Resp

Question 1

Chronic COPD ABG

Answer 1

Respiratory
pH 7.30
pCO2 >40 (hypercapnea)
pO2 24 as this is chronic

Question 2

Cold agglutinins

Answer 2

IgM Abs that agglutinate RBCs at 4C (39.2 F)

Seen with Mycoplasma pneumoniae (extracellular bacteria)

Question 3

Tx. Atypical CAP d/t Mycoplasma pneumoniae

Answer 3

Erythromycin

Question 4

Rocuronium and Sevoflurane can cause what adverse effect?

Answer 4

Malignant Hyperthermia

Question 5

S&S of Theophylline toxicity

Answer 5

HypOtension, lethargy, confusion, A. Fib, seizures

Formerly used to reverse bronchospasm in asthma/COPD by inhibiting phosphodiesterase and releasing epinephrine from adrenal medulla

Question 6

S&S of Massive Pulmonary Embolism (PE)

Answer 6

• HypOtension
• Acute RV failure –> neck vein distension (as blood backs up because RV can’t push it to lungs) –> ↑ CVP
• ↑ Pulm. A. Pressure (d/t hypoxic vasoconstriction)
• Normal PCWP, SVR
• ↓ Cardiac Index (SV * HR / BSA)
• Right Bundle Branch Block

Question 7

Mycobacterium tuberculosis category

Answer 7

Obligate aerobe

Question 8

Pink puffers

Answer 8

Emphysema: purse lips, no cough, decreased breath sounds

Question 9

Blue bloaters

Answer 9

Chronic bronchitis: cyanosis, cough, right-sided heart failure (Elevated end-diastolic right ventricular pressure: Systemic congestion - enlarged liver, ascites, jugular venous distention, dependent pitting edema; fatigue, liguria, nocturia, cyanosis, pleural effusion, anorexia and bleeding, unexplained weight gain)

Question 10

Tx. for nosocomial pneumonia d/t pseudomonas

Answer 10

Piperacillin + Amikacin

Question 11

Succinylcholine (depolarizing NM blocking drug)

MOA

Adverse SE

Answer 11

ACh receptor agonist causing sustained depolarization thus preventing mm. contraction

hypercalcemia, hyperkalmia, malignant hyperthermia

Question 12

Pancuronium (non-depol NM blocking drug)

MOA

Reverse blockade with?

Answer 12

competitive antagonist of ACh

Reversal of blockade: Neostigmine, Edrophonium, Cholinesterase Inhibitors

Question 13

DVT/PE Tx?

Answer 13

Heparin + Warfarin simultaneously for 5 days, until INR 2.0-3.0 then Warfarin only

Question 14

Legionnaire’s Disease keywords

Answer 14

Fever >103
Elderly males
Watery diarrhea
Mental status changes

Question 15

Findings seen in Bronchiectasis?

Answer 15

CXR reveals:

Increased bronchovascular markings
Tram lines
Prominent bronchioles
Atalectasis
Honeycombing
Decreased FEV1/FVC

Question 16

If a pt. has complicated pneumonia with no resolution even after ABX, get what diagnostic procedure done?

Answer 16

Bronchoscopy.

• can identify lung masses and collection of cultures

Question 17

Aspergilloma

Dx?

Tx.?

Answer 17

“Fungal ball”
Cavitary lesion

Dx: Bronchoalveolar lavage

Tx: Voriconazole

Question 18

Empiric ABX for Community Acquired Pneumonia?

Answer 18

Doxycycline for those younger than 60 y.o.

For 60+ y.o.: 3rd gen cephalosporins, Augmentin, Macrolides, and fluoroquinolones

Question 19

TRALI

pathophys

Answer 19

fever, tachycardia, tachypnea, ↑ Peak airway pressure

• complement-mediated ↑ in pulmonary vascular permeability d/t transfusion