Respiratory

Question 1

What are some common triggers for ARDS?

Answer 1

Sepsis
Infection/Aspiration
Blood transfusions

Question 2

What is ARDS?

Answer 2

Respiratory failure with lung edema and decreased compliance

Question 3

What are the 3 initial tests to get when lung pathology presents?

Answer 3

ABG
CXR
A-a gradient

Question 4

How will the CXR look with ARDS?

Answer 4

Bilateral ground glass appearance

Question 5

What will the PaO2:FiO2 ratio be with ARDS?

Answer 5

< 300

Question 6

Treatment for ARDS?

Answer 6

Intubation and mechanical ventilation

Question 7

When a patient is intubated and mechanically ventilated, what 2 things need to be remembered?

Answer 7

1. Prone position can help
2. LOW tidal volume in order to prevent alveolar over distention injury

Question 8

What defines Pulmonary HTN?

Answer 8

Pulmonary arterial pressure > 25mmHg

Question 9

What defines Cor Pulmonale?

Answer 9

Alteration of RV structure/function due to disorder of the lungs

Question 10

What will be some symptoms of Pulmonary HTN?

Answer 10

Dyspnea on exertion
Lethargy
Right CHF signs – edema, JVD, abdominal distention

Question 11

What will be some symptoms of Pulmonary HTN?

Answer 11

Dyspnea on exertion
Lethargy
Right CHF sign – edema, JVD, abdominal distention

Question 12

What may be heard with auscultation of the heart with pulmonary HTN?

Answer 12

Loud split S2
RV heave

Question 13

What is the best initial test if you suspect Pulmonary HTN?

Answer 13

Echo to estimate pulmonary A. pressure and assess RV

Question 14

What will a CXR show with Pulmonary HTN?

Answer 14

Enlargement of central pulmonary arteries with distal tapering

Question 15

What may an ECG show with Pulmonary HTN?

Answer 15

Right ventricular hypertrophy

Question 16

What is the most accurate test to diagnose pulmonary HTN?

Answer 16

Right heart catheterization!

Question 17

What are 3 medication options for Pulmonary HTN?

Answer 17

1. IV prostanoids
2. Bosentan (endothelin antagonist)
3. PDE inhibitors

Question 18

What occurs with Alpha-1-Antitrypsin deficiency?

Answer 18

Proteases like Neutrophil Elastase go unchecked and destroy lung tissue

Question 19

Alpha-1-Antitrypsin will present with what specific lung pathology?

Answer 19

Panacinar emphysema in the lower lobes

Question 20

Alpha-1-Antitrypsin will present with what specific lung pathology?

Answer 20

Panacinar emphysema in the lower lobes

Question 21

Patients with Alpha-1-Antitrypsin deficiency will also present with what other things besides COPD?

Answer 21

Liver diseases
- Cirrhosis
- HCC

Question 22

On CXR, what word may be used to describe the COPD that is present with Alpha-1-Antitrypsin deficiency?

Answer 22

Basilar COPD

Question 23

What physiology causes a Transudative pleural effusion?

Answer 23

Increased pulmonary capillary wedge pressure or decreased oncotic pressure

Question 24

What are 3 common things that cause a Transudative pleural effusion?

Answer 24

CHF
Cirrhosis
Nephrotic syndrome

Question 25

What is typical of the pH with a Transudative pleural effusion?

Answer 25

Alkalotic pH (high)

Question 26

What physiology causes an Exudative pleural effusion?

Answer 26

Increased vascular permeability

Question 27

What are some common things to cause an Exudative pleural effusion?

Answer 27

Pneumonia Malignancy PE -- All other things

Question 28

How will a pleural effusion present?

Answer 28

Dyspnea Pleuritic chest pain Cough

Question 29

What 2 lab values diagnose an Exudative pleural effusion?

Answer 29

Pleural protein:Serum protein > 0.5 Pleural LDH:Serum LDH > 0.6

Question 30

What 2 lab values diagnose an Exudative pleural effusion?

Answer 30

Pleural protein:Serum protein > 0.5 Pleural LDH:Serum LDH > 0.6

Question 31

What is present with an Uncomplicated Parapneumonic Effusion?

Answer 31

Pneumonia + Pleural effusion -- (-) gram stain with clear/cloudy fluid

Question 32

Treatment for an Uncomplicated Parapneumonic Effusion?

Answer 32

Antibiotics -- Pneumonia + Pleural effusion with clear/cloudy fluid and a (-) gram stain

Question 33

What is present with a Complicated Parapneumonic Effusion?

Answer 33

Pneumonia + Bacterial invasion into pleural space

Question 34

What will the pH be of the pleural fluid if a Complicated Parapneumonic Effusion is present?

Answer 34

pH < 7.2 -- Pneumonia + Bacterial invasion into pleural space

Question 35

What is the treatment for a Complicated Parapneumonic Effusion?

Answer 35

Antibiotics + Chest tube

Question 36

What is an Empyema?

Answer 36

Bacterial colonization of the pleural space that produces pus and purulent fluid

Question 37

Treatment for an Empyema?

Answer 37

Antibiotics + chest tube

Question 38

VIRchow's Triad

Answer 38

- Vascular trauma - Increased coagulability - Reduced flow (stasis)

Question 39

What is the best initial step if you suspect a PE?

Answer 39

Calculate the Well's Score

Question 40

If the Well's Score is ______ a PE is unlikely

Answer 40

< 4

Question 41

If a PE is unlikely, what test can be helpful to rule it out?

Answer 41

D-Dimer

Question 42

If the Well's Score is > 4, what test should be done?

Answer 42

CT with contrast

Question 43

What is the most common finding on EKG with a PE? Rare finding?

Answer 43

Common = sinus tachycardia Rare = S1Q3T3

Question 44

If the probability of a PE is high, what treatment should be done and when?

Answer 44

Anticoagulation BEFORE confirmatory testing is done

Question 45

In a patient that is on supplemental O2 who develops rapid neurologic decline, what should be suspected?

Answer 45

Hypercapnia from dead space ventilation