Pulm 4

Question 1

1. 63 yo M with severe SOB Awakens from Sleep. 5 days ago he had elective R Hip Replacement for severe osteoarthritis. BP is 78/50, HR 130 AND RR 34. ECG shows sinus tach, CXR is ordered from preparation of intubation. What is the next step in management?
2. Next step in management if he was NOT critically ill?

Answer 1

1. Emergent beside Transthoracic Echocardiogram (TTE.)
   This needs to be ordered to Confirm RV Dysfunction for indication of Thrombolytics for Massive PE.

Pt is hemodynamically unstable (hypotension) and critically ill (requires intubation)

2. CT Angio.

Question 2

38 yo W with progressive exertional SOB for the last 6 months . She has a 15 pack year smoking hx. BP 142/78, HR 90 and 02 Sar 94% on ROM. Cardiac exam has a 2/6 holosytolic murmur at the lower sternal border that increases with inspiration. She has trace b/l LE edema. FVC 82%, FEV1 80%, FEV1/FVC 97%. Diffusion Capacity is 64% . Dx?

Answer 2

Primary Pulmonary Hypertension.
( Normal Pulmonary Function Test with decreased DLCO)

Question 3

When do give each in ICU:
1. Dobutamine
2. Epipherenine
3. Phenylephrine
4. Norepinephrine

Answer 3

1. CHF who need Ionotropic support
2. Anaphylaxis
3. Septic Shock with Tachyarrhythmias
4. Septic Shock

Question 4

How does NPPV improve cardiogenic pulmonary edema?

Answer 4

It decreases preload which decreases left ventricular filling pressures which then decreases pulmonary capillary overload.

It also improves contractility of the heart with increased intrathoroacic pressure that decreases afterload.

Question 5

73 yo M with hx of Moderate COPD presents fever, malaise, night sweats, cough and yellow sputum for 4 weeks. His inhalers have not helped. Hx of Zenker Diverticulum. Leukocytes 13,000. CXR shows RLL Cavitary Lesion with an Air-fluid level. Dx? Tx?

Answer 5

Dx: Lung Abscess (Weeks or Months of fever with Foul Smelling Sputum) - likely due to Aspiration.

Rx: IV Ampicillin-Sulbactam ( No drainage required, responds well to Abx.)

Treat until CXR is clear

Question 6

54 Y woman presents with persistent nonproductive cough, mild SOB and Sharp, right sided chest pain. She has been taking moxifloxacin for 5 days but no improvement. She has hx of lumpectomy and radiation therapy due to breast cancer. Temp 101.1 BP 150/90. Crackles over the RLL with dullness to percussion. Leukocytes 13,000. Dx? Tx?

Answer 6

Dx: Acute Radiation Pneumonitis - Radiation to Throacic or Neck ( Presents with Antibiotic-NON- Responsive Pneumonia 4-12 weeks after radiation exposure).

Rx: Prednisone Taper

Question 7

Name 4 causes of Massive Hemoptysis from LUNG.

Answer 7

1. Aspergilloma
2. Necrtoizing Pneumonia
3. Bronchogenic Carcinoma
4. Bronchiectasis

Question 8

Management of Massive Hemoptysis.

Answer 8

1. Protect airway
2. ICU, 02 therapy and stabilize
3. CT Chest and Control bleeding with rigid bronchoscopy

Question 9

Pt is a 43 Y M presenting with fever, cough, SOB, weight loss, night sweats x 4 months.

CXR: Bilateral Pleural-Based Dense Infiltrates involving upper and lower lobes, they spare the Central and Perihilar lung regions.
Labs: 6% Eosinophils

DX? Rx?

Answer 9

Eosinophilic Pneumonia. Steroids x 6 months.

Question 10

Diffuse Lung disease with accumulation of Period Acid-Schiff-positive lipoproteinaceous material in distal air spaces of lung. Dx?

Answer 10

Pulmonary Alveolar Proteinosis

Question 11

Which Pulmonary Diseases Need High Resolution CT?

Answer 11

IPF

Hypersensitivity Pneumonitis