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Pulmonary ER Flashcards

1
Q

You think I have CO poisoning, what do I look like, and what do you do to check

A

Cherry red lips

Carboxyhemoglobin

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2
Q

What is the basic workup for all dypneas

A

CBC, CMP, CXR

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3
Q

I have an expiratory/ mixed stridor, what could I have??

A

Croup
FB
Bacterial tracheitis

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4
Q

I have shaggy borders on x- ray of my neck

A

bacterial tracheitis

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5
Q

I have JVD with clear lungs, what could I have?

A

Cardiac tamponade

PE

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6
Q

I have JVD WITH crackles, what could I have?

A

ARDS

ADHF

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7
Q

What diagnosis could crackles lead you too

A

ADHF, ARDS or pneumonia

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8
Q

YOu hear wheezes, what could I have?

A

Asthma
FB
ADHF
COPD

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9
Q

I have absent or diminished breath sounds what could I have

A

COPD
Asthma
Pneumothorax
Hemothorax

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10
Q

I am using accessory muscles to breathe…what is my differential

A

Respiratory failure
severe COPD
Severe Asthma
RSV- children

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11
Q

Why could I be hyperventilating

A

Acidosis
Sepsis
Salicylate poisoning
Anxiety

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12
Q

I have an inspiratory stridor why?

A

FB
Epiglotitis
Angioedema

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13
Q

Why do I have pulsus paradoxus?

A 
RHF
PE
Cardiogenic shock
Pericardial tamponade
Asthma exacerbation
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14
Q

Name some “danger signs” of asthma

A

use of accessory uscles, fragmented speech, inability to lie supine, profound diaphoresis, agitation, cyanosis, depressed mental statis

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15
Q

What do you use to assess an asthma exacerbation?

A

Peak flow

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16
Q

What are a signs of imminent respiratory arrest?

A

severe hypoxemia, hypercapnia

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17
Q

do asthma pts need a CXR?

A

No- not unless they are febrile to 101 or a focal lung exam

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18
Q

What do you give me if I am having an asthma attack

A

Inhaled beta agonist, oxygen, IV NS

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19
Q

If the initial treatment does not work what should you consider next

A

Systemic glucocorticoids

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20
Q

For someone having a life threatening attack of asthma what do you do?

A

Mag sulfate
Epi
Terbutailine
Intubate +Admit

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21
Q

What doses can you give of albuterol

A

1) 2.5 to 5 mg Q20 mins for 3 doses - neb
2) 4-8 puffs Q20 mins
3) 10-15 mg over 1 hr – severe

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22
Q

If I am having a severe asthma attack when I come in what beta agonist will you start…albuterol or ipratropium bromide…and how much

A

Ipratropium bromide
500 mcg neb Q20 mins for 3 doses
8 puffs Q20 for 3 hours

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23
Q

IF you give steroids how do you give them

A

Tapering dose - 60mg3 days, 40mg 3 days, 20mg*5 days

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24
Q

Why do you taper

A

For the lungs….not the adrenals

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25
Q

I am a 20 kg child, what is my prednisone dose for each administration

A

10mg BID to come out to a total of 20mg a day

Dose=1mg/kg

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26
Q

I need mag sulfate, how much will you give me

A

2g IV over 20 mins

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27
Q

I need epi for my asthma, what dose will you give me

A

0.3-0.5 mg IM

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28
Q

If you give me terbutaline can I get epi too

A

No- one or the other

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29
Q

How much terbutaline do you give

A

0.25 mg SC ever 20 mins for up to 3 doses

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30
Q

When do you admit me for my asthma

A

after not responding for 4-6 hours with treatment

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31
Q

What are the classic symptoms of CAP

A

Cough, Fever, pleuritic CP, dyspnea, sputum

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32
Q

I have mucupurulent sputum- what type of PNA do i have?

A

bacterial/typical

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33
Q

I have scant or watery sputum- what type of PNA do I have?

A

Atypical

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34
Q

If an elderly person comes in with mental status changes what should yo consider

A

PNA, UTI

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35
Q

What percentage of people with PNA have rigors

A

15%- but rigors pretty much mean PNA

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36
Q

COPDers get what pathogen with PNA?

A

H. Flu

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37
Q

HIV pts get what pathogen with PNA?

A

Atypical or Pneumocystitis jirovecii

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38
Q

I was on a cruise ship and now I have PNA…what pathogen?

A

legionella

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39
Q

I had the flu and now I have PNA…what pathogen?

A

Staph aureus

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40
Q

I am an alcoholic with PNA…what pathogen?

A

Klebsiella or aspiration

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41
Q

I inhale bird droppings and now i have PNA…what pathogen?

A

Histoplamosis

42
Q

I have been spending some time in the southwest now I have NA…what pathogen?

A

Coccidiodes, hantavirus

43
Q

What may my CBC show if I have PNA

A

Nothing or….> 15, 000 with left shift

44
Q

I f I have leukopenia and PNA what is my prognosis

45
Q

What is the work up for PNA

A

CBC, CMP, UA, BC, CXR, pulse ox

46
Q

What is the gold standard for PNA

A

CXR- infiltrate

47
Q

I have a bad PNA and my troponin is positive do I have an MI??

A

Prob not- just heart strain or ischemia

48
Q

I have a lobar consolidation…

A

Typical bacteria

49
Q

I have interstitial infiltrates…

A

viruses, or pneumocystis jirovecii

50
Q

Treat my CAP

A

Cephalosporin with macrolide

Quinalone

51
Q

Should you send me home with PNA if my O2 sat is 87% on RA?

A

Nope keep at 88 or below

52
Q

What is the most common predisposing factor for an abscess

A

aspiration

53
Q

What does pus or an abscess look like on CXR?

A

straight line

54
Q

I have rust colored sputum, with fever chills and CP while coughing. What will my CXR show?

A

Unilobar consolidation- strep pneumo

55
Q

I have diarrhea, fever of 102.2, a focal infiltrate on CXR, and am confused…what interesting lab values will I have

A

Legionella - Hyponatremia and elevated LFTs

56
Q

I have failed beta lactams for PNA what bug could I have?

A

Legionella or klebsiella

57
Q

So how do you treat y legionella

A

Macrolides, quinalines, tetracyclines

58
Q

I recently had a URI, now I have ear pain and pharyngitis, fever, and a low gad fever what do I have

59
Q

I have bullous myringitis, what does my CXR look like

A

patchy infiltrates

60
Q

I am an alcoholic and I passed out drunk now I have a low grade fever, diffuse crackels, and cyanosis, what does my CXR show

A

Aspiration- Will be neg initially then will be infiltrates involving dependent pulmonary segments

61
Q

Treat my aspiration PNA

A

Clinda 600mg IV Q8hrs followed by 300mg QID

62
Q

I am a tall thin smoker what am I at risk for?

A

Pneumothorax

63
Q

My trachea is deviated and I have labored breathing…help me!!

A

needle decompress- 2nd ICS midclavicular line

64
Q

Is a needle decompression good enough…

A

NO- put a chest tube in after

65
Q

I am on my period and my CXR shows a colapsed lung, what is that called?

A

Cat menial - can be from endometriosis of the thoracic cavity

66
Q

I have decreased chest excursion, diminished breathsounds and hyperresonant percussion, why

A

large pneumo

67
Q

Describe deep sulcus sign

A

marked deepening of the left costophrenic angle- seen with tension pneumothorax or with a vented patient laying down

68
Q

what is the modality of choice to see a pneumothorax

A

CXR- white visceral pleural line

69
Q

My pneumothorax is 7% of my lung do i need a chest tube?

A

No- less than 10% needs observation and repeat CXR

70
Q

what does a large Pneumothorax need

A

chest tube

71
Q

What are major risk factors for COPD

A

Famliy Hx, smoking, environmental hx, and asthma

72
Q

What are the symptoms of COPD exacerbation?

A

dyspnea, cough, wheezing

73
Q

Barrel chest

74
Q

I have a prolonged expiratory phase

75
Q

Work up for COPD exacerbation

A

CBC, CMP, CXR (Trop, EKG- if CHF is thought)

76
Q

Tx my COPD exacerbation

A

duoneb (atrovent and albuterol)

PO predinsone if no relief with duoneb

77
Q

If I have PNA with my COPD what antibiotics will you give me?

A

5 days of Avalox or z pack

78
Q

when do you admit a COPD exacerbation

A

hypoxia, underlying PNA, failure to outpaieint therapy, maxed out on therapy in ER

79
Q

What is the definition of Massive hemoptysis

A

bleeding that has the potential to be life threatening

80
Q

1 thing to think with hemoptysis

81
Q

Other causes of hemoptysis

A

CA, infection (TB, PNA), PE, airway trauma, anticoagulant problem

82
Q

Work up for hemoptysis

A

CBC, CMP, PT/INR, CXR

83
Q

If you can’t find a cause for hemoptysis what do you need to do

A

Flexible bronhoscopy

84
Q

I have a tram track appearace on CXR… treat me!

A

Bronchiectasis- Start on Avalox or levoquin while wait for sputum cultures

85
Q

What test do I need to have if I have bronchiectasis

A

Sputum culture- often polymicrobial and very helpful to Tx

86
Q

I have dyspnea, decreased lung sounds, dull percussion - what work up do i need

A

Pleural effusion –CXR, Fluid analysis

87
Q

Do you need to admit me– I have a asymptomatic new pleural effusion

88
Q

I have pleuritic CP and a friction bub may be heard, what is the most common cause and what will you treat me with

A

Pleurisity (Viral)

NSAIDs

89
Q

PAthologic hallmark of diffuse aveolar damage

90
Q

Clinical hallmarks of ARDS

A

hypoxemia, bilateral radiographic opacities

91
Q

Work up for ARDS

A

CBC, CMP, PT/INR, BCx2, UA cx, Port CXR, ABD

92
Q

Tx of ARDS in ER

A 
2 large bore IVs
Cardiac monitoring 
Intubate
Full sepsis work up
Admit
93
Q

How do you get the diagnosis of ARDS

A

respiratory failure not due to cardiac failure

94
Q

I have had a cough for 2 weeks with a preceding URI, what caused it

A

Bronchitis (viral)

95
Q

Bacterial causes bronchitis

A

mycoplasm
Chlamydophila
Bordetella

96
Q

Should you get a CXR for cronchitis

A

No- not unless fever

97
Q

Tx my bronchitis

A

Will resolve on its own

98
Q

A child will not stop coughing what should you think

A

FB aspiration

99
Q

Who gets FB aspiration

A

children, decreased level of consciousness, alcohol

100
Q

Dx of FB aspiration

A

Expiratory CXR for children (Unilateral hyperinflation), FB, pleural effusion, area of consolidation

101
Q

Tx of FB aspiration

A

Bronchoscope

ED (7 decks)

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