Pulmonology/cc

Front 1

What size is a sub-centimeter SPN?

Back 1

<=8mm

Front 2

What to do for a subcent SPN in low and high risk patients for the following sizes?

<4mm

4-6mm

6-8mm

>8mm

Back 2

- low risk: no f/u CT, f/U CT in 12 months only, CT in 6-12 and 18-24 months, CT in 3, 9 and 24!months

-High: same as above but shift up so you never not do a f/u CT in high risk patients

Front 3

Diagnose COPD

Back 3

FEV/FVC ratio <0.70

plus

symptoms

Front 4

When to start LAMA/ LABA in COPD?

Back 4

FEV1< 60%

Front 5

When to start call pulm rehab in COPD?

Back 5

FEV1 < 50%

Front 6

When to start continuous oxygen therapy in COPD?

Back 6

Arterial PO2 < 55 mm Hg or oxygen saturation < 88%.

Arterial PO2 < 60 mmHg and pulmonary hypertension peripheral edema secondary to right heart failure or polycythemia

Front 7

Which long cancer presents with bulky mediastinal lymphadenopathy plus a hilar mass and is also associated with paraneoplastic syndromes?

Back 7

Small cell lung cancer

Front 8

Name the paraneoplastic syndrome which causes a symmetric proximal muscle weakness? What is the cancer associated with this?

Back 8

Lambert-Eaton syndrome

Small cell lung cancer

Front 9

Name the paraneoplastic syndrome which causes a symmetric proximal muscle weakness? What is the cancer associated with this?

Back 9

Lambert-Eaton syndrome

Small cell lung cancer

Front 10

When is lung volume reduction surgery indicated?

Back 10

Upper lobe emphysema

Front 11

In what type of emphysema is long transplant indicated?

Back 11

Homogenous emphysema

Front 12

What are contraindications to lung transplant?

Back 12

Malignancy in the last two years, infection with hepatitis B or C, significant liver disease, active or recent smoking history, severe psychiatric history, drug or alcohol abuse, medication non-adherence, absence of social support, age greater than 65, and multiple comorbidities.

Front 13

What are contraindications to lung transplant?

Back 13

Malignancy in the last two years, infection with hepatitis B or C, significant liver disease, active or recent smoking history, severe psychiatric history, drug or alcohol abuse, medication non-adherence, absence of social support, age greater than 65, and multiple comorbidities.

Front 14

Why should high-resolution long CT not be used for suspected localized lung disease as pulmonary nodules?

Back 14

HRCT takes very thin slices and reconstructs them at high resolution to get a very detailed image of the long parenchyma however these slices are obtained at relatively wide intervals approximately 1 cm between image slices and therefore may miss smaller lesions.

HRCT is better for diagnosing defuse parenchymal lung disease.

Front 15

What is mean pulm arterial pressure in pulmonary HTN? What about systolic pulm artery pressure?

Back 15

Mean PAP >= 25mm Hg

Systolic PAP >= 40mm Hg

Front 16

Define ventilator-associated pneumonia (VAP).

What bugs need to be covered for?

Back 16

Pneumonia within 48 hrs after intubation.

Multi-drug resistant organisms such as pseudomonas and MRSA.

Front 17

Indications for initiating dialysis

Back 17

Hyperkalemia

Severe acidosis

Uremia

Front 18

Indications for initiating dialysis

Back 18

Hyperkalemia

Severe acidosis

Uremia

Front 19

Plural fluid ADA

Back 19

Tuberculosis

Front 20

Indications for initiating dialysis

Back 20

Hyperkalemia

Severe acidosis

Uremia

Front 21

Plural fluid ADA

Back 21

Tuberculosis

Front 22

Exudative pleural effusion

Back 22

Fluid prot / serum prot > 0.5

Fluid LDH > 200 or 2/3 upper nl

Fluid LDH / serum LDH > 0.6

Front 23

Pleural fluid studies to suggest Empyema

Back 23

> 50,000 nucleated cells (leuks)

pH < 7.0

Glucose < 60

Front 24

Pleural fluid studies to suggest Empyema

Back 24

> 50,000 nucleated cells (leuks)

pH < 7.0

Glucose < 60

Front 25

Amylase ratio > 1

of

Pleural fluid / serum

Back 25

Esophageal rupture

Pancreatic disease

Cancer

Front 26

Causes of transudative pleural effusion

Back 26

HF

Nephrotic syndrome

Cirrhosis

Constrictive pericarditis

SVC obstruction

Front 27

Anion gap, no osmolal gap

Back 27

Salicylate toxicity

Front 28

Osmolal gap, no amion gap

Back 28

Isopropyl alcohol poisoning

Front 29

Anion gap and osmolal gap

Back 29

Methanol ---> formic acid (retinal toxicity)

Ethylene glycol --> oxalic acid (crystallizes in renal tubules to cause AKI)

Front 30

Calculate osmolal gap

Back 30

Measured osmolality - calculated osmolality = os gap

Measured osmolal is given

Calculated osmolal = 2xsodium + glucose/18 + BUN/2.8

Normal osmolal gap is 10mOsm/kg

Front 31

Dramatically improved survival in ARDS

Back 31

Prone positioning

Front 32

If suspicion for malignancy is high, what should you do if first pleural fluid cytology is neg?

Back 32

Repeat pleural fluid cytology

Front 33

If suspicion for malignancy is high, what should you do if first pleural fluid cytology is neg?

Back 33

Repeat pleural fluid cytology

Front 34

Pleural fluid / serum amylase ratio > 1

Back 34

Pancreatic disease

Esophageal rupture

Cancer

Front 35

Preferred test to diagnose CTEPH?

Back 35

V/Q scan is better than CT angio

Front 36

Positive vasoreactive testing in PAH

Treatment?

Back 36

Calcium channel blocker

Front 37

Positive vasoreactive testing in PAH

Treatment?

Back 37

Calcium channel blocker

Front 38

Test to obtain baseline prior to initiating PAH therapy

Back 38

6-minute walk test

Front 39

What to use for tidal vol.

Back 39

Ideal body wt x 5

That's how much tidal volume to get

Front 40

ICU mode

Back 40

Continuous mandatory mode volume control

Front 41

Know the new gold criteria chart for COPD (focus on exacerbations)

Back 41

CHART

Front 42

Pleural plaques on CXR

Back 42

Asbestosis

Front 43

Went to initiate noninvasive positive pressure ventilation in patients with chronic respiratory failure or do to muscular weakness?

Back 43

FVC < 50%

Vital capacity < 60%

Inspir pressure < -30 cm H2O

Front 44

Hypotension, increased QRS interval (>100ms), seizures and anti-cholinergic signs.

Back 44

TCA overdose

Treat with sodium bicarbonate to increase serum pH and decrease ionized form of the drug which vines to sodium channels making it less available.

Front 45

What is the timeframe for radiation fibrosis?

Back 45

6 to 24 months

Front 46

What is the timeframe for radiation pneumonitis?

Back 46

6 to 12 weeks

Front 47

Mediastinal mass in 20s and 30s

Back 47

Hodgkin lymphoma

Front 48

Mediastinal mass in 40s and 50s

Back 48

Thymoma

Front 49

Target CVP in ARDS

Back 49

4 mmHg A.k.a. the conservative fluid management strategy

Front 50

Treatment for shift work sleep disorder.

Back 50

1st line: sleep hygiene

2nd line: modafinil (stimulant used on ADHD)

Front 51

Indication for pulmonary rehab

Back 51

FEV1 < 50% or after acute COPD exacerbation requiring hospitalization

Front 52

Goal FiO2 in ARDS.

How do we achieve it?

Back 52

FiO2 < 0.60

Increase the PEEP

Front 53

Goal FiO2 in ARDS.

How do we achieve it?

Back 53

FiO2 < 0.60

Increase the PEEP

Front 54

Which pneumococcal vaccine should be given once before the age of 65 when indicated? 13 or 23? What are the trade names?

Back 54

PPSV-23, Pneumovax, polysaccharide vaccine

The other one is Prevnar, PCV-13, conjugated vaccine given after age 65.

Front 55

Lung protective strategy in ARDS.

Back 55

Low tidal volume (6 mL/kg of ideal body weight) and low plateau pressure (<30 mmH2O)

Front 56

Medication to treat high altitude pulmonary edema (HAPE)

Back 56

Nifedipine

Front 57

Medication to treat high altitude sickness and hi altitude cerebral edema

Back 57

Acetazolamide

Front 58

Medication to treat high altitude sickness and hi altitude cerebral edema

Back 58

Acetazolamide

or

Dexamethasone

Front 59

Medication to treat high altitude sickness and hi altitude cerebral edema

Back 59

Acetazolamide

or

Dexamethasone