Pulmonary and Critical Care

Question 1

Lung and renal. Etiology is ab to alpha-3 chain of type 4 collagen (lots
expressed on glom and alveolar basement membranes). -dx?

Answer 1

goodpastures nephritic

Question 2

cut off for PET or bx of solitary pulm nodule based on size

Answer 2

> 8mm = PET or bx

Question 3

most sensitive predictor of hypovolemia

Answer 3

FeNa

Question 4

Due to recurrent infection and inflammation. has more prominent sputum production than chronic bronchitis and exacerbations are bacterial (not viral as in chronic bronchitis). No smoking association. High resolution CT diagnostic, showing bronchial wall thickening.

Dx?

Answer 4

bronchiectasis

Question 5

Vents: how do you improve oxygenation?

Answer 5

FiO2 first, then PEEP

Question 6

in a renal pt with GFR<30 who has a Pulm embolism - do what?

Answer 6

unfractionated hep bridge to warfarin

do not use and x’s (enoxaparin or Xa inhibitors)

Question 7

mediastinal tumors by location:
Anterior = ?
Posterior = ?
Middle = ?

Answer 7

Anterior = thymoma

Posterior = neurogenic or esophageal leiomyoma (sx @ >5cm)

Middle = bronchogenic cyst

Question 8

in COPD, at what O2 sat does long term O2 supplementation start having mortality benefit?

what is most mortality - beneficial prior to this?

Answer 8

when O2 sat <88%

when >88%, smoking is most beneficial.

Question 9

NASAL POLYPS + recurren sinopulm infxn + digital clubbing –> ?

Answer 9

cystic fibrosis

Question 10

Asbestos predisposes to what two types of cacner?

Answer 10

bronchogenic carcinoma (MC in smokers and is BILATERAL plerual abnormality) and pleural mesothelioma (presents UNILATERAL).

Question 11

obstr and restrictuve FEV1/FVC = <70% in ? v. >70% in ?

FVC = nml/dec in ___ ; <80% in ___

Answer 11

obstr and restrictuve FEV1/FVC = <70% in obst; >70% in

restrictive FVC = nml/dec in obstructive; <80% in restrictive

Question 12

~Pulm infection (i.e. PCP pna) may lead to hypotonic hyponatremia in a euvolemic pt due to ____. In this pt, IVF with NS may worsen hypoNa.

Answer 12

SIADH

Question 13

pt wiht asthma, chornic rhinosinusitis with nasal polyposis who has angina/HTN/stroke risk - thi
what?

Answer 13

A: Aspirin exacerbated respiratory disease

Question 14

in nonsmoker with recent URI sx and persistent cough of productive, yellow/purulent, blood-tinged sputum. CXR shows clear lung fields. PE - bl wheezes and crackled that clear with coughing.

Answer 14

ACute bronchitis (definition: >5d cough, usual cause dt viral). Tx = supportive

Question 15

~Q: describe the mechanism of chronic nonproductive cpugh in ACEi use.

Answer 15

imparied metab of kinins and substance P = kinin b/u = incr prod of PGs. also ACEinhibition incr thromboxan dt activation of acrachidonic acid pathway = bronchoconstriction.

Question 16

Cor pulmonale = ?

Answer 16

primary RHF

Question 17

In anaphylaxis/type 1 reaction - Epinephrine pharm: B2 and Alpha1 receptor agonist = how is wheezing decr and how are upper airway edema and raised BP decr

Answer 17

bronchia smooth muscle relaxation (decr wheezing) and vasoconstriction (decr upper airway edema and raised BP)

Question 18

newborn with clear rhinorrhe and bl wheezes and crackles –> think ___. major SE of this

Answer 18

bronchiolitis. SE include

APNEA AND RESPIRATORY FAILURE

Question 19

difference in inhalers for COPD v. asthma.

Answer 19

A: asthma is corticosteroids, COPD is long-acting

anticholinergic.

Question 20

nasal poly ddx:

Answer 20

CF v. ASA induced resp dz

Question 21

immunocomp with ground glass on CXR = aspergillosis v. CMV. diff how?

Answer 21

aspergillosis = bloody sputum

CMV = nonproductive

Question 22

COPD indicaiton for home oxygen:

Answer 22

SaO2 88% or less OR PaO2 55mm Hg or less.