Pulmonary Rosh Review
A 4-year-old is brought to the emergency department by his parents after they found
him in the backyard shed choking and gagging. Before this event, he was otherwise
healthy. His temperature is 101°F, heart rate is 95, blood pressure is 100/60, and
respiratory rate 40. On exam, he appears sleepy but continues to cough. Pulmonary
findings include moderate retractions and diffuse wheezes. A chest X-ray shows patchy
infiltrates. What is the most likely diagnosis? - ANS-Hydrocarbon ingestion
A 64-year-old man presents with a headache and cough for the past week. Physical
exam shows facial edema, facial plethora, and prominent venous distention of the
chest. His history is significant for lung cancer. what is the most likely diagnosis -
ANS-SVC syndrome
Are solitary lung nodules usually benign or malignant? - ANS-benign
atypical pneumonia associated with contaminated water sources and sx of non-bloody
diarrhea - ANS-legionella
best initial test to confirm the presence of a PE - ANS-helical CT angiography
bibasilar crackles on auscultation
calcifications in the lower lobes
honeycombing and ground glass appearance
decreased lung volume
h/o work on old buildings, old insulation, ship building - ANS-asbestosis
blood-tinged (rusty) sputum pneumonia - ANS-strep pneumo
carcinoid syndrome associated with bronchial carcinoid tumors - ANS-periodic episodes
of diarrhea, flushing, tachycardia, and bronchoconstriction
causative organism typical bacterial pneumonia - ANS-Most commonly caused by Strep
pneumo
common bacterial pneumonia in extremes of age, immunocompromised, and those with
underlying pulmonary dz - ANS-H flu
common causes of hospital-acquired pneumonia - ANS-staph aureus
, pseudomonas
MRSA
Common factors that precipitate COPD exacerbations - ANS-viral upper respiratory
infections (such as rhinovirus infection)
bacterial infections
excessive exposure to smoke or smog
inadequate use of medications that control COPD symptoms
CT of pneumoconiosis - ANS-small, round opacities which denote inflammatory areas of
dust-laden macrophages and fibrosis,
CURB65 criteria - ANS-admission if at least 2:
Confusion
Uremia
Respiratory rate >30
BP <90
age > 65
CXR of pneumoconiosis - ANS-small cystic radiolucencies described as honeycombing
CXR of typical bacterial pneumonia - ANS-interstitial infiltrates and lobar opacity
definitive management of bronchial carcinoid tumors - ANS-surgical excision
Describe sx of typical bacterial pneumonia - ANS-Sx onset is acute and severe
productive cough
May follow URI or flu
fever
dyspnea
fatigue
diagnosis of ARDS - ANS-- severe hypoxemia that is refractory to supplemental O2
- bilateral diffuse pulmonary infiltrates that SPARE THE COSTOPHRENIC ANGLES
- normal LA pressure
diagnostic gold standard for pleural effusion - ANS-thoracentesis
also therapeutic
A 4-year-old is brought to the emergency department by his parents after they found
him in the backyard shed choking and gagging. Before this event, he was otherwise
healthy. His temperature is 101°F, heart rate is 95, blood pressure is 100/60, and
respiratory rate 40. On exam, he appears sleepy but continues to cough. Pulmonary
findings include moderate retractions and diffuse wheezes. A chest X-ray shows patchy
infiltrates. What is the most likely diagnosis? - ANS-Hydrocarbon ingestion
A 64-year-old man presents with a headache and cough for the past week. Physical
exam shows facial edema, facial plethora, and prominent venous distention of the
chest. His history is significant for lung cancer. what is the most likely diagnosis -
ANS-SVC syndrome
Are solitary lung nodules usually benign or malignant? - ANS-benign
atypical pneumonia associated with contaminated water sources and sx of non-bloody
diarrhea - ANS-legionella
best initial test to confirm the presence of a PE - ANS-helical CT angiography
bibasilar crackles on auscultation
calcifications in the lower lobes
honeycombing and ground glass appearance
decreased lung volume
h/o work on old buildings, old insulation, ship building - ANS-asbestosis
blood-tinged (rusty) sputum pneumonia - ANS-strep pneumo
carcinoid syndrome associated with bronchial carcinoid tumors - ANS-periodic episodes
of diarrhea, flushing, tachycardia, and bronchoconstriction
causative organism typical bacterial pneumonia - ANS-Most commonly caused by Strep
pneumo
common bacterial pneumonia in extremes of age, immunocompromised, and those with
underlying pulmonary dz - ANS-H flu
common causes of hospital-acquired pneumonia - ANS-staph aureus
, pseudomonas
MRSA
Common factors that precipitate COPD exacerbations - ANS-viral upper respiratory
infections (such as rhinovirus infection)
bacterial infections
excessive exposure to smoke or smog
inadequate use of medications that control COPD symptoms
CT of pneumoconiosis - ANS-small, round opacities which denote inflammatory areas of
dust-laden macrophages and fibrosis,
CURB65 criteria - ANS-admission if at least 2:
Confusion
Uremia
Respiratory rate >30
BP <90
age > 65
CXR of pneumoconiosis - ANS-small cystic radiolucencies described as honeycombing
CXR of typical bacterial pneumonia - ANS-interstitial infiltrates and lobar opacity
definitive management of bronchial carcinoid tumors - ANS-surgical excision
Describe sx of typical bacterial pneumonia - ANS-Sx onset is acute and severe
productive cough
May follow URI or flu
fever
dyspnea
fatigue
diagnosis of ARDS - ANS-- severe hypoxemia that is refractory to supplemental O2
- bilateral diffuse pulmonary infiltrates that SPARE THE COSTOPHRENIC ANGLES
- normal LA pressure
diagnostic gold standard for pleural effusion - ANS-thoracentesis
also therapeutic
