Pulmonary Emergencies

Question 1

Sound that indicates airway obstruction is incomplete

Answer 1

stridor

Question 2

Where can the infection of a retropharyngeal abscess spread to?

Answer 2

mediastinum causing pleural or pericardial effusion

Question 3

extends from the base of the skull to the tracheal bifurcation

Answer 3

retropharyngeal space

Question 4

Xray finding that is consistent with retropharyngeal abscess

Answer 4

expansion of the prevertebral soft tissues

Question 5

What is the imaging modality of choice for a suspected retropharyngeal abscess (ie gold standard)?

Answer 5

CT scan of neck

Question 6

What is the managemnet of a patient with a retropharyngeal abscess?

Answer 6

IV abx (clinda or unasyn) started in ER and IV hydration. ENT consult for I&D.

Question 7

Subdermal or submucosal swelling that is diffuse and nonpitting affecting the face, lips, mouth, throat, larynx, extremities, genitalia and possibly the bowel (colicky abdominal pain) . Can occur in isolation, with urticaria or as a component of anaphylaxis

Answer 7

angioedema

Question 8

What is the treatment of allergic (mast cell mediated) angioedema after assessing the airway?

Answer 8

epi 0.3 mg IM, methylprednisolone IV or oral prednisone, and diphenhydramine 25-50 mg IV

Question 9

what is the difference in the between angioedema that is mast cell or bradykinin mediated?

Answer 9

mast cell responds to epi, glucocorticoids, antihistamines whereas bradykinin mediated is due to ACEI or hereditary angioedema

Question 10

What is the treatment of ACEI (bradykinin) induced angioedema after assessing the airway?

Answer 10

discontinue ACEI and reassess in 24-72 hrs if sx haven’t resolved

Question 11

What is the treatment of hereditary (bradykinin mediated) angioedema after assessing the airway?

Answer 11

C1 inhibitor concentrate, Bradykinin receptor antagonist or kailikrein inhibitor

Question 12

Acute, potentially lethal, multisystem syndrome from the sudden release of mast cells and basophils into the circulation

Answer 12

anaphylaxis

Question 13

What symptoms are commonly observed in patients experiencing anaphylaxis?

Answer 13

pruritic urticaria, angioedema, flushing and hypotension

Question 14

What is the treatment of anaphylaxis that reverse the process?

Answer 14

epi every 5-15 minutes for up to 3 doses.

Question 15

What are other pharmacological treatment options in addition to epi that may help treat anaphylaxis?

Answer 15

albuterol nebulizer, H1 (ranitidine)/H2 blocker (benadryl), glucocorticoid (solumedrol)

Question 16

Noise during assessment of head and neck trauma that indicates pooling of liquids in the oral cavity or hypopharynx

Answer 16

gurgling

Question 17

What causes wheezing?

Answer 17

Narrowing of lower airways

Question 18

Why do patients in a stupor or coma have an inability to protect their airway?

Answer 18

lack of gag reflex

Question 19

lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain.

Answer 19

stupor

Question 20

Accumulation of air in the pleural space. Can be spontaneous or trauma induced. Sudden onset of dyspnea and pleuritic chest pain that occurs at rest

Answer 20

pneumothorax

Question 21

Describe the patient who is at greatest risk of a pneumothorax

Answer 21

tall, thin males between 20-40 yrs (Marfans)

Question 22

Associated with mediastinal shift to the contralateral side and impaired ventilation leading to cardiac compromise

Answer 22

tension pneumo

Question 23

Patient who has h/o of heavy smoking presents with sudden stabbing pain in right pectoral and right lateral axillary regions and SOB. PE reveals hyperresonance to percussion. What is the appropriate management?

Answer 23

needle aspiration/decompresion followed by chest tube placement (unstable) or primary treatment with chest tube (stable)

Question 24

What locations can be used to accomplish decompression of a pneumothorax?

Answer 24

2nd or 3rd ICS at the midclavicular line or at the 5th ICS at the anterior axillary line

Question 25

From sudden increase in left sided intracardiac filling pressures or increased alveolar capillary membrane permeability

Answer 25

acute pulmonary edema

Question 26

Major cause of noncardiogenic pulmonary edema

Answer 26

ARDS

Question 27

Initial management of acute pulmonary edema both cardiogenic or noncardiogenic

Answer 27

O2, lasix 40-80mg IV if stable, then tx cause

Question 28

requires immediate protection of the airway from further injury by intubation. Once intubated can then lavage and suction the lower airway

Answer 28

massive aspiration

Question 29

Reduction in airway diameter caused by smooth muscle contraction, vascular congestion, bronchial wall edema, and thick secretions.

Answer 29

asthma

Question 30

Quantification of severe hypoxemia

Answer 30

SpO2 ≤ 95% despite high flow O2 by nonrebreather

Question 31

Helps give an objective measurement as to the severity of airflow obstruction. Less than 40% of predicted is severe. Should be measured before and after each nebulizer or MDI tx

Answer 31

peak flow

Question 32

Bronchodilators used for medical therapy of asthma. Given every 20 minutes via neb or puffs

Answer 32

beta 2 agonist (albuterol) or antichoinergic (atrovent)

Question 33

For life threatening asthma exacerbations that remain severe after 1 h of intense bronchodilator therapy. 2 g IV over 20 min

Answer 33

magnesium sulfate

Question 34

For severe asthma unresponsive to standard therapies. 0.25mg SQ q 20 min X 3 doses. Administration contraindicated with epi

Answer 34

terbutaline

Question 35

Most often precipitated by a viral or bacterial infection. Increase or change in character of usual symptoms of dyspnea, cough or sputum production.

Answer 35

COPD exacerbation

Question 36

What is the initial management of an acute COPD exacerbation?

Answer 36

O2, solumedrol, levaquin (includes pseudo coverage), bronchodilators

Question 37

EKG findings consistent with a PE

Answer 37

S waves in lead 1, Q waves in lead III, and inverted T waves in lead III (S1Q3T3)

Question 38

Pharmacological treatment of hypotension in patient with a PE

Answer 38

Fluid bolus of 500 to 1000 ml NS and Vasopressors

Question 39

use in unstable patients for treatment of acute PE in case you need to stop anticoagulation and trial thrombolytics

Answer 39

Unfractionated Heparin (UFH)

Question 40

Risk factors for PE described by Virchow’s triad

Answer 40

hypercoaguable state, venous stasis, endothelial injury

Question 41

Patient presents with pleuritic chest pain, cough, hemoptysis, diaphoresis. PE reveals tachycardia, tachypnea, crackles, and accentuation of the 2nd heart sound. What is the imaging of choice to work-up this patient?

Answer 41

CT scan

Question 42

Give an example of abx options for treating non-ICU pneumonia. Include a respiratory fluoroquinalone and antipneumococcal beta-lactam + a macrolide

Answer 42

levoflaxacin or ceftriaxone plus azthromycin

Question 43

What is the abx option for a patient with pneumonia in the ICU who is allergic to PCN?

Answer 43

Respiratory fluoroquinolone PLUS aztreonam

Question 44

How does the differentiation between inspiratory and expiratory stridor help distinguish level of airway obstruction?

Answer 44

inspiratory- level of larynx

expiratory- level of trachea