LA pulm 3

Question 1

what differentiates costochondritis from Tietze syndrome

Answer 1

Tietze syndrome has the presence of palpable edema

Question 2

most common foreign body aspirated in children

Answer 2

peanuts

Question 3

what is mean age for FB aspiration and why

Answer 3

2 years, no molars

Question 4

complications include bronchiectasis, pneumonia, lung abscess, atelectasis

Answer 4

FB aspiration

Question 5

definitive dx test for FB aspiration

Answer 5

rigid bronchoscopy, therapeutic as well sometimes

Question 6

what is the parapneumonic type of pleural effusion

Answer 6

non infected pleural effusion, secondary to bacterial pneumonia

Question 7

what is the empyema type of pleural effusion

Answer 7

direct infection of pleural space, purulent

Question 8

what is the hemothorax type of pleural effusion

Answer 8

gross blood; trauma or malignancy

Question 9

what is the chylothorax type of pleural effusion

Answer 9

increased lymph, persistent turbidity after centrifuge

Question 10

most common type of pleural effusion

Answer 10

transudative; CHF most common

Question 11

nephrotic syndrom, cirrohosis, atelectasis, hypoalbuminemia

Answer 11

think transudative pleural effusion due to increased hydrostatic pressure or decreased oncotic pressure

Question 12

Pulmonary emboli and malignancy in pleural effusion

Answer 12

usually exudative

Question 13

percussion, fremitus, breath sounds in a pleural effusion

Answer 13

all decreased, dullness

Question 14

blunting of costophrenic angles/meniscus sign

Answer 14

CXR in pleural effusion

Question 15

best film for pleural effusion

Answer 15

lateral decubitus

Question 16

gold standard for pleural effusion from thoracentesis

Answer 16

lights criteria
1. pleural fluid protein : serum protein > 0.5 or
2. pleural fluid LDH : serum LDH >0.6 or
3. pleural fluid LDH >2/3 the upper limit of normal LDH

Question 17

primary vs secondary pneumothorax

Answer 17

primary is idiopathic

secondary is underlying lung disease

Question 18

percussion, fremitus, breath sounds in a pneumothorax

Answer 18

hyperresonance, decreased fremitus/breath sounds

Question 19

what type of CXR(position)

Answer 19

expiratory upright view

Question 20

companion lines

Answer 20

visceral pleural line running parallel with ribs; pneumothorax

Question 21

pulm HTN is what pressure

Answer 21

elevated mean pulmonary arterial pressure >20

Question 22

BMPR2 gene defect

Answer 22

primary pulm htn

Question 23

pulm HTN auscultation

Answer 23

accenuated S2.

Question 24

definitive dx in pulm HTN

Answer 24

right heart cath is gold standard

Question 25

labs: polycythemia with increased hematocrit

Answer 25

pulm HTN

Question 26

what percentage of PE arise from deep vein in legs

Answer 26

70%

Question 27

most common sign of a PE

Answer 27

tachypnea

Question 28

most common abnormal finding in PE

Answer 28

atelectasis

Question 29

westermark sign

Answer 29

avascular markings distal to the PE

Question 30

hamptons hump

Answer 30

wedge shaped infiltrate due to PE infarction

Question 31

EKG: nonspecific ST/T changes and sinus tachycardia

Answer 31

PE

Question 32

S1Q3T3

Answer 32

most specific for PE wide deep S wave in lead 1 isolated q and t wave inversion in lead 3

Question 33

abg in PE

Answer 33

initally respiratory alkalosis and hypoxemia. respiratory acidosis occurs with more time

Question 34

d dimer and PE

Answer 34

only helpful if negative and low suspicion for PE

Question 35

best initial test for PE gold standard

Answer 35

helical(spiral) CT angiography pulm angiography gold standard

Question 36

PE tx if hemodynamically unstable

Answer 36

thromobolytic tx: LMWH

Question 37

PE tx if hemodynamically stable

Answer 37

IV unfractionated heparin 3 months or LMWH

Question 38

antidote for LMWH

Answer 38

protamine sulfate

Question 39

PTT for what

Answer 39

monitor unfractionated heparin

Question 40

avoid LMWH in who

Answer 40

renal failure,thombocytopenia

Question 41

major complication with unfractionated heparin

Answer 41

heparin induced thombocytopenia

Question 42

ARDs and high mortality rate why

Answer 42

acute hypoxemic respiratory and organ failure

Question 43

hypoxemia without hypercarbia

Answer 43

ARDs

Question 44

what kinds of pts at risk for ARDs

Answer 44

gram neg sepsis most common. critically ill pts

Question 45

CXR: bilateral diffuse pulm infiltrates, spares costophrenic angles similar to what?

Answer 45

ARDs CHF does not spare the angles

Question 46

PCWP < 18 and > 18

Answer 46

< 18 is ARDs >18 is cardio pulm edema

Question 47

tx of ARDs

Answer 47

CPAP, PEEP, and low tidal volume

Question 48

sleep apnea sleep study positive with what lab

Answer 48

15 or more events/hour polycythemia(due to chronic hypoxemia)

Question 49

cheyne stokes

Answer 49

cyclic breathing in response to hypercapnia leading to decreased brain blood flow/ increase then decrease in respirations

Question 50

biots breathing

Answer 50

irregular respirations with irregular periods of apnea: due to damage of medulla oblongata or opioid use

Question 51

kussmaul respiration

Answer 51

hyperpnea; deep, rapid, continuous respirations due to metabolic acidosis.

Question 52

CXR: bilateral diffuse reticular(ground glass) opacities and air bronchogram

Answer 52

neonatal respiratory distress syndrome

Question 53

neonatal respiratory distress syndrome tx

Answer 53

exogenous surfactant via endotracheal tube to open alveoli, continuous CPAP

Question 54

CXR: coarse, irregular infiltrates with lung hyperinflation

Answer 54

meconium aspiration

Question 55

signs of respiratory distress after birth(post term), cyanosis, tachypnea

Answer 55

meconium aspiration