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ABIM Critical Care > CHEST Questions > Flashcards

CHEST Questions Flashcards

1
Q

Elevated ScVO2 (e.g., >75%) indicates what?

A

Left to right intracardiac shunt

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2
Q

Loud, fixed split S2 indicated cardiac dysfunction?

A

ASD

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3
Q

Cardiac contraindications (3) to right heart cath?

A

Mechanical tricuspid valve, RVAD, LBBB.

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4
Q

Indications for CTSurgery for TV IE? (4)

A

-Refractory bacteremia
-Vegetations >1cm
-HF
-Fungal BCx (+).

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5
Q

What is ‘reverse triggering’ on a vent?

A

When a patient (usually deeply sedated) initiated a breath while in the inspiratory phase of a controlled breath.

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6
Q

Characteristic lab finding in TTP?

A

ADAMST13 level <10

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7
Q

2 diseases with anti-β2-Glycoprotein antibodies (+)?

A

SLE, Anti-phospholipid Antibody

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8
Q

Treatment of catastrophic antiphospholipid antibody syndrome?

A

Anticoagulation, steroids, plasma exchange.

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9
Q

Mechanism of action of levosimendan?

A

Myocardial calcium sensitizer. Not available in US.

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10
Q

Pathophysiology of re-expansion pulmonary edema?

A

Rapid re-expansion -> stress capillary leak -> inflammatory cell release cytokines -> pulmonary edema BILATERALLY.

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11
Q

Organophosphate pesticides cause what kind of poisoning?

A

Cholinergic symptoms: Parasympathetic. Salivation, Lacrimation, Urination, Diarrhea, GI distress, Emesis. Also, bradycardia, and bronchorrhea. Like sarin nerve gas.

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12
Q

Treatment of cholinergic poisoning?

A

-Diazepam to prevent seizures.
-Atropine (high doses).
-Pralidoxime (Acetylcholinesterase reactivator)

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13
Q

Mechanism of action of Pralidoxime? Use?

A

Acetylcholinesterase reactivator. Used in cholinergic poisoning (Sarin gas, organophosphate poisoning, neostygmine Rx).

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14
Q

Management of exposure to varicella PNA (aerosolized) for heatlchare workers who are not vaccinated?

A

Vaccinate. Remove from patient care areas from post-exposure days 8-21. Only give IV varicella immunoglobulin if vaccine contraindicated (e.g., pregnant), or immunosuppressed.

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15
Q

Tx of severe blastomycosis?

A

IV Liposome B, followed by PO voriconaozle. If ARDS, use adjunctive steroids.

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16
Q

Sx of Steven-Johnson Syndrome / Toxic Epidermic Necrolysis?

A

Fever, malaise, myalgia, musous membrane involvement (photophobia, orodynia, odonyphagia). Prodrome of skin pain.

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17
Q

Other name for Acute Interstitial Pneumonia?

A

Hamman-Rich Syndrome.

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18
Q

In using an EVD to treat intraventricular hemorrhage, what intervention has been shown to improve mortality?

A

Administering tPA into the EVD to clear the blood clots in the CSF.

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19
Q

Best POCUS view for assessing RV?

A

Apical 4-chamber view.

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20
Q

Anti-NMDA-Receptor encephalitis associated with what condition?

A

Benign ovarian & testicular teratomas.

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21
Q

SCLC associated with what 2 paraneoplastic syndromes most commonly?

A

-Lambert-Eaton (Anti-acetylcholine receptor antibodies)
-Opsiclonus-Myoclonus (Anti-Hu)

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22
Q

Breast Cancer associated with what paraneoplastic, autoimmune condition?

A

Retinal Blindness (Anti-Ri antibodies)

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23
Q

Colon cancer increases the risk for what non-GI infection?

A

Clostridium myonecrosis. Believed to be hematogenous seeding from colon cancer.

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24
Q

Risk factor for vibrio vulnificus wound infection?

A

Salt water exposure.

25
Q

2 antibiotic options to treat Vibrio Vulnificus wound infection?

A

Cipro, doxy

26
Q

Vibrio vulnificus sepsis (not wound infection) seen with what 2 concomitant risk factors?

A

Eating raw shellfish with liver disease.

27
Q

What is a Lean Design?

A

Method of analyzing a process to reduce wastes steps and maximize efficiency.

28
Q

What is a Root Cause Analysis?

A

Analysis of an adverse outcome for a single patient, asking “why” repeatedly.

29
Q

What is a Plan-Do-Study-Act analysis?

A

Changing one small aspect of a process while keeping other aspects stable to examine outcome.

30
Q

What is a FMEA (Failure Modes Event Analysis)?

A

Analysis of risk and consequence of failure of different steps of a process, but offers no solution.

31
Q

What effect does prone positioning have on CVP & PAOP?

A

Raises them both due to relative lowering of heart compared to large splanchnic reservoir or blood.

32
Q

What is an AIVR (Accelerated Idioventricular Rhythm)?

A

Seen after cardiac reperfusion, wide-complex rhythm 50-120bpm. The reperfused Purkinje fibers beat faster than the SA node. Stable, no treatment needed.

33
Q

Indications for dexamethasone for bacterial meningitis?

A

For suspected or known Strep Pneumo. Give for first 12 hours empirically, then only continue if you know it’s Strep Pneumo.

34
Q

What two pathogens cause meningitis which presents with prolonged course, severe encephalopathy, in immunocompromised hosts?

A

Listeria, TB.

35
Q

Hallmark of CSF analysis in TB meningitis?

A

Extremely low glucose

36
Q

What is the Jod-Basedow phenemenon?

A

Thyroid storm precipitated by iodinated contrast.

37
Q

Buzzword: “Weakly Acid-Fast”. What organism?

A

Nocardia

38
Q

Tx (Nocardia)?

A

Bactrim

39
Q

Tx (Actinomycetes)?

A

Penicillin

40
Q

Buzzword: chemical weapon that smells like freshly cut hay or corn?

A

Phosgene

41
Q

Sx of Phosgene gas attack?

A

Dissolves to be acidic, so eye & mucous membrane irritation. Non-cardiogenic pulmonary edema (like chlorine). There is a 8-48hr time delay.

42
Q

Buzzword: chemical weapon that smells like bleach?

A

Chlorine gas

43
Q

Sx of Chlorine gas exposure?

A

Dissolves to be acidic, so eye & mucous membrane irritation. Non-cardiogenic pulmonary edema (like phosgene). Immediate effect.

44
Q

Sx of cyanide exposure?

A

Tachycardia followed by bradycardia, hypotension, cyanosis, metabolic acidosis, and seizures

45
Q

Tx of cyanide exposure?

A

-Hydroxycobalamin.
-Sodium nitrate.
-Sodium thiosulfate.

46
Q

Major drug classes causing serotonin-syndrome (7)?

A

SSRI, SNRI, MAOI, analgesic, anti-emetics, linezolid, drugs of abuse

47
Q

Treatment of severe serotonin-syndrome?

A

BZDs, cyproheptadine

48
Q

False positives for the beta-D-glucan test for aspergillosis (7)?

A

HD with cellulose filters, PJP, Pseudomonas, Candida, augmentin, albumin, IVIG.

49
Q

What lab abnormalities are expected while rewarming a hypothermic patient?

A

Hyperkalemia, hypoglycemia.

50
Q

EKG changes of Brugada syndrome?

A

ST elevations in V1, V2

51
Q

Drug used to induce Brugada syndrome during EP studies?

A

Flecanide

52
Q

Tx (Brugada syndrome)?

A

ICD or anti-arrhythmics (procainamide, amiodarone)

53
Q

Implication of Staph Lugdunesis bacteremia?

A

Treat like S Aureus: workup for IE and prolonged antibiotics.

54
Q

Lab testing for VITT (Vaccine Induced Thrombotic Thrombocytopenia)?

A

(+) Anti-Platelet-Factor-4 IgG antibodies (just like HIT).

55
Q

Timeframe for VITT (Vaccine Induced Thrombotic Thrombocytopenia)?

A

5-30 days. Makes sense because IgM mediated.

56
Q

Zanamivir (Antiviral for influenza) is contraindicated when?

A

AEAsthma or AECOPD. Inhaled medicine.

57
Q

Empiric antibitoics for treatment of Acute Hyperammonemia status post lung transplant?

A

Doxy & Levaquin/Azithro

58
Q

Bacterial infections implicated in Acute Hyperammonemia status post lung transplant?

A

Mycoplasma Hominis.
Ureaplasma Urealyticum & Parvum

59
Q

Drugs used in ICU metabolized via 0-order kinetics? “Peas and WHEATS”

A

-Phenytoin
-Warfarin
-Heparin
-Ethanol
-Acetaminophen
-Theophyline
-Salicylates

ABIM Critical Care (37 decks)

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