MKSAP Pulm/Crit Care

Question 1

next best step in patient with previous PE with pulm HTN findings

Answer 1

V/Q scan to evaluate for chronic thromboembolic pulmonary hypertension (CTEPH)

positive V/Q –> right heart cath

Question 2

fever, mental status changes
muscle rigidity, and dysautonomia after taking antipsychotics/antiemetics

Answer 2

neuroleptic malignant syndrome

tx –> dc drug, active cooling, supportive

Question 3

how to tell the difference between neuroleptic malignant syndrome and serotonin syndrome?

Answer 3

serotonin syndrome = hyperreflexia and myoclonus

both have mental status changes, dysautonomia

Question 4

For acutely hospitalized patients ventilated for more than 24 hours, guidelines suggest protocols to _______ sedation

Answer 4

reduce sedation by holding sedation and analgesia

not down-titrate –> takes too long

Question 5

How to tell the difference between complicated and uncomplicated parapneumonic effusion?

how does this effect treatment?

Answer 5

complicated (infected/loculated) = pH <7.2 or glucose <40

complicated requires drainage, uncomplicated can resolve on its own

Question 6

what do you screen COPD patients with before flying?

Answer 6

resting pulse ox

if <92%, will need supplemental O2 during flight

if normally on >4L, no flying

Question 7

In patients with persistently debilitating dyspnea due to COPD –> next step after pulm rehab?

Answer 7

nonpharmacologic treatment strategies –> pursed lip breathing, handheld fan

pulm rehab benefits decrease over time– if they’ve recently gone, don’t need to go again