Pulmonary

Question 1

MVA pt comes in with trouble breathing, tachycardia, and trachea deviated to the right?

Answer 1

left pneumothorax

shove a needle in the 2nd intercostal on the left side. Dont bother with at CXR. Don’t intubate yet b/c PEEP will make the pneumothorax worse!

Insert a chest tube only if the needle doesn’t work.

Question 2

SIRS criteria?

Answer 2

Temp >101.3 or 90
RR >20
WBC >12000 or

Question 3

Where are bronchogenic cysts found?

Answer 3

The middle mediastinum

Question 4

FEV1 and RV for Obstructive disease?

Answer 4

FEV1 will be 120% predicted

I.E. more air is in and it is trapped

Question 5

FVC, RV and FEV1 or Restrictive disease?

Answer 5

FVC 75% predicted
RV = normal until the disease gets severe, then it starts to drop.

I.E. - the lung space is smaller and able to push the little air that it has out easier

Question 6

A kid with asthma who is on daily fluticasone has to use his albuterol inhaler 1x per day. What is the next treatment?

Answer 6

Switch the albuterol to a long term B agonist (salmeterol.()

Question 7

How does ipratropium work in asthma?

Theophylline?

Answer 7

Ipa = AcH R blocker - prevents bronchoconstriction

Theophylline = a methylxanthine that blocks PGE - causing less cAMP breakdown. Bronchodilates. Has a narrow T.I. so its use is limited

Question 8

Mild Intermittent Asthma?

Answer 8

symptoms

Question 9

How many symptoms before pt needs to use salmeterol?

Answer 9

Daily symptoms + >1 night per week symptoms

tx = albuterol, fluticasone, and salmeterol

Question 10

What are the only 2 interventions proven to improve survival in patients with COPD?

Answer 10

Supplemental O2 >90% for >15h per day

Smoking Cessation

Question 11

What kind of lung diseases do myasthenia and sarcoid cause?

Answer 11

Restrictive!

Question 12

What kind of lung disease does amiodarone cause?

Answer 12

Interstitial Lung Disease

Question 13

Lab markers in sarcoidosis?

Answer 13

Hi ACE levels, Hypercalcemia, hypercalcuria

Hi alk phos

Question 14

What will lung pathology look like in Hypersensitivity Pneumonitis?

Answer 14

Alveolar thickening and granulomas

CXR = upper lobe fibrosis

Question 15

Characteristic lung finding in silicosis?

What annual screening do they need?

Answer 15

Eggshell calcifications - will cause a restrictive disease

Need to screen for TB annually

Question 16

What 3 things could an increased Aa gradient suggest?

Answer 16

Shunt
VQ mismatch
Diffusion impairment

Question 17

Algorythm for “Is low PO2 correctable with O2?

Answer 17

Yes = VQ mismatch has occured
No = Shunt has occured

Question 18

ARDS criteria

Answer 18

Acute onset

PaO2/FiO2 ratio

Question 19

What should PO2 and PCO2 be to indicate it is ok to stop mechanical ventialtion?

Answer 19

PO2 should be > 70 (on 40% FiO2)

PCO2 should be

Question 20

What will the heart exam of a pt with a pulmonary embolism sound like?

Answer 20

A loud P2, prominent jugular A waves

Question 21

25 yo black female w/ painful bumps on her shins, weight loss, cough. Exam shows 1cm right axillary lymph node. What is the next best step for dx?

Answer 21

Take a bx of the axillary lymph node. She likely has sarcoidosis, and this is less invasive than a lung bx

Question 22

What is the only lung cancer to not be associated with smoking?

Answer 22

Bronchoalveolar carcinoma

Question 23

What extra symptoms to look for with:
Small Cell Lung Cancer
Squamous Cell Lung Cancer
Large Cell lung cancer
AdenoCA

Answer 23

Small = hi ACTH, SIADH, Lambert Eatooon, peripheral neuropathy
SqCC = hi PTHrP
Large = Gynecomastia
Adeno = thrombophlebitis, nonbacterial verrucous endocarditis

All can cause anemia, acanthosis nigricans, dermatomyositis!

Question 24

What are the causes of transudative and exudative pleural effusions?

Answer 24

Transudative - increased PCWP or decreased oncotic pressure (CHF, cirrhosis, nephrotic)

Exudative - increased pleural vascular permeability (infection, malignancy, pancreatitis, RA/SLE, trauma)