CSE exam tips
Croup - Answer-IG: Viral infection of the upper airway with a barking cough and often stridor, low grade
fever developed over 2-5 days, rhinorrhea, marked intercostal retractions. X-ray shows pencil point of
the upper airway.
DM: give racemic epi (if you have to give more than 1 be worried) and corticosteroids Decadron
(dexamethasone), along w/ cool aerosol mist. If no improvement with epi suction and intubate. make
sure to listen for a leak around the cuff before you extubate.
neonatal resuscitation - Answer-wipe baby off, put under radiant warmer, if grunting & HR 80 Initiate
CPAP or neopuff if HR decreases to 60 or less initiate compressions and 100% FiO2
-NRP: 1 rescuer 30:2
2 rescuer 15:2
pulmonary edema - Answer-IG: sudden onset with orthopnea, pink frothy secretions, enlarged heart, ST
depress, bilateral fluffy infiltrates on x ray.
DM: give hyperinflation therapy, put in fowler's position. Thoracentesis for infiltrate and fluid.
Medication: Lasix, morphine, and digitalis.
Myocardial Ischemia/infarction - Answer-IG: chest pain and nausea, substernal squeezing pain in left
shoulder, shows elevated ST segment, ST depression T wave inversion on EKG.
IG: Troponin 0.78 (elevated) (> 0.1), CK shows recent MI, pedal edema, character of chest pain,
peripheral pulses, CBC, electrolytes, ECG, if intubated evaluate CXR for tube placement, elevation in
cardiac enzymes
DM: give oxygen for hypoxemia 2L/M BP 80/40 give dopamine, digoxin, Levophed (inotropic drug) to
increase BP. Use Verapamil if BP is high . Sublingual nitroglycerin, O2, aspirin, and morphine. (OMAN)
,ultrasound to determine if mitral valve is blocked
PVC's ---> lidocaine or amiodarone
Guillian-Barre - Answer-IG: pt. comes in with acute weakness in legs, onset of difficulty walking, reduced
lower extremity strength, recent infection
Test: Lumbar puncture if not diagnosed. positive if increase in protein within cerebral spinal fluid
(Tx: plasmapheresis)
IG: ability to swallow, cough effort, sensory and motor function, level of consciousness, and deep tendon
reflexes.
--> closely monitor respiratory muscle strength
(VC,VT, MIP) VC < 1.0 intubate, MIP < -60- -70
DM: continue to monitor MIP and VC if not intubated, refer to physical therapy for evaluation, pressure
stockings
Cystic Fibrosis - Answer-IG: has elevated hemoglobin and hematocrit sweat chloride to diagnose must be
above 60(usually already diagnosed so wont need to do), tenacious yellow-green sputum (infection),
decreased BS, coarse crackles,
IG: Spirometry, sputum culture & sensitivity for infection, 6MWT, CXR (bronchiectasis give antibiotics-
ciprofloxacin)
DM: oral ciprofloxacin (antibiotic), increase frequency of airway clearance therapy.
hemoptysis present give epinephrine
, ivacafort, cayston is medication for CF first being diagnosed
DM: Home care management: bronchodilator, pulmozyme, HFCWO, tobramycin, pancreatic enzymes,
For C.F. adult at college give DPI TOBI instead of Nebulizer.
neonate being delivered - Answer-pick intubation supplies if needed: size 2.5-3.5 ETT, laryngoscope
blades, bag to ventilate suction material, warmer, drying materials (if suction material and tubes already
gathered don't pick again) wipe off and warm under radiant warmer first
-baby ends up having a pneumothorax on left, insert chest tube
otherwise suction, give surfactant, right after birth & 12 hours later if needed. If still showing distress
put on ventilator, PC/SIMV
Asthma - Answer-IG: Personal best PEF establish different zones, adherence to medication regimen,
nocturnal awakenings. Complete education on medications and yellow zone. Add inhaled steroid
(Flovent) for persistent yellow zone.
DM: Asthma exacerbation: albuterol multiple treatments and IV methylprednisone if no improvement
with albuterol
DM: if exercise induced use albuterol 2 puffs prior to exercise. seasonal allergies Singulair and
budesonide/formoterol (Symbicort) complete allergen testing, vacuum, wash sheets, change filters
COPD - Answer-IG: Diffuse crackles & wheezing, bronchospasm, progressive dyspnea, SOB,
ABG: 50-50 club PaCO2 & PaO2- normal pH, hyperinflation
DM: first give: 24-28% (1-2L) O2
IG: FEV1 Pre and post 12-15% difference, Lung volumes, DLCO, O2 titration during exercise, 6MWT, CXR,
PFT (not acute) , for infection do sputum C&S, chemistry panel, ECG if pedal edema present
Croup - Answer-IG: Viral infection of the upper airway with a barking cough and often stridor, low grade
fever developed over 2-5 days, rhinorrhea, marked intercostal retractions. X-ray shows pencil point of
the upper airway.
DM: give racemic epi (if you have to give more than 1 be worried) and corticosteroids Decadron
(dexamethasone), along w/ cool aerosol mist. If no improvement with epi suction and intubate. make
sure to listen for a leak around the cuff before you extubate.
neonatal resuscitation - Answer-wipe baby off, put under radiant warmer, if grunting & HR 80 Initiate
CPAP or neopuff if HR decreases to 60 or less initiate compressions and 100% FiO2
-NRP: 1 rescuer 30:2
2 rescuer 15:2
pulmonary edema - Answer-IG: sudden onset with orthopnea, pink frothy secretions, enlarged heart, ST
depress, bilateral fluffy infiltrates on x ray.
DM: give hyperinflation therapy, put in fowler's position. Thoracentesis for infiltrate and fluid.
Medication: Lasix, morphine, and digitalis.
Myocardial Ischemia/infarction - Answer-IG: chest pain and nausea, substernal squeezing pain in left
shoulder, shows elevated ST segment, ST depression T wave inversion on EKG.
IG: Troponin 0.78 (elevated) (> 0.1), CK shows recent MI, pedal edema, character of chest pain,
peripheral pulses, CBC, electrolytes, ECG, if intubated evaluate CXR for tube placement, elevation in
cardiac enzymes
DM: give oxygen for hypoxemia 2L/M BP 80/40 give dopamine, digoxin, Levophed (inotropic drug) to
increase BP. Use Verapamil if BP is high . Sublingual nitroglycerin, O2, aspirin, and morphine. (OMAN)
,ultrasound to determine if mitral valve is blocked
PVC's ---> lidocaine or amiodarone
Guillian-Barre - Answer-IG: pt. comes in with acute weakness in legs, onset of difficulty walking, reduced
lower extremity strength, recent infection
Test: Lumbar puncture if not diagnosed. positive if increase in protein within cerebral spinal fluid
(Tx: plasmapheresis)
IG: ability to swallow, cough effort, sensory and motor function, level of consciousness, and deep tendon
reflexes.
--> closely monitor respiratory muscle strength
(VC,VT, MIP) VC < 1.0 intubate, MIP < -60- -70
DM: continue to monitor MIP and VC if not intubated, refer to physical therapy for evaluation, pressure
stockings
Cystic Fibrosis - Answer-IG: has elevated hemoglobin and hematocrit sweat chloride to diagnose must be
above 60(usually already diagnosed so wont need to do), tenacious yellow-green sputum (infection),
decreased BS, coarse crackles,
IG: Spirometry, sputum culture & sensitivity for infection, 6MWT, CXR (bronchiectasis give antibiotics-
ciprofloxacin)
DM: oral ciprofloxacin (antibiotic), increase frequency of airway clearance therapy.
hemoptysis present give epinephrine
, ivacafort, cayston is medication for CF first being diagnosed
DM: Home care management: bronchodilator, pulmozyme, HFCWO, tobramycin, pancreatic enzymes,
For C.F. adult at college give DPI TOBI instead of Nebulizer.
neonate being delivered - Answer-pick intubation supplies if needed: size 2.5-3.5 ETT, laryngoscope
blades, bag to ventilate suction material, warmer, drying materials (if suction material and tubes already
gathered don't pick again) wipe off and warm under radiant warmer first
-baby ends up having a pneumothorax on left, insert chest tube
otherwise suction, give surfactant, right after birth & 12 hours later if needed. If still showing distress
put on ventilator, PC/SIMV
Asthma - Answer-IG: Personal best PEF establish different zones, adherence to medication regimen,
nocturnal awakenings. Complete education on medications and yellow zone. Add inhaled steroid
(Flovent) for persistent yellow zone.
DM: Asthma exacerbation: albuterol multiple treatments and IV methylprednisone if no improvement
with albuterol
DM: if exercise induced use albuterol 2 puffs prior to exercise. seasonal allergies Singulair and
budesonide/formoterol (Symbicort) complete allergen testing, vacuum, wash sheets, change filters
COPD - Answer-IG: Diffuse crackles & wheezing, bronchospasm, progressive dyspnea, SOB,
ABG: 50-50 club PaCO2 & PaO2- normal pH, hyperinflation
DM: first give: 24-28% (1-2L) O2
IG: FEV1 Pre and post 12-15% difference, Lung volumes, DLCO, O2 titration during exercise, 6MWT, CXR,
PFT (not acute) , for infection do sputum C&S, chemistry panel, ECG if pedal edema present
