Pulm UW

Question 1

for every uncompensated 10mmhg increase in PaCO2, pH decreases…

Answer 1

.08 dec pH for every 10mmhg uncompensated inc PaCO2

Question 2

how long for kidneys to compensate for respiratory acidosis

Answer 2

48 hours

Question 3

rapid worsening of respiratory symptoms in COPDEer think…

Answer 3

spontaneous pneumothorax from ruptured bleb

Question 4

bronchiectasis
signs and symptoms
pathophys

Answer 4

cough, mucopurulent sputum, rhinosinusitis, dyspnea, hemmoptysis, crackles, wheezing

infectious insult with impaired bacterial clearance (immunodeficiency, structural airway defect)

Question 5

TF

24yo w bronchiectasis could be from CF

Answer 5

T

7% of CF presents after age 18…

Question 6

how does lung exam for bronchiectasis hint at CF as the cause

Answer 6

Upper lobe involvement (crackles, infiltrate) suggests CF rather than another cause

Question 7

TF

pt with bronchiectasis may have impaired neutrophil migration

Answer 7

F

more like too many neutrophils with excessive elastase production causing airway structural damage

Question 8

shoulder pain with horner syndrome with smoking history think

Answer 8

Pancoast tumor

Superior Pulmonary Sulcus Tumor

Question 9

5 presenting symptoms of Pancoast Tumor

Answer 9

shoulder pain

horner syndrome

C8-T2 neuro atrophy/pain of forearm and hand

supraclavicular lymphadenopathy

weight loss

Question 10

Pancoast tumor aka

Answer 10

Superior Pulmonary Sulcus Tumor
SPS tumor
usually SCC or Adenocarcinoma

Question 11

how does pancoast tumor produce shoulder pain

Answer 11

brachial plexus invasion

Question 12

how does pancoast tumor produce horner syndrome

Answer 12

paravertebral sympathetic chain and inferior cervical ganglion invasion

Question 13

edrophonium testing is used to diagnose

Answer 13

myasthenia gravis muscle weakness/fatigue

Question 14

PaCO2, Bicarb, and Chloride levels in OSA with OHS (obstructive sleep apnea with obesity hypoventilation syndrome)

Answer 14

PaO2 up because excess weight on chest hypoventilating

Bicarb up to neutralize respiratory acidosis

Cl- down because intercalated cells of distal nephron exchange for bicarb resorption

Question 15

Do patients with OSA and OHS (obstructive sleep apnea and obesity hypoventilation syndrome) have high or low PaCO2?

Answer 15

high

hypoventilating

Question 16

TF

pts with OSA and OHS have low PaCO2 because they are hyperventilating from low oxygen

Answer 16

F

high PaCO2 from hypOventilation because so much weight on chest

Question 17

patient with fever, respiratory distress, hypoxemia and bilateral lung opacities on FiO2 70% and 5cmH2O PEEP… with PaO2 55%…

increase FiO2 or PEEP?

Answer 17

pt has ARDS with low oxygenation
2 ways to increase oxygenation with vent – FiO2 and PEEP

increase PEEP preferred here when FiO2 is already high and peep under barotrauma limit so far – will improve oxygen transport and open up atelectasis, and avoid pulmonary oxygen toxicity (free radical inflammation) from excessive FiO2

FiO2 - generally want to wean to v60% asap to limit pulmonary oxygen toxicity, so adjust PEEP if possible if FiO2 already running high (^60%)

Question 18

describe pleural effusion from PE

• size
• etiology
• transudate/exudate?
• painful?

Answer 18

small
due to hemorrhage or inflammation
exudative or bloody
pleuritic pian

Question 19

asthma med ladder

Answer 19

1 SABA
2 low dose ICS
3 low ICS and LABA or med ICS
4 med ICS and LABA

5 high ICS and LABA maybe Omalizumab for allergies

6 high ICS and LABA and Oral Corticosteroid maybe Omalizumab for allergies

Question 20

asthma severity and treatment

Answer 20

intermittent v2days/wk 2nights/mo
-SABA

mild persist ^2days/wk 3-4nights/mo
-low ICS

mod persist daily weekly
-med ICS or low ICS and LABA

sev persist thru daily multiple nights/wk
-med ICS and LABA or high ICS LABA maybe Oral Steroid maybe Omalizumab

Question 21

acid base disturbance in renal failure

ABG

Answer 21

metablic acidosis
due to inadequate excretion of metabolic acids

low pCO2 low Bicarb