CHEST SEEK Questions Flashcards
What is bovine pegylated carboxyhemoglobin used for? What is the brand name?
Bovine soured oxygen carrier. Replaced PRBCs for Jehovah’s Wittnesses. Brand name is Sanguinate. Available through expanded access program.
Parkinson’s Disease is associated with what sleep disorder?
REM sleep behavior disorder
What is the difference between defining airflow obstruction with FEV1/FVC < 0.7 as opposed to LLN?
The “< 0.7” method is more accurate for defining hospitalizations and mortality.
What is the FDG activity pattern of sarcoidosis?
- (+) in 2/3 of patients with stage II and III
- (-) in stage I and IV
Histology of silicosis?
ANodular perilymphatic fibrosis that tend to have the greatest profusion in the upper lung zones
What is Samter’s Triad?
(NSAID)-exacerbated respiratory disease (NERD)
- Asthma / chronic sinusitis
- Nasal polyps
- Exacerbated by NSAIDs or aspirin
Sentinel symptoms prior to GBS (Guillain-Barre Syndrome)?
Autonomic dysfunction
Lumbar muscle spasm/pain
Common causes of GBS (Guillain-Barre Syndrome)?
- Campylobacter Jejuni diarrhea (MC)
- Cytomegalovirus, Epstein-Barr virus, human immunodeficiency virus, and Zika virus
- Immunization, surgery, trauma, medications, or bone-marrow transplantation
Treatment of Periodic Limb Movement Disorder?
- Check ferritin
- Gabapentin +/- enacarbil
- Pramipexole, ropinerole
Symptoms & epidemiology of DIPNECH (Diffuse Idiopathic Pulmonary Neuro-Endocrine Cell Hyperplasia)?
- Middle-aged, female, nonsmokers
- Cough, dyspnea, wheezing
- Flushing, watery diarreha
PFTs of DIPNECH (Diffuse Idiopathic Pulmonary Neuro-Endocrine Cell Hyperplasia)?
-Obstructed, DLCO decreased. Not restricted
Histology of DIPNECH (Diffuse Idiopathic Pulmonary Neuro-Endocrine Cell Hyperplasia)?
-Peribronchioloar fibrosis & small airway obliteration, leading to Obliterative Bronchiolitis
Treatment of DIPNECH (Diffuse Idiopathic Pulmonary Neuro-Endocrine Cell Hyperplasia)?
- Steroids, immunosuppressants
- Somatostatin analogs
- Transplant
Histology of follicular bronchiolitis?
-Multiple reactive lymphoid follicles with germinal centers, focused around bronchi and bronchioles. This leads to narrowing of airway.
Treatment of follicular bronchiolotis?
- Treat underlying infectious, inflammatory or immunodeficiency disease.
- Immunosuppression, prednisone, maybe azithromycin.
Symptoms of hydrogen sulfide (H2S) inhalation?
-Loss of consciousness due to displacement of iar
-Rotten eggs smell
-neurologic, cardiovascular, renal, hepatic, hematologic
(From ‘sour’ crude oil)
Symptoms of carbon monoxide inhalation?
-Vomiting, confusion, collapse, death.
Symptoms of Toluene Diisocynate (TDI) toxicity?
-asthma, skin reactions
from polyurethane and consumer production
Symptoms of cadmium poisoning?
-long-term exposure leads to cancer, multiple organ system failure if chronic.
Treatment of pulmonary AVM?
Embolization, especially when feeding artery is <2-3mm.
What disease and what gene account for most pulmonary AVMs?
- Hereditary Hemorrhagic Telangiectasia (HHT)
- Endoglin gene (ENG) and Activin-Like-Receptor-Kinase-1 (ACVLR1)
Treatment of PAH due to Sickle Cell?
Endothelin Receptor Antagonists. Epoprostanil is 2nd line. Avoid sildenafil.
Name of new cephalosporin that targets everything?
Cefiderocol (Fetroja). Not affected by ESBL or carbanapem-ase.
Buzzword: “foamy macrophages on BAL”
Amio-induced interstitial pneumonitis
3 differentials of calcification of entire tracheobronchial tree?
- Warfarin use
- ESRD
- Advanced age
Initial and maintenance therapy for DAH?
- Induce with steroids & cyclophosphamide
- Maintenance with azathioprine
Treatment for malignancy-related VTE:
- While inpatient & discharged?
- 2nd line?
- Initial hospitalization: LMWH, not UFH.
- On discharge, LMWH. If refusing parenteral, Edoxaban is DoC.
Treatment for airway surgical dehiscence after lung transplant?
- Chest tube for PTX
- Antibiotics
- Minimize steroids
- Bronchoscopy with fibrin patch, blood patch, or stenting.
- Last resort is surgical exploration.
Histology of cocciodomycosis?
Large spherules seen on low power
Histology of histoplasmosis?
Small, round cells. (Significantly smaller than the surrounding cells)
Histology of blastomycosis?
Larger bud with thick capsule and distinctive daughter bud on broad base.
Histology of sporothrix?
Small, cigar-shaped.
Treatment for Guillain-Barre?
-IVIG or plasmapharesis
steroids don’t work
Best test to diagnose Guillain-Barre?
CSF with increased protein but normal WBC.
Blood test for Pulmonary Alveolar Proteinosis (PAP)?
Anti-GM-CSF
CT findings of Pulmonary Alveolar Proteinosis (PAP)?
“crazy paving” sign
Bronchoscopy findings of Pulmonary Alveolar Proteinosis (PAP)?
- BAL fluid is milky-white, and positive for PAS (Periodic-Acid-Shiff)
- TBBx shows intra-alveolar deposits of lipoproteinaceous material
Pulse oximetry readings for methemoglobinemia?
Initially high, then hover around 85% as toxicity increases
Common inciting drugs for methemoglobinemia?
Chloroquine
Dapsone
Trimethoprim
Sulfonamides
Local anesthetics (benzocaine, lidocaine)
Nitrates (nitroglycerin, nitroprusside, nitric oxide).
Best test for pulmonary hypertrophic osteoarthropathy?
99m-TC bone scan
What is “Good Syndrome”?
Hypogammaglobulinemia, as paraneoplastic syndrome resulting from thymoma.
Treatment for pertussis?
Azithromycin (within 4 weeks)
Relative risk reduction from flu vaccine?
50%
Size of renal abscess that means it needs drainage instead of antibiotics alone?
0.5cm
Treatment options for LTBI?
- Rifampin daily for 4 months
- INH + Rifampin daily for 3 months
- INH + Rifampetine injections weekly for 3 months
Medicine shown to improve CPAP compliance?
Eszopiclone (Lunesta)
Echocardiographic findings of tamponade?
-diastolic collapse of RV
-IVC dilation and loss of respiratory dilation
-respiratory increase of ventricular interdependence
Doppler
->25% respiratory variation of mitral or tricuspid flow.
Possible: swinging heart, RA collapse.
PAH medications OK for pregnancy?
Prostacycline, sildenafil.
Initial therapy for CF?
If 1 or 2 delF508 mutations, use triple modulator therapy: Elexacaftor/tezacaftor/ivacaftor.
Criteria for (+) bronchoprovocation testing for asthma?
- 20% for direct stimuli (methacholine, histamine)
- 15% for indirect stimuli (mannitol)
Follow up after lung cancer treatment?
CT every 6 months for 2 years, then annually through year 5.
Criteria for Hypoglossal Nerve Stimulator for OSAS, besides failed CPAP?
- 22yo +
- AHI 20-65
- BMI <=32
MCID for 6MWT distance?
30m
Treatment for AIDS w/ tuberculous meningitis?
- Start RIPE now.
- Start steroids, taper over 6-8 weeks.
- Hold cART for 8 weeks
Treatment for AIDS with pulmonary tuberculosis?
- Start RIPE now
- Start steroids within 2 weeks to Ppx(IRIS)
- Start cART within 2 weeks if CD4<50, and in weeks 8-12 for CD4>50
Treatment for cryptococcal meningits?
- Induction phase with Liposomal Amphotericin + Flucytosine (2 weeks from negative CSF)
- Consolidation phase with high-dose fluconazole
- 1yr (or lifetime if immunosupporessed) fluconazole
Bronchial fistulae should raise suspicion for what infectious organism?
Actinomyces
What is Mounier-Kuhn syndrome?
-Dilated tracheobronchial tree, with impaired mucociliary clearance, leading to recurrent infections & bronchiectasis.
Most common myositis-specific auto-antibody?
Antisynthetase antibodies
Antibodies present in ILD prior to clinical myositis?
-IPAF = Interstitial Pneumonitis with AI features.
- Anti-Jo-1
- Anti-MDA5
- Anti-PL-12
Antibodies with myositis overlap syndromes?
Anti-Ku
What is “buffalo chest”? What patient population is it seen in?
Bilateral pleural spaces communicate, like a Buffalo.
-Seen in s/p bilateral lung transplant patients. Mediastinum is disrupted in surgery.
Positive score on STOP-BANG?
5
Buzzword: “safety-pin appearance of bacteria”
Y. Pestis
Treatment for Babesia?
Atovaquone & Azithromycin
CT findings of pulmonary Kaposi Sarcoma?
bilateral, ill-defined, interstitial or alveolar opacities in a peribronchovascular distribution (“flame-shaped” infiltrates)
