EM 2 Pulm (tidbits)

Question 1

Asthma has a prolonged __ phase. Why?

Answer 1

Expiratory, b/c unable to push air out of alveoli.

Question 2

Define pulsus paradoxus.
Why does it happen?
When does it happen? (3)

Answer 2

drop in systolic bp >10 during inspiration.

Due to decreased blood flow to left side of heart b/c of hyperinflation (seen in asthma, COPD, cardiac tamponade)

Question 3

Dx of asthma via:
PEFR
FEV1

Answer 3

PEFR < 300

FEV1 < 1L

Question 4

What is PEFR measuring?

What is FEV1 measuring?

Answer 4

PEFR - max speed of expiration (measures for obstruction)

FEV1 - Amount of air that can be exhaled in 1 second.

Question 5

Asthma airway obstruction was not promptly resolved by inhaled albuterol. Whaddya do now?

Answer 5

Corticosteroids

Question 6

Onset of action of corticosteroids:

Peak?

Answer 6

3 hours

6-12 hours

Question 7

Patient hasn’t responded to albuterol, you give Prednisone, but they’re in acute distress and their O2 stat is <90% now, and they have excessive hypercapnia.. Whaddya do?

Answer 7

Intubate.

Question 8

Baseline paCO2 level

Answer 8

35-45

>45 = hypercapnia

Question 9

Crunch heard during heart auscultation while patient is holding breath (while in resp distress) is indicative of:
What causes it?

Answer 9

Pneumomediastinum

Rupture of alveoli, found in asthma exacerbation.

Question 10

Patient has dyspnea and cough on exertion. What’s this a sign of?

Answer 10

COPD

Question 11

Key sign of COPD

Answer 11

New onset hemoptysis (Bronchitis)

Question 12

Pursed lip exhalation is a key sign in:

Answer 12

Emphysema

Question 13

Differentiate between Chronic Bronchitis and Emphysema

Answer 13

Chronic Bronchitis - due to increased mucous production
Emphysema - due to walls between alveoli breaking down & alveoli get much bigger and have less surface area for gas exchange.

Question 14

What will you hear when auscultating a patient with chronic bronchitis?
emphysema?

Answer 14

chronic bronchitis: rales & ronchi (b/c inc mucous)

emphysema: diminished breath sounds (lack of gas exchange)

Question 15

Main tx for a COPD exacerbation?

Answer 15

Oxygen via CPAP or BiPap

Question 16

MC origin of Pulm embolism

Answer 16

DVT in iliofemoral region (calf)

Question 17

8 Ruleout criteria for PE

Answer 17

Age 94%
No unilateral leg swelling
No hemoptysis
No exogenous estrogen use

Question 18

Wells Criteria - Pretest probability for PE - and their points(7)

0-2: Low risk
3-6: Moderate
>6: High risk

Answer 18

Suspected DVT -> 3
Alternative dx less likely than PE  -> 3
HR >100 -> 1.5
Immobilzn/surgery in past 4 weeks -> 1.5
Previous DVT/PE -> 1.5
Hemoptysis -> 1
Malignancy -> 1

Question 19

Test of choice to dx PE

Answer 19

CT Pulmonary Angiography

Question 20

Heparin dosing (2)

Answer 20

Loading dose: 80 units/kg

Maintenace dose: 18 units/kg/hour

Question 21

MC artery involved witih hemoptysis:

Answer 21

bronchial artery

Question 22

What happens to tall thin boys?

Answer 22

SPONTANEOUS Pneumothorax.

Question 23

What organism pneumonia will have sputum that looks like red-currant jelly (blood tinged)?

Answer 23

Klebsiella

Question 24

Pneumonia Outpatient tx

Answer 24

Macrolide (Azithro, Clarithro)

Question 25

Pneumonia tx for suspected HCAP (3)

Answer 25

4th gen Cephalosporin (Cefepime, ceftazidine) - antipseudomonas drug)
+ Levo
+ Vanco (anti MRSA drug)

Question 26

Pneumonia Inpatient non-ICU tx

Answer 26

Quinolone + Azithromycin

Question 27

Best single tx for CAP

Answer 27

Azithromycin

Question 28

Pneumonia Inpatient ICU tx (4)

Answer 28

Ceftriaxone
Macrolide
Quinolone
Aztreonam/Clindamycin

Question 29

What is CURB-65? What’s it stand for?

Answer 29

assesses severity of pneumonia
Confusion
Uremia
RR >30
Systolic BP  65

Question 30

What screening tool assesses severity of pneuomnia?

Answer 30

CURB-65