UWorld GI Nephro Pulm 11/7

Question 1

53 m after motor vehicl collision. Has bilateral chest pain and left leg pain. initial ABG shows 7.45, PO2 81, and PCO2 of 32. has broken right fourth and fifth rib fractures. FOur hours after IVF, they have SOB. Lung auscultation reveals diffuse rales in both lower lung fields. CXR shows alveolar opacitis over the right and left lower lobes. ABG now shows PO2 of 75, PCWP is 12 (5-16). Most likely dx?

Answer 1

Pulmonary Contusion

Question 2

Diagnostic Criteria for Pulmonary Contusion

Answer 2

Rales or decrased breth sounds, CT scan or CXR with patchy, alveolar infiltrate not restricted by anatomical borders

Question 3

Management of Pulmonary contusion

Answer 3

Pain control, pulmonary hygein (nebulizer, chest PT), supplemental o2

Question 4

Difference between pulmonary contusion and aspiration pneumonia

Answer 4

aspiration pneumonia is UNILATERAL

Question 5

45 year old white man comes to ED for SOB, cough, hemoptysis for the past 2 days, as well as weight loss, GERD, and works at a granite and marble stone company. Creatinine is 2, BUN is 28. They have multiple bilateral lung nodules with cavitation. Theres tracheal narrowing and ulceration. Why is this NOT SILICOSIS WITH TB?!? and what is it?

Answer 5

Upper airway involvement and kidney injury is noT associated with Silicosis. Granulomatosis with Polyangitis is a much better fit.

Question 6

Prevention of recurrent nephrolithiasis via diet

Answer 6

More fluids
reduce NA
Reduce Protein
Normal Calcium Intake
Increase CITRATE (fruits and vegetables.)
Reduce oxalate

Question 7

Prevention of nephrolithiasis via drugs

Answer 7

thiazide diuretic, Potassium Citrate, bicarbonate salt, allopurinol