Pulmonary Flashcards
Your patient has swallowed a foreign object (coin) and it is lodged in the c-spine area according to XR. How to get it out?
a bronchoscope (pic will be side view of CXR)
Your patient has a Gunshot chest wound. What kind of dressing does he need?
3-sided dressing
Allows air to escape, but not enter (and thus be trapped) in the lungs, so as not to cause a tension pneumothorax. When the pt exhales, air tries to enter the hole. This is why we have the pt take a deep breath and hold hit when we pull a chest tube. Air won’t enter chest cavity when the lungs are full of air.)
Your pt is 3d post appendectomy and develops dysphagia, drooling, and expiratory stridor. What is going on (there will be lots of distracting information):
Epiglottitis
Your patient is ventilated and becomes confused with arm edema. What low cost test do you order? (Pt could also have HIV)
Ultrasound
Your patient with VAP is on broad spectrum coverage including Levaquin, Cefipime, & Vancomycin. Your culture comes pack growing Pseudomonas. What do you do now?
Narrow the spectrum (you don’t need the vanc)
Which of the following does not cause hypoxemia?
Hyperventilation
What is the initial abG finding in a pulmonary embolism?
Respiratory alkalosis
Your 32M patient has a history of MVR (distractor) and c/o wheezing with exercise. What is your order?
PFTs
The mother of 19-yr old Alice calls you with concerns about her dtr’s asthma attack. She tells you that Alice has SOB and difficulty speaking in sentences. She adds that Alice’s usual medicine, Alupent (Albuterol), is not working. Which of the following should the mother administer to treat Alice’s asthma attack?
Ipratropium bromide (anticholinergic)
A 36-yr old pt who has a hx of asthma comes to the ED in a fatigued state. She has difficulty speaking d/t respiratory distress. but able to explain she is recovering from a cold, but her s/s are so severe that she came to the ED. HR is 118, FVC WDL, FEV1 45% of expected value. You order metaproterenol (albuterol) 0.3 mL in 5% solution, but the pt does not respond. Now what?
Methylprednisolone
Your patient with asthma has decreased breath sounds on presentation. You give a nebulizer treatment. Now, the SaO2 is decreased to 86% and there are no breath sounds. What do you do?
Intubate
A 51 yr-old male is admitted to the ED w/severe dyspnea. The pts’ Hx indicates emphysema. The NP orders O2, since the pt SaO2 dropped from 96% to 90%. However, the NP also advises the attending RN to continue monitoring the pt because
He has lost his hypercapnic respiratory drive
What is the earliest sign of PNA in the elderly patient?
Tachypnea
Your patient is a 79 M Japanese immigrant. What TB induration measurement is diagnostic?
11 mm
Your asthmatic patient is on a SABA and ICS. She has no secretions but her symptoms are still not well controlled. What do you order next?
Salmeterol (LABA)
What is paradoxical abdominal and diaphragmatic movement?
Asthma ominous sign
Which of the following is reason to intubate in an asthmatic patient?
Change in behavior
What history do you ask about before you prescribe a sleep aid to your 69 yr old patient?
OSA
Your patient is an RN with a positive PPD. Her CXR comes back negative/WDL. What do you do now?
Offer 6 mos INH
Which national measure is more important to prevent VAP, ↑HOB or frequent oral care?
↑HOB 30°
XR identification: Pneumonitis.
Pt with SOB and dry cough CXR reveals generalized inflammation throughout. • numerous poorly defined small (<5 mm) opacities throughout both lungs, sometimes with sparing of the apices and bases • airspace dz: usu seen as ground-glass opacities (patchy or diffuse, resemble pulmonary edema) or rarely, as consolidation • a pattern of fine reticulation may also occur
XRay: Blunting of costophrenic angle:
Pleural effusion Tx: thoracentesis
XRay: Kerley B lines
pulmonary edema
Exudative effusion
higher ratio of pleural protein and LDH to serum levels
When is the greatest risk for a mechanically ventilated pt to contract VAP?
48-72 hours
VAP TX
Pseudomonas: (zosyn, cefepime, or imipenem/meropenem) + (fluoroquinolone or azithromycin) ± gentamycin
• 37 yp s/p endotracheal intubation 2 days ago has fever, chills and purulent sputum. CXR = lung infiltrates. Which of the following is the best regimen for the pts condition? Cefepime and Cipro (Pseudomonas for VAP)
Spontaneous pneumothorax common in what disorder:
Marphan syndrome
Most important HPI questions in pt w/hemoptysis:
amount of blood, previous episodes, dyspnea
Patho of PE:
Failure of right ventricle
What is the best non-pharmacologic tx in a pt with end stage COPD
Bipap (NIPPV)
Which med decreases mortality in COPD:
LABA-ICS combo…Advair (Salmeterol + Fluticasone) (O2 also)
Example of a patient most likely to have emphysema
59 yo with increased AP diameter
Mainstay COPD Tx:
Sympathomimetics (Albuterol)
What PFTs show asthma:
Obstructive: decreases in FEV1, FEV25-75, PEFR, FVC
Most important in a status asthmatic patient who was extubated
follow up w/ asthma specialist in 3-5 days
A patient has TB and lives with 6 other people. Do you treat the 6 other people, or test them?
Test them
A patient who has HIV or some comorbidity tests positive for TB. It wants you to select Tx:
answer is 4 drug regimen
Pt presents with night sweats and dry cough with wt loss. You suspect TB. Which of the following is diagnostic
Culture X 3
38 yo F immobilized for 4 months. Examining her before releasing you note dyspnea and tachycardia. You suspect PE, but V/Q scan does not confirm. What is the next diagnostic test?
Pulmonary angiography
What confirms the dx of PNA?
Consolidation in the lungs (CXR)
Which of the following is recommend for asthmatics or smokers ages 19-64?
PNA vaccine
Elderly women who has a hx of lung dysfunctions comes to our office. She presents with a number of respiratory symptoms. Most severe c/o HA. Which is the most likely respiratory dx based on HA?
Acute bronchitis
