pulm 1 final test

Question 1

upper airway obstruction-
definition-
sentinel signs-
causes -

Answer 1

blockage of the airway above the thoracic inlet
sentinal signs- stridor, suprasternal retractions, and change in voice
causes- tongue, trauma, foreign body, burns, infection-

Question 2

upper airway obstruction H/P C/O

Answer 2

complains of difficulty breathing and unable to swallow, pain, stiffness, drooling.

Question 3

upper airway obstruction H/P exam

Answer 3

anxious, altered mental status, panic, cyanotic, dyspneic, gasping for air, wheeze, stridor, unresponsive

Question 4

upper airway obstruction eval and management
diagnostics-
management

Answer 4

diagnostics- direct visualization, chest x-ray, PFT
management- Treat life threatening symptoms first
dc foreign body
trache if airway is compromised.

Question 5

aspiration - causes and complications

Answer 5

causes- chemical exposure, eosinophillic esophagitis,

complications- lung injury, pneumonia, ARDS, parapneumonic efffusion, empyema, lung abcess, bronchopleural fistula.

Question 6

OSA- definition and causes

Answer 6

symptoms of nocturnal breathing disturbance or =======daytime sleepiness, ========fatigue despite adequate rest.
5 or more episodes of obstructive apnea or hypopnea per hour of sleep during a sleep study.

Question 7

OSA risk factors

Answer 7

obeisity, male, family history, genetics, adenotonsillar hypertrophy, menopause, endocrine disorders.

Question 8

OSA complications

Answer 8

poor QOL
HTN
Increased risk of CAD, CHF, dysrymias, stroke and DM,

Question 9

OSA Diagnostics

Answer 9

sleep study- polysomnogram
breathing
02sat
body position and cardiac rythm 
MRI,CT,Fiberoptic endoscopy, ABG

Question 10

Class I

Answer 10

uvula, fauces, soft palate, pillars are visable

Question 11

class II

Answer 11

cant see pillars

Question 12

class III

Answer 12

base of uvula visable, soft palate visable

Question 13

Class VI

Answer 13

only hard palate visable

Question 14

Apnea definition -

Answer 14

cessation of air flow for >10 seconds

Question 15

hypopnea

Answer 15

> 30% reduction in airflow for at least 10 seconds with a >3% desat or arousal

Question 16

resp effort related arousal:

Answer 16

partial obstructed breath, increasing effort, punctuated by an arousal.

Question 17

flow limit breath

Answer 17

partially obstructed breath. flattened or scooped out inspiratory flow.

Question 18

AHI

Answer 18

number of apnic or hypopnic breaths per hour of sleep.

Question 19

Resp disturbance index-

Answer 19

apneas + hypopnes+ respiratory effort related arousal per hour of sleep

Question 20

mild OSA-

Answer 20

AHI 5-14 events per hour

Question 21

moderate OSA

Answer 21

AHI 15-29 events per hour

Question 22

severe OSA

Answer 22

AHI >30 per hour

Question 23

OSA TX

Answer 23

reduce risk factors, manage comorbidities, reduce weight, regulate sleep, treat nasal allergies, increase physical activity, no booze within 3 hours of sleep, minamize sedatives, CPAP, UVPPP

Question 24

pleural effusion, definition

Answer 24

excess fluid in the plural space, small amount is normal, and is removed by the lymphatic system.

Question 25

pleural effusion causes

Answer 25

HF, Hepatic hydrothorax, parapneumonic effusion, malignancy, mesothelemia, pulmonary emboli, TB, other infection, Hemothorax.

Question 26

Transudative pleural effusion

Answer 26

CHF, Cirrhosis, nephrotic syndrome, peritoneal Dialysis, superior vena cava obstruction, myxedema,

Question 27

Exudative pleural effusion

Answer 27

Malignancy, infection, PE, GI disease, collagen vascular disease, post cabg, sarcoid, asbestos exposure, drug induced, hemothorax.

Question 28

pleural effusion diagnostics

Answer 28

CXR- fluid appears white
CT scan
US
thoracentisis

Question 29

pleural fluid assessment- it is exudative if one critera is met

Answer 29

protein/serum protein >0.5
LDH/serum greater than > 0.6
LDH/Serum more than 2/3 of upper limit of normal for serum

Question 30

pleural effusion management - LV heart failure

Answer 30

needs diagnostic thoracentisis - treat the heart failure

Question 31

pleural effusion- hepatic hydrothorax

Answer 31

secondary to cirrhosis and ascites, peritoneal fluid moves through microscopic openings in the diaphragm

Question 32

pleural effusion- parapneumoic efffusion,

Answer 32

theraputic thoracentesis, 2 attempts to drain fluid then needs chest tube or thorascopy

Question 33

pleural effusion - malignancy

Answer 33

treat cancer, pleurodesis

Question 34

Pleural effusion- PE

Answer 34

treat PE, and pleural effusion should subside

Question 35

pleural effusion- - infection

Answer 35

tx underlying cause may need theraputic thoracentesis

Question 36

pleural effusion- chylothorax

Answer 36

thoracentesis, fluid is milky white, chest tube pluse octreotide

Question 37

pleural efffusion- hemothorax

Answer 37

chest thorascostomy

Question 38

empyema - definition
associated with
caused by bacteria entering the pleural space

Answer 38

collection of pus in plural cavity (loculated), usually gram positive.

associated with pneumonia or thoracic surgery/trauma
-chest pain, pleurisy, cough, diaphoretic, night sweats, fever, chills, malaise, dyspnea

Question 39

empyema dx and management

Answer 39

chest x-ray, ct scan, labs , pleural fluid culture - management is DC pus, and abx

Question 40

ARDS - characterized by and caused by direct or indirect injury

Answer 40

Rapid onset
hypoxemia
diffuse pulmonary infiltrates,
respiratory failure

Question 41

exeudative ards

Answer 41

day 0-7 alvoli are damaged, fluid accumulats, interstitial edema ensues, diminished aeration and atelectasis leading ot poor lung compliance.

Question 42

proliferative ards

Answer 42

day 7-21, most recover but have dyspnea, tachypnea, and hypoxemia.

Question 43

fibrotic ards

Answer 43

day 21-30 edematous alvoli become fibrotic if lung does not recover.

Question 44

VAP 3 factors

clinical manifestations

Answer 44

can be MDR or non MDR -
colonization, aspiration, compromised immune system
fever, leukocytosis, increase in secretions, pulmonary consolodiation on physical exam.

Question 45

VAP management - no risk factors for MDR vs risk factors

Answer 45

no risk 1 abx, risk factors = 3 abx.

Question 46

TB
caused by -
primary-
secondary

Answer 46

caused by mycobacterium complex
primary TB - clinical illness directly after infection
secondary TB- bacteria is there for years with no infection, reactivated and is likley cavitation, more infectious than primary.

Question 47

TB management goals,

Answer 47

prevent morbidity and death

prevent transmission

Question 48

TB drug regimin

Answer 48

at least 2 months of 
INH 5mg/kg
Rifampin 10mg/kg
ppyrazinamide 25mg/kg
ethambutol 15mg/kg