8. Hypoxia DSAs

Question 1

Acute cough lasts less than 3 weeks while subacte is 3 to 8 weeks. What is the MCC of acute cough?

Answer 1

Viral upper respiratory tract infection

Influenza A/B, parainfluenza, RSV, coronavirus, adenovirus, rhinovirus

Question 2

Viral coughs/rhinitis/sinusitis have normal chest sounds and usually present rhinorrhea, sneezing, nasal congestion and postnasal discharge without headache, tearing throat discomfort or?

Answer 2

Fever*

Question 3

Influenza A/B has sudden onset of fever and malaise followed by cough, HA, myalagia and ?

Answer 3

nasal/pulmonary sx, during the appropraite season (Oct-Mar)

Question 4

Bordatella pertussis, M pneumoniae, and C pneumoniae are nonviral cuases of uncomplicated acute bronchitis and cough in adults (5-10%) and do not gram stain, treatment should not be given unless they have a cough for greater than 2 weeks with an unknown cause =?

Answer 4

Probably pertussis - give antimicrobial therapy (gone in 7-10 days)

Question 5

Pneumonia is the 3rd MCC of acute cough illness and most serious, the absense of the following point to pneumonia not being the cause…. HR below 100, RR below 28, oral temp below 100, or what on chest examination?

Answer 5

no crackles or diminished breath sounds

Question 6

Asthma should be considered in someone with an acute cough, but need a hx of asthma/ wheezing and shortness of breath to determine if its asthma– note all of these that would present with asthma also present after acute ?

Answer 6

bronchitis (up to 8 weeks after may see asthma like sx)

Question 7

Chronic cough is greater than 8weeks, detailed hx and physical all pts should undergo chest radiography causes include, asthma, GERD, upper airwau cough syndrome, brochiectasis, medication reaction (ACE) or?

Answer 7

chornic bronchitis due to smoking

Question 8

asthma, GERD, upper airway cough syndrome (UACS) are responsible for 90% of cases in nonsmokers with normal CXR and not on ACE inhibitors. UACS is when mucus from the nose goes down the oropharynx and causes?

Answer 8

cough

Question 9

In GERD cough is d/t vagally mediated distal esophageal tracheobronchial reflux. what may be given to treat this once found a + pH esophageal test?

Answer 9

Proton pump inhibitors - takes 3 months to work

Question 10

Patients with chronic cough who have normal CXR, normal spirometry and negative methacholine challenge tests should be considered to have what dx?

Answer 10

nonasthmatic eosinophilic bronchitis (NAEB)

Question 11

Chornic bronchitis is diagnosed by?

Answer 11

chornic cough with sputum for 3 months for the past two consequetive years

Question 12

Hemoptysis is defined as coughing up blood and may be assoc with acute or chronic cough syndromes. MC seen in ambulatory patients after infection (pneumonia/bronchitis) followed by?

Answer 12

malignancy

Question 13

Hemotypisis- get chest CT and fiberoptic bronchoscopy if everything is normal then what can it be classified as?

Answer 13

cryptogenic hemoptysis (dont know why)

Question 14

Dyspnea is described as work or effort in breathing, tightness and unsatisfactory inspirations usually originiating from the cerebral cortex with two main mechanisms including impaired ventilartory mechanisms and an increase in ?

Answer 14

respiratory drive

Question 15

impaired ventilartory mechanisms may be d/t airflow obstruction (COPD) muscle weakness or dec chest wall compliance, impaired respiratory drive due to parenchymal or pulmonary lung disease, CHF, impaired gas exchange or?

Answer 15

pregnancy

Question 16

In acute dyspnea developed rapidly over minutes to a day, vital sign assesment and stabilization of the pt should be performed. Then do history and physical, what is the initial diagnostic tool?

Answer 16

CXR

Question 17

Dyspnea becomes chronic when symptoms persist longer than 1 month, in 2/3 of people usually due to COPD, asthma interstitial lung dz or?

Answer 17

heart failure

***need detailed hx

Question 18

What describes a common disorder encountered in the critical care unit that remains a significant cause of morbidity and mortality?

Answer 18

ARDS

acute respiratory distress syndrome

Question 19

Pts with ARDS is quick onset (within 7 days), bilateral diffuse lung infiltrates, non cardiac origin, and oxygenation of?

Answer 19

less than 200 (paO2)

*severe hypoxemia

Question 20

managment strategies for ARDS include using low tidal volumes (6cc instead of 12cc/kg), prone ventilation, fluid management, cardiopulm monotiriing and?

Answer 20

corticosteroids (although no clear benefit)

Question 21

80 to 90% of developing COPD is due to smoking cigarettes. And cessation is the most clinically effective and cost effective way to prevent and slow COPDs progression. Screening for airway obstruction is not?

Answer 21

recommended in asymptomatic patients

Question 22

dx of COPD- hx of smoking, hyperinflation, barrel chest, hyperresonant percussion distant breath sounds and prolonged?

Answer 22

expiratory time

pursed lips breathing, paradoxical chest or abdominal wall movements

Question 23

Cor pulmonale may be seen with COPD, including JVD, liver enlargement, peripheral edema. also flattening of what may be seen ?

Answer 23

of the diaphragms in emphysema

*COPD is confirmed with spirometry

Question 24

Therapy of COPD has 3 options in a stepwise approach. Bagonists, anticholergic agents and methylxanthines. ICS are not commonly used for COPD unless they are paired with?

Answer 24

long acting beta agonists LABA

Question 25

COPD exacerbations are due to infection or air pollution, SABAs are preferred for tx, nonpharm adjunctive tx to alleviate dyspnea and sputum production can help too including: percussion, vibration to enhance clearance sputum, relaxation techniques, OMM, andbreathing throuhg?

Answer 25

pursed lips and diaphragmatic breathing to alleviated dyspnea

Question 26

usual interstitial pneumonitis (UIP) hetergenous involvement of the lung with different stages of progression of fibrosis in adjacent areas of the lung- usually seen in what diagnosis?

Answer 26

idiopathic pulmonary fibrosis

Question 27

Nonspecific interstitial pneumonitis (NSIP) has uniform involvement with cellular infiltration or fibrosis, usually bilateral and can see?

Answer 27

honeycombing

Question 28

Cryptogenic organizing pneumonia (COP) shows small airway bronchiolitis with granulation tissue (granulomas) and organizing pneumonia. What is the hallmark?

Answer 28

granulomas

Question 29

pt with progressive dyspnea, reduced exercise tolerance, and persisitent dry cough should raise the possibility for DPLD which is?

Answer 29

diffuse parenchymal lung
disease
(restrictive lung dz)

Question 30

Obstructive sleep apnea OSA is extremely common and can be dx by excessive daytime sleepiness, snoring, insomnia, ED, What is the most important risk factor for OSA?

Answer 30

excess body weight

inc in weight = inc in OSA prevalence

Question 31

Polysomnopgraphy is used to test for OSA becaus what is not specific or sensitive enough for a dx?

Answer 31

clinical features

Question 32

The mediastinum has 3 compartments. Anterior MC are thymomas, lymphomas, teratomatous neoplasms, and thyroid masses. Middle is vascular masses, LN enlargement and bronchogenic cysts. posterior are neurogenic tumors, meningoceles, meningomyeloceles, gastroenteric cysts and?

Answer 32

esophageal diverticula

Question 33

acute mediastinitis are due to esophageal perforation or occur after median sternotomy for cardiac surgery. Chronic mediastinitis ranges from granulomatous inflammation of LN to mediastinum fibrosing medisastinitis. most cases are due to?

Answer 33

tuberculosis, histoplasmosis

Question 34

Community acquired pneumonia is the most common type- streptococcus pneumonia is 40% of CAP. others include h influenzae, and atypical such as?

Answer 34

mycoplasma pneumoniae

chlamydia pneumoniae

Question 35

Klebsiella pneumonia is common in alcoholics and pseudomonas is more common in patients with structural lung disease after abx therapy or hospitalization. What should be expected with aspiration pneumonia?

Answer 35

enteric gram negative or anaerobic organisms

Question 36

Pneumonia should be considered in a pt with cough, sputum, fever, chills, or dyspnea- sx developing abruptly or getting worse over the past few days. What is CURB65 which identifies high risk patients and to predict complicated course?

Answer 36

Confusion
blood UREA nitrogen >19.6
Respiration Rate >30
systolic BLOOD pressur <90 or diastolic <60
Age >65

Question 37

for hospitalized patients, order CXR and two sets of blood cultures, CMP, pulse oximetry, and CBC. what should be considered in pts who do not respond to empiric therapy in 48 hrs?

Answer 37

unusual pathogens (M tuberculosis, fungi, viruses, pneuocytitis)

Question 38

if the pt is previously healthy w no risk factors for drug resistant strep, give a macrolide. If there are risk factors for drug resistant strep then give?

Answer 38

respiratory fluoroquinolone or B lactam plus a macrolide or doxycyline

Question 39

health care associated pneumonia aka hospital acquired pneumonia is pneumonia that develops 48 hours after hospitalization, most commonly being gram negative and?

Answer 39

staph aureus

Question 40

Ventilator associated pneumonia is suspected if the patient has infiltrates that is new or progressive along with clinical findings suggesting infection such as fever, purulent sputum, leukocytosis and a decline in?

Answer 40

oxygenation

Question 41

Tb is common worldwide and 80% mortality in untreated persons. Pt with Tb are usually asymptomatic with constitutional symptoms such as anorexia, fatigue, weight loss, chills, fever, night sweats and some local sx such as?

Answer 41

cough may develop

Question 42

if suspecting Tb, obtain acid fast bacilli smears and cultures, CXR and skin tests or IGRA in patients suspective of having active Tb. What makes a Tb patient or likely to get/have tb?

Answer 42

HIV

Question 43

What is the standard tx for someone with Tb?

Answer 43

RIPE for 6 months
Rifampin
Isoniazid
Pyriazinamide
Ethambutol

Question 44

Fat embolisms can cause hypoxia and clinical present with a TRIAD of hypoxemia, neurologic abnormalities and?

Answer 44

petechial rash - none specific for FES (usually due to broken bones-femur fractures)

Question 45

most tx for fat embolism is supportive care and the prognosis of fat embolisms is that they will?

Answer 45

fully recover spontaneously

Question 46

Upper and lower airway obstruction may present with similar symptoms such as SOB, noisy breathing and physical findings such as wheezing and diminished?

Answer 46

breath sounds

*stridor is loudest during inspiration and is loudest in the neck

Question 47

Must use CT scan for upper airway obstructions or can also use endoscopy. What is an infectious process that causes varibale degress of inflammation and edema of the epiglottis causing UAO?

Answer 47

epiglottitis

present: odynophagia, cant swallow, sore throat, dyspnea, hoarseness, fever, tachycardia, and stridor

Question 48

Venous thromboembolism collectively refers to deep venous thrombosis and pulmonary embolism together. usually due to venous stasis, hypercoagulability and ?

Answer 48

endothelial damage

Question 49

DVT patients with no contraindications should undergo immediate anticoagulation with usually warfarin, initiated simultaneously with heparin for 5 days. all pts should be treated with anticoags for a minimum of?

Answer 49

3 months

Question 50

PE sx include dyspnea, pleuritic chest pain, cough and hemoptysis; tachypnea, crackles, tachycardia and accentuated S2 are the?

Answer 50

most common findings

normal D dimer = no PE