Pulmonary

Question 1

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?

Answer 1

a bronchoscope (pic will be side view of CXR)

Question 2

Your patient has a Gunshot chest wound. What kind of dressing does he need?

Answer 2

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.)

Question 3

Your pt is 3d post appendectomy and develops dysphagia, drooling, and expiratory stridor. What is going on (there will be lots of distracting information):

Answer 3

Epiglottitis

Question 4

Your patient is ventilated and becomes confused with arm edema. What low cost test do you order? (Pt could also have HIV)

Answer 4

Ultrasound

Question 5

Your patient with VAP is on broad spectrum coverage including Levaquin, Cefipime, & Vancomycin. Your culture comes pack growing Pseudomonas. What do you do now?

Answer 5

Narrow the spectrum (you don’t need the vanc)

Question 6

Which of the following does not cause hypoxemia?

Answer 6

Hyperventilation

Question 7

What is the initial abG finding in a pulmonary embolism?

Answer 7

Respiratory alkalosis

Question 8

Your 32M patient has a history of MVR (distractor) and c/o wheezing with exercise. What is your order?

Answer 8

PFTs

Question 9

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?

Answer 9

Ipratropium bromide (anticholinergic)

Question 10

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?

Answer 10

Methylprednisolone

Question 11

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?

Answer 11

Intubate

Question 12

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

Answer 12

He has lost his hypercapnic respiratory drive

Question 13

What is the earliest sign of PNA in the elderly patient?

Answer 13

Tachypnea

Question 14

Your patient is a 79 M Japanese immigrant. What TB induration measurement is diagnostic?

Answer 14

11 mm

Question 15

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?

Answer 15

Salmeterol (LABA)

Question 16

What is paradoxical abdominal and diaphragmatic movement?

Answer 16

Asthma ominous sign

Question 17

Which of the following is reason to intubate in an asthmatic patient?

Answer 17

Change in behavior

Question 18

What history do you ask about before you prescribe a sleep aid to your 69 yr old patient?

Answer 18

OSA

Question 19

Your patient is an RN with a positive PPD. Her CXR comes back negative/WDL. What do you do now?

Answer 19

Offer 6 mos INH

Question 20

Which national measure is more important to prevent VAP, ↑HOB or frequent oral care?

Answer 20

↑HOB 30°

Question 21

XR identification: Pneumonitis.

Answer 21

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

Question 22

XRay: Blunting of costophrenic angle:

Answer 22

Pleural effusion Tx: thoracentesis

Question 23

XRay: Kerley B lines

Answer 23

pulmonary edema

Question 24

Exudative effusion

Answer 24

higher ratio of pleural protein and LDH to serum levels

Question 25

When is the greatest risk for a mechanically ventilated pt to contract VAP?

Answer 25

48-72 hours

Question 26

VAP TX

Answer 26

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)

Question 27

Spontaneous pneumothorax common in what disorder:

Answer 27

Marphan syndrome

Question 28

Most important HPI questions in pt w/hemoptysis:

Answer 28

amount of blood, previous episodes, dyspnea

Question 29

Patho of PE:

Answer 29

Failure of right ventricle

Question 30

What is the best non-pharmacologic tx in a pt with end stage COPD

Answer 30

Bipap (NIPPV)

Question 31

Which med decreases mortality in COPD:

Answer 31

LABA-ICS combo…Advair (Salmeterol + Fluticasone) (O2 also)

Question 32

Example of a patient most likely to have emphysema

Answer 32

59 yo with increased AP diameter

Question 33

Mainstay COPD Tx:

Answer 33

Sympathomimetics (Albuterol)

Question 34

What PFTs show asthma:

Answer 34

Obstructive: decreases in FEV1, FEV25-75, PEFR, FVC

Question 35

Most important in a status asthmatic patient who was extubated

Answer 35

follow up w/ asthma specialist in 3-5 days

Question 36

A patient has TB and lives with 6 other people. Do you treat the 6 other people, or test them?

Answer 36

Test them

Question 37

A patient who has HIV or some comorbidity tests positive for TB. It wants you to select Tx:

Answer 37

answer is 4 drug regimen

Question 38

Pt presents with night sweats and dry cough with wt loss. You suspect TB. Which of the following is diagnostic

Answer 38

Culture X 3

Question 39

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?

Answer 39

Pulmonary angiography

Question 40

What confirms the dx of PNA?

Answer 40

Consolidation in the lungs (CXR)

Question 41

Which of the following is recommend for asthmatics or smokers ages 19-64?

Answer 41

PNA vaccine

Question 42

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?

Answer 42

Acute bronchitis