Pulm and Critical Care I Flashcards by Smita Armstrong

A modified Wells score > […] suggests that pulmonary embolism is likely.

A modified Wells score > 4 suggests that pulmonary embolism is likely.

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All patients with acute COPD exacerbation should receive inhaled bronchodilators and systemic […].

All patients with acute COPD exacerbation should receive inhaled bronchodilators and systemic corticosteroids.

corticosteroids have been shown to improve lung function and promote a shorter hospital stay; supplemental O2, antibiotics and ventilatory support should be administered when indicated

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An endotracheal tube that is advanced too far will preferentially enter into the […] mainstem bronchus (left or right).

An endotracheal tube that is advanced too far will preferentially enter into the right mainstem bronchus (left or right).

causes asymmetric chest expansion and markedly decreased breath sounds on the contralateral side

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An infant with a fever, runny nose, and cough has the X-ray findings below. What does the arrow on the CXR point to?

Thymus

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Antibiotics should be given to patients with COPD exacerbation if they have > 2 of the following: increased […], increased cough, or increased sputum production (cardinal symptoms).

Antibiotics should be given to patients with COPD exacerbation if they have > 2 of the following: increased dyspnea, increased cough, or increased sputum production (cardinal symptoms).

or if they require mechanical ventilation

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Antibiotics should be given to patients with COPD exacerbation if they have > 2 of the following: increased dyspnea, increased […], or increased sputum production (cardinal symptoms).

Antibiotics should be given to patients with COPD exacerbation if they have > 2 of the following: increased dyspnea, increased cough, or increased sputum production (cardinal symptoms).

or if they require mechanical ventilation

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Are lung adenocarcinomas typically centrally or peripherally located?

Peripherally

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Bradycardia, hypoventilation, and decreased shivering are associated with […] hypothermia (severity).

Bradycardia, hypoventilation, and decreased shivering are associated with moderate hypothermia (severity).

seen with temperatures between 82-90 F; the bradycardia seen with hypothermia is often refractory to treatment with atropine/cardiac pacing, but improves with correction of hypothermia

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Chronic bronchitis is defined as a chronic productive cough for > […] months in 2 successive years.

Chronic bronchitis is defined as a chronic productive cough for > 3 months in 2 successive years.

cigarette smoking is the leading cause

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Chronic bronchitis-predominant COPD is characterized by a […] DLCO.

Chronic bronchitis-predominant COPD is characterized by a normal DLCO.

also has prominent vascular markings on CXR vs. emphysema, which has decreased vascular markings and low DLCO

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Coma and cardiovascular collapse are associated with […] hypothermia (severity).

Coma and cardiovascular collapse are associated with severe hypothermia (severity).

seen with temperatures

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Consolidation of the lung results in […] breath sounds, […] tactile fremitus, and […] to percussion (e.g. lobar pneumonia).

Consolidation of the lung results in increased breath sounds, increased tactile fremitus, and dullness to percussion (e.g. lobar pneumonia).

fluid is present within the lung in the thoracic cavity and sound travels faster in solid or liquids than air

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Does hypoxemia secondary to intrapulmonary shunt correct with supplemental O2?

important distinguishing feature of shunting versus other causes of hypoxemia

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Emphysema-predominant COPD is characterized by a […] DLCO.

Emphysema-predominant COPD is characterized by a low DLCO.

also has decreased vascular markings on CXR vs. chronic bronchitis, which has increased vascular markings and normal DLCO

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Extrinsic causes of restrictive lung disease are characterized by a […] DLCO.

Extrinsic causes of restrictive lung disease are characterized by a normal DLCO.

e.g. myasthenia gravis, ALS

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Exudative pleural effusions are characterized by a […] pleural/serum protein ratio.

Exudative pleural effusions are characterized by a > 0.5 (high) pleural/serum protein ratio.

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Exudative pleural effusions are characterized by […] pleural/serum LDH ratio.

Exudative pleural effusions are characterized by > 0.6 (high) pleural/serum LDH ratio.

or pleural LDH > 2/3 upper normal limit of serum LDH

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Features of a high-risk solitary pulmonary nodule include size > […] cm, age > 60, and smoking cessation within the last 5 years (or current smoker).

Features of a high-risk solitary pulmonary nodule include size > 2 cm, age > 60, and smoking cessation within the last 5 years (or current smoker).

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Features of a high-risk solitary pulmonary nodule include size > 2 cm, age > […], and smoking cessation within the last 5 years (or current smoker).

Features of a high-risk solitary pulmonary nodule include size > 2 cm, age > 60, and smoking cessation within the last 5 years (or current smoker).

Features of a low-risk solitary pulmonary nodule include size […], age < 40, and smoking cessation for > 15 years (or never smoked).

Features of a low-risk solitary pulmonary nodule include size 0.8 cm, age < 40, and smoking cessation for > 15 years (or never smoked).

Features of a low-risk solitary pulmonary nodule include size 0.8 cm, age […] and smoking cessation for > 15 years (or never smoked).

Features of a low-risk solitary pulmonary nodule include size 0.8 cm, age < 40, and smoking cessation for > 15 years (or never smoked).

Features of an intermediate-risk solitary pulmonary nodule include size […] - […] cm, age 40 - 60, and smoking cessation within the last 5 - 15 years (or current smoker).

Features of an intermediate-risk solitary pulmonary nodule include size 0.8 - 2 cm, age 40 - 60, and smoking cessation within the last 5 - 15 years (or current smoker).

Features of an intermediate-risk solitary pulmonary nodule include size 0.8 - 2 cm, age […] - […], and smoking cessation within the last 5 - 15 years (or current smoker).

Features of an intermediate-risk solitary pulmonary nodule include size 0.8 - 2 cm, age 40 - 60, and smoking cessation within the last 5 - 15 years (or current smoker).

Goodpasture’s disease is characterized by antibodies against glomerular and alveolar […].

Goodpasture’s disease is characterized by antibodies against glomerular and alveolar basement membranes.

specifically against the alpha-3 chain of type IV collagen

How do RBC levels change in patients with obstructive sleep apnea and obesity hypoventilation syndrome?

Increased (secondary erythrocytosis) due to hypoxia; may also develop pulmonary hypertension (hypoxic vasoconstriction) with eventual cor pulmonale

How do the following pressures change with pulmonary embolism? ## Footnote RA pressure: [...] Pulmonary artery pressure: [...] LA pressure: [...]

How do the following pressures change with pulmonary embolism? RA pressure: **increased** Pulmonary artery pressure: **increased** LA pressure: **decreased** decreased LA pressure (measured as PCWP) suggests an intrinsic pulmonary process; an increased PCWP suggests left-sided heart failure leading to right-sided heart failure

How does lung compliance change in patients with ARDS?

Decreased due to loss of surfactant and increased elastic recoil of edematous lungs

How does pulmonary arterial pressure change in patients with ARDS?

Increased (pulmonary hypertension) due to hypoxic vasoconstriction, destruction of lung parenchyma, and compression of vascular structures from PEEP

How does residual volume, FRC, and total lung capacity change with obstructive lung disease (e.g. COPD)?

Increase decreased elasticity of alveoli results in decreased collapsing pressure, thus alveoli retain more air (air trapping)

How does the A - a gradient change in patients with a decreased DLCO?

Increased

How does the A - a gradient change in patients with pulmonary embolism?

Increased (V/Q mismatch)

How does the PaO2/FiO2 ratio change in patients with ARDS?

Decreased ( PaO2 decreases and leads to an increased FiO2 requirement; lower P/F values indicate more severe ARDS

Idiopathic pulmonary fibrosis eventually results in diffuse fibrosis with end-stage '[...]' lung on CT.

Idiopathic pulmonary fibrosis eventually results in diffuse fibrosis with end-stage '**honeycomb**' lung on CT.

If a patient with airway obstruction has significant reversal of symptoms with an inhaled bronchodilator, they likely have [...] (asthma or COPD).

If a patient with airway obstruction has significant reversal of symptoms with an inhaled bronchodilator, they likely have **asthma** (asthma or COPD). COPD typically has partial or non-reversal of symptoms

In addition to rewarming techniques, hypotensive patients with hypothermia should receive warmed [...].

In addition to rewarming techniques, hypotensive patients with hypothermia should receive warmed **IV fluids**.

In general, tidal volumes in mechanically ventilated patients should be about [...] ml/kg of ideal body weight.

In general, tidal volumes in mechanically ventilated patients should be about **6** ml/kg of ideal body weight.

In mechanically ventilated patients, an increased peak pressure with an increased plateau pressure suggests [...].

In mechanically ventilated patients, an increased peak pressure with an increased plateau pressure suggests **decreased compliance**. e.g. pulmonary edema, atelectasis, pneumonia, pneumothorax

In mechanically ventilated patients, an increased peak pressure with an unchanged plateau pressure suggests [...].

In mechanically ventilated patients, an increased peak pressure with an unchanged plateau pressure suggests **increased airway resistance.** e.g. bronchospasm, mucus plug, endotracheal tube obstruction

In mechanically ventilated patients, peak inspiratory pressure (PIP) is equal to the sum of [...] + [...].

In mechanically ventilated patients, peak inspiratory pressure (PIP) is equal to the sum of **resistive pressure + plateau pressure**.

In mechanically ventilated patients, plateau pressure is equal to the sum of [...] + [...].

In mechanically ventilated patients, plateau pressure is equal to the sum of **elastic pressure + PEEP**. measured during an inspiratory hold maneuver; elastic pressure is a measure of tidal volume/compliance

Infants age \< 2 months with bronchiolitis are at high risk of developing [...] and/or respiratory failure.

Infants age \< 2 months with bronchiolitis are at high risk of developing **apnea** and/or respiratory failure. may administer prophylactic palivizumab for patients with very high risk for complications (see table)

Interstitial lung disease is characterized by a [...] DLCO.

Interstitial lung disease is characterized by a **low** DLCO.

Is smoking cessation associated with a mortality benefit in patients with COPD?

Yes the only therapies proven to prolong survival in COPD patients are smoking cessation, supplemental O2, and lung reduction surgery

Massive pulmonary embolism may result in [...] shock.

Massive pulmonary embolism may result in **cardiogenic** shock. right heart strain causes RV dysfunction with decreased return to the left heart, causing LV dysfunction

Mechanical ventilation in patients with ARDS should use [...] tidal volumes and [...] PEEP (low or high).

Mechanical ventilation in patients with ARDS should use **low** tidal volumes and **high** PEEP (low or high). low tidal volume ventilation (LTVV) decreases the likelihood of overdistending alveoli and improves mortality