Uworld Respiratory

Question 0

Next steps depending on the risk of a solitary pulmonary nodule?

Answer 0

Low risk: serial CT scans

Intermediate risk:
1. If 1 cm – PET scan

High risk: surgical excision

Question 1

Assessment of malignancy risk for solitary pulmonary nodule? (Diameter, age, smoking, smoking cessation, nodule characteristics)

Answer 1

Low risk: less than 1.5 cm, less than 45 years, never, quit in seven years ago, smooth

Intermediate risk: 1.5 to 2.2 cm, 45 to 60 years, less than 20 per day, quit less than seven years ago, scalloped

High risk: > 2.3 cm, >60 years, >20 per day, never, Corona Radiate/spiculated

Question 2

Peak airway pressure?

Answer 2

Resistive pressure (flow x resistance) + Plateau pressure

Question 3

Plateau pressure?

Answer 3

Elastic pressure + PEEP

Question 4

Elastic pressure?

Answer 4

Tidal volume / compliance

Question 5

Causes of Increased peak pressure with normal plateau pressure?

Answer 5

Bronchospasm, mucous plug, biting ET tube

Question 6

Causes of increased peak pressure and increased plateau pressure

Answer 6

Pneumothorax, pulmonary edema, pneumonia, atelectasis

Question 7

Shunt versus dead space?

Answer 7

Perfusion without ventilation (atelectasus) versus Ventilation without perfusion (PE)

Question 8

In ventilation, goal FiO2 level?

Answer 8

50 to 60%

Question 9

Bacterial causes of empyema?

Answer 9

Strep pneumonia, staph aureus, Klebsiella

Question 10

Patient with PE. Best way to anticoagulate?

Answer 10

Start heparin and warfarin. Stop heparin in 5 to 6 days.

Question 11

Recurrent bacterial infections in an adult patient indicates? Work up?

Answer 11

Humoral immunity defect. Quantitative measurement of serum immunoglobulin levels

Question 12

Wedge shaped pleural-based opacification on x-ray signifies?

Answer 12

PE

Question 13

Diarrhea increases chance of what pulmonary pathology?

Answer 13

PE via dehydration

Question 14

Patient with dry cough, weight loss, pain in the right arm?

Answer 14

Pancoast tumor

Question 15

90% of PEs come from which veins?

Answer 15

Deep veins (iliac, femoral, popliteal)

Question 16

Can present with erythema multiforme and interstitial infiltrates?

Answer 16

Mycoplasma pneumonia

Question 17

Patient with parapneumonic effusion. Aspiration result that would necessitate chest tube for drainage?

Answer 17

Empyema. pH <7.2

Question 18

Common causes of hemoptysis?

Answer 18

1. Pulmonary (bronchitis, PE, bronchiectasis, PNA, lung cancer)
2. Cardiac (mitral stenosis)
3. Infectious (tuberculosis, aspergillosis, lung abscess)
4. Hematologic (coagulopathy)

Question 19

Pickwickian syndrome? Leads to?

Answer 19

Obesity hypoventilation syndrome – obesity impedes expansion of chest and abdominal wall doing breathing. Leads to chronically elevated PaCO2.

Question 20

pH ranges of pleural effusions?

Answer 20

7.64 – normal pleural fluid pH

<7.2 indicates empyema

Question 21

Glucose level <60 in pleural effusion suggests what causes?

Answer 21

Parapneumonic effusion, tuberculosis, rheumatoid arthritis

Question 22

Indicators of a severe asthma attack?

Answer 22

1. Normal/increased PCO2
2. Speech difficulty
3. Diaphoresis
4. Cyanosis

Question 23

Theophylline mechanism of action? Toxicities?

Answer 23

1 Bronchodilation via phosphodiesterase inhibition
2. Increased diaphragm contraction via increased calcium uptake through adenosine channels

Toxicity:

1. CNS stimulation (headache, insomnia, seizures)
2. Cardiac toxicity (arrhythmia)
3. G.I. disturbances (n/v)

Question 24

Antimuscarinics used in COPD?

Answer 24

Ipratropium and Tiotropium

Question 25

Complications of ventilation with a high PEEP?

Answer 25

Alveolar damage, tension pneumothorax, hypotension

Question 26

Lofgren’s syndrome?

Answer 26

Erythema nodosum, hilar lymphadenopathy, migratory polyarthralgias, fever

Question 27

Most common adverse associated with inhaled steroids?

Answer 27

Oral thrush

Question 28

When to use non-invasive positive pressure ventilation?

Answer 28

When pt is refractory to medical therapy but not crashing (before intubation)

Specifically, when pH25

Question 29

SVC syndrome?

Answer 29

Dyspnea
Venous congestion
Swelling of head, neck and arms

Question 30

ARDs vs Cardiogenic pulmonary edema?

Answer 30

Wedge pressure < 18 in ARDs

Question 31

Causes of exudative effusions?

Answer 31

1. Infection
2. malignancy
3. pulmonary embolism
4. connective tissue disease
5. iatrogenic

Question 32

COPD, when does oxygen have a mortality benefit?

Answer 32

PaO2 55

Cor pulmonale

Question 34

Complications of PEEP?

Answer 34

Alveolar damage, tension pneumothorax, hypotension

Question 35

dyspnea from long standing HTN leads to? Tx?

Answer 35

Left sided heart failure. Nitroglycerin