Pulm

Question 1

Pertusiss on XR and abx choice

Answer 1

• Peribronchial thickening, atelectasis or pulmonary consolidation
• Azithromycin

Question 2

Persistent cough with negative CXR

Answer 2

Bronchitis, likely viral - symptomatic treatment

Question 3

Lung abscess presentation

Answer 3

Several weeks of cough, fever, pleuritic chest pain, weight loss, and night sweats
(progression of lung abscess is indolent: tachycardia, tachypnea, or fever may be absent)
CXR: area of dense consolidation with air-fluid level inside thick-walled cavitary lesion

Question 4

Induction agent preferred in asthma patients?

Answer 4

Ketamine - causes bronchodilation

Question 5

Lights criteria

Answer 5

PF/serum protein >0.5
PF/serum LDH >0.6
PF LDH >0.66 (2/3 upper limit of normal)

Question 6

air gas embolism

Answer 6

Rapid and immediate ascent- deep/frequent exhalation preventative
Sudden LOC on surfacing <10m
100% O2 via NC, IVF, hyperbaric chamber

Question 7

TB treatment in pregnant patient

Answer 7

Rifampin, pyrazinamide, ethambutol

Question 8

TACO vs TRALI

Answer 8

TRALI will have fever

Question 9

TRALI

Answer 9

Hypoxemia
pulmonary infiltrates within 6h of blood transfusion
Hypotension, tachycardia, fever

Question 10

Time frame of anaphylaxis and cause in blood transfusion

Answer 10

Minutes

IgA antibodies in IgA deficient patients

Question 11

Bug that requires double abx coverage in CF patients

Answer 11

Pseudomonas

Question 12

Dx fat embolism

Answer 12

Clinical dx (not often seen on imaging)
Hypoxemia, neuro changes, petechial rash

Question 13

Treat pulmonary contusion

Answer 13

Seen as edema on XR after blunt injury
Opacification within 6hrs is diagnostic
Pain control

Question 14

Aspiration

Answer 14

Upright: Rt lower lobe
Supine: superior rt lower or posterior rt upper lobe

Question 15

Pulmonary effects of bipap

Answer 15

Increased: FRC, alveolar surface area, oxygen diffusion, tidal volume
Decreased: venous return, after load

Question 16

CO2 value on capnography that indicates adequate compressions

Answer 16

> 10

Question 17

Only FDA approved drug for hiccups

Answer 17

Chlorpromazine (Thorazine); reglan and haldol also help

Question 18

Abx for uncomplicated pna with no comorbidities

Answer 18

Zpack or doxy or amoxicillin

Question 19

Abx CAP with comorbidities

Answer 19

Levofloxacin (5days) or augmentin plus azithro

Question 20

Abx inpatient CAP non-ICU

Answer 20

Levofloxacin or rocephin + azithro

Question 21

Abx CAP ICU

Answer 21

Rocephin + levaquin; vanc if MRSA suspected

Question 22

Abx HCAP inpatient

Answer 22

Double pseudomonas coverage: levaquin + cefepime or zosyn

Add vanc or linezolid for MRSA

Question 23

Abx empyema

Answer 23

Zosyn add vanc for MRSA or
Cephalosporin + flagyl
(All 3 for hospital acquired)

Question 24

Abx lung abscess

Answer 24

Clinda + rocephin

Question 25

Abx for aspiration pna

Answer 25

Levaquin + clinda

Question 26

Usual location of infiltrates in reactivation TB

Answer 26

Upper lobes

Question 27

Gold standard to diagnose TB

Answer 27

Sputum culture

Question 28

Ketamine dose for asthma/COPD

Answer 28

Bolus of 0.2 mg/kg + infusion 0.5 mg/kg/hr

Question 29

Dx of empyema

Answer 29

Bacteria present on gram stain | Will typically have elevated WBC and decreased glucose

Question 30

Causes of pulmonary cavitary lesions

Answer 30

Bacterial pna, fungal disease, TB, cancer, recent viral infection

Question 31

Pancoast tumor

Answer 31

Peripheral lung tumor | Horners syndrome

Question 32

Vent settings in acute pulm pathology

Answer 32

TV: 6-8ml/kg ideal body weight (~45 in women, ~60 men) PEEP: 5-10 RR: 10-12

Question 33

Decrease pCO2 on vent

Answer 33

Increase RR or TV

Question 34

Elevated peak pressure to plateau pressure

Answer 34

Increased resistance: mucous, obstruction, dislodged, bronchoconstriction

Question 35

Low peak pressure to plateau pressure

Answer 35

Poor compliance: ARDS, volume overload, pneumothorax

Question 36

Pulmonary hypertension dx

Answer 36

MAP >25