Pulmonary

Question 1

Upper Airway Obs. (UAO) Causes

Answer 1

Foreign body
Tongue
Swelling (angioedema, trauma)

Question 2

Stridor indicated an _____ obstruction

Answer 2

Incomplete

Question 3

Retropharyngeal abscess

Answer 3

Serious and can spread to mediastinum

Question 4

Retropharyngeal abscess etiology

Answer 4

Children: lymph node
Adults: penetrating trauma, oral infxn, lymph nodes

Question 5

X-ray of retropharyngeal abscess will show?

Answer 5

Expansion of the prevertebral tissues

Question 6

Best imaging for retropharyngeal abscess

Answer 6

CT scan

Question 7

S/S of retropharyngeal abscess

Answer 7

Fever, dysphagia, neck pain
Limited cervical ROM, lymphadenopathy
ST, muffled voice
Stridor in children

Question 8

Retropharyngeal abscess tx

Answer 8

Immediate ENT consult
Surgical I&D
IV hydration and abx
Clindamycin (600 - 900mg) or 
Unasyn (1500 - 3,000)

Question 9

Angioedema

Answer 9

Subdermal or submucosal swelling
Diffuse and nonpitting
Can occur w/ or w/o urticaria

Question 10

Mast cell mediated angioedema

Answer 10

Responds to epi, glucocorticoids and antihistamines

Question 11

Bradykinin mediated angioedema

Answer 11

Secondary to ACE or

Hereditary

Question 12

Tx of mast cell mediated angioedema

Answer 12

Intubate if in resp distress
Epi .3 mg IM
Methylpred 60 - 80mg IV
Diphenhydramine 25 - 50mg IV

Question 13

Hereditary angioedema tx

Answer 13

Intubate if in resp distress

C1 inhibitor concentrate (Berinert)

Question 14

2nd line tx for hereditary engioedema

Answer 14

FFP

Question 15

Anaphylaxis presentation

Answer 15

SUdden onset:
Urticaria
Angioedema
Flushing
Pruritis
Hypotension

Question 16

Anaphylaxis tx

Answer 16

EPINEPHRINE
Adults: .3 - .5 mg IM
Children: .1 (max dose of .5)
Give q5-15 up to 3 doses

Question 17

Other meds for anaphylaxis

Answer 17

H1 or H2 blocker
Glucocorticoid (solumedrol 125 mg IV)
Albuterol neb 2.5mg
Vasopressors prn for shock

Question 18

Gurgling =

Answer 18

Pooling of liquids in the oral cavity or hypopharynx

Question 19

Snoring =

Answer 19

Partial airway obs at the pharyngeal level form the tongue

Question 20

Inspiratory Stridor

Answer 20

Obstruction at level of larynx

Question 21

Expiratory stridor

Answer 21

Obstruction at level of trachea

Question 22

Wheezing

Answer 22

Narrowing of lower airways

Question 23

Stupor

Answer 23

Lack of critical cognitive fxn and low level of conciousness to only painful stimuli

Question 24

Coma

Answer 24

A state of unconciousless lasting for longer than 6 hours.

Person cannot be awakened, fails to respond to painful stimuli

Question 25

Spontaneous pneumothorax

Answer 25

Pneumo that occurs w/o precipitating event or lung dz

Question 26

Spontaneous pneumo risks

Answer 26

Thin, smoking men 20-40. | Marfans, family hx

Question 27

Spontaneous pneumo s/s

Answer 27

``` Sudden onset dyspnea and pleuritic CP Often occurs at rest Decreased BS Hyperresonance Hypoxemia Tracheal deviation JVD ```

Question 28

Where is decompression done?

Answer 28

*ABOVE rib* 2nd or 3rd ICS midclavicular and/or 5th ICS @ anterior axillary line

Question 29

Acute pulmonary edema S/S

Answer 29

``` Pink frothy sputum Dyspnea, edema, ascites Rales, wheezing HTN Hypoxemia, restlessness, tachy ```

Question 30

Acute pulmonary edema patho

Answer 30

Sudden increase in L sided intracardiac filling pressures or Increased alveolar permeability

Question 31

Cardiogenic pulm edema causes

Answer 31

``` Ischemia Acute severe mitral regurg Acute aortic regurg Hypertensive crisis Stress induced cardiomyopathy ```

Question 32

Noncadriogenic pulm edema causes

Answer 32

``` ARDS is major cause Altitude Neurogenic Narcotic OD PE Eclampsia Transfusion related injury Salicylate OD ```

Question 33

Diuretic for pulm edema

Answer 33

Furosemide (Lasix) 40-80 mg IV

Question 34

Massive aspiration =

Answer 34

Intubation | Suction lower airway

Question 35

Asthma

Answer 35

Inflammation of the airways w/ abnormal accumulation of inflammatory cells.

Question 36

Severe asthma peak flow

Answer 36

Less than 40% of expected

Question 37

Asthma medical therapy

Answer 37

Albuterol Ipatropium bromide (atrovent) Methylpred 60-125 mg IV

Question 38

Meds for severe asthma

Answer 38

Mag sulfate (after 1 hr of failed therapy) Epi (for anaphylaxis) Terbutaline (for unresponsive asthma)

Question 39

COPD exacerbation

Answer 39

Usually precipitated by an infxn | Dyspnea, cough, sputum

Question 40

Therapy for COPD exacerbation

Answer 40

O2 Solumedrol 60mg IV ABX (levaquin) Albuterol

Question 41

Pulmonary Embolism

Answer 41

Obs of pulm artery by clot, tumor, fat, air Common and fatal Acute or chronic

Question 42

S/S or PE

Answer 42

DYspnea, tachycardia, cough Hemoptysis, syncope, edema Cyanosis, diaphoresis, Hypotension

Question 43

2 most common S/S of PE

Answer 43

Dyspnea and tachycardia followed by Pleuritic CP and Rales

Question 44

PE diagnostics

Answer 44

CT angio w/ PE protocol CXR, EKG D-DImer?

Question 45

Hamptons hump

Answer 45

Found in PE | Consolidation at bottom of lung

Question 46

EKG changes in PE

Answer 46

S1 QT3 S waves in lead I Q waves in lead III Inverted T waves in lead III

Question 47

PE Tx

Answer 47

``` O2 Fluid bolus if hypotensive Vasopressin LMWH UFH if unstable ```

Question 48

Abx for noncomplicated pneumonia

Answer 48

``` Levoquin or Ceftriaxone or Zithromax ```

Question 49

Complicated pneumonia abx

Answer 49

Ceftriaxone and Zithromax or Ceftriaxone and levofloxacin

Question 50

Gram+ diplococci

Answer 50

Strep

Question 51

Gram - rods

Answer 51

Pseudomonas