Pulm 5

Question 1

Bronchiolitis, topically affects children < 2 yo, during winter months, often with other family members with URI, and the baby will have URI symptoms + respiratory distress (nasal flares, retractions)

What bug causes it?

DX?

TRX?

Answer 1

RSV

DX = Clinical

TRX = Supportive, may need to hospitalize and do respiratory isolation.

Question 2

Infants < 2 months of age with Bronchiolitis is at increased risk of what?

Answer 2

Apneic events

Question 3

Infants with RSV Bronchiolitis is at increased risk of what two diseases?

Answer 3

1. Recurrent otitis media

2. Future dev of Asthma.

Question 4

What pulmonary complication would you be concerned about with chronic long term Amiodarone use?

How do you manage?

Answer 4

Pulmonary toxicity –> most commonly chronic interstitial pneumonitis (non-productive cough, fever, pleuritic cp, dyspnea, CXR –> diffus interstitial opacity)

DC immediately, can be sever and life threatening.

Question 5

What is the ABX of choice for Aspiration PNA?

Answer 5

Clindamycin (covers gram + cocci, gram - rod and anaerobes)

Question 6

How does the time frame of Aspiration PNA and Aspiration Pneumonitis differ?

How do you manage each?

Answer 6

Aspiration PNA –> 1-5 days after aspiration event. TRX = Clindamycin

Aspiration Pneumonitis –> 2-5 hours after aspiration event. TRX = Supportive.

Question 7

What are the 5 indications for Dialysis?

Answer 7

AEIOU

Acidosis (Ph <7.25) 
Electrolyte ABN (especially hyperK) 
Ingestion of toxin
Overload (fluid)
Uremia (uremic encephalopathy or uremic pericarditis)

Question 8

After adjusting for age, what remains the single most important PROGNOSTIC FACTOR in COPD?

Answer 8

FEV1

Question 9

What post op days do you typically see Post-op atelectasis?

how does it present?

CXR shows?

Mangament?

Answer 9

Post op day 2-5

Presents as hypoxemia and respiratory difficulty

CXR = linear opacification at lung base

Management:
Secretion - Aggressive pulmonary hygiene (chest physiotherapy + suctioning)
No Secretions - positive airway pressure

Question 10

Sudden onset hyperglycemia in a patient receiving total parenteral nutrition…what should you think on ddx?

Answer 10

Sepsis.

Question 11

Turners Syndrome is characterized by short stature and hypogonadism.

What test must you order at the time of dx?

Answer 11

Echocardiogram to rule out cardiac defects.

Also order:

1. TSH
2. Renal US
3. Visual/hearing test

(because association with hypothyroidism, horseshoe kidney and visual/hearing impairment)

Question 12

What cardiac defects are associated with Turners?

Answer 12

Coarctation of Aorta
Bicuspid Aorta
MVP
Hypo-plastic heart

Question 13

OSA in elderly can present with an atypical symptom of…

Answer 13

Mild cognitive impairment (poor concentration, irritability, poor memory ext)

Should get polysomnography if elderly person with MCI and physical exam findings that suggest OSA (htn, neck >17 inch, snoring, tiredness, age > 50, male)

Question 14

What is Bronchiectasis and what is the pathophysiology?

What illness is commonly comorbid?

What are the common symptoms?

DX?

TRX?

Answer 14

PERMANENT DILATION of small and medium bronchi due to loss of elastic component, due to RECURRENT BACTERIAL INFECTIONS.

Commonly seen in CF.

Symptoms:

• Chronic cough with foul smelling copious sputum.
• Dyspnea
• Occasional hemoptysis

DX: High resolution CT

TRX:

1. Pulmonary hygiene and chest physiotherapy is key
2. Albuterol
3. Abx for exacerbations (change in sputum, fever, CP ext)

Question 15

What is the most reliable method of verifying correct placement of ET tube?

Answer 15

CAPNOGRAPHY (O2 measurement)