Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > Pulm and Critical Care V > Flashcards

Pulm and Critical Care V Flashcards

1
Q

What is the recommended treatment for patients with SIADH who have severe hyponatremia (e.g. seizures, coma)?

A

Hypertonic (3%) saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the recommended treatment regimen for patients with intermittent asthma?

A

Short-acting β2-agonist, PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the recommended treatment regimen for patients with mild persistent asthma?

A

daily low-dose inhaled corticosteroid and SABA PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the recommended treatment regimen for patients with moderate persistent asthma?

A

daily long-acting β2-agonist, daily low-dose ICS, SABA PRN

or daily medium-dose ICS with SABA PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the test of choice to diagnose pulmonary embolism in clinically stable patients with a high likelihood of PE (modified Wells > 4)?

A

CT angiography

in patients with low likelihood of PE (modified Wells < 4), D-dimer testing can help rule out PE due to high negative predictive value

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the underlying cause of low glucose in complicated parapneumonic effusions?

A

High metabolic activity of leukocytes and/or bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the underlying etiology for aspiration pneumonia in patients with impaired consciousness and/or advanced dementia?

A

impaired swallowing and cough reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the underlying etiology in a patient with severe COPD who develops altered consciousness and seizures after administration of supplemental O2?

A

O2-induced CO2 retention

patients have a decreased respiratory drive and loss of compensatory vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the underlying etiology of aspirin-exacerbated respiratory disease?

A

aspirin-induced prostaglandin/leukotriene imbalance

this is a non-IgE-mediated reaction (pseudo-allergic reaction); treatment includes avoidance of NSAIDs and/or administration of leukotriene receptor antagonists (e.g. montelukast)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What maternal pathology is associated with increased risk for neonatal respiratory distress syndrome?

A

Maternal diabetes

maternal diabetes results in fetal hyperinsulinism, which antagonizes cortisol and blocks maturation of sphingomyelin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What medications should be administered to patients with severe asthma exacerbation?

[…], […], […]

A

inhaled short-acting β2 agonists, inhaled ipratropium, systemic corticosteroids

additional bronchodilation with one-time infusion of IV magnesium sulfate may be added if no improvement appreciated after an hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What paraneoplastic syndrome presents with euvolemic hyponatremia?

A

SIADH

other common findings include low serum osmolality (< 275 mOsm/kg) and high urine osmolality (> 100 mOsm/kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What physiologic change helps compensate for chronic respiratory acidosis and hypercapnia in patients with COPD?

A

Increased renal HCO3 retention

i.e. compensatory metabolic alkalosis; similar changes may occur with other pulmonary pathologies (e.g. obesity hypoventilation syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What pneumonia complication is characterized by frank pus or bacteria in the pleural space?

A

Empyema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What regions of the lung are most commonly involved in supine patients with aspiration pneumonia?

[…] and […]

A

posterior segments of upper lobe and superior segments of lower lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What risk factor acts synergistically with asbestos to increase risk of lung cancer?

A

Smoking

asbestos alone increases risk by nearly 6-fold; smokers with asbestos exposure have nearly 59-fold increased risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What test/imaging study is the best diagnostic test for bronchiectasis?

A

high-resolution CT scan of the chest

characteristic findings include bronchial dilation, lack of airway tapering, and bronchial wall thickening (arrows)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What test/imaging study should be ordered first to evaluate an older patient with a 30 pack-year smoking history and recurrent episodes of pneumonia in the same anatomic location?

A

CT scan of chest

in patients > 50 with significant smoking history (> 30 pack-years), it is essential to evaluate for lung malignancy; CT scan has better sensitivity than CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What type of pleural effusion, transudative or exudative, is characterized by pH 7.30 - 7.45?

A

Exudative

normal pleural fluid pH is 7.60; transudative effusions typically have higher pH (7.40 - 7.55)

20
Q

What type of pleural effusion, transudative or exudative, is characterized by pH 7.40 - 7.55?

A

Transudative

normal pleural fluid pH is 7.60; exudative effusions typically have lower pH (7.30 - 7.45)

21
Q

What type of pleural effusion, transudative or exudative, is commonly seen with pneumonia (e.g. parapneumonic effusion)?

A

Exudative

22
Q

What type of pleural effusion, transudative or exudative, is commonly seen with pulmonary embolism?

A

Exudative (typically a small, bloody effusion)

due to hemorrhage or inflammation

23
Q

What type of V/Q mismatch is worsened in COPD patients with O2-induced CO2 retention?

A

Dead space

at baseline, hypoxic vasoconstriction shunts blood away from non-functional alveoli; supplemental O2 increases blood flow to these areas

24
Q

What type of V/Q mismatch may occur in patients with pneumonia?

A

Right-to-left intrapulmonary shunt

due to alveoli filling with inflammatory exudate; results in hypoxemia

25
Q

What ventilator setting change is best for a 65 kg patient with the following ABG and the ventilator settings:

pH: 7.42

PaO2: 105 mmHg

PaCO2: 37 mmHg

FiO2: 80%

PEEP: 7 mmHg

VT: 380 mL

RR: 14/min

A

What ventilator setting change is best for a 65 kg patient with the following ABG and the ventilator settings:

pH: 7.42

PaO2: 105 mmHg

PaCO2: 37 mmHg

FiO2: 80%

PEEP: 7 mmHg

VT: 380 mL

RR: 14/min

Decrease FiO2

FiO2 should be reduced to prevent oxygen toxicity; in general FiO2 < 60% is considered safe

26
Q

What ventilator setting change is best to improve oxygenation in a patient with the following settings:

FiO2: 70%

PEEP: 5 mmHg

VT: 400 mL

RR: 24/min

A

What ventilator setting change is best to improve oxygenation in a patient with the following settings:

FiO2: 70%

PEEP: 5 mmHg

VT: 400 mL

RR: 24/min

Increase PEEP

if high levels of FiO2 (> 60%) are required to maintain oxygenation, PEEP should be increased to allow for reductions in FiO2 as oxygenation improves

27
Q

What ventilator setting change is best to improve respiratory alkalosis in a 70 kg patient with the following settings:

FiO2: 40%

PEEP: 5 mmHg

VT: 450 mL

RR: 18/min

A

What ventilator setting change is best to improve respiratory alkalosis in a 70 kg patient with the following settings:

FiO2: 40%

PEEP: 5 mmHg

VT: 450 mL

RR: 18/min

Decrease RR

the patient is on an appropriate tidal volume (70 kg * 6ml/kg = 420mL), thus, decreased RR is the most appropriate management

28
Q

What warming technique is best for patients with mild hypothermia?

A

Passive external warming

remove wet clothing, cover with blankets

29
Q

What warming technique is best for patients with moderate hypothermia?

A

Active external warming

warm blankets, heating pads, warm baths

30
Q

What warming technique is best for patients with severe hypothermia?

A

Active internal warming

warmed pleural or peritoneal irrigation, warmed humidified oxygen

31
Q

When using a ventilator, prolonged FiO2 levels > […]% are associated with oxygen toxicity.

A

When using a ventilator, prolonged FiO2 levels > 60% are associated with oxygen toxicity.

thus it is usually preferable to increase PEEP to allow for lower levels of FiO2 if oxygenation needs to be increased

32
Q

When using a ventilator, the goal is to keep PaO2 between […] - […] mmHg.

A

When using a ventilator, the goal is to keep PaO2 between 55 - 80 mmHg.

33
Q

When using a ventilator, the goal is to keep SpO2 between […] - […]%.

A

When using a ventilator, the goal is to keep SpO2 between 88 - 95%.

34
Q

Which part of the mediastinum (anterior, middle, posterior) are bronchogenic cysts usually found?

A

Middle mediastinum

other middle mediastinal masses include tracheal tumors, pericardial cysts, lymphoma, lymph node enlargement, and aortic aneurysms of the arch

35
Q

Which part of the mediastinum (anterior, middle, posterior) are neurogenic tumors usually found?

A

Posterior mediastinum

other posterior mediastial masses include enteric cysts, lymphomas, diaphragmatic hernias, esophageal tumors, and aortic aneurysms

36
Q

Which part of the mediastinum (anterior, middle, posterior) are thymomas usually found?

A

Anterior mediastinum

other anterior mediastinal masses include thyroid neoplasm, teratoma, and lymphoma

37
Q

Which type of lung cancer is associated with Cushing’s syndrome (ectopic ACTH) and SIADH?

A

Small cell carcinoma

38
Q

Which type of lung cancer is associated with hypercalcemia (ectopic PTHrP production)?

A

Squamous cell carcinoma

39
Q

Which type of parapneumonic effusion is characterized by low pH, low glucose, and positive gram stain & culture?

A

Empyema

positive gram stain & culture helps distinguish empyema from complicated pleural effusion; both are managed with antibiotics and drainage

40
Q

Which type of parapneumonic effusion, uncomplicated or complicated, is characterized by glucose <60 mg/dL?

A

Complicated

41
Q

Which type of parapneumonic effusion, uncomplicated or complicated, is characterized by glucose > 60 mg/dL?

A

Uncomplicated

42
Q

Which type of parapneumonic effusion, uncomplicated or complicated, is characterized by pH <7.2?

A

Complicated

43
Q

Which type of parapneumonic effusion, uncomplicated or complicated, is characterized by pH > 7.2?

A

Uncomplicated

44
Q

Which type of pleural effusion, exudative or transudative, is commonly caused by decreased plasma oncotic pressure or elevated hydrostatic pressure?

A

Transudative

e.g. hypoalbuminemia, CHF

45
Q

Which type of pleural effusion, exudative or transudative, is commonly caused by increased capillary permeability or disruption to lymphatic outflow?

A

Exudative

e.g. malignancy, infection, PE

Medicine (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions