Pulm

Question 1

Definitive treatment for chronic pulmonary aspiration

Answer 1

Layngotrachael separation

• TE from upper trachea to esophagus
• Proximal trachael is blind pouch
• Tracheostomy to mid-distal trachea

GT = will NOT prevent aspiration from reflux or salivary aspiration

Question 2

Recurrent Pneumonia

Answer 2

2 or more episodes in 1 year
3 or more lifetime episodes with radiographic clearance

DDX:
H-type TEF
CPAM - would be shown on imaging
CGD - recurrent infections, X-linked, neutrophil oxidative burst test
CF - malabsorption, bronchiectasis (not lobar PNA), sweat test
primary ciliary dyskinesia - chronic purulent rhinitis with recurrent infections.

Question 3

Hereditary Hemorrhagic Telangiectasia

Osler-Weber-Rendu syndrome

Answer 3

• Autosomal Dom
• Recurrent epistaxis (esp night) or other bleeding
• Vascular malformations in lungs, CNS, Liver, GI
  (can lead to PULM HEMORRHAGE)
• Telangiectasias on lips, oral cavity, palms, fingers, nails, soles, ears

Question 4

Cystic Fibrosis

Answer 4

Chronic sinopulmonary disease

• normal lungs at birth then infection, inflammation, obstruction of airways leads to chronic bronchitis and bronchiectasis
• barrel chest, clubbing, nasal polyps

Pancreatic insufficiency, FTT
- no ADEK vitamins

Salt loss syndromes

Infertility
- agenesis of vas deferences or women with abnormalities in cervical mucus

Mean onset at 20 yrs

Question 5

How to diagnose CF?

Answer 5

Sweat chloride testing

• Need to confirm if newborn screen is positive.
• NOT genetic testing.

Question 6

Croup XR

Answer 6

Steeple sign

- loss of the normal shoulders of the subglottic airway

Question 7

Lymphocytic Interstitial Pneumonitis (LIP) - who is it seen in?

Answer 7

Homogenous chronic ground glass opacities

Seen in HIV pts

Question 8

Blastomycosis vs. Histoplasmosis vs. Coccidiodomycosis

Answer 8

Blasto

• central, southEAST, mid-atlantic states
• wooded sites - farmers, forestry workers, hunters, campers
• Budding yeast - single, broad based budding
• itraconazole
• disseminates to the skin

HIsto

• midwest, mississippi and ohio river valleys
• bat and bird droppings
• itraconazole

Coccidio

• southWEST- “valley fever” - deserts
• presents with erythema multiforme, erythema nodosum, lung cavities
• fluconazole

Question 9

What is associated with vocal cord paralysis?

Answer 9

Difficult breach delivery

- vocal cord paralysis may occur due to injury of the recurrent laryngeal nerve

Question 10

Vit ADEK deficiencies cause…

Answer 10

Night blindness is an early manifestation of vitamin A deficiency. Impaired immunity and hematopoiesis can occur in addition to the ocular changes.

Vitamin D deficiency is associated with impaired bone mineralization, which is associated with rickets in children and osteomalacia and osteoporosis in adults.

Vitamin E deficiency can cause hemolytic anemia and neurologic deficits.

Vitamin K deficiency can manifest as easy bruising and/or bleeding.

Question 11

Alpha 1 antitrypsin in children

Answer 11

Liver disease in children and adults
Lung disease is ONLY in adulthood.

Children get liver fibrosis and cirrhosis.
Whereas pulm is in 4th and 5th decades of life.

Question 12

Expected respiratory compensation for given degree of metabolic acidosis

Answer 12

Winter’s Formula

pCO2 = (1.5 * HCO3 + 8) +/- 2

If it’s lower, its a primary disorder

Question 13

Tx of epiglottitis

Answer 13

Stabilize Airway - AKA 100% O2 until expert help arrives.

Question 14

How to estimate CO in a pt with cardiogenic shock?

Answer 14

Measure mixed venous O2 saturation from an internal jugular venous catheter (central catheter)

Bc arterial oxygen content can be obtained from pulse ox.

Oxygen delivery = Arterial oxygen content × Cardiac output

Cardiac output = Stroke volume × Heart rate

Oxygen content = (1.34 × hemoglobin concentration × % oxygen saturation) + 0.003 × PO2

Oxygen consumption = Cardiac output × (arterial oxygen content - mixed venous oxygen content)

Oxygen consumption is a constant in pts who are like not moving and shit.