of infiltration in the case of re-activation TB?
- apex/upper lobe with cavitation lesions
How many sputum acid fasting staining and cultures needed for TB
- 3 samples on 3 consecutive days
Thrombocytopenia and orange colored urine is AE of what med
- Rifampin
Pt has lupus, hepatitis and peripheral neuropathy. what TB med?
- Isoniazid
Photosensitive dermatologic rash cause by what TB med
- Pyrazinamide
Ototoxicity and nephrotoxicity cause by what TB med
- Streptomycin
tested (+) for PPD, what next?
- Get CXR or Interferon Gamma Release Assay
- pt most likely have Latent TB, even if it is BCG vax, still rec tx
incidential finding of lung nodule on CXR, what next?
- CT chest to determine malignancy
Periodic diarrhea, flushing, tachy, and bronchoconstriction. what dx?
- Carcinoid syndrome
Lung CA screening
- Annual low-dose CT for 55-80 y/o with 30 PPY smoking hx who current smoke or quit within 15 yrs
Location of adenocarcinoma of the lung
- Peripheral
Central lesion on xray, cavitation, hypercalcemia, pancoast syndrome
- Squamous cell lung CA
which long CA has worst prognosis
- small cell carcinoma
Dx test for lung CA
- CXR for location
- CT guide biopsy or bronchoscopy biopsy for central lesions
- Aspiration biopsy for non-central lesion
- Cushing syndrome
- SIADH
- Lambert-eaton myasthenic syndrome
- SVC syndrome
what lung cancer
- Small cell carcinoma
- Horner syndrome
- shoulder and arm pain
- atrophy of muscle of the hand
- Pancoast tumor syndrome
Gold standard Dx for Pulm HTN
- right heart catheterization
initial confirmatory dx test for PE
- Helical CTA
When to use V/Q scan to dx PE instead of CT
- Preggo
- Increased creatinine
Gold standard for PE dx
pulmonary angiography
indication for IVC filter in PE management
- anticoagulation is contraindicated
- anticoagulation is unsuccessful
- If RV dysfunction is seen on Echo
When to use Wells' criteria for PE
- to determine probability of PE
When to use PERC
- when PE probability is low from Wells. use to rule out PE
What anti-hypertension medication can induce asthma
- ACE-I
- Chronic non-productive cough WORSE at night
- Absent of wheezing and rhonchi
- Cough triggered by exercise, allergens, or forced exhaling
What Dx
- Cough-variant asthma
Common cause of COPD exacerbation
- viral > bacterial infx
- Nasal congestion, cough
- wheezing/crackle
- retraction, nasal flaring
- Pt< 2 y/o
- Bronchiolitis
- Pancreatic insufficiency
- chronic sinusitis
- nasal polyps
- chronic bronchitis
What dz are these associated with?
- Cystic fibrosis
What pathogens are CF pt at risk of getting
- Pseudomonas (common in adult)
- H. influenzea
- S. Aureus
When to do emergent thoracotomy vs tube thoracostomy in hemothorax
- when initial bloody output > 1500 ml
- persistent hemorrhage > 200 ml/hr
- Decreased breath sound
- hypoxic
- severe distress
- (+) transillumination on the affected side, with mediastinal deviation
- Ped pt
what dx
- tension ptx
Initial tx of choice for chronic osteomyelitis
- surgical debridement + cultures
MCC of Osteomylitis
- S. aureus > S. pyogenes
MCC of osteomyelitis in puncture wounds
- Pseudomonas
MCC of osteomyelitis in sickle cell dz
- Salmonella
MCC of osteomyelitis in prosthetic joint placement
- S. Epidermis
Dx tests for osteomyelitis
- Initial?
- Most sensitive?
- Gold Standard?
- initial = xray
- most sensitive = MRI
- Bone aspiration
Joint x-ray
- asymmetric joint narrowing
- osteophytes
- subchondral bone sclerosis
- OA
Joint x-ray
- symmetric joint narrowing
- osteopenia
- Bone and joint erosions
- RA
Complications from pelvis fx
- DVT
- Sciatic nerve damage
- Vascular injury
Most common type of hip fx
- femoral neck fx
Worrisome complication from hip fx and hip dislocation
- Avascular necrosis
Initial tx for Legg-calve-perthes
- Observation with therapy and brace/cast
Dx test for ALC
- Initial
- Test of choice
- initial = Xray
- Test of choice = MRI
What xray view for patella fx
- sunrise view + cross table lateral view
Low riding patella with knee pain, inability to extend knee. What dx
- quadriceps tendon rupture
High riding patella with knee pain, inability to extend knee. what dx
- patellar tendon rupture
Worrisome complication from knee dislocation
- popliteal artery injury --> need to do ateriography or duplex
When to get xray of the ankle and foot for ankle sprain?
- pain along both malleolus and foot
- cant walk > 4 steps
What position to splint for Achilles tendon rupture
- Plantar flexion
Spiral fx of proximal fibular and distal medial malleolar fx. What dx?
- Maisonneuve fx
- Inferior heel pain, worse AFTER waking up. Pain better during the day, worse with prolong standing, worse with dorsiflexion of toes
- Planter fasciitis
Compression of posterior tibial nerve cause what foot syndrome?
- Tarsal Tunnel Syndrome
Tx for Jones fx
- Non weight-bearing with short leg cast X 6-8 wk
Jones vs Pseudojones fx?
- Which one involve diaphysis
- which one involve the base of 5th metatarsal
- Diaphysis = Jones
- Base of metatarsal = Pseudojones
x-ray findings - sunburst appearance and Codman's triangle. what dx?
- Osteosarcoma
- Chondrosarcoma
- Ewing sarcoma
- Osteosarcoma
x-ray findings - Punctate or ring appearance calcification
- Osteosarcoma
- Chondrosarcoma
- Ewing sarcoma
- Chondrosarcoma
x-ray findings - Periosteal reaction "onion skin" or :moth-eaten" appearance
- Osteosarcoma
- Chondrosarcoma
- Ewing sarcoma
- ewing sarcoma
Tenderness > 11/18 trigger points, extreme fatigue, numbness. Dx?
- Fibromyalgia
- Pain and stiffness of shoulders and hip joints
- NO muscle weakness
Dx?
- Polymyalgia rheumatica