Pulm

Question 1

Pt with frequent bacterial PNA’s, 50 py smoking hx. Consider what diagnosis?

Answer 1

Post-obstructive PNA
d/t bronchogenic carcinoma
Next step - CT
Best test for dx - bronch

Question 2

intubated pt with acute worsening of: fever, increased secretion, worsening lung infiltrate after being intubated x 48 hours. What should you be worried about?

Answer 2

Vent associated PNA
Occurs when someone is intubated > 48 hours
Need a tracheobronchial aspirate for culture
Be concerned for MRSA and Pseudomonas

Question 3

Pulmonary nodule with popcorn calcification on CXR, what does this mean??

Answer 3

Suggests a benign etiology (pulmonary hamartoma)

Other benign findings in pulmonary nodules - concentric, central, or diffuse homogeneous calcification

Question 4

What is your goal for fluid resuscitation in sepsis?

Answer 4

30 mL/Kg in the first 3 hours

Ideally done in 500 cc boluses

Question 5

Pt w/ h/o asthma with frequent asthma exacerbations and infiltrates in different parts of the lung with exacerbations, be suspicious of?

Answer 5

Allergic bronchopulmonary asperillosis (ABPA)
IgE and IgG mediated hypersensitivity in response to aspergillus
Usually seen in pts with pre-existing asthma or CF

Question 6

Tx for allergic bronchopulmonary aspergillosis

Answer 6

Steroids (goal is to stop the inflammation of the allergic rxn)
Can consider adding itraconazole or voriconazole to decrease fungal burden

Question 7

Post-op patient with hypoxic hypercapnic respiratory failure. Why?

Answer 7

Residual effect of anesthesia

Decreases respiratory drive

Question 8

gold standard to dx TB pleural effusion?

Answer 8

Pleural bx
Suspect in when thoracentesis has elevated adenosine deaminase
Typically only seen in immunocompromised people

Question 9

What is the most important factor of predicting prognosis in COPD?

Answer 9

FEV1 <40%

Question 10

initial tx for snoring in a pt that doesn’t seem to have OSA

Answer 10

Eliminate EtOH or tobacco

Question 11

Who should get low dose CTs for lung cancer?

Answer 11

55-80
>30 per smoking hx who have smoked or quit within the last 15 years
20% reduction in mortality
96% false positive

Question 12

Kiddo with 4 weeks of cough w/o infectious symptoms

Work her up for?

Answer 12

Asthma

Question 13

What homeostasis changes are observed in pts with brain death?

Answer 13

Central DI (increases UOP --> volume depletion)
Systemic hypotension (loss of sympathetic tone)
Hypothermia

Question 14

until what age are infants allowed to have brief periods of apnea?

Answer 14

6 months

Question 15

how do you treat OSA in kids?

Answer 15

Tonsillectomy and adenoidectomy

Question 16

weight loss in the setting of cold is called?

Answer 16

pulmonary cachexia

loss of lean muscle d/t energy imbalance and systemic inflammation

Question 17

What causes hypoxemia in COPD pmts?

Answer 17

V/Q mismatch in lung regions that are obstructed