Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
94 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
These patients are at high risk for vent failure
|
VC>20ml/kg; NIF <30 cm H20; declining values
(NIF = negative inspiratory force) |
|
|
|
Best method to predict in-flight hypoxemia in COPD patients |
HAST or hypoxia altitude simulation test (patient breathes a hypoxic gas x 20mins) |
|
|
|
How to interpret the HAST? |
PaO2 <50, give in-flight O2; PaO2 >55, no supplemental O2; 50-55 borderling; measure HAST during activity. |
|
|
|
Mechanism of alpha-1 antitrysin (AAT) disease
|
AAT is antiproteolytic enzyme; it neutralizes neutrophil elastase, deficiency results in excessive amounts of neutrophil elastase --> destruction of elastin --> early COPD (panacinar emphysema with basilar predominance). Suspect this condition in patients with COPD and age of 45 or younger/Non-smokers and with possible chronic liver disease.
|
|
|
|
Diagnostic test for CF; hallmarks of CF? |
Sweat chloride testing; bronchiectasis, purulent sputum |
|
|
|
Initial treatment of anaphylaxis
|
IM or SQ epinephrine + inhaled albuterol |
|
|
|
Young woman with dyspnea; CXR shows hyperinflation; comes with spontaneous pneumothorax and/or chylothorax, what diagnosis to consider? |
Lymphangioleiomyomatosis (LAM) |
|
|
|
Pathophysiology of LAM or lymphangioleiomyomatosis |
Smooth muscle cells that infiltrate the lung with inactivating tuberous sclerosis complex gene mutations resulting in constitutive activation of the mammalian target of rapamycin (mTOR) signaling pathway. |
|
|
|
Characteristic high res CT abnormalities seen in RB-ILD (respiratory bronchiolitis–associated ILD) |
Centrilobular nodules with air-trapping and scattered ground-glass attenuation |
|
|
|
Lesions located in the anterior mediastinum |
-Thyroid tumors -Thymic tumors -Lymphomas |
|
|
|
Tumors in the middle mediastinum |
-Bronchogenic cysts -Pericardial cysts -LAD |
|
|
|
When is pulmonary rehabilitation indicated? |
Symptomatic patients with FEV1 < 50% |
|
|
|
Most patients require a tissue diagnosis, but there are some exceptions that do not warrant histologic confirmation such as: |
-Löfgren syndrome (fever, erythema nodosum, polyarthralgia, and hilar lymphadenopathy). Seen in sarcoidosis.
-Heerfordt syndrome (uveitis, parotid gland enlargement, and fever). Also seen in sarcoidosis. |
|
|
|
Phosphodiesterase type-4 (PDE-4) inhibitor indicated for chronic treatment of severe and very severe COPD with recurrent exacerbations.
|
Roflumilast. Not used for acute exacerbations; because mostly anti-inflammatory properties without bronchodilator effect. This is not the asthma medication Xolair.
|
|
|
|
The newest National Asthma Education and Prevention Program guidelines - which asthma patients need ICU admission? |
-Symptomatic, even with mild CO2 retention (PCO2 >= 42) or
- Severely decreased PFTs despite bronchodilator (FEV1 or PEF <40%) |
|
|
|
Primary indication for thrombolysis in PE. |
Persistent hypotension and hemodynamic instability |
|
|
|
Confirmatory diagnosis of cystic fibrosis |
measurement of sweat chloride (>60mEq/L) |
|
|
|
Flow-volume loop in cystic fibrosis |
Flattening of inspiratory and expiratory limbs (fixed airway obstruction) |
|
|
|
The only intervention shown to improve survival in selected patients with idiopathic pulmonary fibrosis. |
Lung transplantation |
|
|
|
Indications for long term oxygen therapy: |
PaO2 </= 55 mm Hg (7.3 kPa) or O2 sats <= 88% on RA |
|
|
|
What is the Nocturnal Oxygen Therapy Trial (NOTT)? |
Continuous O2 better than nocturnal O2 in enhancing survival. |
|
|
|
Delirium types
|
-Hyperactive -Hypoactive -Mixed |
|
|
|
Key feature of acute mountain sickness. |
Headache, along with fatigue, nausea, and sleep disturbance (usually due to high-altitude periodic breathing [HAPB], an altitude-associated respiratory change. |
|
|
|
Most effective therapy to prevent acute mountain sickness and high altitude pulmonary edema when gradual ascent is not possible. |
Acetazolamide 24-48 hours before ascent. |
|
|
|
When to start treatment with omalizumab (Xolair) in asthma exacerbations? |
Severe asthma + allergies, elevated IgE + symptomatic despite high-dose inhaled corticosteroids and long-acting beta agonists.
Must be monitored for anaphylaxsis. |
|
|
|
Young, never smoker, with endobronchial obstruction, recurrent pneumonia, smoothly bordered mass; what is the most likely tumor? |
A carcinoid tumor.
Carcinoid syndrom rare with pulmonary carcinoid. |
|
|
|
Contraindications to noninvasive ventilation: |
-Resp arrest -CV instability (hypotension, arrhytmias, MI) -AMS (acute mountain sickness) -High aspiration risk -Copious secretions -Recent face/GI surgery -Craniofacial trauma Fixed nasopharyngeal abnormalities -Burns -Extreme obesity |
|
|
|
How to interpret allergy skin test in allergic bronchopulmary aspergillosis (ABPA). |
-If negative, high negative predictive value;
-If positive indicates sensitization but not necessarily ABPA;
-Check IgE levels, if >1000 IU/ml, suggests ABPA; if <500, prob not ABPA |
|
|
|
When should lung volume reduction surgery (LVRS) be considered? |
Severe COPD, maximal med therapy, completed pulmo rehab + criteria: - bilateral emphysema on CT; - postbronch TLC >150% and RV >100%; - FEV1 max <45%; PaCO2 <60 and PaO2 at least 45 on RA. |
|
|
|
Treatment for stable but symptomatic COPD and FEV1 <60%
|
Inhaled bronchodilator. Anticholinergic for beta-2 agonist people.
|
|
|
|
NOTE: Methylprednisolone and epinephrine are useful in upper airway obstruction from croup and anaphylaxis,
|
but they do not have a clear role in the treatment of angioedema associated with ACE inhibitors.
|
|
|
|
Condition characterized by cyclic central apneas and hyperpneas during sleep upon ascension to high altitude. |
High-altitude periodic breathing (HAPB) |
|
|
|
Best guess for a diagnosis in a former smoker with mediastinal mass and probable myasthenic syndrome (Lambert-Eaton syndrome). |
Small cell lung cancer |
|
|
|
Lambert-Eaton myasthenic syndrome is a rare neuromuscular junction transmission disorder caused by antibodies directed against:
|
- presynaptic voltage-gated P/Q-type calcium channels. There is usuallilyproximal muscle weakness and absent deep tendon reflex.
|
|
|
|
When to start vasoactive agents in hypotension:
|
After fluid challenge 1L and MAP still <65 or CVP <8-12
|
Normal MAP 70-110
|
|
|
The mean arterial pressure (MAP) is calculated with the following equation: |
[(2 x DBP) + SBP] / 3 |
|
|
|
Diagnostic criteria for sepsis: |
Known or suspected infection + 2 of SIRS criteria: - T>38 <36; - WBC >12 or <4; - RR>20; - HR>90 |
|
|
|
Septic patient; central venous O2Sat <70% after fluid challenge, next step? |
Transfusion |
|
|
|
Normal diffusing capacity (DLCO)? |
>/=80% predicted |
|
|
|
Indications for chest tube placement for effusions:
|
- Effusions >1/2 hemithorax;
- Loculation; - Positive gram stain/CS; - Pleural fluid glucose <60; - Pleural fluid pH <7.2 |
|
|
|
How is asbestosis diagnosed? |
pulmonary fibrosis + exposure history + appropriate latency period (10-15 years) |
|
|
|
Goal plateau pressure on vent: |
<30 cm H20 |
|
|
|
In victims of smoke inhalation, which test is sensitive to determine cyanide poisoning? |
Lactate >90 |
|
|
|
Antidote for inhaled cyanide toxicity |
Sodium thiosulfate |
|
|
|
NOTE: ARDS + normal BP and normal crea -- when treated with aggressive diuresis |
spent less time on the venilator compared to usual care.
|
|
|
|
NOTE: Early use of cisatracurium (to paralyze patients) in severe lung injury does what? |
Improves mortality and shortens ventilation duration. |
|
|
|
Recommendations for PEEP on vent? |
No absolute number, look for PEEP # that achieves FiO2 <0.6 and doesn't cause hypotension. |
|
|
|
Target BP for hypertensive emergency: |
No more than 25% in the first hour; then down to 160/100-110 in next 2-6 hours. |
|
|
|
Which poisoning develope shaped crystals in urine? |
calcium oxalate, ethylene glycol ingestion |
|
|
|
How to identify benign or malignant nodules in the Xray? |
- Borders: smooth benign, spiculated malignant;
- Calcification pattern: popcorn, lamellar, central, diffuse are all benign. |
|
|
|
When to start oxygen therapy in COPD? |
PaO2 <55 or O2sats >/= 88% +/- hypercapnea; or
PaO2 56-59 or O2 sats <89% + one of: - pulmo HTN, - cor pulmonale or edema, - Hct >56 |
|
|
|
When is alteplase indicated in PE? |
Persistent hypotension (SBP <90 or drop in SBP >40) |
|
|
|
Changes in the 2012 Berlin consensus definition for ARDS |
1. Echo or pulmonary artery wedge pressure not necessary. 2. Acuity defined as 1 week. 3. CT chest can be used. 4. Classify into mild, mod, or severe based on hypoxemia. Acute lung injury term no longer used. |
|
|
|
Index for assessing severity of COPD; what score to refer for evaluation for lung transplantation? |
BODE index (BMI, Obstruction, Dyspnea, Exercise) ; score >5 indicates referral for possible lung transplantation |
|
|
|
When is lung transplantation indicated? |
BODE index 7-10 + one of: - hospitalization for hypercapnea / exacerbation - Pulmo HTN - Cor pul despite O2 therapy - FEV1 <20% predicted - Homogenous emphysema |
|
|
|
Radiographic description most consistent with BOOP |
Bilateral, diffuse, alveolar opacities in the presence of normal lung volume. |
|
|
|
Consistent with a transudative process: |
Serum : pleural fluid albumin >1.2 or
Serum : pleural fluid total protein >3.1 |
|
|
|
Ideal body weight formula: |
In men: 50 Kg + (2.3Kg for every inch >60)
In women: 45.5 Kg + (2.3Kg for every inch >60) |
|
|
|
Most common diagnoses for patients with chronic cough and normal CXR: |
-Brochial asthma -Post nasal drip -GERD |
|
|
|
ACCP guidelines for pulmonary nodules follow-up: |
Repeat CT in 1 year if (former and current) smoker and <4mm nodule; if unchanged, no further CT. |
|
|
|
What is a benign / stable nodule? |
Solid nodule on CXR or CT, stable x 2 years |
|
|
|
What is the apnea-hypopnea index (AHI)? |
apnea + hypopnea per hour of sleep |
|
|
|
How to interpret apnea-hypopnea index? An AHI of 5 to 15: |
5-15: mild OSA 6-30: moderate OSA > 30: severe OSA |
|
|
|
Idiopathic form of BOOP |
COP
|
|
|
|
Form of bronchiolitis that occurs in most smokers? |
Respiratory bronchiolitis–associated interstitial lung disease (RB-ILD) |
|
|
|
Ambient air FiO2?
|
21%
|
|
|
|
Proximal nocturnal dyspnea
|
A sensation of shortness of breath and coughing that generally awakens the patient, often one or two hours after sleep and is generally relieved when an upright position.
|
|
|
|
What is the diagnosis in a thin patient with history of CHF and partner reports proximal nocturnal dyspnea?
|
China Stokes breathing/central sleep apnea. this condition is related to CHF and severity tends to correlate with degree of CHF.
These patients are typically not sleepy during the day, do not snore or generally obese. Treat this condition by improving underlying CHF. |
|
|
|
Describe lung granuloma?
|
Densely, centrally calcified with smooth borders.
|
|
|
|
Treatment of ethylene glycol toxicity with evidence of end organ damage such as kidney failure:
|
-IV Femepizole and hemodialysis
|
|
|
|
Went to give RBCs in severe sepsis?
|
When evidence of tissue hypoperfusion marked by:
-Hypotension or lactic acidosis -Active bleeding -Profound anemia -Coronary artery disease Goal hemoglobin should be 7 to 9. |
|
|
|
What is the best test for tuberculous pleural effusion?
|
Pleural fluid adenosine deaminase measurement.
-Greater than 70 is positive -Less than 40 excludes it |
|
|
|
Describe lung granuloma?
|
Densely, centrally calcified with smooth borders.
|
|
|
|
Treatment of ethylene glycol toxicity with evidence of end organ damage such as kidney failure:
|
-IV Femepizole and hemodialysis. Note to Flumazanil is the reversal agent for benzodiazepines.
|
|
|
|
Went to give RBCs in severe sepsis?
|
When evidence of tissue hypoperfusion marked by:
-Hypotension or lactic acidosis -Active bleeding -Profound anemia -Coronary artery disease Goal hemoglobin should be 7 to 9. |
|
|
|
What is the best test for tuberculous pleural effusion?
|
Pleural fluid adenosine deaminase measurement.
-Greater than 70 is positive -Less than 40 excludes it |
|
|
|
Lung conditions associated with amiodarone use:
|
-Chronic interstitial pneumonitis (most common)
-Organizing pneumonia, -Acute respiratory distress syndrome, -Solitary pulmonary mass |
|
|
|
In asthma, went to add a leukotriene receptor antagonist?
|
If asthma control is not possible following proper use of inhaled steroids and beta-2 agonist.
|
|
|
|
What is the required follow up in a non-smoker with a pulmonary nodule less than 4 mm and no other respecter's for malignancy?
|
No follow up
|
|
|
|
What is the treatment of CPAP associated nasal congestion?
|
Heated humidified distilled water
|
|
|
|
Diagnoses of vocal cord dysfunction
|
-Inspiratory and expiratory wheezes which can be difficult to discern from asthma
-respiratory distress -anxiety -Sudden onset and abrupt termination -Lack of hypoxemia |
|
|
|
What is the maximum dose of Narcan if highly suspicious of opioid overdose?
|
After 5 to 10 mg should consider other diagnosis. Can give an escalating doses typically 0.4 mg to 1 mg every few minutes. can even start Narcan infusion if indicated.
|
|
|
|
What test can be done after completion of anticoagulation for 3 months in PEto predict likely recurrence or not?
|
D-dimer. Patient must be off anticoagulation for 3 to 4 weeks. If D-dimer high off anticoagulation patient should go back on anticoagulation
|
|
|
|
What is the treatment of acute exacerbation of idiopathic pulmonary fibrosis?
|
Palliation. Remote likelihood of recovery.
|
|
|
|
When to use prone positioning in ARDS?
|
In severe cases of hypoxemia with ARDS. It improves oxygenation primarily by facilitating the recruitment of flooded and collapsed alveoli in the posterior, dependent regions of the lung.
|
|
|
|
Onset of clinical symptoms and hypersensitivity pneumonitis?
|
Most patients exposed to an Inhalational antigen develop symptoms within 4 to 12 hours.
|
|
|
|
What type of pulmonary conditions are seen coal miners?
|
Emphysema (obstructive lung disease). This condition is worsen with history of smoking. Check PFTs.
Coal miners are also at risk for interstitial lung disease. |
|
|
|
What is the treatment for acute mountain sickness is?
|
Dexamethasone.
|
|
|
|
Treatment of neuroleptic malignant syndrome?
|
Largely supportive:
-Stop offending agent -IV fluids -Benzodiazepines for agitation -cooling techniques such as cooling blankets, ice packs, or lavage -NitroProside or other IV vasodilator for blood pressure control -Heparin to prevent DVT |
|
|
|
On the ventilator, how to improve oxygenation in severe hypoxemia with FIO2 100%?
|
Increase PEEP
|
|
|
|
Treatment of carbon monoxide poisoning?
|
-100% oxygen
-Hyperbaric oxygen if available. Both will aid in clearing carboxyhemoglobin more quickly. Remember high carboxyhemoglobin and cyanide toxicity are not the same. |
|
|
|
Treatment of cocaine induced chest pain with hypertension?
|
Calcium channel blocker and benzodiazepine.
|
|
|
|
Type of lung nodule that requires follow-up after two years even if stable?
|
Ground-glass opacity nodules. This is because they may represent slow-growing invasive adenocarcinoma's or adenocarcinoma in situ. May need to follow up for five years.
|
|
|
|
Which part of the lungs is most affected by Sarcoidosis?
|
Upper lobes often best seen on lateral view. Patients with lung sarcoid typically have normal or minimally abnormal PFTs.
|
|
