Step 2 ck pulmo

kafopaci2016's version from 2016-05-28 00:10

Section 1

Question Answer
sudden onset arthropathy+clubbing=HOA (hypertrophic osteoarthopathy)
underlying disease in HOA includeslung cancer, tuberculosis, bronchiectasis, emphysema
best initial test to identify underlying cause of HOACXR
the goal INR in idiopathic VTE is 2.0-3.0
the goal INR in pt with prosthetic heart valve is 2.5-3.5
possible cause of thiophyllin toxicity ? why?illnesses( liver cirrhosis,rest infection with fever, cholestasis) drugs(cimetidine,ciprofloxacin,erythromycin,clarithromycin,verapamil) . cuz they inhibit cytochrome oxidase system in the liver
pt given high dose b2 agonist (asthma) developed tremor weakness and arrhythmia , you do ?sr.electrlytes to check hypOkalemia
pt with pneumonia lying on his rt side o2 sat drops when lying on lt side why?Increase physiologic shunting
indicators of sever asthma attacknormal PCo2
txt of acute bacterial rhinosinusitis ?oral amoxicillin-clavulanic acid

Section 2

Question Answer
pt with hypovolemic shock 1st you do ? 2nd ? why?1st: volume resuscitation 2nd:+ve pressure mechanical ventilation. to avoid circulatory collapse
most common post operative complication is atelectasis
ABG in post operative atelectasishypoxemia , hypocapnea , resp alkalosis
prevention of postoperative pulmonary complications by:breathing exercises: incentive spirometry , forced expiration techniques .
pt with sever blunt chest truma and hypoxemia worsens by IV fluid is due to pulmonary contusions
CXR findings of pulmonary contusionsalveolar opacities
pt with suspected lung cancer initial evaluation is CXR
antibiotics could be given in acute exacerbation of COPD macrolides or flourquinilones or penicillins/beta lactamase inhibitors
in Restrictive lung diseasediffusion lung capacity will be decreased
normal plural fluid PH is 7.60
Transudate plural fluid PH is VS Exudate plural fluid PH isTransudate (7.4-7.55) Exudate(7.30-7.45)
causes of transudate plural effusion increase hydrostatic pressure, hypoalbuminemia
causes of exudative plural effusion inflammation
plural fluid PH <7.30 assoc withempyema, pluritis, tumor, plural fibrosis
in both transudate and exudate plural effusion fluid glucose concentration issimilar to blood glucose concentration
if plural fluid glucose concentration is <60mg/dl its assoc with parapneumonic effusion, malignancy,tuberculosis,RA (plural fluid/sr glucose ratio will be <0.5)
high plural fluid amylase is ascot with panceriaitis assoo effusion or esophageal rupture (saliva)
sarcoidosis is chronic granulomatous inflammation
what kind of granuloma in sarcoidosis and what skin assoc with it ?non caveating granuloma . assoc with erythema nodosum
pt with colon ca present with S/S of PE develop syncope+hypotension+high JVP due to ?right ventricular dysfunction
new onset blood tinged sputum in pt with acute bronchitis stepobservation & follow up

Section 3

Question Answer
alveoler hypoventilation VS atelectasisalveoler hypoventilation( resp acidosis + normal A-a gradient) atelectasis (resp alkalosis+high A-a gradient)
most common cell type in lung cancer in both smoker and non smoker isadenocarcinoma
in pneumonia the mechanism responsible for hypoxemia is Vent/Perfusion mismatch=increased A-a gradient
fever induce hyper dynamic state leads to which kind of murmursoft crescendo/decresendo systolic murmur
ARDS causes hypoxemia refractory to high Fio2 next you do:add PEEP
pt with ankylosing spondylitis the explanation of PFTs is chest wall motion restriction
pt with ankylosing spondylitis with +ve serology forHLA-B27
extrarticuler features of ankylosing spondylitis are:anterior units, IBD, cardiac involvement with(aortic regurge)
pt with chronic cough on ACEIs you do 1st then 2nddiscontinue drug should precede any testing
in COPDCh bronchitis VS emphysema 1-DLCO: normal in ch.brnochitis vs decreased in emphysema. 2-CXR: prominent bronchovasculer marking in ch.Bronchitis vs decreased vascular marking in emphysema

Section 4

Question Answer
bronchoalveolar lavage is useful in evaluation for opportunistic infections (PCP in AIDS pt) and suspected malignancy
exudative plural effusion+plural fluid acidosis(PH<7.20)+low plural fluid glucose(<60mg/dl) seen in pt with:complicated parapneumonic effusion, rheumatoid plurisy, drug induced lupus, tuberculosis.malignancy
postoperative pt. what can increase her lungs functional residual capacity FRCelevation of the bed of the head. increasing FRC prevent postoperative atelactasisi
sq cell carcinoma of the lung assoc withsca+++mous= Hypercalcemia due to PTHrp, hilar mass, in smoker pt,
squamous call ca VS small cell carcinomaSq(PTHrp->hi calcium) vs Small(paraneoplastic->ACTH & SIADH)
idiopathic pulmonary fibrosisincreased A-a gradient, decreased DLCO,
cough assoc with ACEIs cuz ofhigh kinin level due to its accumulation as a result of arachidonic acid pathway activation
P.jiroveci in CXR bilateral defuse interstitial infiltrates beginning in the perihilar region
aspiration pneumonia in pt with dementia,impaired consciousness,neurologic disorder. is due to impaired epiglottic reflex
what are mediastinal lesions based on location?ant?middle?post?ant:thymoma (middle:bronchogenic cyst) post:neurologic tumors
to prevent upper airway oust by edema in burn its you do next:endotracheal intubation
ABG of pt with obesity hypoventilation syndromechronic elevated Paco2 and reduced Pao2
aspiration pneumonitis vs aspiration pneumoniapneumonitis:chemical injury by acidic secretions vs pneumonia:infected oropharyngeal secretions
chronic cough thats predominantly nocturnal should be evaluated with PFTs ( spirometry to asses bronchodilator response)
pt with hx of coronary artery disease who developed hypoxia after IV fluid .the following (hypoxemia corrected with moderate flow o2??, A- gradient, lung compliance)?yes it will be corrected , high gradient , low compliance
decompensated heart failure given IV fluid developed hypoxia due topulmonary edema-> VQ mismatch->increase A-a gradient . excess fluid->reduce lung compliance by preventing alveoli from full expansion
how do you correct hypoxemia,vq mismatch and A-a gradient in pt with decompansated HF who developed dyspnea after IV fluidsupplemental oxygen
young pt with(chronic dyspnea on exertion,decreased breath sounds,slight LFTs abnormalities, family hx of cirrhosis )evaluate forAAT(alpha 1 antitrypsin difcency )
think of ?? in pt with COPD at your age<45,COPD with minimal or no hx of smoking, family hx of emphysema or liver diseasealpha 1 anti trypsin dificency
in plural effusion tactile frets will bedecreased
pt with advanced COPD given high flow oxygen mask developed tonic-clonic seizures why?carbon dioxide retention->cerebral VD-> seizures .
pt with obesity hypoventilation syndrome. cause of her condition isnocturnal hypoventilation
newborn with irregular respirations and HR:80bpm+ central you dobaby requires PEEP
PT<45 WITH S/S of COPD and CXR:bilateral basilar think of AAT (ALPHA1 ANTI TRIPSIN )
THE GOLD STANDARD TO DIAGNOSE OSA isnocturnal polysomnography
laryngomalacea VS vascular ring inspiratory stridor worse in supine position vs Biphasic stridor improves with neck extension
to dx laryngomalacialaryngoscopy
to Dx vascular ringbarium swallow followed by MRI angiography
vascular ring isanomalous branch of aortic arch encircles the trachea and esophagus
pt with syncope and shock pul artery cath:hi RT atrial and pull artery pressure with normal PCWP .DX ispulmonary embolism