Others Flashcards
The most common second solid malignancy in a pt with previously treated and cured Hodgkin lymphoma is
Lung ca
A pt with significant smoking hx, hypercalcemia and hilar mass, suspect——?
Squamous cell ca of the lung
Clinical presentation and risk factor for amniotic fluid embolism
Inflammatory response leading to vasospasm, cardiogenic shock, hypoxemic respiratory failure, seizure secondary to hypoxia, DIC
Risk factors include advanced maternal age and multigravidity
What is the route of administration of epinephrine in anaphylaxis?
IM! IV is only when there is no response for initial IM epinephrine. This is because of ADR, arrhythmia
Chronic low back pain in an otherwise healthy young man, esp at night, improving with activity, increased ESR is suggestive of———?
PFT pattern would be? Why?
Ankylosing spondylitis
Mildly restrictive pattern
Fixation of the rib cage in the inspiratory position( limitation in lung expansion due to diminished chest wall n spinal mobility.
Most common cancer associated with asbestos exposure is ———? Risk is increased to 59fold if the pt is also a ————?
Bronchogenic carcinoma
Risk increased in smokers
ATELECTASIS Typical ABG At which post op day? Imaging would demonstrate? Treatment The most effective way of preventing postop atelectasis is
-Hypoxemia, hypocapnia, resp alkalosis (hyperventilation)
-second to fifth pod
-loss of lung volume due to collapsed lung
-adequate pain control, deep breathing exercise, directed coughing, incentive spirometry, early mobilization
The most effective preventive… is incentive spirometry
CXR findings in diaphragmatic rupture
Definitive diagnostic modality
NG tube in the pulmonary cavity; bowel loops in the chest
CT scan of the chest and abdomen is more sensitive
Upper airway cough syndrome is diagnosed n treated with———
1st generation antihistamines
Recurrent pneumonia in the same anatomical location raises the suspicion for———?
Localized airway obstruction.
Do different investigations to look for internal or external bronchial obstructions depending on associated sxs patients present with or exposure to risk factors. eg chest CT for a 50yr old pt with smoking hx n evidence of localized airway obstruction
In a pt with advanced COPD, oxygen should b used cautiously with a goal of PaO2 n SaO2 of——? Why?
PaO2- 60-70 mm Hg
SaO2- 90-93%
This is because supplemental O2, although it improves the hypoxia, it can cause CO2 retention. Loss of compensatory vasoconstriction in areas of ineffective gas exchange worsens v/q mismatch, decreased respiratory derive n slowing of the RR reduces minute ventilation
In a child with respiratory distress from epiglottitis what should b the 1st step in the mx?
Intubation in a controlled setting
Primary mediastinal germ cell tumors, how can u tell whether they r seminomatous or non seminomatous based on biochemical studies?
HCG is typically elevated in both but non seminomatous typically also produce alpha feto protein (AFP)
Common mediastinal tumors,, anterior, middle, posterior
Anterior- 5Ts
Middle- bronchogenic cyst, tracheal tumor, …
Posterior- neurogenic tumors
Lymphomas can b found in all the regions
In burn pts with inhalational injury, early intubation is important. Clinical indicators include…
Burns on face, oropharyngeal carbon deposits, strider, carboxy hemoglobin level>10%
The best treatment of hypersensitivity pneumonitis eg. Bird fancier’s lung is
Avoidance of antigen exposure
A pt presented with digital clubbing, sudden-onset arthropathy affecting wrist n hand joints and has smoking hx what should b the initial study to identify the underlying cause? What is it?
CXR
Hypertrophic pulmonary osteoarthropathy(HPOA) the underlying pulmonary disease could b lung ca, TB, bronchiectasis, empyema
A pt with flat neck veins, decreased mentation, abdominal distention and bruises after sustaining RTA,, he develops asystole as soon as mechanical ventilation is started. Y?
Positive pressure mechanical ventilation causes an acute increase in intrathoracic pressure. In the setting of hypovolemic shock, this can cause acute loss of RV preload, loss of CO n sudden death
OHS- obesity hypoventilation syndrome is characterized by (ABG)?
Day time hypercapnia >45mm Hg leading to chronic resp acidosis compensated by met alkalosis most have coexisting OSA(but here hypoventilation is only at night with transient hypoxia n hypercapnia that resolve while awake)
A post op pt presenting with syncope, hypotension and or rt heart strain( raised jvp, rt BBB on ECG) most likely has?
Massive pulmonary embolism(not just segmental but massive!)
PE Rx in a pt with severe renal insufficiency is?
Unfractionated heparin. Because decreased renal clearance increases anti- xa activity levels and bleeding risk, LMWH(enoxaparin), fondaparinux, rivaroxaban cant b used
