Cardio/Pulm

Question 1

What should you think if uncompensated res acidosis w/ hypoxia?

Answer 1

acute hypoventilation, ex. tension pneumothorax

Question 2

What should you think if severe met acidosis w/ resp compensation and no hypoxia?

Answer 2

early shock, diarrhea

treat = hydration

Question 3

What should you think is etiology if mildly acidic but low PO2?

Answer 3

severe pna, bronchiolitis, asthma, ventilation perfusion inequality

Question 4

What is treatment for severe resp alkalosis?

Answer 4

rebreathe into paper bag

Question 5

What should you think if pna like sx that do not improve w/ treatment? dx?

Answer 5

think foreign body

dx/tx: rigid bronchoscopy

Question 6

What are sx and treatment mild intermittnet vs mild persistent vs mod persistent vs severe persistent asthma?

Answer 6

mild intermittenet

• sx 2/wk, 3-4 nights/mo
• low dose steroid, cromolyn, or leukotriene inhibitor

moderate persistent:

• daily sx, night > 1/wk
• medium steroid or combo steroid + long B agonist

severe persistent:

• continual sx and lots of nights
• daily high dose steroid + long acting B agonist
• may need oral steroids

Question 7

What are sx of retropharyngeal abscess?

Answer 7

hx of pharyngitis, abrupt onset fever, sore throat, refuse food, drooling, muffled or noisy breathing

Question 8

What are sx of croup? Tx?

Answer 8

inspiratory stridor, barky cough, fever, rhinorrhea, congestion

Tx: racemic epi + steroids if in resp distress

Question 9

What are sx of laryngomalacia?

Answer 9

inspiratory stridor that worsens supine/crying/feeding and improves prone

begins in neonate, pesk 4-8 mo, then resolves; due to laxity supraglottic structures

Question 10

How do you dx/tx laryngomalacia?

Answer 10

dx: flexible laryngoscopy shows collapse supraglottis, omega shaped epiglottis
treat: reassure, resolves by 18 mo

Question 11

What is vascular ring? sx?

Answer 11

abnormal dev of aortic arch causes tracheal or bronchial compression, present

Question 12

What is next step if bacterial trachietis?

Answer 12

establish airway/intubation and IV antibiotics

Question 13

What is presentation bacterial trachietis?

Answer 13

viral URI then acute high temp, increased resp distress w/ insp + exp stridor

Question 14

What is mech of pneumothorax in pneumonia?

Answer 14

toxin of bacteria ruptures alveoli into pleural space, common w/ staph pna

have resp acidosis w/o compensation due to hypoventilation

Question 15

What is next step if suspect tension pneumo?

Answer 15

insert needle/cath into 2nd/3rd intercostal space midclavicular line

Question 16

What is idiopathic pulmonary hemosiderosis? findings? dx?

Answer 16

recurrent pna-like presentation w/ rapid clearing of radiographic findings + hemoptysis, clubbing, microcytic anemia, low Fe, occult blood in stool

dx: BAL –.> hemosiderin laden macrophages

Question 17

What is subQ emphysema? next step?

Answer 17

air leaks from chest wall into subcutaneous tissue due to high intra-alveolar pressure w/ severe cough

do CXR to r/o pneumothorax

Question 18

Treatment of empyema?

Answer 18

vanco b/c lots of resistance

Question 19

How do you dx phrenic nerve paralysis?

Answer 19

US chest to look for asymmetric diaphragm motion

Question 20

What are sx of epiglottitis? dx? next step?

Answer 20

more toxic/abrupt than croup, high fever, muffled voice, dysphagia, stridor, excess drooling, tripod

dx: lateral neck xray = thumb sign

next step: do emergency endotracheal intubation in OR

Question 21

How do you Dx croup?

Answer 21

lateral neck xray shows subglottic narrowing

Question 22

How do you treat bronchiolitis? prevent? complications?

Answer 22

treat: supportive care –> O2 and hydration
prevent: palivizumab if