acute pulm

Question 1

big 5 emergent causes of chest pain

Answer 1

aortic dissection
MI
esophageal rupture
tension pneumothorax
PE

Question 2

resp indications for mechanical ventilation

Answer 2

apnea
oxygenation deficit refractory to other interventions
acute/impending ventilatory failure (hypercapneic)

Question 3

COPD primary symptom

Answer 3

dyspnea

also productive cough w sputum, resp distress

Question 4

COPD exacerbation primary RF

Answer 4

history of previous exacerbation

ask about previous hospitalizations, steroids, intubations

Question 5

COPD exacerbation home mgmt

Answer 5

beta agonist
anticholinergic
oral steroids
antibiotics

Question 6

COPD exacerbation inpatient mgmt

Answer 6

aggressive bronchodilator therapy (duoneb - Bagonist/anticholinergic)
IV glucocorticoids
antibiotics - depends on pseudomonas RF

Question 7

bronchiectasis

Answer 7

abnormal & permanent distortion of 1+ conducting bronchi

secondary to infectious process

Question 8

bronchiectasis symptoms

Answer 8

cough, sputum production

dyspnea, fevers, weakness, weight loss

Question 9

bronchiectasis dx

Answer 9

CT chest - signet ring

Question 10

bronchiectasis mgmt

Answer 10

antimicrobials (broad spectrum 7-10d & CPT!!!

Question 11

TRALI presentation

Answer 11

immediately or up to 6 hours after blood transfusion

hypoxemia, pulm infiltrates on CXR, pink sputum, fever, hoTN, cyanosis

type of ARDS

Question 12

ARDS definition

Answer 12

diffuse alveolar injury
lung capillary endothelial injury
bilateral pulmonary infiltrates
severe hypoxemia
absence of cardiogenic pulmonary edema

Question 13

ARDS severity

Answer 13

mild P/F 200-300
moderate P/F 100-200
severe P/F <100

Question 14

ARDS CXR

Answer 14

diffuse bilateral pulm infiltrates

may be symmetric or asymmetric

patchy, then diffuse/GGO

Question 15

ventilation strategy for ARDS

Answer 15

low tidal volume ventilation (6ml/kg)

permissive hypercapnia

Question 16

sarcoidosis

Answer 16

unknown antigen triggers cell-mediated response, results in non-caseating granuloma

granuloma most often in lungs, but can be anywhere

Question 17

sarcoidosis symptomatology

Answer 17

asymptomatic

or fever, anorexia, arthralgias, DOE, fatigue, cough, CP

Question 18

sarcoidosis exam findings

Answer 18

crackles

erythema nodosum

ocular uveitis, conjunctival lesions

Question 19

sarcoidosis diagnostics

Answer 19

CXR - hilar lymphadenopathy, infiltrates

CT chest - most sensitive

biopsy - definitive diagnostic (non-caseating granuloma)

Question 20

sarcoidosis mgmt

Answer 20

symptomatic therapy w NSAIDs

corticosteroids