Respiratory-Surgery Flashcards
SOB, 12hr post op, diminished breath sound on LLL, homogeneous opacification on CX-ray
Atelectasis
Post op dyslexia, opacity on CX-ray, fever, cough productive, crackles
Pneumonia (usually 3-5 days after surgery)
newborn, cyanotic, dyspneic, tachypneic, absent lung sound on Left, abd concave (scaphoid abd). Dx? NSIM?
Congenital diaphragmatic hernia (CDH), Intubation & mechanical ventilation
Nasal whistling around 6 months after sustaining a nasal fracture, Dx? Prevention?
- Nasal septal perforation
- Nasal septal hematoma drainiage
Massive hemoptysis and pulmonary nodules on x-ray. NSIM?
- Bronchoscopy (actively bleeding)
- CT scan of the chest (if pt has stopped bleeding)
Tx for active TB
- Isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months ( kill bacteria, minimize the risk of resistance)
- followed by, isoniazid and rifampin for 4 months (to reduce the risk of relapse).
The most common deep neck infection in adolescents and young adults? tx?
- Peritonsillar abscess (PTA)
- I & D, with IV abx (ampicillin-sulbactam)
Decreased breath sounds, increased airway pressure, respiratory alkalosis and deep sulcus sign on chest x-ray in a mechanically ventilated pt indicates? NSIM?
- Pneumothorax
- Insertion of chest tube
Fever, painful swallowing, drooling, asymmetrical neck position, inspiratory stridor, and a bulge in the posterior pharyngeal wall in a child suggests? NSIM?
- retropharyngeal abscess
- Endotracheal intubation
pt with flair chest who have respiratory distress refractory to noninvasive assistance (face mask, analgesic) are indicated for
intubation with positive pressure ventilation
a child with acute onset cough, SOB, unilateral wheezing and hyperlucency of the lung fields indicates? NSIM?
Foreign body aspiration (FBA)
Bronchoscopy
If pts are allergic to amoxicillin you can’t give penicillin for strep/tonsillitis but you can give
Macrolides like erythromycin
Retropharyngeal abscess is a polymicrobial disease caused by which bacterias (4 listed) & TX?
Streptococci Staphlyococci Haemophilus influenzae Oral anaerobes TX: Ampicillin-sulbactam
Ventilated pt with Pa02 54 & pC02 31, respitaroty alkalosis , NSIM?
- Increased PEEP - to improve oxygenation
- decrease TV to normalize PaC02
What is the purpose of increasing PEEP?
- Helps expand collapsed alveoli and decreases fluid within alveoli (in pt with pulmonary edema) to increase oxygenation
increased oxygen transfer to pulmonary capillaries does
- alleviate diffuse hypoxic pulmonary vasoconstriction
- help correct V-Q mismatch
Imaging for high possibility of PE (Wells’ score >4)
spiral CT angiogram (visible intraluminal filling defect of the pulmonary arteries & wedge-shaped infraction)
Imaging for pt who cannot tolerate IV contrast or allergic, with possible PE
V/Q scans
- takes long time and requires a nuclear medicine tech
Testing for low possibility of PE (Wells’ score <2)
D-dimer level
D-dimer can be elevated by other reasons (false positive result) like (5 listed)
recent surgery malignancy renal diseaese pregnance sepsis
NSIM for suspected traumatic diaphragmatic rupture after MVA
CT of the chest, abd and pelvis (X-ray is not sufficient)
MVA, crepitation on palpation of the R thorax, decreased breath sounds on R, crunching sound synchronous with the heartbeat best heard over the percordium, DX?
Bronchial rupture (air leakage into the mediastinum)
Crunching sounds synchronous with the heartbeat is called
Hamman’s sign
Spitting/foaming, drooling of new born unsuccesful NG tube insertion, cyanotic attacks immediately after birth, coughing spells. Chest and Abd x-ray with air bubble(gas) in the stomach Dx?
Esophageal atresia with tracheoesophageal fistual to the distal esophageal segment
Spitting/foaming, drooling of new born unsuccesful NG tube insertion, cyanotic attacks immediately after birth, coughing spells. Chest and Abd x-ray with NO air bubble(gas) in the stomach Dx?
Esophageal atresia with tracheoesophageal fistual to the proximal esophageal segment
79F, chronic fatigue, non-productive cough, wt loss, nodular pleural lesions, work as a seamstress in a textile factor for 50years with exudate pleural effusion. Dx?
Mesothelioma
asbestos exposure
79F, chronic fatigue, non-productive cough, wt loss, nodular parenchymal lung lesions, work as a seamstress in a textile factor for 50years with exudate pleural effusion. Dx?
Bronchial adenocarcinoma
Critaria for exudate effusion
Light’s criteria
Effusion protein: serum protein ration >0.5
Effusion LDH:Serum LDH ration >0.6
MVA, dyspnea and hypoxia worsens after giving fluids indicates
pulmonary vasulature damage= pulmonary contusion
Managment of severe epistazis and associated hematemesis
hematoemesis suggests posterior bleeding
-Endoscopic ligation of the sphenopalatine artery
Ulcerating tonsillar mass and cervical lymphdenopathy in a heavy smoker. Dx? NSIM?
- Oropharyngeal cancer
- Panendoscopy- evaluation of entire upper airway & digestive tract
CP, dyspnea, decreased breath sounds, dullness to percution over the left lung base following a rib tracture, increased opacity and tracheal deviation on cxray. Dx? NSIM?
- Hemothorax
- Chest tub in the 5th intercostal space at the midaxillary line
CP, dyspnea, decreased breath sounds, hyperresonant to percution over the left lung base following a rib tracture, and On chest x-ray-decreased lung marking, increased radiolucency, hemidiaphragmatic elevation and contralateral tracheal deviation. Dx? NSIM?
- Tension pneumothorax
- Needle thoracostomy in the second intercostal space at the midclavicular line
Pt with gunshot wound to the neck with stable VS and normal physcial exam. NSIM?
CT angiography
Pt with penetrating neck injury with signs of decompensation, an expaning hematoma or tracheal/esophageal injury. NSIM?
Surgical exploration
Pt with stab wound to chest, dyspnea and tachypena with decreased breath sound and hyperresonance to percussion with bubbling of blood, NO JVD, and hemodynamicly stable with midline trachea. DX? NSIM?
- open pneumothorax
- Partially occulusive dressing (pt stable rules out tension pneumothorax)
