Pulmonary/critical Care

Front 1

Asthma:
3 cardinal features..

Does normal spirometry rule out asthma...

Back 1

1. hyperresponsiveness
2. airway obstruction
3. inflammation

normal spirometry does not rule out asthma

Front 2

Asthma

Airway remodeling

Back 2

ASTHMA patient lungs with subepithelial fibrosis, increased smooth muscle mass, angiogenesis and hyperplasia of mucous gland and goblet cells

Front 3

Asthma Severity: Mild Intermitt
a. Symptoms (3)
b. Night Symptoms
c. Lung Function

Back 3

a. less than or equal 2x a wk
Asx and normal Peak Exp Flow between flares
Flares brief (few hrs to few days)
intensity may vary
b. less than or equal 2 times a month
c. FEV1 or PEF greater than or equal 80%, predicted PEF variability less than 20%

Front 4

Asthma Severity: Mild Persistent
a. Symptoms (2)
b. Night Symptoms
c. Lung Function

Back 4

a. Sx greater than 2x a wk, but less than once a day
flares may affect activity
b. greater than twice a month
c. FEV1 or PEF equal or greater than 80%, predicted PEF variability 20-30%

Front 5

Asthma Severity: Mod Persistent
a. Symptoms (4)
b. Night symptoms
c. Lung Function

Back 5

a. daily symptoms
daily use of albuterol
flares affect activity
flares equal or greater twice a wk, may last days
b. greater than once a wk
c. FEV1 or PEF greater than 60% less than or equal PEF variability greater than 30%

Front 6

Asthma Severity: Severe Persist
a. Symptoms (3)
b. Night symptoms
c. Lung Function

Back 6

a. continual symptoms
limited physical activity
freq flares
b. frequent
c. FEV1 or PEF less than or equal 60% predicted PEF variability greater than 30%

Front 7

Peak Expiratory Flow - Asthma
1. change of 20%
2. 20-50% change
3. >50%

Back 7

1. stable disease
2. moderate airway obstruction
3. severe obstruction

Front 8

Bronchial challenge test
1. what is it
2. goal of test (normal test result vs positive test)
3. predictive value
4. Do not take this test

Back 8

bronchoconstrictor which reduces FEV1.

like methacholine or histamine
high negative predictive value (sens not specific)
excludes asthma from patients with atypical pulm symptoms
*asthmatic with typical symptoms

normal test rules out asthma while positive test does NOT rule in

Front 9

Asthma
Type that does not respond to therapy

Back 9

ABPA - acute bronchopulmonary aspergillosis

Front 10

Asthma
Subset of occupational asthma that occurs with no previous history of asthma and high exposure to respiratory irritant

Back 10

RADS - reactive airway dysfunction syndrome

Front 11

Asthma
ABPA is______ asthma with imaging (3) and (1) sign

Back 11

persistent
1. central bronchiectasis
2. pulm infiltrates upper lobes
3. fibrosis
1. brown sputum with Aspergillus

Front 12

Asthma
ABPA treatment

Back 12

oral steroids for several weeks

Front 13

Asthma
worsening condition taking leukotriene receptor blocker with development of pulm infiltrates and eosinophilia during steroid taper

Back 13

Churg strauss vasculitis

Front 14

Asthma
exercise induced asthma trigger

Back 14

exercise in cold dry air

Front 15

Asthma
exercise induced asthma treatment

Back 15

beta agonist inhaler

Front 16

Asthma
Symptoms of Aspirin sensitive asthma (2)

Back 16

rhinorrhea and nasal congestion

Front 17

Asthma
Aspirin sensitive asthma but still needs aspirin

Back 17

see specialist for desensitization

Front 18

Asthma
mild aspirin intolerance and asthma

Back 18

leukotriene modifying agent

Front 19

Asthma
3 big symptoms

Back 19

cough
wheeze
chest tightness

Front 20

Asthma
1. breakthrough symptoms
2. exercise induced asthma prophylaxis

Back 20

short acting beta2 agonist

Front 21

Asthma
persistent asthma treatment and mainstay controller therapy for asthma

Back 21

inhaled steroids

Front 22

Asthma
Side effect of inhaled steroids(2)

Back 22

thrush and dysphonia related to laryngeal muscle myopathy

Front 23

Asthma
alternate to inhaled steroids(2)

Back 23

Cromolyn and Nedocromil

Front 24

Asthma
persistent asthma not preferred treatment..

If failing albuterol and inhaled steroids...

Back 24

Leukotriene modifier

add long acting beta 2

Front 25

Asthma
nocturnal asthma treatment...

FEV1/FVC ratio less than 70% on spirometry…

Why avoid this treatment with FQ or macrolide...

Back 25

theophylline

indicates airway obstruction

theophylline toxicity

Front 26

Asthma
moderate to severe persistent asthma with elevated IgE TREATMENT (failed steroids)

Back 26

Omalizumab (Anti- IgE antbody)

Front 27

Asthma
2 contraindications for omalizumab...

measures lung ability to transfer gas across alveolar-capillary membrane…

normal arterial PCO2 with severe symptomatic asthma indicates...

Back 27

1. overweight
2. IgE > 700

DLCO

impending resp failure

Front 28

COPD
4 major disorders..

is clubbing seen in COPD...

Back 28

emphysema
chronic bronchitis
obliterative bronchiolitis
asthmatic bronchitis

No, clubbing is not feature of COPD

Front 29

COPD
chronic bronchitis clinic definition

Back 29

productive cough on most days for 3mo in each of 2 straight years

Front 30

How is COPD different from asthma?

Back 30

asthmatics have greater reversibility of obstruction

Front 31

COPD
#1 risk factor

Back 31

smoking

Front 32

Spirometry
FEV1/FVC < 70%...

TLC less than 80% predicted...

Low TLC, but increased residual volume...

Back 32

obstructive lung process

restrictive lung process

resp muscle weakness from neuromusc disease

Front 33

Emphysema
2 types

Back 33

1. centrilobular
2. panlobular

Front 34

Centrilobular emphysema
- lung pathology
- risk factor

Back 34

- dilation and destruction of resp bronchioles
- tobacco

Front 35

Panlobular emphysema
- lung pathology
- risk factor

Back 35

- destruction of whole acinus
- alpha 1 anti trypsin

Front 36

COPD
blue bloater (ankle edema, enlarged liver, engorged neck veins)

Back 36

alveolar hypoxia remodel pulm arteries causing RVH and secondary pulm HTN

Front 37

COPD
key to diagnosis

Back 37

expiratory airflow limitation

Front 38

COPD
spirometer 2 values...
which confirm

Back 38

post bronchodialtor FEV1 <80%
FEV1/FVC less than 70%
airflow limitation

Front 39

COPD
BODE index correlates with...

Back 39

BMI, airflow Obstuction, Dyspnea, 6min walk Exertion
(survival)

Front 40

COPD
DLco

Back 40

diffusing capacity of carbon monoxide. single breath uptake of CO over 10sec breath hold. measures gas transfer

Front 41

COPD
DLco in emphysema; asthma; chronic bronchitis

Back 41

low in emphysema
normal in asthma
mild reduced chronic bronchitis

Front 42

COPD
end stage COPD ABG (2)

Back 42

elevated carboxyhgb can cause false normal oxygen saturation via pulse ox. need ABG to eval CO2 retention. arterial hypoxemia and alveolar hypoventilation

Front 43

COPD
ABG values for resp failure on RA (2)

Back 43

PaO2 less than 60
PaCO2 greater than 55

Front 44

COPD
differential (6)

Back 44

asthma, CHF, bronchiectasis, Tb, obliterative bronchiolitis, diffuse panbronchiolitis

Front 45

COPD
screen for this condition if early onset COPD and family history of lung or liver disease

Back 45

alpha1 anti trypsin def

Front 46

COPD
anticholinergics work better in...

When to initiate treatment with serevent or spiriva ...

Back 46

COPD treatment

when FEV1 less than 60% predicted

Front 47

COPD
Do not combine spiriva with...

Back 47

atrovent. do not combine long acting with short acting anticholinergic

Front 48

COPD
oral anticholinergic.

Back 48

theophylline

Front 49

COPD
theophylline level need to be monitored because in can potentiate

Back 49

steroids

Front 50

COPD
do not use for regular maintenance...

Do not use alone or for maintenance or rescue in COPD....

Back 50

oral steroids

inhaled steroids

Front 51

COPD
2 recommended vaccines...

young patient with COPD....

Back 51

annual flu shot and pneumovax.

alpha 1 anti trypsin df

Front 52

COPD
alpha 1 antitrypsin treatment.
problem...

Back 52

IV infusion of purified protein weekly
expensive

Front 53

COPD
avoid these meds in stable COPD, why?

Consider this for all symptomatic COPD with FEV1 less than 50% predicted

Back 53

antitussives because cough is protective

pulm rehab

Front 54

COPD
treatment if also has rhinitis or asthma

SEVERE COPD treatment if chronic bronchitis and frequent exacerbations...

Back 54

leukotriene modifier

Roflumilast - daliresp

Front 55

COPD
3 surgeries

If FEV1<=20% of predicted...

Back 55

bullectomy
lung volume reduction surgery for upper lobe emphysema
lung transplant

DO NOT CONSIDER SURGERY

Front 56

COPD
when to use NPPV?
ph, PaCO2, RR

Back 56

SOB with ph <7.35
PaCO2 >45
RR >25

Front 57

ILD
Acute (days to weeks) to Subacute (less than 3mo) presentation (8)

Back 57

Acute interstitial pneumonia
both idiopathic and collagen vasc disease associated ILD
Acute eosinophilic pneumonia
Chronic eosinophilic pneumonia
Cryptogenic organizing pneumonia
Drug induced interstitial lung disease
Diffuse alveolar hemorrhage
hypersensitivity pneumonitis

Front 58

ILD - physical findings
crackles common in....
less common...

Back 58

common in fibrosing ILD
less common sarcoid

Front 59

ILD - physical findings
mid inspiratory squeaks

Back 59

bronchiolitis

Front 60

ILD - physical findings
increased P2, RV lift, TR murmur

Back 60

severe restrictive disease like pulm HTN seen in ILD, scleroderma, PLCH

Front 61

ILD - physical findings
Clubbing

Most common idiopathic interstitial pneumonia

Back 61

IPF

Front 62

ILD - physical findings
erythema nodosum (3)

Back 62

sarcoid
IBD
behcet

Front 63

ILD - physical findings
maculopapular exantham (3)

Back 63

sarcoid
amyloid
Behcet

Front 64

ILD - physical findings
uveitis/conjunctivits(4)

Back 64

sarcoid
behcet
IBS
AS

Front 65

ILD - physical findings
Lacrimal/salivary gland enlargement(2)

Back 65

sarcoid
Sjogren

Front 66

ILD - physical findings
adenopathy, hepatosplenomegaly (2)

Back 66

sarcoid
amyloid

Front 67

ILD - physical findings
arthritis (5)

Back 67

collagen vascular disease
IBD
sarcoid
behcet
AS

Front 68

ILD - physical findings
muscle weakness or tenderness

Back 68

polymyositis

Front 69

ILD - physical findings
1. cranial nerve deficit
2. mental retard

Back 69

1. sarcoid
2. tuberous sclerosis

Front 70

ILD - lab findings
eosinophilia (4)

Back 70

eosinophilic pneumonia
sarcoid
systemic vasculitis
drug induced

Front 71

ILD - lab findings
hemolytic anemia (4)

Back 71

connective tissue disease
sarcoid
lymphoma
drug induced

Front 72

ILD - lab findings
normocytic anemia carcinomatosis (3)

Back 72

diffuse alveolar hemorrhage syndromes
connective tissue
lymphangitic

Front 73

ILD - lab findings
urinary sediment abnormalities (3)

Back 73

connective tissue
systemic vasculitis
drug induced

Front 74

ILD - lab findings
hypogammaglobulinemia

Back 74

lymphocytic interstitial pneumonia

Front 75

ILD - lab findings
serum ACE (4)

Back 75

sarcoid
hypersensitivity pneumonitis
silicosis
Gaucher

Front 76

ILD - lab findings
anti basement membrane antibody

Back 76

goodpasture

Front 77

ILD - lab findings
ANCA (3)

Back 77

wegener
churg strauss
microscopic polyangiitis

Front 78

ILD - lab findings
serum precipitating antibodies

Back 78

hypersensitivity pneumonitis

Front 79

ILD
most common IIP

Back 79

IPF - idiopathic pulm fibrosis

Front 80

ILD
IPF histopathology

Back 80

fibroblast foci

Front 81

ILD
IPF Sx (2)
Lung exam
Chest CT (2)

Back 81

sx: worsening SOB and nonproductive cough
Exam: end insp crackles
CT: peripheral and basal predominant disease, no nodules or opacities

Front 82

ILD
IPF on PFT
prognosis(2)

Back 82

restrictive lung process
linked to degree of restriction
less than 3yrs

Front 83

ILD
IPF treatment

Back 83

lung transplant

Front 84

ILD
rapid onset of disease over days to wks that leads to progressive resp failure

Back 84

acute interstitial pneumonia

or idiopathic diffuse alveolar damage

or Hamman-rich syndrome

Front 85

ILD
resembles IPF, but younger and less rales on exam

Back 85

NSIP - nonspecific interstitial pneumonitis

Front 86

ILD
NSIP chest xray and chest CT

Back 86

CXR - bilat lower zone opacities
Chest CT - bilat lower lung opacities.

Front 87

ILD
NSIP on chest CT lacks

Back 87

honeycombing

Front 88

ILD
NSIP lung biopsy

Back 88

homogenous lymphoplasmacytic inflammation +- fibrosis

Front 89

ILD
NSIP prognosis

Back 89

level of fibrosis on biopsy

Front 90

ILD
NSIP treatment

Back 90

steroids

Front 91

ILD
lower resp infection that fails antibiotics

Back 91

COP - cryptogenic organizing pneumonia

Front 92

ILD
COP Sx (1 common, 1 not)

Back 92

crackles, not clubbing

Front 93

ILD
COP chest xray
chest CT

Back 93

CXR - consolidation
chest CT - airspace consolidation with bronchograms in lower zones with ground glass opacities

Front 94

ILD
COP PFT (2)

Back 94

restrictive with low DLCO

Front 95

ILD
COP biopsy

Back 95

organizing pneumonia with preserved lung architecture

Front 96

ILD
COP treatment

Back 96

24wk taper of steroids

Front 97

ILD
smoking related disorders (2)

Back 97

(DIP)- desquamative interstitial pneumonitis
(RB-ILD) - resp bronchiolitis associated interstitial lung disease

Front 98

ILD
DIP chest xray

Back 98

ground glass pattern

Front 99

ILD
DIP chest CT

Back 99

fibrosis with traction bronchiectasis and honeycombing

Front 100

ILD
DIP PFT (2)

Back 100

restrictive lung, low DLCO

Front 101

ILD
DIP path

Back 101

pigmented macrophages in alveolar spaces

Front 102

ILD
DIP treatment (2)

Back 102

stop smoking and steroids

Front 103

ILD
RB-ILD vs DIP age

Back 103

RB-ILD younger

Front 104

ILD
RB-ILD Chest xray

Back 104

basilar reticular or reticulonodular in centrilobular distribution

Front 105

ILD
RB-ILD chest CT

Back 105

ground glass

Front 106

ILD
RB-ILD PFT

Back 106

normal vs mixed rest/obst
low DLCO

Front 107

ILD
RB-ILD path

Back 107

similar to DIP

Front 108

ILD
RB-ILD treatment

Back 108

stop smoking
steroids

Front 109

ILD
DIP vs RB-ILD prognosis

Back 109

RB-ILD can still have significant disease

Front 110

ILD
acute disease

Back 110

AIP - acute interstitial pneumonia

Front 111

ILD
other name for AIP

Back 111

Hamman-Rich syndrome

Front 112

ILD
AIP progress

Back 112

hypoxemic resp failure

Front 113

ILD
AIP chest xray

Back 113

diffuse bilat airspace disease

Front 114

ILD
AIP similar to

Back 114

ARDS

Front 115

ILD
AIP path

Back 115

diffuse alveolar samage

Front 116

ILD
AIP treatment

Back 116

IV steroids

Front 117

ILD
AIP prognosis

Back 117

poor, die in 2mo

Front 118

ILD
rarest ILD and seen more in women

Back 118

LIP-lymphoid interstitial pneumonia

Front 119

ILD
LIP
chest xray
chest CT(2) - one is not seen in other conditions

Back 119

honeycombing
ground glass opacity and pervascular cysts

Front 120

ILD
LIP
BAL

Back 120

lymphocytosis

Front 121

ILD
LIP path

Back 121

interstitial pneumonia with dense lymphoid infiltrate

Front 122

ILD
LIP path seen in (2)

Back 122

Sjogren and HIV

Front 123

ILD
LIP differential

Back 123

lymphoma

Front 124

Eosinophilic pneumonia
classic chest xray

Back 124

no pulm edema

Front 125

Eosinophilic pneumonia
simple eosinophilic pneumonia

Back 125

Loffler syndrome

Front 126

Eosinophilic pneumonia
acute vs chronic lab value

Back 126

acute eosinophilia may not be seen in periph smear. Check BAL.

Front 127

Eosinophilic pneumonia
treatment

Back 127

steroids

Front 128

LAM
What is it?

Back 128

lymphangioleiomyomatosis
cystic lung disease affecting child bearing age women

Front 129

LAM
a. effusion
b. complication
c. PFT

Back 129

a. chylous
b. PTX
c. physiologic obstruction

Front 130

LAM
a. give bronchodilator
b. DLCO

Back 130

a. no help
b. reduced

Front 131

LAM
histo (2)

Back 131

LAM smooth muscle cells and cysts

Front 132

LAM
treatment after PTX

Back 132

pleurodesis

Front 133

LAM
prognosis

Back 133

may lead to ESLD requiring transplant

Front 134

PLCH
what is it and 2 other names

Back 134

pulmonary langerhans cell histiocytosis
Histiocytosis X
eosinophilic granuloma of lung

Front 135

PLCH
who?

Back 135

young smokers (less than 40yo)

Front 136

PLCH
25% develop complication

Back 136

PTX

Front 137

PLCH
CXR

Back 137

cysts and nodules

Front 138

PLCH
path (2)

Back 138

1. bronchiolocentric cellular infiltration with langerhans cells
2. Birbeck granules - rod shaped structures in cells

Front 139

PLCH
treatment

Back 139

stop smoking

Front 140

Sarcoid
protective?

imaging finding:

Back 140

smoking

upper lobe infiltrates on lateral chest xray pg.126

Front 141

Sarcoid
1. uveo-parotid fever
2. eyrethama nodosum, polyarthralgia, and bilat hilar LN that do not warrant histo confirmation....

Back 141

Heerfordt syndrome
Lofgren syndrome, usually resolves spontaneously

Front 142

Sarcoid
90% have this involvement

Back 142

lung

Front 143

Sarcoid
chest CT

Back 143

widespread nodules

Front 144

Sarcoid
Treatment
a. mainstay
b. cutaneous and pulm

Back 144

a. steroids
b. hydroxychloroquine

Front 145

Rheumatoid lung disease
physical finding
PFT

Back 145

clubbing
restrictive defect

Front 146

Rheumatoid lung disease
who

Back 146

men with advanced joint disease

Front 147

Scleroderma
Lung finding
Heart finding
PFT

Back 147

pulm HTN
R heart failure
restrictive lung

Front 148

Scleroderma
Chest CT

Back 148

ILD

Front 149

Scleroderma
GI finding (2)

Back 149

esophageal dilation and dysmotility

Front 150

Scleroderma
path

Back 150

fibrotic form on nospecific interstitial pneumonitis

Front 151

Scleroderma
Treatment

Back 151

cyclophosphamide

Front 152

polymyositis/dermatomyositis
lung Sx(2)
similar presentation

Back 152

DOE and nonproductive cough
ARDS

Front 153

polymyositis/dermatomyositis
Lab (2)
PFT (2)

Back 153

elevated muscle enzymes
anti Jo-1 Ab
restrictive defect
reduce DLCO

Front 154

polymyositis/dermatomyositis
imaging

Back 154

honeycombing

Front 155

polymyositis/dermatomyositis
therapy(2)

Back 155

steroids
cytotoxic agens

Front 156

polymyositis/dermatomyositis
who responds best?

Back 156

pathologic organizing pneumonia

Front 157

SLE
at risk for

Back 157

venous thromboembolism

Front 158

Sjogren
chest CT expiratory

Back 158

focal air trapping

Front 159

Sjogren
treatment(2)

Back 159

steroids
cytotoxic agents

Front 160

Diffuse alveolar hemorrhage
linked to...

Back 160

goodpasture or small vessel vasculitis

Front 161

Pulm vasculitis
necrotizing granulomatous vasculitis affecting small and medium vessels in lungs and kidney

Back 161

wegener's granulomatosis

Front 162

Pulm vasculitis
+ C-ANCA

Back 162

Wegener's granulomatosis

Front 163

Pulm vasculitis
Wegener's perform this type of lab

Back 163

culture to RO infection

Front 164

Pulm vasculitis
Wegener's UA (3)

Back 164

red cell casts, RBC, WBC

Front 165

Pulm vasculitis
Chest CT with nodules, focal consolidation, cavitary and airspace disease

Back 165

Wegeners

Front 166

Pulm vasculitis
Wegener's treatment (2)

Back 166

steroids and cyclophosphamide

Front 167

Pulm vasculitis
Wegener's treatment after 3-6mo

Back 167

azathioprine

Front 168

Pulm vasc
triad of asthma, hypereosin, necrotizing vasculitis

Back 168

churg-straus

Front 169

Pulm vasc
Churg straus associated withdrawal of this drug

Back 169

corticosteroids

Front 170

Pulm vasc
Churg straus PFT

Back 170

reversible airflow

Front 171

Pulm vasc
Churg strauss complication

Back 171

GI bleed or ischemia

Front 172

Pulm vasc
Churg straus dx

Back 172

periph blood eosinophilia

Front 173

Pulm vasc
Churg straus chest CT

Back 173

ground glass opacity

Front 174

Pulm vasc
Churg straus bx

Back 174

necrotizing vasculitis and granuloma

Front 175

Pulm vasc
Churg straus treatment

Back 175

steroids

Front 176

Pulm vasc
Churg straus treatment refactory to steroids

Back 176

cyclophosphamide

Front 177

Pulm vasc
small vessel affecting lung and kidney

Back 177

microscopic polyangiitis

Front 178

Pulm vasc
microscopic polyangiitis presents with (2)

Back 178

glomerulonephritis
hemoptysis

Front 179

Pulm vasc
microscopic polyangiitis Labs
1 serum, 2 UA

Back 179

elevated Cr
proteinuria
active sediment on UA

Front 180

Pulm vasc
microscopic polyangiitis + test

Back 180

P-ANCA

Front 181

Pulm vasc
microscopic polyangiitis bx

Back 181

focal segmental necrotizing glomerulonephritis

Front 182

Pulm vasc
microscopic polyangiitis
treatment (2)

Back 182

steroids and cyclophosphamide

Front 183

Sarcoid
presenting manifestations
2 systems
2 body parts

Back 183

lymph and pulm systems as well as eyes and skin

Front 184

Drug Induced Lung Disease
Lab results

Back 184

eosinophilia

Front 185

Drug Induced Lung Disease
Chest CT

Back 185

reticular and ground glass opacities with or without consolidation

Front 186

Drug Induced Lung Disease
Treatment

Back 186

steroids

Front 187

Drug Induced Lung Disease
Hypersensitivity drug rxn symptom

Back 187

fever

Front 188

Drug Induced Lung Disease
Drug induced lupus(3)

Back 188

procainamide
hydralazine
isoniazid

Front 189

Drug Induced Lung Disease
drug with high attenuation parenchymal lesions and high incidence of pulm toxicity

Back 189

amiodarone

Front 190

Drug Induced Lung Disease
chemo drug that causes acute or delayed lung toxicity

Back 190

nitrosurea carmustine

Front 191

XRT Lung Disease
Treatment

Back 191

steroids

Front 192

XRT Lung Disease
Y shaped CXR

Back 192

mediastinal lymphoma and Hodgkin due to paramediastinal fibrosis

Front 193

Hypersensitivity Pneumonitis
other name

Back 193

extrinsic allergic alveolitis

Front 194

Hypersensitivity Pneumonitis
pathogensis

Back 194

cell mediated immunity

Front 195

Hypersensitivity Pneumonitis
Immunomodulatory role...
modulate severity...

Back 195

Interferon gamma
IL-10

Front 196

Hypersensitivity Pneumonitis
farmer's lung cause

Back 196

thermophilic bacteria in decaying hay and grain

Front 197

Hypersensitivity Pneumonitis
CBC

Back 197

leukocytosis

Front 198

Hypersensitivity Pneumonitis
end stage clinical

Back 198

cyanosis and R heart failure

Front 199

Hypersensitivity Pneumonitis
chest xray in early disease

Back 199

normal

Front 200

Hypersensitivity Pneumonitis
chest xray in acute disease

Back 200

diffuse ground glass opacification and fine reticulonodular disease

Front 201

Hypersensitivity Pneumonitis
chest xray in chronic disease

Back 201

honeycombing

Front 202

Hypersensitivity Pneumonitis
Chest CT high res

Back 202

centrilobular nodules
*more sensitive than chest xray

Front 203

Hypersensitivity Pneumonitis
biopsy triad

Back 203

cellular bronchiolitis
lymphoplasmacytic interstitial infiltrate
non-necrotizing granuloma

Front 204

Hypersensitivity Pneumonitis
Treatment

Back 204

avoid antigen
oral steroids

Front 205

Hypersensitivity Pneumonitis
Refractory cases

Back 205

cytotoxic agents such as cyclophosphamide and azathioprine

Front 206

Mesothelioma
cancer of 2 locations...

asbestos is linked to 3 cancers...

Back 206

pleura mostly and peritoneum

small cell

non small cell

mesothelioma

Front 207

Mesothelioma
90% cases due to

Back 207

asbestos exposure

Front 208

Mesothelioma
Not a RF

Back 208

smoking

Front 209

Mesothelioma
other Risk factor

Back 209

erionite - turkish fiber used in home building

Front 210

Mesothelioma
clinical

Back 210

chest pain with pleural effusion

Front 211

Mesothelioma
confirm dx

Back 211

surgical lung biopsy

Front 212

Mesothelioma
prognosis

Back 212

10% survival in 2 yrs

Front 213

Mesothelioma
treatment

Back 213

pemetrexed

Front 214

Asyphyxiant
most common chemical

Back 214

carbon monoxide

Front 215

Asyphyxiant
carbon monoxide path

Back 215

hgb binds CO rather than o2

Front 216

Asyphyxiant
CO labwork

Back 216

carboxyhgb

Front 217

Asyphyxiant
CO treatment

Back 217

nonrebreather oxygen and hyperbaric oxygen

Front 218

Asyphyxiant
odor of rotten eggs

Back 218

HS - hydrogen sulfide

Front 219

Asyphyxiant
HS treatment

Back 219

nitrites

Front 220

Asyphyxiant
HS path

Back 220

severe metabolic acidosis

Front 221

Asyphyxiant
hypoxia with AG lactic acidosis but no cyanosis

Back 221

HCN

Front 222

Asyphyxiant
cyanide path

Back 222

inhibit MTCH cytochrome oxidase

Front 223

Asyphyxiant
Cyanide treatment (3)

Back 223

100% oxygen, nitrite and thiosulfate

Front 224

RADS
cause

Back 224

exposure to chlorine gas and other irritants

Front 225

RADS
histology

Back 225

epithelial desquamation, submucosal inflammation and basement membrane thinkening

Front 226

RADS
similar to...

Back 226

asthma

Front 227

RADS
PFT

Back 227

obstructive pattern

Front 228

RADS
after exposure, what happens to symptoms away from exposure

Back 228

little relief

Front 229

memory loss, impaired judgement and poor concentration can begin 2-28 days after...

Back 229

CO2 toxicity especially with LOC

Front 230

Pleural Effusion
Transudate

Back 230

when hydrostatic pressure greater than clearance

Front 231

Pleural Effusion
exudates

Back 231

increased vasc permeability

Front 232

Pleural Effusion
Light's criteria

Back 232

exudate if (any of 3)
- fluid protein/eff protein > 0.5
- fluid LDH/serum LDH >0.6
- pleural LDH > 2/3 serum LDH

Front 233

Pleural Effusion
transudate common cause (3)

Back 233

CHF
Hepatic hydrothorax
Nephrotic syndrome

Front 234

Pleural Effusion
nephrotic syndrome differential (1)

Back 234

pulm embolism

Front 235

Pleural Effusion
malignant effusion is this type of effusion

Back 235

exudative

Front 236

Pleural Effusion
types of exudate (3)

Back 236

parapneumonic (lots of lymphocytes)
malignant
PE

Front 237

Pleural Effusion
Parapneumonic effusion thoracentesis

Back 237

>10mm of pleural fluid on lat decub or US

Front 238

Pleural Effusion
lymphocytic exudate &
Pleural fluid adenosine deaminase > 70

Back 238

Tb

Front 239

Pleural Effusion
most common cause of eosinophil effusion

Back 239

PTX

Front 240

PTX
Spont. is primary when

Back 240

lung is overtly normal

Front 241

PTX
Primary spont PTX seen in..
CT scan shows...

Back 241

tall men who smokes
subpleural blebs and bullae

Front 242

PTX
Secondary PTX most common linked to..

Back 242

COPD

Front 243

PTX
women who don't smoke

Back 243

LAM

Front 244

PTX
treatment for primary spont PTX: aspirate (2)

Back 244

if >2cm or if SOB present

Front 245

PTX
treatment for primary spont PTX if aspiration failed

Back 245

intercostal tube

Front 246

PTX
treatment for primary spont PTX if drainage failed

Back 246

chest surgery

Front 247

PTX
treatment for secondary spont PTX +/- SOB. >2cm

Back 247

aspiration

Front 248

PTX
treatment for secondary spont PTX that fails aspiration

Back 248

intercostal tube drainage

Front 249

PTX
tension PTX defined

Back 249

intrapleural pressure exceeds atmospheric pressure throughout resp cycle

Front 250

PTX
tension PTX treatment (3)

Back 250

1. high oxygen
2. cannula in pleural space in 2nd intercostal space to remove air and stabilize patient
3. chest tube in pleural space

Front 251

PE
dangerous phsyio

Back 251

increase pulm vasc resistance, increase R heart work, reduce cardiac output, infarction and death

Front 252

PE
virchow triad…

T/F: Normal pulse ox or arterial PO2 RULES out pulm embolus

Back 252

hypercoag
venous stasis
vascular damage

FALSE: does not rule out.

Front 253

PE
CT scans miss

Back 253

sub segmental pulm arteries

Front 254

PE
Lung VQ, chest CT and leg doppler neg, but patient unstable and PE concern is strong

Back 254

gold standard test pulm angiography.

Front 255

PE
measure activity of lovenox and arixtra...

intermediate to high probability of pulm embolus then (even if D-dimer normal)….

If high probability for PE/DVT...

Back 255

Anti-Xa activity

CHEST CTA if no contraindications

start therapy first, then imaging.

Front 256

PE
unstable PE treatment to decrease risk of short term embolization…

IF lung VQ and chest CT indeterminate with intermediate probability then…

if that test negative...

Back 256

IVC filter

indeterminate - check doppler of legs

negative - no further evaluation or therapy

Front 257

PE

Duration of anticoagulation typically...

refractory hypotension and pulm embolus in acute setting...

Back 257

at least 3mo

thrombolytic therapy followed by anticoag

Front 258

CTEPH
1. Definition
2. prognosis if untreated

3. DIAGNOSTIC TEST

Back 258

chronic thromboembolic pulm HTN
fatal if untreated

VQ scan is better than chest CT

Front 259

CTEPH
Treatment (combo)

Back 259

resect chronic thrombus and start warfarin if no contraindications

Front 260

CTEPH
physio

Back 260

increased resistance of pulm arteries.

Front 261

CTEPH
monitor

Back 261

2decho after initial acute PE treatment

Front 262

CTEPH
diagnosis…

if inconclusive...

Back 262

lung VQ scan > chest CT. if still inconclusive pulm angiography

Front 263

CTEPH
Treatment combo

Back 263

pulm thromboendarectomy and warfarin

Front 264

CTEPH
who get it

Back 264

acute PE patients who do not recover completely

Front 265

PAH
physio...

mean pulm art pressure...

pulm capillary wedge pressure....

pulm vasc resistance

Back 265

narrow lumen of small pulm arteries and arterioles.

elevated mean pulm art pressure

normal wedge

increased resistance

Front 266

PAH
familial and gene

Back 266

AD with variable penetrance
BMPR2

Front 267

PAH
lung VQ

Back 267

moth eaten perfusion pattern

Front 268

PAH
Differential (2)

Back 268

connective tissue disorder
HIV

Front 269

PAH
diagnosis and treatment…

What happens medication does not decrease pulm artery pressure with vasoreactivity test...

Back 269

R heart cath to diagnose and assess acute vasodilator response before long term vasodilator is attempted.

if drug does not reduce pressure with vasoreactivity test then do not order that drug.

Front 270

PAH
Treatment (BP med)

Back 270

Ca channel blocker to reduce art pressure in acute setting

Front 271

PAH
IV treatment (3) and the best...
physio of treatment (2)
helps with

Back 271

prostacyclin (EPOPROSTENOL, treprostinil, and iloprost)
vasodilator and remodeling
cor pulmonale

Front 272

PAH
treatment that improves DOE
improves...

Back 272

bosentan- endothelin-1 receptor antogonist. endothelin 1 is potent vasoconstrictor
mortality

Front 273

PAH
man's favorite treatment

Back 273

sildenafil. inhibits cGMP phosphodiesterase. cGMP induced by nitric oxide to regulate vascular smooth muscle tone

Front 274

PAH
Non drug treatment (2)

Back 274

oxygen because alveolar hypoxemia causes vasoconstriction.
transplant

Front 275

Pulm nodule
minimum size for pulm nodule...

no follow up is needed for nodule…

if nodule is >3cm...

Back 275

less than 3cm in diameter (surrounded by normal tissue with no LN)

less than 4mm if never smoked or no cancer risk factors. if smoked or still smoking follow up 12mo if no change

LUNG mass for >3cm

Front 276

Pulm nodule
malignant findings(3)

approx 35% of solitary nodules are...

Back 276

spiculated margin
little or no calcification
intermediate doubling time

Bronchogenic ca

Front 277

Pulm nodule
Benign(3)

Ground glass nodule followup:

Back 277

smooth margin
laminated calcification
double within 30 days or no growth in 2yrs

yearly followup greater than 2 yrs due to possibility of transforming to slow growing adenoca

Front 278

Lung ca
85%

#1 overall cancer killer

Back 278

non small cell such as adeno

lung ca kills more than any other

Front 279

Lung ca
15%

chest xray and lung cancer screening

Back 279

small cell

not effective

Front 280

Lung ca
central lesion workup

Back 280

bronchoscopy

Front 281

Lung ca
peripheral lesion workup

Back 281

transthoracic needle aspiration

Front 282

Lung ca
T - primary tumor

Back 282

primary lesion size and invasion of contiguous structures

Front 283

Lung ca
N

Back 283

thoracic nodules

Front 284

Lung ca
M

Back 284

distant mets

Front 285

Lung ca
stage 4 lung ca

Back 285

M1

Front 286

Lung ca
3 cancers that often go to lungs

Back 286

kidney
colon
breast

Front 287

Mets to Lung
present as..

Back 287

asymptomatic single or multiple lung nodule

Front 288

Mets to lung
prognosis

Exception...

Back 288

poor and inoperable

mets from colorectal ca can be resected and good prognosis

Front 289

Lung tumor
benign

Back 289

hamartoma

Front 290

Lung tumor
Benign on chest xray or CT

Back 290

eccentric popcorn calcification

Front 291

Terminal Care
COPD survival scale

Back 291

BMI
airflow Obstruction
Dyspnea
Exercise capacity

Front 292

Terminal Care
Medicare criteria (3)

Back 292

1. medicare part A coverage
2. less than 6mo left
3. revocable agreement that hospice benefits replace medicare benefits

Front 293

Terminal Care
Medicare criteria for terminal phase of lung disease (3)

Back 293

1. disabling SOB @ rest
2. frequent ER visits
3. PaO2 <=55
O2 sat<=88

Front 294

OSA
define

Back 294

absence of airflow for at least 10 sec despite resp effort

Front 295

OSA
severity scale

Back 295

AHI
apnea hypoapnea index
# of apnea + # of hypoapnea/hour sleep

Front 296

OSA
AHI mild
AHI moderate
AHI severe

Back 296

mild 5-15
moderate 16-30
severe >30

Front 297

OSA
hallmark symptom

Back 297

excess daytime sleepiness.

Front 298

OSA
common physical findings

Back 298

obesity
large neck
large tongue/tonsils

Front 299

OSA
diagnosis

Back 299

nocturnal polysomnography

Front 300

OSA
treatment if conservative treatment FAILS (like wt loss, reduce eton, avoid supine)…

Is oxygen primary therapy for OSA...

Back 300

CPAP

No, oxygen is not primary therapy

Front 301

OSA
still sleepy after CPAP

Back 301

CPAP ineffective or another sleep disorder

Front 302

OSA
still sleepy after effective CPAP

Back 302

modafinil

Front 303

OSA
obstructive hypoapnea

Back 303

reduction of airflow or aplitude of thoraco-abdominal movement by at least 30% at least 10sec in duration, and oxygen desat of 4% or more

Front 304

OSA
treatment for anatomical abnormalities

Back 304

surgery

Front 305

OSA
treatment for mild to moderate OSA did not tolerate CPAP or surgery…

Is obesity-hypoventilation syndrome (Pickwickian) the same as OSA….

Back 305

oral device

No, o-h syndrome is associated with COPD with CO2 retention while awake. It may co-exist with OSA.

Front 306

CSA
non hypercapnic central sleep apnea

Back 306

sleep unmasks sensitive apnea threshold for CO2.

Front 307

CSA
who?

Back 307

CHF with EF<40%

Front 308

CSA
diagnosis

Back 308

nocturnal polysomnography

Front 309

CSA
treatment

Back 309

treat underlying disease such as treat heart failure to improve cardiac function.

Front 310

Sleep and COPD
desats occur mostly in..

Back 310

REM sleep

Front 311

Sleep and COPD
If on home oxygen, then with sleep

Back 311

increase by 1L/min at night

Front 312

Sleep and asthma
asthma worsened by (2)

Back 312

gerd
OSA

Front 313

Sleep and asthma
OSA and asthma treatment

Back 313

CPAP improves asthma control

Front 314

Sleep and asthma
nadir in peak flow rate when

Back 314

early morning hours

Front 315

Sleep
restrictive lung disease as well as pregnancy associate

Back 315

sleep related oxygen desat

Front 316

High Altitude

Condition with cyclic central apneas and hyperpneas associated with repetitive arousals from sleep, often with paroxysms of dyspnea

Back 316

High altitude periodic breathing (HAPB)

Front 317

HAPB
Treatment (2)

Back 317

1. acetazolamide
2. low dose hypnotics

Front 318

High Altitude
when does acute mountain sickness occur?

Back 318

4-36hr after ascent of above 2000m or 6500ft

Front 319

Acute Mountain Sickness
resolves

Back 319

after 2-5 days

Front 320

Acute Mountain Sickness
concern for acute mountain sickness..

Back 320

transition to HACE, high altitude cerebral edema

Front 321

Acute Mountain Sickness
less at risk

Back 321

older people

Front 322

Acute Mountain Sickness
1. prevention

2. to treat acute mountain sickness or cerebral edema

Back 322

1. acetazolamide before and after ascent; great for prevention
2. dexamethasone, not for prevention

Front 323

HAPE

(High Altitude Pulm Edema)
frequency

Back 323

very rare

Front 324

HAPE
symptoms occur

Back 324

2-4 days of ascent

Front 325

HAPE
Symptoms...

Back 325

SOB, cough with blood, AMS, and death

Front 326

HAPE
physio...

Back 326

blunted vent response to hypoxia, which increase pulm art pressure, leak protein into alveoli

Front 327

HAPE
prevention

Back 327

give time to acclimatize

Front 328

HAPE/HACE
immediate management for both…

3 meds for HAPE...

1 med for HACE...

Back 328

immediate travel to lower altitude with supplemental oxygen and/or hyperbaric oxygen.

HAPE - lasix or nifedipine or viagra

HACE - dexamethasone

Front 329

Air Travel
cabin pressure

Back 329

altitude less than 8000ft

Front 330

Air Travel
patients with lung disease

COPD with long flight...

Back 330

check pulse ox @ sea level.

oxyhgb saturation less than 92% should get in

flight supplemental oxygen

hypoxia altitude stimulation test

Front 331

High Altitude
breathing pattern with sleep

Back 331

cresendo-decrescendo ventilation followed by hypopnea or apnea

Front 332

Resp failure
acute hypoxemic resp failure includes

Back 332

caridiogenic

Front 333

Resp failure
what shifts oxyhgb dissociation curve to Right, lowering oxygen content ?(2)

Back 333

high temp and acidity

Front 334

Pulm edema
cardiogenic cause vs noncardiogenic

Back 334

hydrostatic pressure vs permeability related issue

Front 335

ARDS
define
cardiogenic or noncardiogenic

imaging...

Back 335

PaO2/FIO2 <= 200
noncardiogenic

alveolar opacities

Front 336

2 mechanisms of resp failure

Back 336

1. hypoxic
2. ventilatory

Front 337

COPD
mechanisms of resp failure (3)

Back 337

1. airway obstruction
2. auto PEEP
3. resp muscle issue

Front 338

Acute Vent failure
lab test

Back 338

PaCO2

Front 339

Acute vent failure
Lab test if chronic lung disease and why

Back 339

check pH on ABG. baseline elevated CO2. "hypercapnic"

Front 340

Acute vent failure
#1 cause

Back 340

drugs

Front 341

Acute vent failure
neuromuscular syndrome affects
3 muscle groups

Back 341

1. inspiratory - diaphragm, intercostal
2. exipratory - abd
3. bulbar - protect airway
If all 3 systems affected, BAD

Front 342

Acute vent failure
Spinal cord injury. if lesion below C4

Back 342

C3-C5 phrenic nerve

Front 343

Phrenic nerve injury

ALS or myasthenic crisis

Back 343

orthopnea with abdominal paradox in supine

Front 344

Acute vent failure
Most common cause in acute care setting

Back 344

acute inflammatory demyelinating polyneuropathy (Guillain BArre)

Front 345

Acute vent failure
surgical...
How to avoid

Back 345

neuromuscular blocking agents combined with high dose steroids
check train of 4 stimulation

Front 346

Acute vent failure
SIRS- how to avoid

Back 346

tight glycemic control

Front 347

Acute vent failure
Airway obstruction causers (2)

Back 347

COPD,
asthma

Front 348

Acute vent failure
Acute severe asthma signs

Back 348

tachycardia
tachypnea
accesory muscle use
pulsus paradoxus - pulse and BP drops more than 10 with inspiration

Front 349

Acute Vent Failure
asthma treatment new....

When to worry about asthma exacerbation....

Back 349

Mag sulfate with beta agonist

slightly elevated or normal PCO2 may indicate impending resp arrest

Front 350

Acute Vent failure
obesity hypoventilation rule out

Back 350

hypothyroid

Front 351

Mechanical ventilation
CPAP in COPD (2)

in moderate to severe COPD exacerbation...

Back 351

counterbalance auto PEEP
reduce/eliminate inspiratory threshold load

Noninvasive positive pressure ventilation is standard of care.

Front 352

Mechanical ventilation
CPAP in ICU (4 indications)

Back 352

1. acute hypercapnic failure in COPD
2. cardiogenic pulm edema
3. ARF in immunosuppressed
4. weaning extubation COPD

Front 353

NPPV
patient predictors for success (4)

When is it bad?

Back 353

improvement in pH, PaCO2, Level of consc., RR
(within 2 hrs of starting NPPV)

delays intubation in high risk patients

Front 354

VENTS
asthma and vents

Back 354

avoid intubation due to PTX and pneumomediastinum

Front 355

Vents
when to wean? (3)
SaO2
FIO2

Back 355

SaO2 >89%
FIO2 <= 40%
hemodynamic stable

Front 356

Vents
wean with (2)

Back 356

T piece or low level CPAP

Front 357

Vents
Failure to wean over 3 wks

Back 357

trach

Front 358

Vents
Settings for acute lung injury and ARDS (2)

Back 358

lung protective strategy
low tidal volume 6mL/kg
limited plateau pressure <30cm H20

Front 359

VENTS
intubated COPD:

settings need to minimize adverse effects of…

3 ways to avoid this condition...

Back 359

auto PEEP

remove airway obstruction

lower tidal volume

lower resp rate

Front 360

CPR outcomes
best survival (3)

Back 360

1. witnessed arrest
2. vfib
3. vtach

Front 361

severe sepsis

After IVF bolus and MAP less than 65 or central venous pressure less than 8...

poor prognosis if...

Back 361

start pressors. MAP= (2xDP +SBP)/3 refractory septic shock.

poor prognosis if still need IVF and pressors to maintain pressure

Front 362

sepsis
key component of sepsis physiology

Back 362

endothelial damage

Front 363

Sepsis
3 things important to surviving sepsis

Back 363

a. spont breathing trial
b. ulcer prophylaxis
c. DVT prophylaxis

Front 364

sepsis
give to high risk of death or 2 organ dysfunction

Back 364

activated protein C or Drotrecogin alfa

Front 365

sepsis
Should avoid this drug in sepsis only if BP does not respond to IVF and pressors

Back 365

IV hydrocortisone

Front 366

severe sepsis
6 criteria of organ dysfunction

Back 366

hypoxemia, shock, delerium, thrombocytopenia, high Cr, high bili

Front 367

shock
? etiology, then check

Defn....

Back 367

bedside echo

decreased tissue perfusion that results in inadequate oxygen delivery for cellular needs (tissue ischemia)

Front 368

shock - echo findings
1. PE
2. acute MI
3. hypovolemia
4. sepsis

Back 368

R vent dilatation
focal wall motion abnormality
poorly filled hyperdynamic L vent
global decrease in contractility

Front 369

warfare
most potent

Back 369

nerve agent

Front 370

warfare
nerve agent treatment for:
1. bronchorrhea
2. muscle weakness

Back 370

1. atropine
2. pralidoxime

Front 371

Anaphylaxis
anaphylactic rxn vs anaphylactoid rxn

IV steroids are helpful in...

Back 371

anyphylactic - IgE mediated
oid - non Ab-antigen mechanism

ANAPHYLAXIS, not angioedema from ACE inhibitor. angioedema may be part of anaphylaxis, it can occur alone without urticaria or other features of anaphylaxis

Front 372

Anyphalactic shock
due to...(2)

anaphylaxis treatment…

if BP is low...

Back 372

hypovolemia and vasodilation

epinephrine

pressors if low BP

Front 373

anyphlactic shock
death from...

Back 373

refractory bronchospasm, resp failure with airway obstruction, and CV collapse

Front 374

anyphalaxis
refractory anaphylaxis with low BP and bradycardia due to bblocker, then give...

Back 374

glucagon

Front 375

HTN emergency
goals of treatment (2)

Back 375

MAP by 20-25%
or diastolic BP <120

Front 376

HTN urgency
captopril side effect and avoid

Back 376

1. reflex tachycardia
2. ARF with high grade bilat renal stenosis

Front 377

HTN urgency
Clonidine side effect

Back 377

sedation

Front 378

HTN urgency
Labetalol side effect (2)

Back 378

bradycardia
bronchospasm

Front 379

HTN urgency
pheochromocytoma treatment

Back 379

prazosin

Front 380

HTN emergency
avoid enalapril in...

Back 380

pregnant women

Front 381

HTN emergency
med used when there is renal involvement

Back 381

fenoldopam - dopamine 1 receptor agonist. decreased both preload and afterload

Front 382

HTN emergency
decreases cerebral and cardiac ischemia

Back 382

nicardipine

Front 383

HTN emergency
pheochromocytoma IV med and side effect

Back 383

phentolamine. tachycardia causing ischemia

Front 384

HTN emergency
Sodium nitroprusside monitor

Back 384

thiocyanate

Front 385

HTN emergency
acute aortic dissection

Back 385

trimethaphan - ganglionic blocker

Front 386

HTN emergency
overall treatment and goal

Back 386

ICU with IV agents. goal is not normal BP, but lower BP to avoid further organ damage

Front 387

Hyperthermia
104 or 40C
106 or 41

Back 387

life threatening
brain death

Front 388

Hyperthermia
1st sign of heat stroke

Back 388

no sweat
warm, dry skin

Front 389

Hyperthermia
increased intracellular calcium causing mucle contraction

Back 389

malignant hyperthermia

Front 390

Hyperthermia
2 causes of malignant hyperthermia

Back 390

expose muscle to halothane or caffeine

Front 391

Hyperthermia
malignant hyperthermia treatment (5)

Back 391

stop drug, hydration, oxygen, cooling measures
Dantrolene

Front 392

Hyperthermia
preventive

Back 392

pretreat with dantrolene

Front 393

Hyperthermia
idiosyncratic reaction to neuroleptic meds and antipsychotics (within 2wks after starting meds)

Back 393

neuroleptic malignant syndrome

Front 394

Hyperthermia
neuroleptic malignant syndrome and Parkinson.

Back 394

can occur when quickly stop levodopa or anticholinergic meds

Front 395

Hyperthermia
neuroleptic malignant syndrome and parkinson treatment…

Back 395

restart parkinson meds

Front 396

Hypothermia
EKG finding

Back 396

J wave or osborn wave

Front 397

Hypothermia
treatment and complications

Back 397

re-warming
compartment syndrome, rhabdo, DIC

Front 398

ICU nutrition
lab for severe protein and calorie malnutrition

Back 398

prealbumin less than 5

Front 399

ICU nutrition
avoid aspiration

Back 399

TF into small intestine

Front 400

ICU nutrition
TPN risks

Back 400

gastric mucosa atrophy and bacteremia from translocation of bacteria from gut to bloodstream

Front 401

OD
visual complaints -1
Ca oxalate crystals urine -1
no osmolar gap due to ketones - 1

Back 401

methanol toxicity
ethylene glycol
isopropyl alcohol

Front 402

OD
alcohol toxicity treatment (2)

Back 402

IV ethanol and fomepizole

Front 403

OD
bruxism and jaw clenching

Back 403

ecstasy
bruxism - teeth grinding

Front 404

OD
amphetamine treatment (2)

Back 404

supportive and benzo for agitation

Front 405

OD
CO poisoning pathophys...

Back 405

shifts L on curve. impairs oxygen offload @ tissue

Front 406

OD
CO poisoning rare finding...

Back 406

cherry red lips

Front 407

OD
CO poisoning diagnosis…

What about pulse ox...

Back 407

venous or arterial carboxyHgb. CARBOXYHGB >25% is diagnostic of acute poisoning

pulse ox is unreliable, cannot separate carboxyhgb from oxyhgb

Front 408

OD
CO poisoning and normal lab...

Back 408

carboxyHgb may be normal due to oxygen already given

Front 409

OD
CO poisoning treatment(2)

Back 409

oxygen or hyperbaric oxygen

Front 410

OD
cocaine OD treatment (2)
if overt psychosis

Back 410

benzo for agitation and dilt for chest pain/HTN
haldol, but can lower seizure threshold

Front 411

OD
cocaine and cardiac

Back 411

ASA and NTG

Front 412

OD
salicylate

Back 412

alkalinization of urine to pH 7-8 for renal clearance

Front 413

OD
TCA with cardiotoxicity (arrthymia)

Back 413

IV Sodium bicarb (blood alkalinaztion)

Front 414

Rhabdo
pathophys

Back 414

skeletal muscle damage with myoglobin and CK release into circulation.

Front 415

Rhabdo
#1 risk factor

Back 415

etoh abuse

Front 416

Rhabdo
classic triad

Back 416

muscle pain, weakness, dark urine

Front 417

Rhabdo
Urine - 1
blood - 2

Back 417

myoglobinuria
CK and potassium

Front 418

Rhabdo
complication

Back 418

hypovolemia from fluid shifts to muscle
ARF from ATN

Front 419

Rhabdo
treatment and goal
stop treatment

Back 419

aggressive IVF for goal of UOP 300cc/hr
No myoglobin in urine

Front 420

Pulm diagnostic tests
FEV1/FVC less than 70% on spirometry
bronchial challenge test and asthma
DlCO

Back 420

airway obstruction
sensitive but not specific
lung ability to transfer gas across alv-cap membrane

Front 421

Pulm diagnostic tests
avoid pulse ox in...

Back 421

fire or smoke inhalation due to carboxyhgb which looks like oxyhgb to pulse ox

Front 422

Pulm HTN

defn...

2 main causes

Back 422

elevation of mean pulm art pressure of 25mm Hg or greater at rest

L side heart dysFN

underlying chronic lung disease

Front 423

Pulm HTN

if patient with suspected pulm art HTN or uncertain cause of pulm HTN

Back 423

R heart cath

Front 424

Pulm HTN

follow up after diagnosis

Back 424

2decho and 6min walk test

Front 425

Lung ca

how to stage preoperative NSCL ca or suspected NSCL ca....

Back 425

PET scan

Front 426

Lung ca

staging lung ca: endoscopic guided needle aspiration vs mediastinoscopy

Back 426

endoscopic guided aspiration is better

Front 427

Lung ca

treatment for stage 1 or 2 NSCL ca....

stage 3 or 4 lung ca treatment...

Back 427

surgical resection

chemo or chemo +XRT

Front 428

Lung ca

prognosis of lung ca depends on 2...

Back 428

stage @ presentation and performance status

Front 429

Lung tumor

typical carcinoid treatment...

Back 429

resection

low grade neuroendocrine tumor

Front 430

Sleep

therapy of excessive daytime sleepiness regardless of cause...

Back 430

at least 7-8hrs sleep a night

Front 431

ARDS

physio...

corrected by 3 things...

Back 431

hypoxemia

mechanical ventilation with supplemental oxygen and PEEP

Front 432

ARDS

How to avoid ventilator associated lung injury in ARDS? (4)

Back 432

limit tidal volumes 6ml/kg of ideal BW

lower plateau pressure

optimize PEEP

reduce FIO2 to less than 0.6

Front 433

Intubation

obstructive lung disease and intubation strategy

Back 433

allow adequate time for exhalation before next delivered breath and minimize airway resistance through PEEP

Front 434

Intubation

readiness to wean intubation

Back 434

rapid shallow breathing index

Front 435

Intubation

daily interruption of sedation and spont breathing trial...

Back 435

lead to earlier extubation

Front 436

Critical Care

after stabilized in ICU, sugar goal if severe sepsis and hyperglycemia

Back 436

less than 180

Front 437

COPD

symptomatic COPD with FEV1 less than 50% predicted should receive...

Back 437

pulm rehab

Front 438

OD

ethylene glycol (antifreeze) poisoning or methanol (wood alcohol) or isopropyl (rubbing) alcohol poisoning treatment...(3)

Back 438

fomepizole, ethanol, dialysis

Front 439

PTX

Primary

Secondary

If less than 2cm between chest wall and lung...

Back 439

primary - no previous lung disease

secondary - previous lung disease, usually COPD

manage inpatient with serial chest xrays, no tube.

Front 440

Sleep

First step of evaluation for daytime sleepiness.

Back 440

sleep diary for 1-2wks

Front 441

Spirometry

evaluate fixed airway obstruction

Back 441

Flow volume loops, not lung volume measurments

Front 442

Vents

How to avoid autoPEEP in intubated status asthmaticus or severe airflow obstruction?

Back 442

allow adequate time for exhalation to avoid stacking breaths and autoPEEP

Front 443

Asthma

pregnant and not controlled by albuterol and inhaled steroids...

avoid this oral drug...

avoid this asthma test...

Back 443

add long acting beta agonist

theophylline

methacholine challenge

Front 444

OSA

nasal congestion and CPAP...

avoid this drug...

Back 444

humidify CPAP circuit to improve compliance

oxymetazoline nasal spray due to rebound congestion when med is stopped.

Front 445

Silicosis

If history of silicosis, puts you at risk for...

Back 445

Tb

Front 446

PE

unprovoked PE/DVT with completed course of AC and still high DDimer

Back 446

restart anticoag because of risk of recurrence. should test DDimer 3-4 wks after stopping warfarin

Front 447

Resp Failure

hypoxemia from atelectasis after abdominal surgery or lung resection

Back 447

CPAP helps avoid intubation and pneumonia

Front 448

Resp failure

ARDS with normal BP and kidney function

Back 448

aggressive diuresis may reduce time on ventilation

Front 449

Critical Care Illness

best means of nutritional support in critically ill if can tolerate

Back 449

NG tube with enteral tube feeds

Front 450

Work Exposure

Coal workers with breathing symptoms: PFT or chest CT

Back 450

PFT first to eval obstructive disease

Front 451

ICU

common cause of AMS in ICU

Back 451

delerium

Front 452

Lung mass

from posterior mediastinum...

from anterior mediastinum...

from middle mediastinum...

Back 452

neural tissue origin like schwannoma

anterior: thymus or thyroid

middle: LN

Front 453

Resp Failure

2 bedside test for resp failure and neuromuscular disorder

Back 453

vital capacity and maximum inspiratory pressure. VC less than 20 are poor prognosis

Front 454

COPD

CPAP vs NPPV

Back 454

use NPPV for moderate to severe COPD. do not use NPPV if high risk COPD, just go to intubation. CPAP is for OSA.

Front 455

Lung Ca

If abnormal PET scan, next step of workup and why?

Back 455

mediastinal LN sampling is better than CT guided biopsy for STAGING. During US can see all area LN

Front 456

Lung Ca

Stage 1 or 2 non-small cell lung ca treatment...

Stage 3 or 4 lung ca treatment...

Back 456

surgical resection

chemo +/- XRT

Front 457

Hyperthermia

Neuroleptic malignant hyperthermia is caused by:

treatment:

Not helpful....

Back 457

antipsychotic agents

stop agent, start IVF, start IV ativan

not helpful dantrolene

Front 458

Sleep

obese with daytime CO2>45 (hypercapnia) and DOE...

Treatment...

Back 458

Obesity Hypoventilation syndrome or Pickwickian

CPAP

Front 459

Lung Ca

if nonsmall cell lung ca is suspicious, and thoracentesis is negative, next step...

Back 459

repeat thoracentesis and cytology

Front 460

Interstitial pneumonia

Nonspecific idiopathic interstitial pneumonia with initial negative workup, then in 1 yr....

Back 460

repeat autoimmune testing

(may test negative initially, but will test positive in the future)

Front 461

ARDS

mechanical ventilation goal for PEEP...

(which ensures)..

Back 461

PEEP that acheives FIO2 less than 0.6 that does not reduce BP

Front 462

ARDS

reduce mortality by decreasing (2)

Back 462

tidal volume 6 and plateau pressure <30

Front 463

Asthma

symptomatic with PCO2 greater than or equal to 42 or persistent FEV1 or peak expiratory flow less than 40% despite aggressive bronchodilator treatment....

Back 463

ICU admission

Front 464

Effusion

complicated parapneumonic effusions that are large in size, glucose less than 60, fluid pH less than 7.2

Back 464

Give Abx and pleural drainage (thoracostomy tube)

Front 465

Hypoventilation

hypercapnic resp failure related to neuromuscular weakness (daytime sleepiness with PCO2 >45

Back 465

bipap because cpap will not reduce hypercapnia

Front 466

Lung ca

endobronchial (within bronchus) obstructing neoplasm in young non-smoker and treatment...

Back 466

carcinoid with resection, good prognosis

Front 467

PFT

if patient with low lung volumes and normal DLCO2...

Back 467

extrapulm cause of low lung volume

Front 468

PFT

Who has normal pulse ox, when VERY SOB (2)…

if tissue is underperfused, then...

Back 468

cyanide and CO poisoning

pulse ox may be false low.

Front 469

CF

CF with acute abdominal pain...

Back 469

intestinal intussusception

Front 470

PTX

if SOB, pleurisy or both with normal exam, then…

if suspected tension PTX, do this before CXR results...

Back 470

check upright chest X-ray

needle decompression

Front 471

PTX

primary spont PTX that resolve with aspiration who are stable…

secondary PTX, need this...

Back 471

can DC home

hospitalization

Front 472

Insomnia

when to treat insomnia with antidepressant…

when to prescribe antihistamine for insomnia...

Back 472

when depressed

NEVER

Front 473

Pulm nodule

PET scans in alveolar ca or lesions less than 1cm in diameter…

PET scans in various inflammatory lesions...

Back 473

False Negative

False positive in inflamm lesions

Front 474

Pulm nodule

bronch biopsy or Transthoracic needle aspiration biopsy with nonspecific negative result...

Back 474

DOES not rule out presence of malignant growth

Front 475

Hemoptysis

rule out these 2 common conditions…

check 2 labs...

Back 475

epistaxis and GI bleed

PLT and coags

Front 476

Sarcoid

rule out these 2 conditions…

What lab is NOT helpful in diagnosis or treatment...

Back 476

Tb and fungal infection

ACE level

Front 477

Sarcoid

sarcoidosis like condition in light bulb factory worker or semiconductor factory…

Treatment for asymptomatic sarcoidosis...

Back 477

beryllium exposure

NOTHING

Front 478

Chronic Hypercapnic Resp Failure

obtain these measurements to diagnose neuromuscular disease (ALS, MS, MG)...

Back 478

maximal inspiratory and expiratory pressures

Front 479

ARDS

avoid this drug for acute treatment…

high or low PEEP…

tidal volume goal...

Back 479

avoid corticosteroids.

low PEEP

6ml/kg of ideal body weight

Front 480

Pulm preop

T/F: preop spirometry SHOULD be used to predict risk for post op pulm complications….

Back 480

F: should not be used

Front 481

Ventilator

if resp acidosis…

if resp alkalosis…

if low tissue oxygenation...

Back 481

acidosis - reduce PaCO2 by increase RR and tidal volume

alkalosis - increase PaCO2 by reducing RR and tidal volume

oxygenation - increase Fio2 and increase PEEP

Front 482

Ventilator

avoid this weaning mode, because it increases time to wean...

Back 482

synchronized intermittent mandatory ventilation

Front 483

DVT

after diagnosis, then apply…

T/F: IV thrombolytics therapy for PE improves overall survival...

Back 483

TEDs to reduce risk of postthrombotic syndrome.

False: does NOT improve survival

Front 484

Poisoning

organophosphate poisoning labwork…

Treatment and management…

if fever and delirium...

Back 484

lab: acetylcholineesterase level

treatment: atropine

management - check serum Acetylcholineesterase levels

atropine toxicity

Front 485

Hyperthermia

shivering, hyperreflexia, myoclonus and ataxia (with high fever and cognitive change)...

Back 485

serotonin syndrome

Front 486

ICU

EMG with axonal sensorimotor peripheral neuropathy in patient with generalized weakness or difficult to wean ventilator….

treatment...

Back 486

critical illness neuropathy

stop corticosteroids or neuromuscular blocking agents