Pulm

Question 1

dypsnea
hypoxia
hypercapnia
wheezing
cyanosis 

these are all common problems found where?

Answer 1

ED

Question 2

SUBJECTIVE FEELING OF DIFFICULT, LABORED OR UNCOMFORTABLE BREATHING?

Answer 2

dyspnea

Question 3

6Ps of dyspnea?

Answer 3

possible FB
Pulmonary bronchial constriction 
PE
Pneumo
pneumonia 
pump failure

Question 4

MCC of dyspnea?

Answer 4

asthma/copd
CHF
ischemic Heart disease
penumonia 
psychogenci

Question 5

most immediately life threatening causes of dyspnea?

Answer 5

upper airway obstruction
tension penumo
PE, guillian barre, myastenia gravis

Question 6

the goal for dyspnea is to what?

Answer 6

maintain PaO2 above 60mm Hg or O2 sat above 90% (goals may be lower in pts with COPD or chronic lung dx)

Question 7

inadequate delivery of O2 to the tissues?

Answer 7

hypoxia

Question 8

hypoxia is defined as PaO2 below what?

Answer 8

60 mm Hg `

Question 9

dx of hypoxia:

clinical suspicion or what 2 other things?

Answer 9

ABG or pulse ox

Question 10

PaCO2 above 45 mmHg and is exclusively due to alveolar hypoventiliation?

Answer 10

hypercapnia

Question 11

chronic hypercapnia s/s?

Answer 11

tolerated large variations as seen in COPD

Question 12

severe hypercapnia:above what PACO2? and s/s?

Answer 12

80mm Hg

coma, encephalopathy, seizures

Question 13

dx of hypercapnia?

Answer 13

pulse ox

Question 14

causes of hypercapnia?:

there is a shit ton

Answer 14

kyphoscolisis, morbid obesity

upper airway obstruction

depressed central respiratory drive: CNS dx (brainstem tumor), durgs (opioids, sedatives, anesthetics), tetnaus

MG/GB
botulism, organophosphate poisoning

intrinsic lung dx associated w/ increased dead space like COPD

Question 15

tx of hypercapnia besides tx of underlying cause?

Answer 15

ABC!!!!!!!!!

O2 and ventiliation

Question 16

musical, high pitches, adventitious lung sounds produced by the airflow through the central and lower airways?

Answer 16

wheezing

Question 17

wheezing may result from what?

Answer 17

increased secretions

smooth muscle constrictions
muscular hypertrophy

peri bronchial inflammation

Question 18

not all wheezing is what?

Answer 18

asthma

Question 19

pts with severe airflow obstructions may actually have no wheezing but decreased what?

Answer 19

breath sounds

Question 20

dx of wheezing?

Answer 20

PE (ausculation)

Question 21

tx of wheezing?

Answer 21

UNDERLYING CAUSE

Question 22

peripheral cyanosis:

Answer 22

poor perfusion in extremities

Question 23

central cyanosis:

Answer 23

low PaO2 or abnormal hemoglobins

Question 24

causes of peripheral cyanosis:

Answer 24

reduced CO

cold extremeites

misdistribution of blood flow

arterial/venous obstruction

Question 25

causes of central cyanosis?

Answer 25

hypoxemia (high altitude, hypoventiliation, ventiliation perfusion mismatch, right to left shunt, av fistulas, intrapulmonary shunts) hemoglobin abnormalities: (metheglobinemia, sulfhemoglobinemia, carboxyhemoglinemia)

Question 26

tx of cyanosis:

Answer 26

TX UNDERLYING CAUSE supplemental O2, get that sat above 90%

Question 27

infx of the conducting airways of the lungs?

Answer 27

acute bronchitis

Question 28

acute bronchitis is mainly causes by what?

Answer 28

viruses

Question 29

cough lasting more than 5 days, sputum/purulent, afebrile, wheezing

Answer 29

acute bronchitis

Question 30

work up for acute broncitis:

Answer 30

vitals and pulse ox CXR to rule out pneumonia NO FUCKING CULTURES

Question 31

TX of acute bronchitis:

Answer 31

symptomatics/supportive (SABA/cough suppressants) its viral so let it go away on its own

Question 32

infection of the alveolar portion of the lung?

Answer 32

pneumonia

Question 33

#1 pathogen of pneumonia?

Answer 33

s penumo (kids under 5 is viral)

Question 34

MC pathogen of atypical (walking) pneumonia?

Answer 34

mycoplasma

Question 35

who is at risk for apritation pneumonia?

Answer 35

alcholics, hx of seizures, CVA, neuromuscular dx, intubated pts

Question 36

big "chill" pneumonia is likely what?

Answer 36

strep pneumo

Question 37

fever, cough, dyspnea, pleuritic chest pain, sputum production are s/s of what?

Answer 37

pneumonia

Question 38

lobar pneumonia s/s:

Answer 38

consilidation, bronchial breath sounds, egophony, increased tactile/vocal fremitus, dullness to percussion

Question 39

bronchopenumonia s/s:

Answer 39

rales/rhonchi without consilidation, pleural effusion, empyema!!!

Question 40

interstitial pneumonia: s/s

Answer 40

rales, rhonchi, normal breath sounds

Question 41

tests for pneumonia:

Answer 41

cxr initial ct is best cbc, electrolytes/cmp, abg/vbg, blood cultures

Question 42

hospitalized over 48 hours within prior 90 days, those getting outpt dialysis, chemo, wound care or home IV AB therapy, residents in nursing/rehab all criteria for what?

Answer 42

HAP

Question 43

lung abscess:

Answer 43

pus in the lung

Question 44

empyema:

Answer 44

pus in pleural space (seen in bronchopenumonia)

Question 45

main cause of TB?

Answer 45

mycobacterium tuberculosis

Question 46

slow growing aerobic rod with acid fast properties

Answer 46

myhcobacterium tuberculosis

Question 47

MC place for TB?

Answer 47

high O2 or blood flow like the apical/posterior segments of the upper lobes

Question 48

how is TB spread?

Answer 48

droplets

Question 49

latent and actibe TB will both have a positive skin test?

Answer 49

yes!!

Question 50

extrapulmonary TB: develops in 20% of cases, MC in who? presentation?

Answer 50

children, immunocompromised | lymphadenitis with painless enlargement

Question 51

miliary TB: multisystem dx causes by what?

Answer 51

massive hematogenous dissemination

Question 52

where is miliary tb mc?

Answer 52

young/immunocompromised

Question 53

gold standard TB work up?

Answer 53

sputum

Question 54

when would we admit a TB pt?

Answer 54

instability, hypoxia, dyspnea, unrelaibale pt, suspected or known MDR TB ISOLATE PTS