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Pulmonary > MKSAP Pulm/Crit Care > Flashcards

MKSAP Pulm/Crit Care Flashcards

1
Q

What presents as middle and upper zone thin walled cysts with accompanying nodules in smokers, and is typically associated with PH?

A

Pulmonary Langerhans cell histiocytosis

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2
Q

What presents with cough and dyspnea, and centrilobular micronodules on imaging and GGOs in upper lung predominant distribution in smokers, and has tan pigmented macrophages on biopsy?

A

Respiratory bronchiolitis associated ILD

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3
Q

What is the management for solid lung nodules <6 mm, 6-8 mm, and >8 mm?

A

<6 mm CT at 12 months if high risk
6-8 mm CT at 6-12 months, then 18-24 months
>8 mm consider CT at 3 months, PET/CT, or tissue sampling

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4
Q

What 4 malignant tumors occur in the anterior mediastinum?

A

Thymoma, thyroid, lymphoma, and teratoma/germ cell tumor

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5
Q

What medication should all patients with asthma have?

A

Inhaled glucocorticoid

Can combine with LABA for PRN use or daily use, or with an as needed SABA

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6
Q

What is the MOA for Omalizumab and Mepolizumab/Reslizumab?

A
  1. Anti-IgE - used in patients w/ asthma with elevated IgE (30-700) and sensitivity to allergens
  2. Anti-IL-5, reduces eosinophil levels - used in patients w/ eosinophil levels >150 cells/microL
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7
Q

What is the criteria for O2 therapy in COPD?

A

PaO2 55 mmHg or less, or O2 sat 88% or less

PaO2 59 mmHg or less, or O2 sat 89% or less if patient has cor pulmonale, HF, or erythrocytosis

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8
Q

What lung disease presents w/ “crazy paving” pattern on chest CT and BAL shows proteinaceous material in and around alveolar macrophages?

A

Pulmonary alveolar proteinosis

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9
Q

Which lung disease presents in smokers with cough and dyspnea, and w/ basal predominant and peripheral predominant ground glass opacities with occasional cysts?

A

Desquamative interstitial pneumonia

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10
Q

How does acute hypersensitivity pneumonitis present - sx and on CT?

A

Flu-like illness - fevers, cough, fatigue within 12 hours of exposure
Ground glass opacities; centrilobular micronodules that are upper and mid lung predominant

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11
Q

What are two therapies for IPF?

A

Nintedanib and Pirfenidone

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12
Q

How does IPF present on CT?

A

Basal and peripheral-predominant septal line thickening w/ traction bronchiectasis and honeycomb changes

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13
Q

How does NSIP present on CT?

A

Bilateral lower lobe reticular changes, ground glass opacities (diffuse or basal predominance, immediate subpleural/peripheral sparing); no honeycombing

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14
Q

What presents w/ cough, fever, and malaise for 6-8 weeks, consolidation or GGOs, peripheral nodules and nodules along the bronchovascular bundle? What is the treatment?

A

Cryptogenic organizing pneumonia

Steroids

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15
Q

What presents with upper zone predominant w/ centrilobular or perilymphatic nodules, and eggshell calcification in hilar lymph nodes? What is found in BAL during the acute phase of this disease?

A
  1. Chronic simple silicosis

2. Milky effluent from BAL in acute silicosis

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16
Q

What are some causes of pleural fluid acidosis? Name 4.

A

Parapneumonic, malignancy, rheumatoid pleuritis, lupus pleuritis, esophageal rupture

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17
Q

What are some causes of glucose <60 in pleural fluid? Name 5.

A

Malignancy, empyema, parapneumonic effusion, TB, esophageal rupture, rheumatoid pleuritis, lupus pleuritis

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18
Q

What are the 5 classes of pulmonary hypertension? Name at least 3 causes of class 1 & 5.

A

1: pulmonary arterial - heritable, connective tissue diseases, HIV, schistosomiasis, drugs, toxins, portal HTN
2: left heart disease
3: lung disease
4: CTEPH
5: multifactorial - sarcoidosis, sickle cell, idiopathic

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19
Q

What is the most sensitive imaging study to diagnose CTEPH? What medication can be used after thromboendarterectomy in CTEPH for persistent PH?

A
  1. V/Q scan

2. Riociguat - vasodilator

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20
Q

What are some drugs that can lead to group 1 pulmonary hypertension? Name 5.

A

Interferon alfa, dasatinib, imatinib, methamphetamine, cocaine, appetite suppressants (phentermine, fenfluramine)

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21
Q

What is the MOA of bosentan/ambrisentan? Epoprostenol/treprostinil/iloprost?

A
  1. Endothelin-1 receptor antagonist

2. Prostacyclin analogues

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22
Q

What is the preferred anti-coagulant in pulmonary arterial HTN?

A

Warfarin

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23
Q

What are therapies in the absence of supplemental oxygen and descent for people w/ high altitude pulmonary edema?

A

Nifedipine, Sildenafil, Tadalafil

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24
Q

What are two treatments for acute mountain sickness besides descent?

A

Acetazolamide, Dexamethasone

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25
Q

Using the apnea-hypopnea index what is classified as mild, moderate, and severe OSA?

A

Mild: 5-15/hour
Moderate: 15-30/hour
Severe: >30/hour

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26
Q

What is the Braden scale?

A

Clinical criteria used to define risk of pressure injury in ICU

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27
Q

What values FVC is suggestive of neuromuscular weakness?

A

FVC >20% decrement in supine position compared with upright position

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28
Q

What kind of poisoning occurs with house fires and can present w/ HA, anxiety, nausea, metallic or bitter almond odor/taste? What are 3 treatment options?

A
  1. Cyanide poisoning

2. Hydroxocobalamin (preferred), Amyl nitrite, sodium thiosulfate

29
Q

At what levels of carboxyhemoglobin should hyperbaric oxygen be used on carbon monoxide poisoning?

A

25-40% or higher, or for victims with lower levels who are pregnant

30
Q

At what levels of methemoglobin should methylene blue be used?

A

20-30% or higher

31
Q

What is the qSOFA criteria?

A

RR>22, SBP <100, AMS

qSOFA score of 2 or greater predicts increased mortality

32
Q

What is the two criteria for diagnosing septic shock?

A

Hypotension requiring pressors to maintain MAP >65 mmHg, serum lactate >2 after adequate volume resuscitation

33
Q

What is the goal BP for patients w/ aortic dissection? Patients with severe pre-eclampsia or eclampsia?

A
  1. SBP <120 mmHg

2. SBP <140 mmHg

34
Q

What is the goal BP in first hour in hypertensive emergency? Then next 2-6 hours?

A
  1. SBP reduced by no more than 25% in 1st hour

2. 160/100 mmHg within next 2-6 hours; then normal during following 24-48 hours

35
Q

What is the management for heat stroke?

A 
Evaporative cooling (sprayed water and cooling fans)
May need ice immersion for exertional heat stroke in younger patients
36
Q

Which has hyperreflexia and myoclonus - neuroleptic malignant syndrome or serotonin syndrome?

A

Serotonin syndrome

37
Q

What is the management for mild vs. moderate vs. severe hypothermia?

A

Mild - cover with insulating material
Moderate - warm blankets, forced heated air blanket
Severe - body cavity lavage w/ warm fluids

38
Q

What condition does scooped out inspiratory loop suggest? Narrowed inspiratory & expiratory loops?

A
  1. COPD/Asthma

2. Restrictive lung disease

39
Q

What condition does flattened inspiratory loop suggest? Flattened expiratory loop? Flattened inspiratory & expiratory loops?

A
  1. Intrathoracic obstruction
  2. Extrathoracic obstruction
  3. Fixed obstruction (tracheal stenosis)
40
Q

What causes reduced DLCO + reduced lung volumes? Reduced DLCO + normal lung volumes? Reduced DLCO + airflow obstruction? Increased or normal DLCO + obstruction? Increased DLCO and normal lung volumes?

A
  1. Pulmonary fibrosis
  2. Anemia, pulmonary vascular disease
  3. Emphysema, bronchiectasis
  4. Asthma
  5. Pulmonary hemorrhage, left to right shunt, polycythemia
41
Q

How do you diagnose exercise-induced asthma if the patient has normal spirometry?

A

Bronchoprovocation test

42
Q

What condition is associated w/ injury to small airways, presents w/ dyspnea w/o improvement to bronchodilators, and can be associated with lung or stem cell transplant?

A

Bronchiolitis obliterans

43
Q

What condition should be considered in patients w/ CF and acute abdominal pain?

A

Intestinal intussusception

44
Q

What condition should be ruled out in a patient w/ nephrotic syndrome and pleural effusion?

A

PE since this often occurs in patients w/ nephrotic syndrome

45
Q

In the setting of diuresis what can be used to make diagnosis of transduative fluid in the pleural space?

A

Serum to pleural fluid albumin gradient >1.2 g/dL

46
Q

What condition should be considered when chylothorax is diagnosed in a pre-menopausal woman? What is the tx for this condition?

A
  1. Pulmonary LAM (lymphangioleiomyomatosis)

2. Sirolimus

47
Q

What mean pulmonary artery pressure and systolic pulmonary artery pressure is diagnostic of pulmonary HTN?

A

> 25 mmHg

>40 mmHg

48
Q

What condition is associated w/ hemoptysis, mucocutaneous telangiectasias, evidence right-to-left pulmonary shunts (hypoxemia, polycythemia, clubbing, stroke, brain abscess), and/or pulmonary nodules?

A

Pulmonary AVMs

49
Q

What is the management for pure ground glass nodule <6 mm vs >6 mm? Part solid nodule?

A
  1. No follow up if <6 mm; CT at 6-12 months if >6 mm, then CT every 2 years until 5 years
  2. No follow up if <6 mm; CT at 3-6 months if >6 mm and part solid, then annual CT for 5 years
50
Q

What masses are found in the middle mediastinum? Posterior mediastinum?

A
  1. Lymphadenopathy, cysts (pericardial, bronchogenic, esophageal)
  2. Neurogenic tumors - schwannomas are most common in adults
51
Q

What is the management for minimally symptomatic patients with mild OSA?

A

Weight loss

52
Q

When should mechanical or chemical pleurodesis be considered in pneumothorax?

A

After first episode of secondary spontaneous pneumothorax, or after 2 episodes of primary spontaneous pneumothorax

53
Q

What has been found to lower rate of surgical referral and decrease hospital stay of patients w/ empyema?

A

tPA-DNase +/- streptokinase

54
Q

What is the management for benzodiazepine overdose?

A

Assurance of adequate ventilation, monitor for agitation

Flumazenil is not recommended as it can precipitate seizures

55
Q

What subgroup of patients is roflumilast indicated for? What are some side effects?

A
  1. Severe COPD associated w/ chronic bronchitis and hx of recurrent exacerbations
  2. Diarrhea, nausea, weight loss, headaches, psych effects (anxiety, depression, insomnia); contraindicated in liver impairment; has significant drug interactions
56
Q

How does aspirin-exacerbated respiratory disease present? What is the management?

A

Severe persistent asthma, aspirin sensitivity, and hyperplastic eosinophilic sinusitis w/ nasal polyposis
Tx: stop NSAIDs or ASA, start montelukast +/- prednisone

57
Q

What are the management options for recurrent pleural effusions in setting of malignancy?

A

Indwelling pleural catheter - shorter hospital stay and less dyspnea when compared to talc pleurodesis
Talc pleurodesis - associated w/ increased pain and longer hospital stay
Repeat thoracentesis if poor prognosis and slow reaccumulation of fluid

58
Q

What is the initial step in evaluation of a patient with excessive daytime sleepiness?

A

Wrist actigraphy (measures movement and ambient light to estimate sleep periods during 1-2 week time frame) or sleep diary

59
Q

What is the first line therapy for progressive DPLD and systemic sclerosis?

A

Mycophenolate

60
Q

How do you calculate RSBI and what number is a predictor of successful extubation?

A

Respiratory rate/tidal volume (in liters)

<105 is predictive of successful extubation

61
Q

What are strategies for correcting auto-PEEP, which causes airtrapping? Name 3.

A

Reducing minute ventilation (reduce tidal volume or respiratory rate), increase expiratory time, or use bronchodilators/inhaled corticosteroids to relieve airway obstruction

62
Q

How should vent settings be modified if pO2 is low? pCO2 is high? pcO2 is low?

A
  1. Increase PEEP
  2. Increase RR or increase tidal volume
  3. Decrease RR or decrease tidal volume or increase sedation
63
Q

What presents w/ dyspnea on exertion or orthopnea in the setting of an elevated hemidiaphragm and >10% decrease in forced vital capacity when in supine position? What conditions is it associated with? How is it diagnosed?

A
  1. Unilateral diaphragmatic paralysis
  2. Phrenic nerve injury under cardiac surgery, neck surgery, tumor, trauma, viral infection (herpes, polio)
  3. Fluoroscopic “sniff” test - patient sniffs forcefully under fluoroscopy, the normal diaphragm moves downward during inspiration while paralyzed size has paradoxical upward movement
64
Q

What presents w/ fever, dyspnea, cough, pleuritic chest pain, leukocytosis, +/- pleural effusion in a patient 4-12 weeks after radiation? What is the treatment?

A
  1. Acute radiation pneumonitis

2. Prednisone for 2 weeks, then gradual taper over 3-12 weeks

65
Q

What is the FEV1 and how often do daytime symptoms and nighttime symptoms occur in the following: mild persistent asthma, moderate persistent asthma, severe persistent asthma?

A

Mild: symptoms more than twice a week but no more than once a day; nighttime symptoms more than twice a month; FEV1 >80%
Moderate: daily symptoms; nighttime symptoms at least once a week; FE1 60-80%
Severe: daily symptoms; frequent nighttime symptoms; FEV1 <60%

66
Q

What does a drop in BP of >10-12% on inspiration w/ mechanical ventilation suggest?

A

Hypovolemia

67
Q

What is the first step in diagnosis of ABPA? How is the diagnosis confirmed? What is the treatment?

A
  1. Skin prick test
  2. Serum IgE >417 IU/mL or >1000 ng/mL and positive serum antibodies against aspergillus
  3. Itraconazole and steroids
68
Q

When can neuroleptic malignant syndrome present besides as an effect of anti-psychotic medications?

A

In parkinson disease after withdrawal, dose reduction, or a switch in dopamine agents (referred to as parkinsonism-hyperpyrexia syndrome)

69
Q

What presents with cyanosis, pulse ox ~85%, normal paO2, dark blood after exposure to oxidizing substances (dapsone, nitrites, topical/local anesthetics)?

A

Methemoglobinemia

Pulmonary (1 decks)

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