respiratory Flashcards

Question

What size chest tube is used for a 27-year-old with a tension pneumothorax who is deteriorating?

Answer 1

28-32 Fr inserted at the 5th ICS, anterior axillary line, to evacuate air and prevent further lung collapse in this unstable patient.

Answer 2

Intubate using RSI (e.g., ketamine 1-2 mg/kg IV) to secure the airway and provide mechanical ventilation due to failure of non-invasive support.

Answer 3

Perform thoracentesis to drain the effusion and send fluid for analysis (pH, glucose, LDH) to assess for complicated parapneumonic effusion or empyema.

Answer 4

Tracheobronchial injury, where a traumatic rupture allows air to escape into the mediastinum and subcutaneous tissues.

Answer 5

SpO2 88-92% using controlled oxygen (e.g., Venturi mask) to avoid suppressing hypoxic drive in chronic CO2 retainers.

Answer 6

IM adrenaline 0.5 mg (1:1000) stat, followed by antihistamines and steroids, for anaphylaxis causing bronchospasm and respiratory distress.

Answer 7

Low tidal volume ventilation (6 mL/kg ideal body weight) with PEEP 5-15 cmH2O to minimize barotrauma and optimize oxygenation in ARDS.

Answer 8

Open pneumothorax (sucking chest wound), where air enters the pleural space through a penetrating injury, collapsing the lung.

Answer 9

100 mg IV stat to reduce airway inflammation, with effects starting within 1-2 hours in severe asthma exacerbation.

Answer 10

CTPA to confirm pulmonary embolism, as elevated D-dimer and respiratory symptoms suggest a high pretest probability in this scenario.

Answer 11

IPAP 12 cmH2O, EPAP 5 cmH2O initially, titrated to reduce RR and improve CO2 clearance in this hypercapnic exacerbation.

Answer 12

Administer oxygen via NRB and IV analgesia (e.g., fentanyl 100 mcg) to stabilize breathing and reduce pain from paradoxical chest wall motion.

Answer 13

Noradrenaline 0.01-0.5 mcg/kg/min IV after fluid resuscitation to maintain MAP ≥65 mmHg in septic shock.

Answer 14

High-flow nasal cannula at 30-60 L/min to increase FiO2 and accelerate pneumothorax resorption in a stable patient.

Answer 15

Impending respiratory failure, as rising PaCO2 in asthma suggests fatigue and inadequate ventilation, requiring urgent escalation.

Answer 16

NIV (BiPAP, IPAP 15 cmH2O, EPAP 5 cmH2O) to reduce CO2, improve mentation, and avoid intubation in this acute hypercapnic failure.

Answer 17

Within 1 hour of recognition, as early broad-spectrum antibiotics (e.g., ceftriaxone 1 g IV) reduce mortality in septic shock.

Answer 18

Aortic injury, where traumatic aortic rupture causes hemodynamic changes, potentially leading to respiratory compromise from mediastinal hematoma.

Answer 19

Heparin 80 units/kg IV bolus followed by 18 units/kg/h infusion to anticoagulate and prevent further clot propagation in pulmonary embolism.

Answer 20

Trial NIV (e.g., BiPAP IPAP 12-15 cmH2O, EPAP 5 cmH2O) for 1-2 hours to correct acidosis and hypercapnia, with reassessment for intubation if no improvement.

Answer 21

2nd intercostal space, midclavicular line, using a 14-gauge needle to relieve pressure and restore hemodynamic stability.

Answer 22

Low rate (6-8 breaths/min), tidal volume 6-8 mL/kg, long expiratory time (I:E 1:4) to prevent air trapping and barotrauma.

Answer 23

Cardiogenic pulmonary edema, where left heart failure causes fluid backup into the lungs, leading to respiratory distress.

Answer 24

Benzylpenicillin 1.2 g IV every 6 hours, targeting the most common CAP pathogen in a penicillin-sensitive strain.

Answer 25

Controlled oxygen via Venturi mask at 24-28% FiO2 to maintain SpO2 88-92%, avoiding CO2 retention.

Answer 26

Apply a three-sided occlusive dressing to allow air exit but prevent entry, followed by chest tube insertion to manage the open pneumothorax.

Answer 27

Magnesium sulfate 2 g IV over 20 minutes to relieve severe bronchospasm and improve airflow in this near-fatal asthma scenario.

Answer 28

Chest CT to evaluate for complications like empyema, abscess, or underlying malignancy in this hypoxic patient.

Answer 29

36 Fr inserted at the 5th ICS, anterior axillary line, to drain large-volume blood and monitor ongoing bleeding.

Answer 30

Pulmonary embolism, where a normal CXR with hypoxia and elevated D-dimer strongly suggests a clot obstructing pulmonary arteries.

Answer 31

Worsening hypercapnia (e.g., PaCO2 >80 mmHg) or acidosis (pH <7.20) despite optimized NIV, indicating respiratory muscle fatigue.

Answer 32

Prednisolone 50 mg PO or hydrocortisone 100 mg IV to reduce airway inflammation, with oral preferred if the patient can swallow.

Answer 33

Normal saline 30 mL/kg IV over 1 hour to address hypoperfusion in early septic shock, guided by lactate elevation.

Answer 34

Chest tube insertion (28-32 Fr) at the 5th ICS, anterior axillary line, to relieve pressure and stabilize hemodynamics.

Answer 35

ARDS, where diffuse alveolar damage from trauma, sepsis, or aspiration causes non-cardiogenic pulmonary edema and hypoxia.

Answer 36

Salbutamol 5 mg and ipratropium 500 mcg nebulized every 20 minutes to reverse bronchospasm, as this is a compensated exacerbation.

Answer 37

Tuberculosis or lung abscess, where cavitation suggests necrotizing infection requiring sputum AFB and possible drainage.

Answer 38

Salbutamol 5 mg and ipratropium 500 mcg nebulized every 20 minutes to reverse bronchospasm, as this is a compensated exacerbation.

Answer 39

Tuberculosis or lung abscess, where cavitation suggests necrotizing infection requiring sputum AFB and possible drainage.

Answer 40

Pressure control ventilation with low rate (8-10/min) and PEEP 5 cmH2O to manage bronchospasm and prevent barotrauma.

Answer 41

Intubate with RSI (e.g., ketamine 1-2 mg/kg IV) due to refractory hypoxia indicating respiratory failure in severe pneumonia.

Answer 42

IV fentanyl 1-2 mcg/kg titrated to pain, reducing splinting and improving ventilation in this chest wall injury.

Answer 43

Heparin 80 units/kg IV bolus followed by 18 units/kg/h infusion to prevent clot progression in high-probability pulmonary embolism.

Answer 44

Intubate with RSI (e.g., propofol 1-2 mg/kg IV) as persistent acidosis indicates failure of non-invasive ventilation.

Answer 45

High-flow nasal cannula at 40-60 L/min and 100% FiO2 to correct hypoxemia while escalating bronchodilator therapy.

Answer 46

Ceftriaxone 1 g IV daily plus azithromycin 500 mg IV daily to cover severe CAP with risk of ICU admission.

Answer 47

5th intercostal space, anterior axillary line, using a 28-32 Fr tube to fully evacuate air and prevent recurrence.

Answer 48

Upper airway obstruction, potentially from epiglottitis or foreign body, causing inspiratory distress and visible neck muscle use.

Answer 49

Salbutamol 5 mg and ipratropium 500 mcg nebulized back-to-back to rapidly relieve bronchospasm and improve air entry.

Answer 50

Chest tube drainage (e.g., 14-20 Fr) for empyema, followed by antibiotics (e.g., piperacillin-tazobactam 4.5 g IV).

Answer 51

RSI with ketamine 1-2 mg/kg IV and rocuronium 1 mg/kg IV due to silent chest indicating critical airflow limitation.

Answer 52

PEEP 5-10 cmH2O, tidal volume 6 mL/kg IBW, FiO2 titrated to SpO2 >90% for ARDS management.

Answer 53

Insert a 32-36 Fr chest tube at the 5th ICS, anterior axillary line, to drain blood and air, monitoring output for surgical referral.

Answer 54

CTPA to confirm pulmonary embolism, as elevated D-dimer with acute symptoms warrants definitive imaging in moderate-high risk.

Answer 55

Increase IPAP to 18-20 cmH2O while maintaining EPAP at 5 cmH2O to enhance CO2 elimination in worsening hypercapnia.

Answer 56

IV salbutamol 250 mcg over 10 minutes as a bolus, followed by infusion if needed, to achieve systemic bronchodilation.

Answer 57

High-dependency unit (HDU) for close monitoring and potential escalation to NIV or intubation if hypoxia worsens.

Answer 58

Occlusive three-sided dressing taped on three sides to allow air escape during expiration, preventing tension pneumothorax.

Answer 59

Nebulized adrenaline 5 mL (1:1000) to reduce airway edema in croup, with dexamethasone 0.6 mg/kg IV for longer-term effect.

Answer 60

Increase IPAP by 2-4 cmH2O (e.g., to 14-16 cmH2O) to improve ventilation and correct mild acidosis.

Answer 61

Noradrenaline 0.01-0.5 mcg/kg/min IV titrated to MAP ≥65 mmHg after 30 mL/kg fluid bolus in septic shock.

Answer 62

Decrease tidal volume to 6 mL/kg and rate to 6-8/min to reduce air trapping and prevent barotrauma in bronchospasm.

Answer 63

Alteplase 100 mg IV over 2 hours to dissolve the clot, indicated for massive PE with RV strain and hemodynamic compromise.

Answer 64

Mechanical ventilation via intubation with volume control (6 mL/kg) to stabilize chest wall and support breathing.

Answer 65

Hemodynamic instability (e.g., SBP <90 mmHg) with confirmed PE, warranting alteplase 100 mg IV for massive embolism.

Answer 66

IPAP 15 cmH2O, EPAP 5 cmH2O initially, titrated upward if CO2 persists, to improve ventilation in hypercapnic failure.

Answer 67

Magnesium sulfate 2 g IV over 20 minutes to relax bronchial smooth muscle and prevent progression to respiratory arrest.

Answer 68

Intubate with RSI (e.g., ketamine 1-2 mg/kg IV) due to refractory hypoxia requiring mechanical ventilation in severe pneumonia.

Answer 69

Fentanyl 100 mcg IV stat, titrated every 5-10 minutes, to reduce pain and improve chest wall excursion without respiratory depression.

Answer 70

Nebulized adrenaline 5 mL of 1:1000 solution to reduce laryngeal edema in croup, repeated if needed every 20-30 minutes.

Answer 71

Increase IPAP to 18 cmH2O from baseline to enhance CO2 clearance, monitoring for improvement within 1-2 hours.

Answer 72

Hartmann’s solution 30 mL/kg IV over 1 hour, preferred for balanced electrolytes in septic shock resuscitation.

Answer 73

Dynamic hyperinflation from air trapping, causing reduced venous return; treat by disconnecting ventilator briefly to allow exhalation.

Answer 74

Alteplase 100 mg IV over 2 hours, given as 10 mg bolus then 90 mg infusion, to lyse the clot in this unstable PE.

Answer 75

36 Fr tube; if >1500 mL blood drained initially or >200 mL/h ongoing, urgent thoracic surgery is indicated.

Answer 76

CTPA to definitively diagnose pulmonary embolism, as tachycardia and elevated D-dimer suggest moderate-high risk.

Answer 77

BiPAP (IPAP 12-15 cmH2O, EPAP 5 cmH2O) with salbutamol 5 mg nebs to reduce work of breathing and CO2 retention.

Answer 78

Ketamine 1-2 mg/kg IV for its bronchodilatory and hemodynamic stability properties, ideal in severe asthma intubation.

Answer 79

Ceftriaxone 1 g IV daily plus azithromycin 500 mg IV daily, escalated to ICU-level care for this critically ill patient.

Answer 80

32 Fr at the 5th ICS, anterior axillary line, to rapidly evacuate air and restore hemodynamic stability in tension pneumothorax.

Answer 81

Croup (laryngotracheobronchitis), where viral infection causes subglottic edema, leading to stridor and respiratory distress.

Answer 82

Venturi mask at 28% FiO2 to maintain SpO2 88-92%, preventing hyperoxia and CO2 retention in this chronic retainer.

Answer 83

Thoracentesis to drain effusion, sending fluid for pH, Gram stain, and culture to diagnose empyema or parapneumonic effusion.

Answer 84

Intubate with RSI (ketamine 1-2 mg/kg IV) as rising CO2 and tachypnea indicate exhaustion and need for mechanical ventilation.

Answer 85

ARDS, where bilateral infiltrates and severe hypoxia (PaO2/FiO2 <300) suggest acute lung injury from sepsis or trauma.

Answer 86

Mechanical ventilation via intubation with volume control (6 mL/kg IBW) to stabilize chest wall and ensure adequate oxygenation.

Answer 87

Heparin 80 units/kg IV bolus then 18 units/kg/h infusion to prevent further embolization in this confirmed pulmonary embolism.

Answer 88

Intubate with RSI (e.g., propofol 1-2 mg/kg IV) due to severe acidosis and hypercapnia unresponsive to NIV.

Answer 89

Hydrocortisone 100 mg IV stat to reduce airway inflammation, followed by oral prednisolone 50 mg daily for 5 days.

Answer 90

ICU admission for probable intubation and advanced respiratory support given persistent hypoxia in severe pneumonia.

Answer 91

14-gauge needle at the 2nd ICS, midclavicular line, to decompress tension and restore lung expansion urgently.

Answer 92

IM adrenaline 0.5 mg (1:1000) stat, followed by H1-blocker (e.g., cetirizine 10 mg) and hydrocortisone 200 mg IV for anaphylaxis.

Answer 93

Salbutamol 5 mg and ipratropium 500 mcg nebulized every 20 minutes to reverse bronchospasm in this compensated exacerbation.

Answer 94

30 mL/kg crystalloid (e.g., normal saline) over 1 hour to improve perfusion in early septic shock, guided by lactate.

Answer 95

Decrease rate to 6-8/min and extend expiratory time (I:E 1:4) to reduce auto-PEEP and improve venous return.

Answer 96

Alteplase 100 mg IV over 2 hours (10 mg bolus, 90 mg infusion) to relieve RV strain and restore pulmonary flow in massive PE.

Answer 97

5th intercostal space, anterior axillary line, using a 32-36 Fr tube to drain both blood and air effectively.

Answer 98

CTPA to confirm pulmonary embolism, as tachycardia and elevated D-dimer in a young patient suggest moderate-high risk.

Answer 99

Increase IPAP to 16-18 cmH2O from baseline to enhance tidal volume and CO2 clearance in worsening hypercapnia.

Answer 100

RSI with ketamine 1-2 mg/kg IV and rocuronium 1 mg/kg IV due to critical airflow limitation and imminent arrest.

Answer 101

Ceftriaxone 1 g IV plus azithromycin 500 mg IV to cover severe CAP, with HDU monitoring for potential deterioration.

Answer 102

Fentanyl 1-2 mcg/kg IV stat, repeated as needed, to control pain and improve ventilation without excessive sedation.

Answer 103

Dexamethasone 0.6 mg/kg IV (max 16 mg) to reduce laryngeal inflammation in croup, complementing nebulized adrenaline.

Answer 104

Venturi mask at 28-35% FiO2 to achieve SpO2 88-92%, balancing oxygenation and CO2 retention risk.

Answer 105

Chest tube drainage (14-20 Fr) for empyema, with antibiotics (e.g., piperacillin-tazobactam 4.5 g IV) targeting anaerobic infection.

Answer 106

Trial NIV (IPAP 12 cmH2O, EPAP 5 cmH2O) for 1-2 hours to support ventilation, escalating to intubation if PaCO2 rises further.

Answer 107

Volume control with tidal volume 6 mL/kg IBW, PEEP 8-12 cmH2O, FiO2 titrated to SpO2 >90% for ARDS.

Answer 108

28-32 Fr at the 5th ICS, anterior axillary line, to evacuate air and stabilize breathing in this traumatic pneumothorax.

Answer 109

Alteplase 100 mg IV over 2 hours (10 mg bolus, 90 mg infusion) for massive PE with hemodynamic instability.

Answer 110

IPAP 14 cmH2O, EPAP 6 cmH2O, adjusted upward if needed, to improve ventilation and correct acidosis.

Answer 111

Magnesium sulfate 2 g IV over 20 minutes to relax bronchial smooth muscle and enhance bronchodilation in severe asthma.

Answer 112

Intubate with RSI (e.g., ketamine 1-2 mg/kg IV) due to persistent hypoxia indicating need for mechanical ventilation.

Answer 113

Three-sided occlusive dressing (e.g., petroleum gauze) to allow air exit, followed by chest tube to manage open pneumothorax.

Answer 114

Urgent ENT consult for possible laryngoscopy or tracheostomy due to post-extubation subglottic stenosis causing obstruction.

Answer 115

Salbutamol 5 mg and ipratropium 500 mcg nebulized every 20 minutes, with BiPAP if RR increases or pH drops.

Answer 116

Noradrenaline 0.01-0.5 mcg/kg/min IV after 30 mL/kg fluids to maintain MAP ≥65 mmHg in septic shock.

Answer 117

Decrease rate to 6/min and extend I:E to 1:4 to reduce dynamic hyperinflation, improving cardiac output.

Answer 118

Heparin 80 units/kg IV bolus followed by 18 units/kg/h infusion to prevent further clot growth in massive PE.

Answer 119

10 mL/kg packed red cells IV if >1500 mL drained initially, with surgical consult for ongoing bleeding.

Answer 120

CTPA to confirm pulmonary embolism, as RV strain on echo and elevated D-dimer indicate significant clot burden.

Answer 121

BiPAP (IPAP 15 cmH2O, EPAP 5 cmH2O) with salbutamol nebs to reduce CO2 and support fatiguing respiratory muscles.

Answer 122

Perform immediate needle decompression by inserting a 14-16 gauge cannula into the 2nd intercostal space, midclavicular line on the affected side. This relieves pressure from trapped pleural air compressing the lung and mediastinum, impairing venous return. A hiss of air confirms diagnosis. Follow with a chest tube (4th-5th intercostal space, anterior axillary line). Monitor for re-accumulation; consider trauma or barotrauma as causes.

Answer 123

Hypotension, tracheal deviation to the opposite side, absent breath sounds on the affected side, and distended neck veins. Tachypnea and hypoxia are common due to lung collapse and mediastinal shift. Diagnose clinically in extremis; urgent decompression precedes imaging. Caused by a one-way valve mechanism (e.g., penetrating trauma).

Answer 124

88-92%, per ACEM and BTS guidelines. Chronic hypercapnia in COPD patients relies on hypoxic drive; excess oxygen (>92%) risks CO2 retention via Haldane effect and V/Q mismatch. Use a Venturi mask (24-28%) and monitor ABG for PaCO2 rise. Escalate to NIV (BiPAP) if pH <7.35.

Answer 125

Streptococcus pneumoniae, a gram-positive diplococcus, accounts for 20-60% of CAP cases. Presents with lobar consolidation, rusty sputum, and fever. Diagnose with chest X-ray (infiltrates) and sputum culture; treat empirically with amoxicillin ± macrolide (CURB-65 for severity).

Answer 126

Administer IV magnesium sulfate (2 g over 20 minutes) to relax bronchial smooth muscle. Use if no response to continuous nebulized salbutamol (5 mg) and ipratropium. Add IV hydrocortisone (200 mg) for inflammation. Monitor for silent chest or respiratory failure (ABG); consider ICU.

Answer 127

Per Berlin criteria: bilateral infiltrates on CXR/CT, PaO2/FiO2 ratio <300 mmHg (on PEEP ≥5 cmH2O), onset within 1 week of insult (e.g., sepsis), and not fully explained by cardiac failure. Reflects diffuse alveolar damage. Treat with lung-protective ventilation (TV 6 mL/kg).

Answer 128

Rupture of subpleural blebs in tall, thin males (primary spontaneous). Presents with sudden chest pain and dyspnea. CXR shows a visceral pleural line. Small (<2 cm apex-to-cupola): observe with oxygen; large: chest tube. Recurrence risk ~30%.

Answer 129

Dyspnea, pleuritic chest pain, hemoptysis—though present in <20% of cases. Dyspnea reflects V/Q mismatch, pain from pleural infarction, hemoptysis from alveolar bleed. Tachycardia and hypoxemia are more common. Confirm with CTPA; risk stratify with Wells score.

Answer 130

Provide high-flow oxygen (target SpO2 >94%), nitrates (GTN 400-800 µg SL, then IV if BP allows), CPAP (5-10 cmH2O) to reduce preload/afterload, and furosemide (40-80 mg IV) for diuresis. Caused by LV failure (e.g., MI). Monitor for hypotension.

Answer 131

Croup (viral laryngotracheobronchitis, often parainfluenza) causes subglottic swelling, leading to stridor, barking cough, and hoarseness. Peak age 6 months-3 years. Treat with dexamethasone (0.6 mg/kg PO/IM) and nebulized adrenaline if severe.

Answer 132

Administer thrombolysis (alteplase 100 mg IV over 2 hours) to lyse the clot and relieve RV strain (SBP <90 mmHg, RV dilation on echo). Contraindications include recent surgery. Support with fluids, noradrenaline; consider ECMO if thrombolysis fails.

Answer 133

S1Q3T3 pattern (S wave in I, Q wave in III, inverted T in III), though rare (<20%). More common: sinus tachycardia, RV strain (RBBB, T-wave inversion V1-V4). Reflects acute RV pressure overload. CTPA confirms diagnosis; ECG guides urgency.

Answer 134

Streptococcus pyogenes (Group A Strep) causes supraglottic inflammation, leading to stridor, dysphagia, and drooling. Less common since Hib vaccine in kids. Diagnose with lateral neck X-ray (thumb sign) or laryngoscopy; secure airway, give ceftriaxone + steroids.

Answer 135

Paradoxical chest wall movement (segment moves inward on inspiration), dyspnea, and severe pain from ≥3 contiguous rib fractures. Hypoxia results from underlying contusion. Diagnose clinically/CXR; treat with analgesia (e.g., PCA), oxygen, consider ventilation.

Answer 136

Initiate non-invasive ventilation (NIV) (BiPAP, e.g., IPAP 10-15, EPAP 4-5 cmH2O) if pH <7.35 despite oxygen and bronchodilators (salbutamol, ipratropium). Improves ventilation, reduces CO2. Monitor ABG; intubate if NIV fails or contraindicated (e.g., coma).

Answer 137

Bronchitis, often viral/bacterial, irritates airways, causing small vessel bleeding. Presents with blood-streaked sputum and cough. Differentiate from massive hemoptysis (e.g., TB, cancer) with CXR/history. Treat supportively; investigate if persistent.

Answer 138

V/Q scan if chest X-ray normal (lower fetal radiation vs. CTPA). If X-ray abnormal or V/Q indeterminate, use CTPA. PE risk rises in pregnancy (hypercoagulability). Use modified Wells score; D-dimer less specific. Balance maternal/fetal safety.

Answer 139

Inability to speak in sentences, respiratory rate >30/min, heart rate >120 bpm, SpO2 <92% on air, silent chest, indicating severe airflow obstruction. PEF <50% predicted if measurable. Treat as life-threatening; escalate to IV magnesium, ICU if unresponsive.

Answer 140

Insert a chest tube (e.g., 12-16 Fr, 4th-5th intercostal space, anterior axillary line) connected to an underwater seal. Oxygen accelerates reabsorption. Monitor CXR post-insertion; remove when no air leak and lung re-expanded. Recurrence risk guides pleurodesis.

Answer 141

Pseudomonas aeruginosa, a gram-negative bacillus, common in ventilated or immunocompromised patients. Presents with fever, purulent sputum, new infiltrates. Treat with piperacillin-tazobactam or meropenem; culture guides therapy.

Answer 142

Give adrenaline (0.5 mg IM, 1:1000, repeat q5 min if needed) to reverse bronchospasm and hypotension. Add oxygen, IV fluids (1 L NS), antihistamines (e.g., cetirizine), and steroids (hydrocortisone 200 mg IV). Monitor airway; intubate if stridor persists.

Answer 143

Bilateral perihilar haziness, interstitial markings, Kerley B lines, pleural effusions. Reflects fluid in alveoli/interstitium from LV failure. Differentiate from pneumonia (focal consolidation). Treat with nitrates, CPAP; echo confirms cardiac cause.

Answer 144

Respiratory syncytial virus (RSV) causes bronchiolitis/pneumonia in <2-year-olds, with wheezing, crackles, and hypoxia. Diagnose clinically; CXR shows hyperinflation, patchy infiltrates. Supportive care (oxygen, fluids); ribavirin rarely used.

Answer 145

Assess airway: if complete obstruction, perform Heimlich maneuver; if partial, urgent bronchoscopy (rigid preferred) to remove the object (e.g., peanut). CXR may show hyperinflation or collapse distal to blockage. Oxygen, stabilize pre-procedure.

Answer 146

Dullness to percussion over the affected lung field, with reduced breath sounds and tactile fremitus. Large effusions cause dyspnea, tracheal shift (if massive). Confirm with CXR (blunted costophrenic angle); ultrasound guides thoracentesis.

Answer 147

Secure airway (intubate if unstable), position bleeding lung down, resuscitate with blood/fluids. Urgent CT angiography identifies source (e.g., bronchiectasis); bronchial artery embolization or surgery if uncontrolled. Antibiotics if infection-driven.

Answer 148

Chronic obstructive pulmonary disease (COPD), from bullae rupture in emphysema. More severe than primary; presents with dyspnea, hypoxia. CXR confirms; treat with chest tube, oxygen. High recurrence risk; consider pleurodesis.

Answer 149

New/progressive infiltrate on CXR after ≥48 hours of ventilation, plus ≥2 of: fever (>38°C), leukocytosis/leukopenia, purulent secretions, worsening oxygenation. Culture ETT aspirate; treat empirically (e.g., piperacillin-tazobactam) pending results.

Answer 150

Secure airway (intubation in OR by ENT, avoid blind attempts), give IV ceftriaxone (1-2 g) for bacterial coverage (e.g., Strep pyogenes), and dexamethasone (10 mg IV) to reduce swelling. Stridor, drooling indicate urgency; lateral X-ray (thumb sign) confirms.

Answer 151

Respiratory syncytial virus (RSV), a paramyxovirus, causes small airway inflammation, wheezing, and crackles in <2-year-olds. Diagnose clinically; supportive care (oxygen, hydration) is mainstay. High-risk (e.g., prematurity) may get palivizumab prophylaxis.

Answer 152

Tachypnea (>60/min), nasal flaring, grunting, intercostal retractions, cyanosis. Reflects immature lungs or pathology (e.g., RDS). Assess SpO2, CXR; treat with oxygen, CPAP, or surfactant if preterm (RDS). Urgent neonatal consult.

Answer 153

Administer 100% oxygen via non-rebreather (reduces CO half-life from 4-6 hours to ~1 hour) or hyperbaric oxygen if severe (COHb >25%, neuro symptoms). CO binds Hb 200x stronger than O2, causing hypoxia. Monitor COHb, ECG, neuro status.

Answer 154

Postnasal drip (upper airway cough syndrome), often from rhinitis/sinusitis, causes persistent throat irritation. History of nasal congestion, mucus. Treat with antihistamines, nasal steroids (e.g., budesonide); CXR if atypical to exclude malignancy.

Answer 155

Insert a chest tube immediately (e.g., 28-32 Fr, 4th-5th intercostal space, anterior axillary line) if needle decompression fails (persistent hypotension, hypoxia). Suspect cannula misplacement or large leak. Surgical consult if ongoing air leak.

Answer 156

Visceral pleural line with absent lung markings beyond it, possible mediastinal shift if tension. Small pneumothoraces (<1 cm) may be subtle; expiratory films enhance visibility. Ultrasound (no lung sliding, barcode sign) is more sensitive.

Answer 157

Klebsiella pneumoniae, a gram-negative bacillus, causes severe, necrotizing pneumonia with “currant jelly” sputum (hemoptysis). CXR shows cavitation. Treat with ceftriaxone + gentamicin; high mortality if delayed.

Answer 158

Isolate (droplet precautions), treat with azithromycin (500 mg day 1, 250 mg days 2-5) to reduce infectivity, support with oxygen if needed. Paroxysmal cough, whoop, post-tussive vomiting in unvaccinated. Diagnose with PCR; notify public health.

Answer 159

Silent chest, exhaustion, altered mental status, SpO2 <90% despite oxygen, PaCO2 >45 mmHg (normalizing from hypocapnia). Indicates severe obstruction/fatigue. Intubate urgently; use ketamine (bronchodilator) for induction.

Answer 160

Provide oxygen to maintain SpO2 >94%, aggressive analgesia (e.g., intercostal block, PCA) to optimize breathing, and monitor for deterioration (CXR shows patchy infiltrates). Avoid overhydration; ventilate if ARDS develops.

Answer 161

Laryngeal edema from anaphylaxis or infection (e.g., epiglottitis). Presents with inspiratory stridor, dyspnea. Diagnose with laryngoscopy (if safe); treat with adrenaline (anaphylaxis) or antibiotics/steroids (infection). Secure airway if worsening.

Answer 162

Tracheal deviation to the opposite side, stony dullness, absent breath sounds, dyspnea. CXR shows complete opacification with mediastinal shift. Thoracentesis (diagnostic/therapeutic) relieves pressure; analyze fluid (e.g., Light’s criteria).

Answer 163

Administer hydroxocobalamin (5 g IV over 15 minutes) to bind cyanide into cyanocobalamin, plus 100% oxygen. Alternative: sodium thiosulfate (12.5 g IV). Rapid apnea from cytochrome oxidase inhibition (e.g., smoke inhalation). Monitor in ICU.

Answer 164

Pseudomonas aeruginosa, thrives in thick mucus, causing recurrent infections. Presents with increased sputum, fever, dyspnea. Treat with IV antipseudomonal (e.g., ceftazidime + tobramycin); bronchoscopy if severe. Chronic therapy includes azithromycin.

Answer 165

Suspect in blunt/penetrating trauma with subcutaneous emphysema, pneumomediastinum, persistent pneumothorax. CT chest confirms; urgent bronchoscopy localizes tear. Secure airway (avoid over-pressurizing), surgical repair by thoracic team.

Answer 166

Worsening dyspnea, dry cough, new ground-glass opacities on CT, often triggered by infection or unknown cause. Hypoxia progresses rapidly. Treat with high-dose steroids (methylprednisolone 1 g/day IV x3), oxygen; prognosis poor if idiopathic.

Answer 167

Give IV antibiotics (e.g., piperacillin-tazobactam) based on prior cultures (often Pseudomonas), chest physiotherapy to clear secretions, and oxygen if hypoxic. Chronic dilatation causes purulent sputum, hemoptysis. Admit; consider bronchoscopy if refractory.

Answer 168

Aspiration of anaerobic oral flora (e.g., Peptostreptococcus) in alcoholics, seizure patients. Presents with foul sputum, fever, cavitation on CXR/CT. Treat with clindamycin or amoxicillin-clavulanate; drain if large (>6 cm).

Answer 169

Diffuse bilateral infiltrates, often “whiteout” appearance, from alveolar flooding (e.g., sepsis, trauma). No cardiomegaly or pleural effusions (unlike CHF). PaO2/FiO2 <300 mmHg. Treat with low tidal volume ventilation (6 mL/kg), PEEP.

Answer 170

Administer naloxone (0.4-2 mg IV/IM, titrate q2-3 min) to reverse μ-receptor-mediated apnea. Onset 1-2 minutes; repeat or infuse (2/3 effective dose/hour) for long-acting opioids (e.g., methadone). Support ventilation first; monitor for withdrawal.

Answer 171

Pseudomonas aeruginosa, prevalent in ventilated patients due to biofilm formation. Fever, purulent sputum, new infiltrates after 48 hours. Treat empirically with meropenem or piperacillin-tazobactam; adjust per culture.

Answer 172

Hypotension, tachycardia, elevated JVP, RV heave, with echo showing RV dilation/hypokinesis. ECG may show RBBB, T-wave inversion V1-V4. Massive PE obstructs >30% pulmonary flow. Thrombolyse if unstable; heparin if stable.

Answer 173

Give nebulized adrenaline (5 mL of 1:1000) for rapid vasoconstriction, plus dexamethasone (0.6 mg/kg PO/IM) to reduce inflammation. Monitor airway; intubate if worsening (rare). Parainfluenza drives subglottic edema.

Answer 174

Pneumocystis jirovecii (PCP) in HIV (CD4 <200) or transplant patients. Diffuse interstitial infiltrates, hypoxia, dry cough. Diagnose with induced sputum (silver stain); treat with trimethoprim-sulfamethoxazole + steroids if PaO2 <70 mmHg.

Answer 175

Pleural fluid pH <7.2, glucose <2.2 mmol/L, LDH >1000 IU/L, with loculations on ultrasound/CT. Complicates pneumonia (e.g., S. pneumoniae). Fever, pleuritic pain persist. Drain with chest tube + antibiotics (e.g., ceftriaxone).

Answer 176

Assess for airway burns (soot, stridor—intubate early), give 100% oxygen for CO/cyanide, check COHb/lactate. Bronchoscopy confirms injury (edema, charring); steroids/antibiotics only if infected. Monitor for ARDS.

Answer 177

Asthma, from reversible airway obstruction (allergens, infection). Wheeze, dyspnea, cough; PEF reduced. Treat with salbutamol (nebulized 5 mg), steroids (prednisolone 50 mg). Differentiate from COPD (irreversible, smoking history).

Answer 178

PaCO2 >50 mmHg, confusion, drowsiness, asterixis, from hypoventilation (e.g., COPD, neuromuscular disease). Tachypnea early, then bradypnea. Treat underlying cause; NIV (BiPAP) improves ventilation, avoiding intubation.

Answer 179

High-dose methylprednisolone (1 g/day IV x3) for inflammation, oxygen to maintain SpO2 >90%, supportive care. Rapid dyspnea, ground-glass on CT. Poor prognosis; rule out infection/CHF. Lung transplant may be considered.

Answer 180

Anaerobic bacteria (e.g., Bacteroides) from oral flora in patients with impaired consciousness (e.g., stroke, alcohol). Right lower lobe infiltrate, foul sputum. Treat with amoxicillin-clavulanate; CT if abscess suspected.

Answer 181

Often normal; Westermark sign (oligemia distal to clot), Hampton’s hump (wedge-shaped opacity), or Fleischner sign (enlarged central artery) are rare. CTPA is diagnostic; CXR excludes mimics (e.g., pneumothorax).

Answer 182

Treat with oral prednisone (0.5 mg/kg/day, taper over weeks) for inflammation, itraconazole (200 mg BD) for Aspergillus. Asthma, eosinophilia, IgE >1000 IU/mL, fleeting infiltrates. Monitor lung function, CXR.

Answer 183

Group B Streptococcus (GBS) from maternal colonization, acquired perinatally. Tachypnea, grunting, infiltrates on CXR. Treat with ampicillin + gentamicin; urgent neonatal consult. Differentiate from RDS (preterm, surfactant-deficient).

Answer 184

Hemoptysis (>200 mL/24h), hypoxia, anemia, diffuse infiltrates on CXR, from alveolar bleeding (e.g., vasculitis, trauma). Shock if massive. Intubate, transfuse, urgent bronchoscopy/CT to localize; treat cause (e.g., steroids for Goodpasture’s).

Answer 185

Support with oxygen, azithromycin (500 mg day 1, 250 mg days 2-5) to reduce spread, isolate. Paroxysmal cough exhausts infants; apnea common. Admit high-risk (e.g., <6 months); ECMO rare but life-saving if hypoxic failure.

Answer 186

Trauma (e.g., thoracic surgery, penetrating injury) disrupts thoracic duct, causing milky pleural fluid (triglycerides >110 mg/dL). Dyspnea, no fever. Diagnose with thoracentesis; treat with drainage, low-fat diet, octreotide if persistent.

Answer 187

Wheezing, crackles, tachypnea in <2-year-olds, often RSV-driven. CXR shows hyperinflation, atelectasis. SpO2 <92% guides admission. Supportive care (oxygen, fluids); bronchodilators controversial (trial if severe).

Answer 188

Suspect in blunt neck trauma with hoarseness, stridor, subcutaneous emphysema. CT neck confirms; secure airway (intubation/tracheostomy by ENT), avoid manipulation. Steroids reduce edema; surgical repair if displaced.

Answer 189

Pneumocystis jirovecii (PCP), causing dry cough, hypoxia, interstitial infiltrates. LDH elevated; diagnose with sputum PCR. Treat with trimethoprim-sulfamethoxazole (15-20 mg/kg/day TMP) + prednisone if PaO2 <70 mmHg.

Answer 190

Persistent air leak post-chest tube, bubbling in underwater seal, failure of lung re-expansion. Common post-lung surgery/trauma. CT locates; treat with large-bore tube, suction, surgical closure if large (>5 mm).

Answer 191

Broad-spectrum antibiotics (e.g., ceftriaxone 2 g IV + azithromycin) within 1 hour, fluids (30 mL/kg NS), noradrenaline if MAP <65 mmHg. Source control (e.g., empyema drainage). Monitor lactate, cultures guide de-escalation.

Answer 192

Idiopathic pulmonary arterial hypertension (IPAH), a rare vasculopathy, causes dyspnea, fatigue, RV failure. Echo shows elevated PA pressure (>25 mmHg at rest); RHC confirms. Treat with vasodilators (e.g., sildenafil), oxygen.

Answer 193

Hyperlucency on affected side, mediastinal shift to opposite side, flattened diaphragm, from air trapping under pressure. Tracheal deviation visible late. Immediate decompression critical; CXR delays treatment in extremis.

Answer 194

Suspect in paradoxical inspiratory stridor, normal SpO2, often anxiety-driven. Diagnose with laryngoscopy (adducted cords on inspiration). Calm patient, coach breathing (pursed lips); no role for bronchodilators. Mimics asthma.

Answer 195

Staphylococcus aureus (MSSA/MRSA), a secondary bacterial infection, causes necrotizing pneumonia with hemoptysis, cavitation. Treat with vancomycin or flucloxacillin; high mortality if delayed. CXR shows rapid progression.

Answer 196

PaCO2 <35 mmHg, pH >7.45, dizziness, paresthesia, from hyperventilation (e.g., anxiety, PE). Tachypnea common; treat underlying cause (e.g., oxygen for hypoxia). Rebreathing into a bag rarely needed.

Answer 197

CPAP (10 cmH2O) or BiPAP, inotropes (e.g., dobutamine 5-20 µg/kg/min) for cardiogenic shock, cautious fluids. Nitrates contraindicated if SBP <90 mmHg. Echo guides therapy; urgent PCI if MI-driven.

Answer 198

Intercostal artery injury from rib fractures, causing >1500 mL blood in pleural space. Shock, dullness, absent breath sounds. CXR/ultrasound confirms; chest tube, transfusion, thoracotomy if bleeding >200 mL/hour.

Answer 199

Exudative fluid (Light’s criteria), lymphocytic predominance, ADA >40 U/L, positive AFB smear/culture (low yield). Chronic cough, night sweats. Thoracentesis + pleural biopsy; treat with RIPE (rifampicin, isoniazid, pyrazinamide, ethambutol).

Answer 200

Adrenaline (0.5 mg IM) if allergic, C1 esterase inhibitor or FFP if hereditary, secure airway if stridor (intubation/tracheostomy). Swelling of tongue/larynx; steroids, antihistamines for allergic type. Monitor closely; CT if unclear cause.

Answer 201

Streptococcus pneumoniae, followed by gram-negatives (e.g., E. coli). Aspiration risk high; presents with altered mental status, infiltrates. Treat with ceftriaxone + azithromycin; adjust per cultures, frailty.

Answer 202

Accessory muscle use, cyanosis, SpO2 <88% on air, confusion, indicating ventilatory failure (PaCO2 >50 mmHg). Silent chest rare. NIV if pH <7.35; bronchodilators (salbutamol, ipratropium), steroids (prednisolone 50 mg).

Answer 203

Manage asthma (salbutamol 5 mg neb, hydrocortisone 200 mg IV), observe pneumomediastinum (CXR: air around mediastinum). Rare from alveolar rupture; resolves spontaneously unless tension (subcutaneous emphysema). Avoid positive pressure if possible.

Answer 204

Fluid overload from impaired excretion, raising pulmonary capillary pressure. Dyspnea, crackles, bilateral infiltrates. Treat with dialysis (urgent if refractory), cautious diuresis (furosemide), oxygen. Echo excludes cardiac cause.

Answer 205

Tram-track lines, ring shadows, cystic dilatation, from chronic airway damage (e.g., CF, infections). Sputum copious, purulent. CT confirms; physiotherapy, antibiotics (culture-guided) manage exacerbations.

Answer 206

Early intubation if signs of injury (soot in mouth, hoarse voice, stridor), oxygen, bronchoscopy to assess extent (edema, charring). Steroids controversial; monitor for ARDS, infection. High mortality if delayed.

Answer 207

Mycoplasma pneumoniae, causing walking pneumonia with dry cough, low-grade fever, patchy infiltrates. Diagnose with PCR/serology; treat with azithromycin (500 mg day 1, 250 mg days 2-5). Common in young adults.

Answer 208

Bronchospasm (wheeze), laryngeal edema (stridor), hypoxia, from mast cell degranulation (e.g., peanuts). Hypotension may coexist. Adrenaline IM (0.5 mg), oxygen, fluids; intubate if airway swells.

Answer 209

Prone positioning (16-18 hours/day) improves V/Q matching, ECMO if PaO2/FiO2 <80 mmHg despite max ventilation (TV 6 mL/kg, PEEP). Paralytics (e.g., cisatracurium) reduce O2 demand. ICU; mortality high.

Answer 210

Staphylococcus aureus (often MRSA), from invasive devices. Tachypnea, infiltrates post-48 hours. Treat with vancomycin; culture ETT aspirate. Differentiate from RDS (surfactant-deficient, preterm).

Answer 211

Pleuritic pain, hemoptysis, wedge-shaped opacity on CT (Hampton’s hump rare), from distal PE occlusion. Hypoxia moderate. CTPA confirms; treat with anticoagulation (e.g., heparin), oxygen.

Answer 212

Trimethoprim-sulfamethoxazole (15-20 mg/kg/day TMP IV) for 21 days, prednisone (40 mg BD) if PaO2 <70 mmHg. Hypoxia, dry cough, interstitial infiltrates in HIV (CD4 <200). Sputum PCR; oxygen support critical.

Answer 213

Diaphragmatic weakness (e.g., Guillain-Barré, myasthenia gravis) reduces tidal volume, causing hypercapnia. Fatigue, shallow breathing, PaCO2 >50 mmHg. NIV.

Answer 214

TMP IV for 21 days, prednisone (40 mg BD) if PaO2 <70 mmHg. Hypoxia, dry cough, interstitial infiltrates in HIV (CD4 <200). Sputum PCR; oxygen support critical.

Answer 215

Diaphragmatic weakness (e.g., Guillain-Barré, myasthenia gravis) reduces tidal volume, causing hypercapnia. Fatigue, shallow breathing, PaCO2 >50 mmHg. NIV (BiPAP) supports; intubate if vital capacity <15 mL/kg.

Answer 216

Retractions, nasal flaring, SpO2 <92%, silent chest, inability to feed/speak. PEF <50% predicted if measurable. Salbutamol (2.5-5 mg neb), oxygen, steroids (prednisolone 1 mg/kg); ICU if deteriorating.

Answer 217

Inhaled nitric oxide (20-40 ppm) reduces PA pressure, IV epoprostenol (2-10 ng/kg/min) vasodilates, oxygen to SpO2 >90%. RV failure (JVP, hypotension) drives hypoxia. Echo guides; ECMO bridge to transplant.

Answer 218

Streptococcus pneumoniae, exacerbated by ciliary dysfunction, followed by Haemophilus influenzae. Cough, sputum, infiltrates. Treat with amoxicillin or ceftriaxone; smoking cessation critical. CXR confirms.

Answer 219

Blunted costophrenic angle, meniscus sign, opacity layering on upright film. Large effusions shift mediastinum. Ultrasound quantifies; thoracentesis (e.g., transudate vs. exudate) guides cause (CHF, malignancy).

Answer 220

High-flow oxygen, monitor for pneumothorax/hemothorax (CXR), avoid overhydration (risks edema). Barotrauma causes alveolar rupture, dyspnea, hypoxia. Intubate if ARDS; chest tubes for pneumothorax.

Answer 221

Pneumonia, often S. pneumoniae or gram-negatives, worsened by comorbidities (e.g., COPD). Confusion, hypoxia, infiltrates. Antibiotics (e.g., ceftriaxone), oxygen; NIV if hypercapnic. High mortality.

Answer 222

Coughing with feeds, recurrent pneumonia, air in stomach on CXR, from congenital or traumatic connection. Dyspnea, cyanosis in infants. Endoscopy confirms; surgical repair urgent. Support respiration pre-op.

Answer 223

Adrenaline (0.5 mg IM, repeat q5 min), oxygen, IV fluids (1 L NS), secure airway if stridor (intubation). Bronchospasm, edema drive hypoxia. Antihistamines (cetirizine), steroids (hydrocortisone 200 mg IV) adjunctive; monitor closely.

respiratory Flashcards

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