Pulmonary and Critical Care

Question 1

difference between spontaneous pneumothorax v. tension pneumothorax on imaging

Answer 1

Spontaneous: Absent lung markings, visceral pleural line.

Tension: sponatneous + contralateral mediastinal shift (and trecheal deviation AWAY from affected side), ipsilateral hemidiaphragm flattening

Question 2

Size determination of needle aspiration or chest tube v. O2/observation in a pneumothorax

Answer 2

Small = <2cm
Large = larger than 2cm

Question 3

GSW on POD4 develops: Fever, tachycardia, SOB, hypotension, poor urine output.

Dx and most appropriate next step

Answer 3

Septic shock (likely dt pneumonia)

Secure airway and then restore adequate tissue perfusion with IV 0.9% SALINE (crystalloid) and then IDENTIFY UNDERLYING INFECTION

Question 4

Initial management of burn injuries.

MCC of burn wound sepsis at 0-5d and >5d.

Answer 4

1. endotracheal intubation (carboxyhemoglobin >10%)

day 0-5: gram positive (staph aureaus)
>5d: Gram negative organisms (pseudomonas or Candida)

Question 5

hyperventilation or tachypnea causes what to ABG?

Answer 5

resp alkalosis with decreased PaCO2

Question 6

POD2 pulmonary complication

Answer 6

atelectasis

Question 7

atelectasis ABG

Answer 7

hypoxemia, hypocapnia, resp alkalosis (hypervent - cannot breath deeply)

Question 8

what does positive pressure mechanical ventilation cause acutely?

Answer 8

acute increase in intra-thoracic pressure

Question 9

acute increase in intra-thoracic pressure (i.e. positive pressure mechanical ventilation) in a pt in hypovolemic shock can cause what?

Answer 9

increased intra-thoracic pressure a pt in hypovolemic shock (so has low CVP) could cause collapse of venous capacitance vessels (IVC) and cut off venous return.

this acute loss of right ventricular preload = loss of CO = sudden cardiac death.

Question 10

define vasovagal sycope

Answer 10

sudden increase in PSNS, leading to bradycardia, peripheral vasodilation, temporary decrease in CO

Question 11

diaphragmatic rupture MC on left or right? why?

mediastinal shift ips or CL to the rupture?

Answer 11

left because right is protected by the liver

mediastinal shift CL to the rupture.

Question 12

Presents <24 h after blunt thoracic trauma. Tachypnea, tachycardia, hypoxia.

PE: rales or decreased breath sounds.
CT or CXR with patchy alveolar infiltrate not restricted by anatomical borders.

Answer 12

Pulmonary contusion

Question 13

Define flail chest

Key findings

Answer 13

At least three ribs fractured in 2 or more places.

Key finding - paradoxical chest wall motion with respiration

Question 14

Management of flail chest

Answer 14

positive pressure ventilation