Dyspnea

Question 1

Treatment for anaphylaxis?

Answer 1

Give EPI IM, and can add on Benadryl, and a powerful antihistamine and can give solumedrol with a NS fluid bolus

Question 2

Should you intubate someone with larynospasm

Answer 2

No, you only get one shot get someone better to do it

Question 3

Signs of epiglottis?

Answer 3

Classically due to Hib, do not intubate yourself, look for drooling, tripod position, hot potato voice

Question 4

Test for asthma ?

Answer 4

Looking for reversibility, spirometery and bronchodilator to see if reversible and less flow - decreased FEV1 and FEV1/FVC ratio

Question 5

Signs of tension pneumothorax?

Answer 5

Deviated trachea, no lung sounds, big IV over the 2nd interspace stab in the chest, then do a chest tube more at risk on planes

Question 6

Transudative vs exudate

Answer 6

Transudate- through the vasculature, normal process but more out than in, clear, relatively protein free, classically caused by CHF and bilateral

Exudate - infectious or CA, usually unilateral, drainage for comfort and testing

Question 7

Alpha 1 anti-trypsin deficiency?

Answer 7

Breaks down the alveoli which hold the airways open (radial traction) will result in prolonged exhalation due to airway collapse = emphysema

Question 8

Chronic bronchitis Pathophysiology

Answer 8

Get rid of cilia due to scar tissue, bronchiectisis, secretions get stuck, repeat pneumonia leads to worsening and worsening lung function

Question 9

Pink, frothing sputum?

Answer 9

Pulmonary edema

Question 10

Cor pulmonale?

Answer 10

Right sided pressure due to pulmonary HTN, can be seen due to scarring of the lungs

Question 11

Tx for acute COPD

Answer 11

Steroids, abx, try BiPAP (avoid intubation), can start with nebulizers (2cc of ventolin, flowvent, atrovent).

Question 12

Signs of pulmonary fibrosis

Answer 12

Honeycombing on CXR, O2 won’t help, lung sounds like Velcro tearing.

If they have an autoimmune disease be aware that this disease may very well target the lungs

Question 13

Prognosis small vs non-small lung CA

Answer 13

Small cell lung CA is fast, and initially responsive to chemo, lots of metastasis.
Non-small cell - not as good response to chemo, have to cut it out if hoping for a cure
Large cell is going to be fast and fatal

Question 14

Signs/Sx of TB?

Answer 14

Ghon complex - caseating granuloma 
Hemoptysis 
Fever 
Potts disease - bone TB 
Can show up in urine and spinal tap 
Owl eyes on the apex of the lung 

2 drugs for 4 months, and 4 drugs for 2 months
If the person has had BCG vaccine they will test positive

Question 15

Bronchitis on CXR?

Answer 15

No consolidation, not reticulanodular shows up linear instead

Question 16

When would you order an expiratory CXR?

Answer 16

Trying to rule out a pneumothorax - shrinks the lung to see if collapsed.

Question 17

Pancoast syndrome?

Answer 17

Nervous compression of the brachial plexus - common in NSCLC

Question 18

SVC syndrome?

Answer 18

Seen in SCLC, blocks the SVC results in edema of the face

Question 19

X-ray findings for pulmonary edema

Answer 19

Kerley B lines, vascular redistribution (more markings to the top of the lungs), air bronco-grams,

Question 20

Lights criteria

Answer 20

Protein/serum ratio greater than 0.5, Lactate LDH/serum LDH greater than 0.6, LDH greater than 2/3 the upper limit of the laboratory serum LDH