Respiratory

Question 1

What volume should surgical intervention be considered with a Chest tube

Answer 1

When drainage exceeds 1 L

Question 2

What would be visualized with Mallampati Airway classification III

Answer 2

-Hard palate
-soft palate–base of uvula

Question 3

Latent TB treatment

Answer 3

Single drug therapy
Isoniazid + vitamin B6 x6 months

Question 4

Typical Antibiotic treatment for CAP

Answer 4

Oral Amoxicillin
Azithromycin- a macrolide
-Ceftiraxone
Common pathogen is streptococcus pneumoniae

Question 5

Complication of barotrauma encountered with Mechanical ventilation

Answer 5

Aveolar- Pleural- Fistula (APF)

Question 6

Gold standard imaging for diagnosing Interstitial Lung Disease (ILD)

Answer 6

High resolution CT
s/s:
-worsening dry cough and fatigue
-Rales in base of lungs
-gradual increase in SOB
-Hx of smoking and lung CA

Question 7

Characteristics of chylous effusion

Answer 7

• milky, white appearance
  -fluid has a high triglyceride count greater than 110 mh/dl
  -elevated WBC
  -higher protein and lower LDH

Chylothorax usually occurs when the thoracic duct is damaged

Question 8

Anticipated finding in Status asthmaticus

Answer 8

-Dehydration
-Tachycardia
- Elevated pCO2
-Spontaneous pneumothorax may occur

Question 9

Antibiotics used for Hospital Acquired Pneumonia (HAP)

Answer 9

-vancomycin- to cover MRSA
-Piperacillin-Tazobactam (Zosyn)
- Meropenem
-Cefepime

Question 10

Diagnostic imagining to Pulmonary hypertension

Answer 10

-Right heart catheterization
s/s
-Right axis deviation with right ventricular hypertrophy
- TTE with show severe tricuspid regurgitation

Question 11

What reverses bronchospasm (difficulty bagging due to stridor after intubation)

Answer 11

Nebulized racemic epinephrine

Question 12

s/s of Pulmonary edema

Answer 12

• Dyspnea
• Tachypnea
  -Wheezing and bilateral crackles
  -Pink frothy sputum

Question 13

Antibiotic treatment for Legionella spp (atypical CAP)

Answer 13

Azithromycin (Zithromax -macrolide

Question 14

Characteristics of Cor Pulmonale

Answer 14

-synonymous with right heart failure
-enlargement of the RV secondary to pulmonary disease

Right heart failure results from pulmonary disease and primary PA hypertension

Question 15

Emperic therapy for VAP

Answer 15

Vancomycin or Linezolid - to cover MRSA
Piperacillin-Tazonactam
Levofloxacin (Levaquin)
Meropenem

Question 16

PFT result that indicates airflow obstruction

Answer 16

A decrease in the FEV1 to FVC ratio

Question 17

PFT result that indicate Restrictive Lung disease

Answer 17

A reduction in both FEV1 with a normal FEV1/ FVC ratio

Question 18

Clinical finding seen in chronic bronchitis but not emphysema

Answer 18

Polycythemia

Question 19

Gold standard for diagnosing OSA-hypopnea syndrome

Answer 19

Overnight polysomnography with direct technician observation

Question 20

EKG findings seen on severe pulmonary hypertension

Answer 20

Tall R in V1 and deep S in V6 indicates RV hypertrophy
Right Axis deviation

Question 21

Initial management of Frail chest

Answer 21

Intubation with positive pressure ventilation

Question 22

Contraindications for a Bullectomy

Answer 22

A patient who continues to smoke
Patient with pulmonary hypertension
Patients who do not have well-defined Bullae on the chest x-ray and CT

Question 23

PCWP <18 vs PCWP> 18

Answer 23

PCWP less than 18 indicates ARDS
PCWP greater than 18 indicates pulmonary edema

Question 24

Supportive care for patients with pulmonary hypertension due to right heart failure

Answer 24

Intravenous prostanoids and platelet aggregation inhibitors ( clopdidogrel)

Question 25

PFT results to confirm COPD

Answer 25

Post-bronchodilator FEV1/FVC less than 0.7

Question 26

Lung sounds auscultated in Pulmonary embolism

Answer 26

Bilateral clear breath sounds RV S3

Question 27

Length of treatment for Tuberculoses

Answer 27

Latent TB -6 months Patients with HIV and/ or immune compromised- 9 months

Question 28

Mainstay treatment for Empyema

Answer 28

-culture data (both peripherally and locally) via blood - Thoracentesis with prolonged drainage via chest tube - systemic antibiotics (vanco and zosyn)

Question 29

What does elevated peak pressures with normal plateau pressure indicate?

Answer 29

Resistance somewhere in the circuit ex. mucous plug, ET obstruction or kinking Intervention: in-line suctioning

Question 30

Tension pneumothorax s/s on the ventilator

Answer 30

High peak inspiratory pressures accompanied by hemodynamic instability Intervention: Decompressing the pleural space

Question 31

What are the chronic medical therapy shown to improve the survival rate of pt with COPD

Answer 31

Smoking cessation with correction of hypoxemia with supplemental oxygen

Question 32

Indication for tube thoracotomy

Answer 32

-Loculated pleural fluid -pH below 7.2 -pleural glucose less than 60mg/dL -Gm+ or culture of pleural fluid or the presence of pus

Question 33

S/S of aortic rupture

Answer 33

-Widened Mediastinum -Rib fracture - Tracheal deviation

Question 34

Stridor and upper airway edema post extubation treatment

Answer 34

Aerosolized racemic epinephrine OR Parenteral steroids Helix