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Board Exam > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Indications for intubation

A

Inability to maintain patent airway
Inability to protect the airway against aspiration
Failure to ventilate
Failure to oxygenate
Anticipation of a deteriorating course that will eventually lead to respiratory failure

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2
Q

“fail safe” on ETT in case the end opening of the tube is blocked

A

Murphy eye

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3
Q

induction drugs

A

etomidate
ketmine
fentanyl
Versed
propofol
thiopental
methohexital (Brevital)

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4
Q

neuromuscular blocking agents (paralytics)

A

succinylcholine
rocuronium
vecuronium

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5
Q

how to give rapid sequence intubation meds

A

induction agent first
neuromuscular blocking agent second

rapid IV push

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6
Q

Adjuctive meds for intubation

A

atropine - vagolytic (intubation will often cause bradycardia)

lidocaine - vagolytic (decreases intracranial pressure in head injury; decrease airway reactivity in asthma)

fentanyl - decreases intracranial pressure in head injury; prevents vasospasm in vascular emergencies (e.g. MI, aortic dissection, SAH)

ondansetron - if the patient is vomiting

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7
Q

How to confirm placement of ETT

A

Colorimetric end-tidal CO2 detector
5 point auscultation (epigastric, bilaterally under the clavicles, bilaterally midaxillary lines)
Mist in tube
Bilateral chest rise
CXR

In normal adults it should be 20-23cm from the teeth

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8
Q

inspiratory capacity

A

The maximum volume of air that can be inspired after reaching the end of a normal, quiet expiration

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9
Q

expiratory reserve volume

A

The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration

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10
Q

residual volume

A

the amount of air that remains in a person’s lungs after fully exhaling

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11
Q

vital capacity

A

the maximal volume of air that can be expired following maximum inspiration

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12
Q

Four lung volumes

A

inspiratory reserve volume (IRV)
expiratory reserve volume (ERV)
tidal volume (V)
residual volume (RV)

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13
Q

Four lung capacities

A

total lung capacity (TLC)
vital capacity (VC)
inspiratory capacity (IC)
functional residual capacity (FRC)

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14
Q

inspiratory reserve volume

A

the amount of air a person can inhale forcefully after normal tidal volume inspiration

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15
Q

tidal volume

A

the amount of air that moves in or out of the lungs with each respiratory cycle

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16
Q

functional residual capacity

A

the volume remaining in the lungs after a normal, passive exhalation

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17
Q

total lung capacity

A

the volume of air in the lungs upon the maximum effort of inspiration

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18
Q

minute volume

A

the volume of gas inhaled (inhaled minute volume) or exhaled (exhaled minute volume) from a person’s lungs per minute

should be between 4-5 LPM
- MV <4 = acidotic
- MV >5 = alkaloid

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19
Q

volume control modes

A

Assist/Control (A/C)
Synchronized Intermittent Mandatory Ventilation (SIMV)

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20
Q

pressure control modes

A

Presssure Controlled Ventilation (PCV)
Pressure-Regulated Volume Control (PRVC)

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21
Q

Assist/Control (A/C)

A

Most frequently used initial mode
Requires the least effort by the patient
Machine does the work, but the patient can trigger the machine

Tidal volume (vT) and respiratory rate are pre-set (f) regardless of whether the patient breathes spontaneously.
If the patient does breathe spontaneously, the ventilator senses this, and delivers a full breath.

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22
Q

A/C can lead to

A

hyperventilation because the patient can breathe over the tidal volume (vT)

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23
Q

Synchronized Intermittent Mandatory Ventilation (SIMV)

A

Allows the patient to take a smaller breath if they want, beyond the pre-set rate (f).

Constantly recalculates expected minute volume every 7.5 seconds. If the calculation suggests the minute volume target will not be met, SIMV breaths are delivered at the pre-set tidal volume (vT) to achieve the desired minute ventilation.

Inspiratory pressure support is also used in this mode to help the patient take a deeper breath.

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24
Q

Pressure Controlled Ventilation (PCV)

A

The ventilator delivers the breath over a pre-set inspiratory time until a pre-set peak inspiratory pressure (PIP) is reached, regardless of tidal volume (vT)

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25
Q

Pressure-Regulated Volume Control (PRVC)

A

Combines pressure-limited, volume-targeted, time-cycled breaths.

The peak inspiratory pressure (PIP) delivered by the ventilator varies on a breath-to-breath basis to achieve a target pre-set tidal volume (vT)

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26
Q

PEEP

A

Positive end-expiratory pressure

prevents against alveolar collapse
applies a pressure to maintain the reserve volume

used to treat obstructive sleep apnea (CPAP)

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27
Q

risks associated with mechanical ventilation

A

barotrauma - pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoperitoneum

VAP, including ARDS
rapid-type of disuse

atrophy involving the diaphgragmatic fibers

impair mucociliary motility in the airways

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28
Q

pressure control mode in Assist/Control (A/C) ventilation

A

the breath is delivered until a desired pressure is met, regardless of volume

lower airway pressure is needed

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29
Q

volume control mode in Assist/Control (A/C) ventilation

A

the breath is delivered until a desired volume is met, regardless of pressure

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30
Q

flow trigger

A

the ventilator is set to detect a minimum amount of inspiratory flow, usually 1-6 LPM

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31
Q

pressure trigger

A

the ventilator is set to detect a minimum amount of inspiratory pressure, usually 1-4 cmH2O

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32
Q

compliance

A

ratio between the change in volume and the change in pressure

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33
Q

If compliance is decreased, a ___ pressure would be required to reach a certain volume (e.g. vT)

A

higher

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34
Q

Which mode of A/C do you choose if volume is more important?

A

volume control

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35
Q

Which mode of A/C do you choose if pressure is more important?

A

pressure control

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36
Q

What mode of A/C do you choose for restrictive or obstructive lung diseases like pneumonia, COPD, asthma, pulmonary edema (“can’t breathe”)?

A

pressure control

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37
Q

What mode of A/C do you choose when compliance was never the issue to begin with (“won’t breathe”), like in neurological disorders, ingestion of respiratory depressants?

A

volume control

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38
Q

Control mode

A

The machine does all the work
Tidal volume (vT) and respiratory rate (f) are preset

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39
Q

Continuous positive airway pressure (CPAP)

A

breathing spontaneously but at a pressure greater than atmospheric

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40
Q

Pressure Support (PS) mode

A

inspiratory effort is totally unassisted but a preset amount of airway pressure is delivered with each breath

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41
Q

bilevel positive airway pressure (BiPAP)

A

CPAP + PEEP

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42
Q

FEV1

A

volume of gas expelled in the first second of the forced vital capacity maneuver

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43
Q

FEV25-75

A

maximal mid-expiratory airflow rate

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44
Q

PEFR

A

maximal airflow rate achieved in forced vital capacity (FVC) maneuver

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45
Q

Obstructive diseases are characterized by ___; lung volumes ___.

A

Obstructive diseases are characterized by reduced airflow rates (FVC, FEV1, FEV25-75, PEFR); lung volumes within normal range or larger

Examples: asthma, bronchitis, emphysema, COPD

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46
Q

Restrictive diseases are characterized by ___

A

Restrictive diseases are characterized by reduced volumes and expiratory flow rates (TLC, FRC, RV)

Examples: morbid obesity, sarcoidosis, pulmonary fibrosis

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47
Q

How do you adjust the ventilator if your patient is in respiratory acidosis?

A

increase rate

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48
Q

How do you adjust the ventilator if your patient is in respiratory alkalosis?

A

decrease rate

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49
Q

asthma exacerbation: management

A

supplemental O2
albuterol nebulizers
systemic corticoids
IV magnesium - improves airflow

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50
Q

asthma exacerbation: S/Sx

A

respiratory distress at rest
difficulty speaking in sentences
diaphoresis
use of accessory muscles
hyperresonance
cough
chest tightness

RR >28
HR >110
pulsus paradoxus > 12mmHg

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51
Q

asthma: ominous signs

A

fatigue
absent breath sounds
paradoxical chest/abdominal movement
inability to maintain recumbency
cyanosis

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52
Q

asthma: labs, imaging

A

leukocytosis w/eosinophilia
PFTs: abnormal
respiratory alkalosis with mild hypoxemia

CXR: hyperinflation; not necessary unless ruling out other conditions

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53
Q

When do you hospitalize a person with asthma?

A

FEV1 does not improve after inhaled bronchodilator
Peak flow <60 L/min initially or does not improve after treatment

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54
Q

Step-wise approach to managing asthma in adults

A

STEP 1
- SABA (e.g. albuterol, levalbuterol) PRN
- consider low-dose ICS (e.g. budesonide, fluticasone, triamcinolone)

STEP 2
- low-dose ICS (e.g. budesonide, fluticasone, triamcinolone)

STEP 3
- low-dose ICS (e.g. budesonide, fluticasone, triamcinolone)
- LABA (e.g. salmeterol, formoterol)

STEP 4
- medium-dose ICS
- LABA

STEP 5
- high dose ICS
- LABA
- PO corticosteroids

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55
Q

combination ICS + LABA inhalers

A

Advair (fluticasone + salmeterol)
Symbicort (budesonide + formoterol)

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56
Q

inpatient management of asthma

A

Supplemental O2
SABA
Anticholinergic (ipratropium)
Systemic glucocorticoids (IV methylpred, PO pred) given within 1 hour of admission to the ED
Magnesium
Mechanical ventilation

Anaphylaxis: epinephrine 0.3-0.5 mg SC

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57
Q

status asthmaticus

A

severe, acute asthma presenting in an unremitting, poorly responsive, life-threatening manner

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58
Q

status asthmaticus management

A

O2
IV D5 1/2 NS
inhaled and parenteral sympathomimetics (e.g. ephedrin, isoprotenerol, orciprenalin, salbutamol, terbutaline)
methylprednisolone or hydrocortisone IV
consider atrovent
continuous pulse ox
ABG q10-20 min
intubate early

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59
Q

chronic bronchitis S/Sx
- dyspnea
- onset
- sputum
- body habitus
- AP ratio
- percussion
- CXR
- HCT

A

intermittent mild to moderate dyspnea
onset of symptoms after age 35
copious sputum production (purulent)
body habitus: stocky, obese
AP ratio: normal
percussion: normal
CXR: hyperinflation
HCT: increased

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60
Q

emphysema S/Sx
- dyspnea
- onset
- sputum
- body habitus
- AP ratio
- percussion
- HCT
- total lung capacity

A

progressive, constant dyspnea
onset of symptoms after age 50
mild sputum (clear)
body habitus: thin, wasted
AP ratio: increased (barrel-chested)
percussion: hyperresonant
HCT: normal
Total lung capacity: increased

61
Q

outpatient management of chronic bronchitis and emphysema

A

lifestyle changes (smoking, allergens)
postural drainage
inhaled ipratropium bromide or sympathomimetics – mainstay of therapy
inhaled tiotropium bromide (Spiriva) promotes bronchodilation

62
Q

Who is at increased risk for TB?

A

crowded living conditions
institutionalized
HIV
DM
chronic renal insufficiency
malignancy
malnutrition
immunosuppression

63
Q

TB: S/Sx

A

most people are asymptomatic

fatigue
anorexia
dry cough progressing to productive and sometimes blood tinged
weight loss
low grade fever
night sweats

64
Q

TB: labs/Dx/imaging

A

Definitive diagnosis by culture of M. tuberculosis x3
-Acid-fast bacillus (AFB) smears are presumptive evidence of active TB

CXR: honeycomb infiltrates in upper lobes

+PPD indicates exposure, not diagnostic for active disease

65
Q

What to do if someone is +PPD with a negative CXR?

A

isoniazid (INH) for 6 months

66
Q

TB: management (no Hx of HIV)

A

RIPE:
- Rifampin 600mg
- Isoniazid 300mg
- Pyrazinamide 1.5-2.0g
- Ethambutol 15 mg/kg/day

If fully susceptible to isoniazid, ethambutol may be dropped

Rifampin, isoniazid, pyrazinamide x2 months, then rifampin and isoniazid x4 months

67
Q

TB: management if HIV+

A

RIPE:
- Rifampin 600mg
- Isoniazid 300mg
- Pyrazinamide 1.5-2.0g
- Ethambutol 15 mg/kg/day

9 months

68
Q

ethambutol monitoring

A

visual acuity
red-green color perception

69
Q

Criteria for +PPD

A

HIV+, immunosuppression d/t chemotherapy TNF-alpha inhibitors or glucocorticoids, contacts of a known case, persons with chest film typical for TB, or post-transplant: 5mm

Immigrants from high prevalence areas, high risk groups including healthcare workers: 10mm

All others not in high prevalence groups: 15mm

70
Q

most common organism that causes CAP

A

strep pneumoniae

71
Q

Patient Outcomes Research Team (PORT) score: class I-II:
-Score
-Risk
-Treatment

A

Score: algorithm or <70
Risk: low
Treatment: outpatient

72
Q

Patient Outcomes Research Team (PORT) score: class III:
-Score
-Risk
-Treatment

A

Score: 71-90
Risk: low
Treatment: brief inpatient

73
Q

Patient Outcomes Research Team (PORT) score: class IV:
-Score
-Risk
-Treatment

A

Score: 91-130
Risk: moderate
Treatment: inpatient

74
Q

Patient Outcomes Research Team (PORT) score: class V:
-Score
-Risk
-Treatment

A

Score: >130
Risk: high
Treatment: ICU

75
Q

Outpatient CAP: low severity
- criteria
- pathogens
- empiric therapy

A

Criteria
- healthy
- no use of ABx in the past 3 months
- no comorbidities or risk factors for MRSA or p. aeruginosa

Pathogens:
- S. pneumoniae
- H. influenzae

Empiric therapy: Choose one
- amoxicillin 1g TID
- doxycycline 100mg BID
- macrolide (-mycin)

76
Q

Outpatient CAP: moderate- to high-severity
- criteria
- pathogens
- empiric therapy

A

Criteria
- comorbidities or risk factors for resistant organisms

Pathogens:
- S. pneumoniae
- H. influenzae

Empiric therapy: choose one
- [augmentin or cephalosporin] + [macrolide or doxycycline]
- respiratory fluoroquinolone (moxifloxacin, levofloxacin)

77
Q

outpatient viral CAP: empiric therapy

A

oseltamivir or zanamivir if onset of symptoms <48 hrs

78
Q

inpatient CAP: nonsevere
- pathogens
- empiric therapy

A

Pathogens:
- s. pneumoniae
- h. influenzae
- legionella

Empiric therapy: choose one
- beta lactam + (azithromycin or clarithromycin)
- respiratory fluoroquinolone (levofloxacin, moxifloxacin)

79
Q

inpatient CAP: severe
- pathogens
- empiric therapy

A

Pathogens
- s. pneumoniae
- s. aureus
- legionella
- gram-negative bacilli
- h. influenzae

empiric therapy
- beta lactam + [IV fluoroquinolone or IV azithromycin]

80
Q

empiric therapy if p. aeruginosa suspected

A

Choose one:
- pip/tazo
- meropenem
- cefepime

AND
- gentamicin or azithromycin

81
Q

empiric therapy if MRSA suspected

A

Choose one:
- pip/tazo
- meropenem
- cefepime

AND
- vanc or linezolid

82
Q

most common causative organisms for HAP

A

S. aureus
Strep. pneumoniae
H. influenzae

83
Q

empiric therapy for HAP if not at high risk for mortality and no risk factors for MRSA

A

Choose one
- pip/tazo
- cefepime
- levofloxacin
- imipenem or meropenem

84
Q

empiric therapy for HAP if not at high risk for mortality WITH risk factors for MRSA

A

Choose one
- pip/tazo
- cefepime or ceftazidime
- levofloxacin or ciprofloxacin
- imipenem or meropenem
- aztreonam

AND
- vancomycin or linezolid

85
Q

empiric therapy for HAP with high risk for mortality or IV antibiotics within the past 90 days

A

Choose two (avoid two beta-lactams)
- pip/tazo
- cefepime and ceftazidime
- levofloxacin or ciprofloxacin
- imipenem or meropenem
- amikacin or gentamicin or tobramycin
- aztreonam

AND
- vancomycin or linezolid

86
Q

HAP

A

PNA that occurs >48 hrs after admission

87
Q

VAP

A

PNA that occurs >48-72 hrs after intubation

88
Q

most common causative organism for VAP

A

pseudomonas

89
Q

empiric therapy for VAP: with MRSA activity

A

vancomycin or linezolid

90
Q

empiric therapy for VAP: beta-lactams with antipseudomonal activity

A

pip/tazo
cefepime or ceftazidime
imipenem or meropenem
aztreonam

91
Q

empiric therapy for VAP: non-beta-lactams with antipseudomonal activity

A

levofloxacin or ciprofloxacin
amikacin or gentamicin or tobramycin
colistin or polymyxin B

92
Q

pneumothorax: S/Sx

A

chest pain, dyspnea, cough
hyperresonance on affected side
diminished breath sounds and diminished fremitus on affected side
mediastinal shift toward the unaffected side (tension)
hypotension
CXR: air pockets

93
Q

pneumothorax: management

A

Asymptomatic, no intervention
chest tube 4th or 5th ICS mid axillary line
- if tension PTX, needle thoracotomy before chest tube (2nd ICS MCL)

94
Q

sarcoidosis

A

disease of unknown etiology characterized by interstitial lung disease and non-caseating granulomas

95
Q

sarcoidosis: S/Sx

A

progressive dyspnea
nonproductive cough
rales (“velcro crackles”) may be noted

lymphadenopathy
swollen painful joints
rash
kidney stones

96
Q

sarcoidosis: labs/Dx

A

BMP
ABG
Elevated ACE level

CXR: mediastinal lymphadenopathy
PFTs

bronchoscopy with transbronchial biopsy of the lung parenchyma to confirm diagnosis

97
Q

sarcoidosis: management

A

1st line: corticosteroids

98
Q

When clinical data and V/Q scan are contradictory, what is recommended to evaluate for PE?

A

pulmonary angiography

99
Q

PE: labs/Dx

A

VQ scan (cheaper than spriral CT, but often come back indeterminate)
Spiral CT if available
pulmonary angiography

ABG: hypoxemia (SaO2 <90%, PaO2 <80 mmHg)
hypocapnia (PaCO2 <35 mmHg) d/t reflexive hyperventilation
D-Dimer

100
Q

PE: management

A

supplemental O2
IV fluids for hypotension and reduced CO2
intubate if worsening hypercapnia w/obtundation

Heparin 80 u/kg bolus followed by drip: 18 u/kg/hr, PTT goal 1.5-2 x normal
Coumadin (simultaneously) to INR goal of 2-3
Fibrinolytic therapy if hemodynamically compromised or shock
- PT and PTT must be <2 x normal

101
Q

ARDS: labs, imaging

A

refractory hypoxemia - hallmark feature
CXR: white out or diffuse bilateral infiltrates

102
Q

ARDS: management

A

Mechanical ventilation with PEEP ~10cm H2O, TV 4-6 ml/kg IBW
Treat underlying infection
Sedation to allow rest, awaken for neuro exam

103
Q

pleural effusions: chylous

A

Characteristic milky white appearance
high triglycerides

104
Q

types of pleural effusions

A

transudate
exudate - protein (LDH), cream colored
empyema - pus
hemorrhagic

105
Q

How do lung capacities change in older adults?

A

total lung capacity stays the same
vital capacity decreases because residual volume increases

106
Q

Why is it important to hospitalize older adults with PNA?

A

Alveoli collapse more easily
Number of cilia diminish
Number of mucus-producing cells increases
Decreased cough reflex
Decreased response to hypoxia and hypercapnia

107
Q

Normal pulmonary physiologic changes in older adults

A

Lungs become stiffer
Respiratory muscle strength and endurance diminish
Chest wall becomes more rigid
Increased AP diameter
Hyperresonance to percussion
Alveolar surface area decreases up to 20%, which reduces maximal oxygen uptake

108
Q

Clinical findings in older adults with PNA

A

Classic expected signs may be absent
Earliest sign: tachypnea
Weakness; decreased ADLs
Anorexia, poor appetite
Tachycardia
Fever with productive cough
Confusion or mental status change
SOB (late sign)

109
Q

CXR findings in older adults with PNA

A

May have multiple presentations based on pathogen
- bacterial: bronchopneumonia, lobar pneumonia, or other locations
- viral: bilateral interstitial infiltrates
- aspiration: localized to the right middle lobe or show diffuse involvement

110
Q

treatment for acute bronchospasm

A

Bronchodilators + IV steroids to augment the bronchodilators
racemic epinephrine nebulizer

111
Q

Exam findings for TB

A

abnormal breath sounds, esp over upper lobes or involved areas

rales or bronchial breath sounds = consolidation

112
Q

Ominous finding in PE

A

hypotension – can indicate massive PE, blocking blood flow from R to L heart

113
Q

Wells Criteria

A

stratifies patients for pulmonary embolism (PE) and provides an estimated pre-test probability

Clinical symptoms, including leg swelling
other Dx less likely than PE
HR >100
Immobilization or surgery within previous 4 weeks
Hx of DVT/PE
Hemoptysis
Malignancy

114
Q

Berlin Definition of ARDS criteria

A

All of the following criteria must be met: ARCHI
-Acute onset (within 7 days)
-Risk factors for ARDS identified
-Cardiac causes ruled out
-Hypoxemia
-Infiltrates: bilateral radiographic infiltrates that are not fully explained by effusion, atelectasis, or masses

115
Q

severe asthma exacerbation: PFTs

A

Peak expiratory flow rate <40% of personal best or <200 L/min

Decreased FEV1:FVC ratio
Increased total lung capacity

116
Q

severe asthma exacerbation: CXR

A

hyperinflation

117
Q

transudative effusion criteria

A

Pleural fluid glucose = serum glucose
pH 7.40-7.55
WBC <1000

118
Q

Transudative effusions

A

Related to imbalance of hydrostatic and oncotic pressures within the chest, or conditions outside of the pleural space
Fluid may move from the peritoneal, cerebrospinal, or retroperitoneal space

119
Q

Exudative effusions

A

Related to pleural or lung inflammation or impaired lymphatic drainage

120
Q

Exudative effusions: etiologies

A

infection
malignancy
immunologic responses
lymphatic abnormalities
noninfectious inflammation
iatrogenic causes
fluid omvement from below the diaphragm
pulmonary embolism

121
Q

Light’s criteria

A

Criteria for exudative effusion
1. pleural fluid lactate dehydrogenase (LDH) above 2/3 of the standard upper limit for serum
2. ratio of pleural fluid LDH to serum LDH >0.6
3. ratio of pleural fluid protein to serum protein >0.5

122
Q

PE is associated with which type of pleural effusion

A

transudative and exudative

123
Q

Risk factors for asthma-related death

A

Comorbidities
Difficulty perceiving obstruction of the airway or the severity of an exacerbation
Use of illicit drugs
Low SES or residence in an inner-city
Major psychosocial problems or psychiatric disorders
Previous exacerbation requiring intubation or ICU
2+ hospitalizations or 3+ visits to the ED within the past year
2+ refills of a SABA per month

124
Q

Most common cause of pneumonia in older adults (pathogen)

A

streptococcus pneumonia

125
Q

When treating ARDS, what can improve alveolar recruitment and oxygenation?

A

increasing PEEP

126
Q

How does the body compensate for reduction of oxygen delivery in chronic hypoxic lung disease (e.g. COPD)?

A

increased red blood cell mass

127
Q

common complication following extubation

A

pulmonary edema

128
Q

pulmonary edema: S/Sx

A

tachypnea
dyspnea
wheezing
bilateral crackles

129
Q

Readiness for a weaning trial: criteria

A

FiO2 less than or equal to 50%
PEEP less than or equal to 8
RR <30
Minute ventilation less than or equal to 10L/min

130
Q

chylothorax: cause

A

Result of damage to the thoracic duct, allowing chyle to build up in the pleural space
-usually iso trauma, thoracic surgery

131
Q

pleural effusions: chylous

A

Characteristic milky white appearance

Elevated triglycerides
Elevated WBC
Elevated protein

132
Q

Very high concentrations of O2 delivered through a ventilator can cause…

A

damage to pneumocystis and may lead to pulmonary fibrosis

133
Q

Increased PEEP may lead to…

A

pneumothorax

134
Q

Gold standard for identifying a PE

A

CT with contrast

135
Q

Most common and serious complication of barotrauma encountered with mechanical ventilation

A

alveolar-pleural fistula
-causes persistent air leak

136
Q

Anticipated findings of a patient with status asthmaticus

A

Elevated pCO2 – often first sign
Dehydration d/t significant insensible fluid losses from respiratory tract 2/2 tachypnea
Tachycardia
Spontaneous pneumothorax may occur

137
Q

pulmonary hypertension: Dx

A

right heart cath is required to confirm diagnosis

138
Q

acute respiratory failure is associated with

A

malnutrition

139
Q

empyema

A

Accumulation of purulent material within the pleural space in the lung

140
Q

empyema: causes

A

malignancy
recent thoracic surgery or trauma
pneumonia

141
Q

empyema: imaging

A

CT: well-defined fluid accumulation in the pleural space often leading to the displacement of lung parenchyma, vasculature and mediastinal organs

142
Q

empyema: management

A

culture data via blood and thoracentesis
chest tube
systemic ABx: pip/tazo, vancomycin

143
Q

Most common pathogen associated with atypical CAP

A

Legionella

144
Q

Legionella PNA: treatment

A

macrolides (azithromycin)

145
Q

Imaging to further characterize pneumonia beyond CXR

A

CT chest without contrast
-allows for accurate visualization of the infiltrate and determination of the lobes involved
-contrast is not indicated to evaluate PNA

146
Q

Imaging used to detect pleural effusion

A

ultrasound

147
Q

optimal placement for ET tube in adults

A

2-3 cm above the carina

148
Q

rib fractures: management

A

Pain control to ensure adequate ventilation
Mobilization and respiratory support to prevent hypoventilation and atelectasis

Board Exam (18 decks)

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