Pulmonary

Question 1

pimp question for pulmonary embolism

Answer 1

S1Q3T3

Question 2

virchow triad

Answer 2

hemostasis
hypercoagulable state
endothelial injury

Question 3

PERC Criteria

Answer 3

over age 50 
HR > 100 
SaO2 < 95% 
unilateral leg swelling 
hemoptysis 
recent surgery or trauma 
history of DVT or PE 
hormone use

Question 4

WELLS criteria

Answer 4

clinical S & Sx of DVT 
PE is likely diagnosis 
HR > 100 
immobilization (3 days or surgery in 4 wks)
prior PE or DVT 
hemoptysis 
malignancy

Question 5

what lab value will be grossly high in PE?

Answer 5

D-Dimer

Question 6

two diagnostic tests for PE

Answer 6

CTPA

V/Q scan

Question 7

Treatment for PE or DVT

Answer 7

systemic anticoagulation

fibrinolysis

Question 8

subjective perception or experience of uncomfortable breathing

Answer 8

dyspnea

Question 9

abnormal collection of blooed between parietal and visceral pleura → usually 5-10 L of serous fluid is normal

Answer 9

pleural effusion

Question 10

Values for Exudative Pleural Effusion:
Pleural fluid protein: serum
pleural fluid LDH: serum LDH
Pleural fluid LDH ____ of UNL serum LDH

Answer 10

PF fluid:serum protein → > 0.5
PF:serum LDH → > 0.6
PF LDH > 2/3 UNL of serum LDH

Question 11

Exudative pleural effusions are associated with

Answer 11

infection, malignancy, inflammation

Question 12

Transudate pleural effusions are associated with

Answer 12

CHF, cirrhosis/ascites, nephrotic syndrome

Question 13

Definitive diagnosis and treatment for pleural effusion

Answer 13

Thoracentesis → cell sount, protein, LDH, glucose

Question 14

with thoracentesis, you should only withdrawal

Answer 14

1.5 L

Question 15

when would you consider thoracentesis for pleural effusion?

Answer 15

if in destress → defer if in no distress

Question 16

infected pleural effusion

Answer 16

empyema

Question 17

what is required with empyema if purulent or a Gram (+) organism?

Answer 17

chest tube

Question 18

What empyema cases can be discharged?

Answer 18

known cause/recurrent accumulations

Question 19

when would get get blood cultures on patient with pneumonia?

Answer 19

admitting to hospital or ICU

Question 20

organisms that cause CAP

Answer 20

S. pneumoniae, H. influenza, M. catarrhalis

Question 21

organisms that cause HAP

Answer 21

S. aureus, MRSA, K. pneumonia, P. aeruginosa, E. coli

Question 22

Atypicals that cause pneumonia

Answer 22

Legionella, M. pneumoniae, chlamydia

Question 23

Outpatient treatment for CAP

Answer 23

azithromycin
levofloxacin
doxycycline

Question 24

Inpatient treatment for CAP

Answer 24

IV levofloxacin

macrolide + B lactam

Question 25

Treatment for HCAP

Answer 25

antipseudomonal cephalosporin + antipseudomonal FQ or AG + linezolid or vancomycin (MRSA coverage)

Question 26

IV therapy/wound care/IV chemo within 30 days live in nursing home or long term care facility hospitalized > 2 days within last 90 days been to hospital or dialysis clinic in last 30 days

Answer 26

HCAP criteria

Question 27

CURB 65 score

Answer 27

``` determine inpatient vs outpatient treatment confusion BUN > 19 RR > 30 BP < 90/<60 Age > 65 ```

Question 28

Other scoring system to determine pneumonia severity

Answer 28

PORT score

Question 29

no clinically aparent lung disease → spontaneously free air enters the potential space between visceral and parietal pleura

Answer 29

primary pneumothorax

Question 30

Two causes of primary pneumothorax

Answer 30

spontaneous | penetration/trauma

Question 31

risk factors for primary pneumothorax

Answer 31

smoker, male, MVP, Marfan, atmospheric pressure changes

Question 32

Pneumothorax that occur in patients with underlying lung disease

Answer 32

secondary pneumothorax

Question 33

pressure in the chest cavity increases → great vessels and heart are compressed and you see contralateral shift

Answer 33

tension pneumothorax

Question 34

Findings of tension pneumothorax

Answer 34

hypoxia and shock | tracheal deviation, hyperresonance, hypotension, dyspnea

Question 35

classic finding of pneumothorax

Answer 35

tachycardia

Question 36

classic finding in traumatic pneumothorax

Answer 36

decreased breath sounds

Question 37

what to look for in US of suspected pneumothorax?

Answer 37

lung sliding

Question 38

Initial test for pneumothorax

Answer 38

upright PA CXR

Question 39

Highly sensitive for pneumothorax

Answer 39

CT

Question 40

Treatment for tension pneumothorax

Answer 40

chest tube ASAP

Question 41

How often do you repeat CXR for pneumothorax? | If you see improvement onf CXR and you discharge your patient when should you follow up on them?

Answer 41

at 4 hours | recheck in 24 horus

Question 42

treatment for large, recurrent hemothorax or bilater pneumothorax

Answer 42

tube thoracostomy

Question 43

Where do you go in for needle decompression of tension pneumothorax?

Answer 43

2nd/3rd ICS midclavicular | 4th/5h ICS anterior axillary line

Question 44

dypnea, wheezing, cough + prolonged expiration + accessory muscle use

Answer 44

asthma

Question 45

hyperresonance + decreased breath sounds + silent chest + tachycardia + wheezing + prolong expiration

Answer 45

asthma

Question 46

What do you use to trend an asthmatics response to therapy?

Answer 46

PFTs

Question 47

Standard ED therapy for asthma

Answer 47

inhaled B2 agonist → Albuterol ipratropium bromide oxygenation relieve inflammation → corticosteroids

Question 48

side effects of albuterol

Answer 48

tremor, nervousness, anxiety, palpitations, tachycardia

Question 49

severe asthma attack that doesn't respond to standard therapy

Answer 49

status asthmaticus

Question 50

hypoxia + tachycardia + tachypnea + accessory muscles +/- wheezing

Answer 50

status asthmaticus

Question 51

Treatment status asthamticus

Answer 51

``` Magnesium NIPPV Ketamine (only for Status Asthmaticus) Epinephrine mechanical ventilation (lets patient rest) ```

Question 52

When can you DC an asthmatic patient?

Answer 52

FEV1 > 70%

Question 53

when do you admit asthmatic patient?

Answer 53

persistent symptoms + FEV1 or PEF <40% predicted

Question 54

what do you give asthmatic patient being discharged with FEV1 or PEF <70%

Answer 54

prednisone (5-10 day) dexamethasone (2 day) single dose methylprednisolone