Lungs

Question 1

What is ARDS?

Answer 1

Noncardiogenic pulmonary edema caused by increase permeability of capillary vasculature

Question 2

Sick person w/sudden SOB, widespread pulmonary edema, white out on CXR
Dx? Tx?

Answer 2

ARDS = PCWP norm or down, LVF normal or up = not a heart prob!

Tx: PEEP

Question 3

Treatment for COPD long term

Answer 3

“COPD’ER”

=Corticosteroids, Oxygen, Prevention(no smoke,flu vac, pneumo vac), Dialators(SABA:Albu+Ipatro), Experimental, Rehab

Question 4

Tx for COPD EXACERBATION

Answer 4

O2, Nebulizer(ipratropium>albuterol) + IV steroids(125mg Methyprednisone) + Abx if sputum(Amox, Bactrim, Azithromycin, Doxy)

Question 5

Virchows Triad

Answer 5

Venous stasis, hypercoaguble state, endothelial dmg

Question 6

PE causes respiratory alkalosis how?

Answer 6

Decrease blood to alveoli, decrease gas exchange, increase PVR(shunts blood), increase R-heart strain, increase diffusion distance due to Inflammatory shit = dec O2 in but same CO2 out =resp alk

Question 7

Lite’s Criteria for Transudate pleural effusions

Answer 7

1. LDH < 2/3 normal
2. LDHeff/LDHser <0.6
3. PROTEINeff/PROTEINser < 0.6

Question 8

Lite’s criteria for EXUDATE pleural effusions

Answer 8

1. LDH > 2/3 normal
2. LDHeff/LDHser > 0.6
3. PROTEINeff/PROTEINser > 0.6

Question 9

Which type of lung cancer responds well to chemo + radiation? What paraneoplastic syndrome is associated with this?

Answer 9

Small/Oat cell

Para: ADH=SIADH, ACTH=cushing
*mets early!

Question 10

SC lung cancer is associated with which paraneoplastic syn?

Answer 10

PTH = Hypercalcemia

Question 11

Peripheral lung cancer stuck to pleura causing pain

Dx?

Answer 11

Adenocarcinoma = asbestos

Question 12

Salt & pepper lung cancer found anywhere on lung.

Dx? Paraneoplastic?

Answer 12

Carcinoid!

Serotonin syndrome

Question 13

Screening criteria for lung cancer

Answer 13

55-80yoa w/30pk/y his + currently or quit <15 yr ago gets annual LD CT of lungs

Question 14

Whats the total FEV1 needed in order to remove a lung due to shit?

Answer 14

Need min of 800 FEV1 left so total min wiht both lungs must be 1600.

Ex: if FEV1 = 1200 when you remove 1 lung will have FEV1 = 600 = not enough! Cant take lung out.

Question 15

How do you Dx asthma w/PFT?

Answer 15

Decreased FEV1/FVC or dec by 20% on methacholine challenge test

Question 16

When do you step up asthma therapy from ICS + SABA?

Answer 16

With asthma attack at least 1x per day = add LABA

Question 17

When do you add HD drugs for asthma control?

Answer 17

When you have at least 1 attack every day and multiple at night!

HD ICS + SABA + LABA

Question 18

Pt comes in you suspect asthma exacerbation. What test do you order?

Answer 18

PEFR, PE, ABG

Question 19

Person comes in with suspected asthma exacerbation. How do you treat?

Answer 19

O2, albuterol/ipratropium neb + steroids

If emergency give subq epi

Question 20

When does a patient with asthma exacerbation go to ICU for continuous nebulizer?

Answer 20

W/no improvment in 3 hrs of starting treatment

Question 21

Tx of CAP…

Answer 21

Ceftriaxone + Azith > Moxifloxicin

Question 22

Tx of HAP?

Answer 22

Vanco + Pip/tazo

Question 23

tx of PCP pneumo…

Answer 23

Bactrim

Question 24

Post viral pneumo

Answer 24

S. aureus

Question 25

Pneuo w/GI + CNS shit…

Answer 25

legonella

Question 26

Pneumo in smoker w/COPD

Answer 26

H. Flu

Question 27

Tx of pneumona in person w/copd?

Answer 27

doxy

Question 28

asthma only 2 x a week tx?

Answer 28

rescue inhaler

Question 29

asthma less than 1x a day and <2x a night per month tx?

Answer 29

LD ICS and SABA

Question 30

asthma @ least 1x per day and >1/w at night tx?

Answer 30

LD ICS, SABA and LABA