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Pulmo Recall > Mixed > Flashcards

Mixed Flashcards

1
Q

Cessation of smoking for at least __ weeks BEFORE and until _ days after surgery to reduce perioperative complications

A

8 weeks; 10 days

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2
Q

Pulsus paradoxus

A

Decrease in systolic pressure > 20 in inspiration

-Seen in conditions with increase in intrathoracic pressure
(COPD, Asthma, Tamponade, Pericardial dse

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3
Q

Causes of peripheral cyanosis?

A

Reduced cardiac output
Cold exposure
Redistribution of blood flow from extremities
Obstruction - arterial and venous

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4
Q

What level of CO2 would predispose to impending respiratory failure?

A

Normal or increasing

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5
Q

Characterize the 2 different types of asthma

A

Type I Brittle - persistent decline, OCS requiring, need for continuous Beta agonist infusion

Type II Brittle- may have precipitous, unpredictable falls
in lung function which may result in death? (HPIM

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6
Q

Causes of Loffler Syndrome?

A

“HAS”

Hookworm
Ascaris
Schistosomiasis

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7
Q

What is the suspected offending agent in a
patient presenting with symptoms similar to
pulmonary alveolar proteinosis and chest CT
demonstrates that characteristic crazy paving
pattern? (HPIM 20th ed. C283 P1979)

A

Silica

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8
Q

PaO2 will start to decrease in COPD px when FEV1 decreases to what percent? PaCO2 will increase when FEV1 decreases to what percent

A

O2 - 50%
CO2- 25%

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9
Q

Indication to NIPPV for COPD?

A

PaCO2 > 45 with absence of contraindications

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10
Q

What is the characteristic of pleural effusion seen
1 week post CABG? (HPIM 20th ed. C288 P2008,

A

Left sided and bloody
(with findings of eosinophils)

Weeks after post op
-Left sided, yellowish, with lymphocytes

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11
Q

Examples of drugs causing exudative pleural effusion?

A

DAN-B

Dasatinib
Amiodarone
Nitrofurantoin
Bromocriptine

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12
Q

Indications for NIPPV for Hypoventilation

A

PACO2 >= 45%
O2 sats <= 88% for consecutive 5 mins
FEV1 pred <= 50%
Inspiratory pressure < 60
Sniff pressure < 40

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13
Q

Risk factors for CA MRSA

A

Summer months
Young
Concurrent influenza
Erythematous rash
Gross hemoptysis
Cavitary infiltrate
Neutropenia

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14
Q

Critical risk factors for VAP development

A

-colonization
-Aspiration
-compromised immune response

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15
Q

SOFA scoring components

A

PFR
MAP
TB
Crea
UO
Plt

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16
Q

Which phase of ARDS is associated with rapid
recovery and liberation from mechanical ventilation?

A

Proliferative phase

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17
Q

What are non-B graded recommendation for ARDS

A

-Low tidal volume (A)
-Recruitment maneuvers (C) - indeterminate evidence
-Inhaled vasodilators (C)
-High frequency ventilation (D)
-Surfactant (D)
-Steroids (D)

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18
Q

Most common cause of transudative pleural effusion

A

Cirrhosis

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19
Q

MC cause of exudative PF?

A

Pneumonia

2nd malignancy

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20
Q

MC cause exudative PF

A
  1. Pneumonia
  2. Malignancy
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21
Q

Differentials for PF Glucose < 60

A

Bacterial infection
Malignancy
RA

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22
Q

DOC for Type 2 Brittle Asthma

A

SC epinephrine

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23
Q

DOC for Aspirin induced asthma

A

Inhaled corticosteroids
Anti leukotrienes can also be effective

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24
Q

Direct causes of ARDS

A

PAP-DT

Pneumonia
Aspiration
Pulmonary contusion
Drowning
Toxic inhalational injury

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25
Q

Close contact definition (2 or more)

A

Less than 1 meter
Exposure more than 15 mins
Poorly ventilated area

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26
Q

Formula for ROX INDEX

A

Sats/fio2 div RR

27
Q

ROX index cutoffs

A

<2.8 at 2 hrs
<3.47 at 6 hrs
<3.85 at 12 hrs

28
Q

Only agents in high risk CAP

A

S. Aureus
Pseudomonas aerginosa

29
Q

What percentage of homogeneous deficiency of alpha 1 anti tryptase is homogeneous deficiency likely?

30
Q

Percentage level when alpha tryptase deficiency should be treated?

31
Q

CAT cut off that differentiates COPD functional capacity?

A

10

> = 10 means B or D

32
Q

Differentials for platypnea

A

Left atrial myxoma
Hepatopulmonary disease

33
Q

Definition of massive hemoptysis

A

400 mL in 24 hours OR 100-150 mL expectorated at one time

34
Q

Atypical pathogen more common in VAP than CAP?

A

Legionella

35
Q

According to HPIM, what is the target O2 sat in asthma?

36
Q

Describe dyspnea of EIA

A

occurs at end of exercise and continues until 30 mins after
prevented by B2 agonist and anti leukotrienes and ICS

37
Q

Duration of witholding
-SABA
-ICS + LABA

A

-4 hrs
-24 hrs

38
Q

Suspect this disease entity if suspecting asthma but refractory to conventional treatment

A

Allergic bronchopulmonary aspergillosis

39
Q

MC cancer associated with asbestosis

40
Q

Threshold for taking ABG

41
Q

Next step if pleural effusion shows negative cytology for malignancy?

A

Thoracoscopy

42
Q

Most cases of chronic mediastinitis are due to which underlying disease?

43
Q

Parameters for failed SBT

A

HR > 140 or 20% inc/dec from baseline
RR > 35 for > 5 mins
O2 < 90%
SBP < 90 or > 180
Diaphoresis or increased anxiety
RR/TV > 105

44
Q

Evidence grade C and D for ARDS

A

Grade C
-Inhaled vasodilators
-Recruitment maneuver

Grade D
-Steroids
-High frequency vent
-Surfactant

45
Q

Good response with prone positioning

A

PF ratio > 20 of baseline
PaO2 > 10 of baseline

46
Q

What antibiotics to add to CAP if with active or prior influenza infection during the past 2 weeks

A

Cover for MRSA
Linezolid 600 mg IV q12
Vancomycin 15 mg/kg IV q8-12

47
Q

Diagnostic thresholds for endotracheal aspirate and protected brush specimen method?

A

Endotracheal -10^6
Protected specimen - 10^3

48
Q

Repeat CXR sched for hospitalized CAP patients

A

After 4-6weeks

49
Q

Treatment duration for
- bacteremic
- Mycoplasma Chlamydia
- LegionellA

A

-28 days
- 10-14
-14-21

50
Q

Timeline regarding pneumonia progression

A

1 wk: resolution of fever
4 wks: chest pain and sputum production (4=pain)
6 weeks: cough and breathlessness
3 months: fatigue
6 months almost no symptoms

51
Q

CURB 65 components and implications

A

Confusion
Urea >7 mmol/L
RR >= 30
BP <=90/60
Age 65

52
Q

Positive sputum microscopy on the 2nd and 5th month of PTB treatment, what to do next?

A

2nd - do Gene Xpert then continue while waiting
5th - treatment failure. Stop meds. Refer to PMDT

53
Q

Post bronchodilator spirometry med and time interval

A

SABA 400 mcg 10-15 mins
SAMA 160 mcg 30-45 mins
FEV1/FVC <0.7

54
Q

Alpha 1 antitrypsin deficiency percentage defect

55
Q

Indications for long time oxygen therapy in COPD

A

<= 88% O2 sat confirmed 2x over 3 week period
PaO2 <= 55 2x over 3 week period

PaO2 55-60 or 88% sar if with pulmo htn, polycythemia, edema

56
Q

Parameters for clearance for air travel

A

O2sat >95%
6 MW > 84%

57
Q

Next step of treatment if on max LABA LAMA ICS on COPD

A

Roflumilast if FEV1 <50 and with hx of exacerbation year before
Macrolide if prior smoker (erythromycin 250 mg BID OR Azithromycin 250 mg daily/500 mg 3 days a week)

58
Q

Candidates for LVRS in COPD

A

Upper lobe emphysema with low post rehab exercise capacity

59
Q

No benefit from LRVS in what subsept of population

A

FEV1 <20% and FeNO <20%
Diffusely distributed emphysema on CT

60
Q

Indications for catheter related thrombolysis

A

If with extensive femoral, iliofemoral and Ue DVT

61
Q

2 parenteral direct thrombin inhibitors

A

Argatroban
Bivalirudib

62
Q

Acute isolated distal DVT management

A

If with symptoms = anticoagulation
If no symptoms and high bleeding risk = serial monitoring 2 weeks

63
Q

Preferred access for thrombolysis

A

Peripheral over catheter

Pulmo Recall (1 decks)

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