Pulmonary

Question 1

Mechanical ventilation with severe asthma exacerbation

Answer 1

Severe obstructive dz - increase exp time to prevent autopeep (which dec venous return, dec BP, causes barotrauma), disconnect vent temporarily, inc insp flow rate, dec TV/RR, permissive hypercapnia

Question 2

COPD Exacerbation with somnolescence

Answer 2

falsely elevated pulse ox from carboxyhemoglobin from smoking - check arterial blood gas for pO2, pCO2

Question 3

End stage COPD

Answer 3

Palliative care - morphine helps dyspnea,

Question 4

Idiopathic pulmonary fibrosis

Answer 4

dypnea/dry cough >6 months, clubbing, work with dust exposure, CT with honeycomb changes - peripheral/septal thickening

Question 5

Lambert-Eaton syndrome

Answer 5

Small cell lung cancer- NMJ - Lambert eaton - ab against presynaptic voltage gated P/Q Ca channels - progressive limb weakness, dyautonomia - dry mouth, constipation, ED, dry eyes - IMPROVEMENT AFTER EXCERCISE

Question 6

Thymoma

Answer 6

a/w myasthenia gravis - anterior wall mass

Question 7

Severe COPD for lung tx

Answer 7

NEED TOB cessation - contraindication (past 6 months) - with hopsitalizations despite max med tx - FEV1<20%, cor pulm, pulm HTN