Pulmonary / Critical Care Exam questions and
answers
UWORLD
Histoplasma - ✅✅-prevalent in central , midwest and northwest US
-exposed to bird or bat droppings
-subacute pulmonary illness with high dose exposure.
Pt: fever, dry cough, fatigue for 2 weeks. from Arizona and explores caves. Biopsy shoes granuloma w/
yeast forms. CXR: hilar lymphadenopathy.
UWORLD
Physiologic shunt 2/2 Acute Pneumonia - ✅✅- early phases = consolidation
-persistent BF w/ impaired ventilation. -- V/Q mis match
-leads to physiologic intrapulmonary shunting.
-R -- L shunt and hypoxemia
-ventilation and perfusion is greatest at the lung bases
-Positioning the pt on side of consolidation can worsen the shunt
UWORLD
Exudate vs Transudate - ✅✅pH < 7.2 --> Empyea (needs chest tube drainage)
Transudate 7.4-7.55
Exudate 7.3-7.45
(due to higher LDK content)
,UWORLD
Post-ictal respiratory acidosis - ✅✅Due to hypoventilation
UWORLD
Spontaneous subconjunctival hemorrhage - ✅✅Pt wakes up with red eye
No itching, pain, discharge, fever
NKA
No meds
Tx: observation
UWORLD
Nasal Polyps - ✅✅Often associated w/ chronic rhinosinusitis asthma, and *aspirin, or NSAID induced
bronchospasm*
-bland tatsing food (2/2 anosmia)
-recurrent nasal discharge/congestion
-b/l glistening grey, mucoid masses in nares
Allergic Rhinitis - ✅✅Cobblestone pharynx
Tx: IGC
UWORLD
,Exertional heat stroke - ✅✅Other wise healthy individuals undergoing conditioning in extreme heat
and humidity
-Fever> 105 --> rhabdomyalsis and end organ dmg
-AMS
-hypotension
-tachycardia
-tachypnea
This is due to inadequate/failure of thermoregulation
Thermoregulatory center fails to diddipate the heat quickly enough
Contrast to heat exhaustion
-NO CNS findings
-Due to failure to replace fluids & electrolytes
UWORLD
Ventilator settings - ✅✅Things to adjust:
1) FiO2
-increase until up to 60%, but anything after that, PEEP should be adjusted to not risk O2 poisoning
2) PEEP
-5 cm H2O is baseline, adjust along with FiO2
-maintain normal pressure plateau as to reduce the risk of barotrauma
UWORLD
, Acute respiratory distress syndrome - ✅✅May be caused by acute pancreatitis --> *phospholipase
A2* can cross pulm capillaries and damage the alveoli + remove surfactant leading to alveolar collapse.
Use the P/F ratio: < 300 --> ARDS
Resp distress
Diffuse crackles on lung exam
Severe hypoxemiaB/l alveolar infiltrates
CXR: White-out
Tx:
Prevent sp O2 < 88% peripherally
AVOID ALVEOLAR OVERDISTENSION due to lack of compliance.
Low tidal volume, but high peep to kee palveoli open, but not to stretch them too much
Evaluation of subacute (3-8 weeks) or chronic (>8 weeks) cough - ✅✅Post-nasal drip (dry cough) -->
anti-histamine [decreases nasal secretions] or a pseudophedrine
GERD, asthma, and post nasal drip are the three MCC chronic cough (> 8 weeks)
UWORLD
Manifestations of sarcoidosis - ✅✅Dry cough
CXR: Bilateral hilar adenopathy
UWORLD
answers
UWORLD
Histoplasma - ✅✅-prevalent in central , midwest and northwest US
-exposed to bird or bat droppings
-subacute pulmonary illness with high dose exposure.
Pt: fever, dry cough, fatigue for 2 weeks. from Arizona and explores caves. Biopsy shoes granuloma w/
yeast forms. CXR: hilar lymphadenopathy.
UWORLD
Physiologic shunt 2/2 Acute Pneumonia - ✅✅- early phases = consolidation
-persistent BF w/ impaired ventilation. -- V/Q mis match
-leads to physiologic intrapulmonary shunting.
-R -- L shunt and hypoxemia
-ventilation and perfusion is greatest at the lung bases
-Positioning the pt on side of consolidation can worsen the shunt
UWORLD
Exudate vs Transudate - ✅✅pH < 7.2 --> Empyea (needs chest tube drainage)
Transudate 7.4-7.55
Exudate 7.3-7.45
(due to higher LDK content)
,UWORLD
Post-ictal respiratory acidosis - ✅✅Due to hypoventilation
UWORLD
Spontaneous subconjunctival hemorrhage - ✅✅Pt wakes up with red eye
No itching, pain, discharge, fever
NKA
No meds
Tx: observation
UWORLD
Nasal Polyps - ✅✅Often associated w/ chronic rhinosinusitis asthma, and *aspirin, or NSAID induced
bronchospasm*
-bland tatsing food (2/2 anosmia)
-recurrent nasal discharge/congestion
-b/l glistening grey, mucoid masses in nares
Allergic Rhinitis - ✅✅Cobblestone pharynx
Tx: IGC
UWORLD
,Exertional heat stroke - ✅✅Other wise healthy individuals undergoing conditioning in extreme heat
and humidity
-Fever> 105 --> rhabdomyalsis and end organ dmg
-AMS
-hypotension
-tachycardia
-tachypnea
This is due to inadequate/failure of thermoregulation
Thermoregulatory center fails to diddipate the heat quickly enough
Contrast to heat exhaustion
-NO CNS findings
-Due to failure to replace fluids & electrolytes
UWORLD
Ventilator settings - ✅✅Things to adjust:
1) FiO2
-increase until up to 60%, but anything after that, PEEP should be adjusted to not risk O2 poisoning
2) PEEP
-5 cm H2O is baseline, adjust along with FiO2
-maintain normal pressure plateau as to reduce the risk of barotrauma
UWORLD
, Acute respiratory distress syndrome - ✅✅May be caused by acute pancreatitis --> *phospholipase
A2* can cross pulm capillaries and damage the alveoli + remove surfactant leading to alveolar collapse.
Use the P/F ratio: < 300 --> ARDS
Resp distress
Diffuse crackles on lung exam
Severe hypoxemiaB/l alveolar infiltrates
CXR: White-out
Tx:
Prevent sp O2 < 88% peripherally
AVOID ALVEOLAR OVERDISTENSION due to lack of compliance.
Low tidal volume, but high peep to kee palveoli open, but not to stretch them too much
Evaluation of subacute (3-8 weeks) or chronic (>8 weeks) cough - ✅✅Post-nasal drip (dry cough) -->
anti-histamine [decreases nasal secretions] or a pseudophedrine
GERD, asthma, and post nasal drip are the three MCC chronic cough (> 8 weeks)
UWORLD
Manifestations of sarcoidosis - ✅✅Dry cough
CXR: Bilateral hilar adenopathy
UWORLD
