CHEST Questions Flashcards
Elevated ScVO2 (e.g., >75%) indicates what?
Left to right intracardiac shunt
Loud, fixed split S2 indicated cardiac dysfunction?
ASD
Cardiac contraindications (3) to right heart cath?
Mechanical tricuspid valve, RVAD, LBBB.
Indications for CTSurgery for TV IE? (4)
-Refractory bacteremia
-Vegetations >1cm
-HF
-Fungal BCx (+).
What is ‘reverse triggering’ on a vent?
When a patient (usually deeply sedated) initiated a breath while in the inspiratory phase of a controlled breath.
Characteristic lab finding in TTP?
ADAMST13 level <10
2 diseases with anti-β2-Glycoprotein antibodies (+)?
SLE, Anti-phospholipid Antibody
Treatment of catastrophic antiphospholipid antibody syndrome?
Anticoagulation, steroids, plasma exchange.
Mechanism of action of levosimendan?
Myocardial calcium sensitizer. Not available in US.
Pathophysiology of re-expansion pulmonary edema?
Rapid re-expansion -> stress capillary leak -> inflammatory cell release cytokines -> pulmonary edema BILATERALLY.
Organophosphate pesticides cause what kind of poisoning?
Cholinergic symptoms: Parasympathetic. Salivation, Lacrimation, Urination, Diarrhea, GI distress, Emesis. Also, bradycardia, and bronchorrhea. Like sarin nerve gas.
Treatment of cholinergic poisoning?
-Diazepam to prevent seizures.
-Atropine (high doses).
-Pralidoxime (Acetylcholinesterase reactivator)
Mechanism of action of Pralidoxime? Use?
Acetylcholinesterase reactivator. Used in cholinergic poisoning (Sarin gas, organophosphate poisoning, neostygmine Rx).
Management of exposure to varicella PNA (aerosolized) for heatlchare workers who are not vaccinated?
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.
Tx of severe blastomycosis?
IV Liposome B, followed by PO voriconaozle. If ARDS, use adjunctive steroids.
Sx of Steven-Johnson Syndrome / Toxic Epidermic Necrolysis?
Fever, malaise, myalgia, musous membrane involvement (photophobia, orodynia, odonyphagia). Prodrome of skin pain.
Other name for Acute Interstitial Pneumonia?
Hamman-Rich Syndrome.
In using an EVD to treat intraventricular hemorrhage, what intervention has been shown to improve mortality?
Administering tPA into the EVD to clear the blood clots in the CSF.
Best POCUS view for assessing RV?
Apical 4-chamber view.
Anti-NMDA-Receptor encephalitis associated with what condition?
Benign ovarian & testicular teratomas.
SCLC associated with what 2 paraneoplastic syndromes most commonly?
-Lambert-Eaton (Anti-acetylcholine receptor antibodies)
-Opsiclonus-Myoclonus (Anti-Hu)
Breast Cancer associated with what paraneoplastic, autoimmune condition?
Retinal Blindness (Anti-Ri antibodies)
Colon cancer increases the risk for what non-GI infection?
Clostridium myonecrosis. Believed to be hematogenous seeding from colon cancer.
Risk factor for vibrio vulnificus wound infection?
Salt water exposure.
2 antibiotic options to treat Vibrio Vulnificus wound infection?
Cipro, doxy
Vibrio vulnificus sepsis (not wound infection) seen with what 2 concomitant risk factors?
Eating raw shellfish with liver disease.
What is a Lean Design?
Method of analyzing a process to reduce wastes steps and maximize efficiency.
What is a Root Cause Analysis?
Analysis of an adverse outcome for a single patient, asking “why” repeatedly.
What is a Plan-Do-Study-Act analysis?
Changing one small aspect of a process while keeping other aspects stable to examine outcome.
What is a FMEA (Failure Modes Event Analysis)?
Analysis of risk and consequence of failure of different steps of a process, but offers no solution.
What effect does prone positioning have on CVP & PAOP?
Raises them both due to relative lowering of heart compared to large splanchnic reservoir or blood.
What is an AIVR (Accelerated Idioventricular Rhythm)?
Seen after cardiac reperfusion, wide-complex rhythm 50-120bpm. The reperfused Purkinje fibers beat faster than the SA node. Stable, no treatment needed.
Indications for dexamethasone for bacterial meningitis?
For suspected or known Strep Pneumo. Give for first 12 hours empirically, then only continue if you know it’s Strep Pneumo.
What two pathogens cause meningitis which presents with prolonged course, severe encephalopathy, in immunocompromised hosts?
Listeria, TB.
Hallmark of CSF analysis in TB meningitis?
Extremely low glucose
What is the Jod-Basedow phenemenon?
Thyroid storm precipitated by iodinated contrast.
Buzzword: “Weakly Acid-Fast”. What organism?
Nocardia
Tx (Nocardia)?
Bactrim
Tx (Actinomycetes)?
Penicillin
Buzzword: chemical weapon that smells like freshly cut hay or corn?
Phosgene
Sx of Phosgene gas attack?
Dissolves to be acidic, so eye & mucous membrane irritation. Non-cardiogenic pulmonary edema (like chlorine). There is a 8-48hr time delay.
Buzzword: chemical weapon that smells like bleach?
Chlorine gas
Sx of Chlorine gas exposure?
Dissolves to be acidic, so eye & mucous membrane irritation. Non-cardiogenic pulmonary edema (like phosgene). Immediate effect.
Sx of cyanide exposure?
Tachycardia followed by bradycardia, hypotension, cyanosis, metabolic acidosis, and seizures
Tx of cyanide exposure?
-Hydroxycobalamin.
-Sodium nitrate.
-Sodium thiosulfate.
Major drug classes causing serotonin-syndrome (7)?
SSRI, SNRI, MAOI, analgesic, anti-emetics, linezolid, drugs of abuse
Treatment of severe serotonin-syndrome?
BZDs, cyproheptadine
False positives for the beta-D-glucan test for aspergillosis (7)?
HD with cellulose filters, PJP, Pseudomonas, Candida, augmentin, albumin, IVIG.
What lab abnormalities are expected while rewarming a hypothermic patient?
Hyperkalemia, hypoglycemia.
EKG changes of Brugada syndrome?
ST elevations in V1, V2
Drug used to induce Brugada syndrome during EP studies?
Flecanide
Tx (Brugada syndrome)?
ICD or anti-arrhythmics (procainamide, amiodarone)
Implication of Staph Lugdunesis bacteremia?
Treat like S Aureus: workup for IE and prolonged antibiotics.
Lab testing for VITT (Vaccine Induced Thrombotic Thrombocytopenia)?
(+) Anti-Platelet-Factor-4 IgG antibodies (just like HIT).
Timeframe for VITT (Vaccine Induced Thrombotic Thrombocytopenia)?
5-30 days. Makes sense because IgM mediated.
Zanamivir (Antiviral for influenza) is contraindicated when?
AEAsthma or AECOPD. Inhaled medicine.
Empiric antibitoics for treatment of Acute Hyperammonemia status post lung transplant?
Doxy & Levaquin/Azithro
Bacterial infections implicated in Acute Hyperammonemia status post lung transplant?
Mycoplasma Hominis.
Ureaplasma Urealyticum & Parvum
Drugs used in ICU metabolized via 0-order kinetics? “Peas and WHEATS”
-Phenytoin
-Warfarin
-Heparin
-Ethanol
-Acetaminophen
-Theophyline
-Salicylates
