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U World Step 2 > Pulmonary & Critical Care > Flashcards

Pulmonary & Critical Care Flashcards

1
Q

Light’s criteria for pleural effusions

  1. Protein
  2. LDH
  3. Common causes
A
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2
Q

Tuberculous effusions

A

Exudative

Very high protein levels (>4 g/dL)

Lymphocytic leukocytosis

Low glucose (< 60 mg/dL)

Markedly elevated LDH levels (>500 U/L)

Low pH

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3
Q

Empyema

A

Presence of frank pus in pleural space

Prominent neutrophilic leukocytosis (>50,000 mm^3)

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4
Q

Measures to prevent aspiration pneumonia

A

Oral care

Diet modification for patients with dysphagia

Elevating the head of the bed to 30-45 degrees

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5
Q

Predisposing conditions for aspiration pneumonia

A
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6
Q

Pneumothorax (Spontaneous versus tension)

  1. Associated features
  2. Signs and symptoms
  3. Imaging
  4. Management
A
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7
Q
A

Tension pneumothorax

Blue arrows: Displaced mediastinal structures

Red arrows: Visceral pleural line, beyone which no pulmonary vasculature or lung parenchymal markings are apparent.

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8
Q
A

Collapsed lung

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9
Q
A

Cardiac tamponade

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10
Q
A

Flash pulmonary edema

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11
Q
A

Pleural effusions

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12
Q

Most common causes of malignant pleural effusions

A

Breast cancer

Lung cancer

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13
Q
A

Pulmonary contusion

Nonlobular airspace opacities

Develop <24 hours after trauma, resolve in 1 week

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14
Q
A

Seen in aortic rupture

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15
Q
A

Pneumomediastinum

Can result from traumatic esophageal rupture

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16
Q
A

Superior pulmonary sulcus tomor (Pancost tumor)

-Involvement of phrenic nerve causing hemidiaphragm paralysis and

elevation of right hemidaphragm

  • Caused by primary lung malignancies (squamous cell carcinoma, adenocarcinoma)
  • Smoking is the strongest risk factor
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17
Q

Clinical presentation of Pancoast tumor

A
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18
Q

Acute exacerbation of chronic obstructive pulmonary disease

  1. Cardinal symptoms
  2. Diagnostic testing
  3. Management
A
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19
Q

Interpretation of V/Q scan results based on pretest probability for PE

A

Range of outcomes for V/Q scan

LEAST LIKELY – normal, low probability, moderate probability, high probability – MOST LIKELY

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20
Q

Anticoagulation during pregnancy

A

Heparin (category C)

Low molecular weight heparin (category B)

Warfarin is category X (do not use)

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21
Q

Central versus peripheral cyanosis

  1. Signs
  2. Cause
A

Central cyanosis: Cyanosis in highly vascularized tissues such as lips and mucous membranes

Caused by low arterial oxygen saturation

Peripheral cyanosis: Cyanosis only in distal extremities

Caused by increased oxygen extraction secondary to sluggish blood flow

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22
Q
A

Bronchiectasis

Characteristic of cystic fibrosis

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23
Q

Differential diagnosis of hemoptysis in children

  1. Diagnosis
  2. Pathogenesis
  3. Clinical features
A
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24
Q
A

Diagphragmatic rupture

Elevation of hemidiaphragm on chest X ray

Nasograstric tube (red arrows) in pulmonary cavity is diagostic

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25
Q
A

Superior pulomonary sulcus tumor (Pancoast tumor)

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26
Q
A

Tuberculosis (reactivation)

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27
Q
A

Aspergilloma

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28
Q
A

Cryptogenic organizing penumonia

Dry cough and systemic symptos

Bilateral ground-glass infiltrates on CT

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29
Q
A

Lung abscess

Thick-walled cavitary lesion with air-fluid level

Cough, hemoptysis, fever, purulent sputum

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30
Q
A

Mesothelioma

Cough, chest pain, dyspnea in patients with significant asbestos exposure.

CT shows pleural thickening with effusion.

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31
Q

Oxygenation goal of mechanical ventilation

A

PaO2 50-80 mm Hg

O2 Saturation >=88%-95%

32
Q

Pulmonary infarction (and effusion)

A
33
Q
A

Bacterial pneumonia

34
Q
A

Lung cancer

35
Q

Treating pneumonia in cystic fibrosis patients

A

Vancomycin for staph aureus (younger patients <20 years)

Ciprofloxacin for Pseudomonas (older patients > 20 years)

36
Q

Elevated or normal partial pressure of CO2 in a patient with acute asthma exacerbation

A

Suggests impending respiratory collapse

Indication for endotracheal intubation and mechanical ventilation

37
Q

Causes of hypoxemia (Example, A-a gradient, Corrects with supplemental O2?)

  1. Reduced PiO2
  2. Hypoventilation
  3. V/Q mismatch
  4. Diffusion limitation
  5. Intrapulmonary shunt
  6. Intracardiac shunt (right to left)
A
38
Q

Modified Wells criteria for pretest probability of pulmonary embolism

A
39
Q

Diagnostic strategy in suspected pulmonary embolism

A
40
Q

Nonallergic rhinitis versus allergic rhinitis

  1. Clinical features
  2. Treatment
A
41
Q

Calculation of the A-a gradient

A

For patients breathing room air at sea level

150 - (PaCO2/0.8)

General equation

(FiO2 x [Patm - PH2O]) - (PaCO2/0.8)

42
Q

Solitary pulomary nodule (SPN)

  1. Definition
  2. Management
A
  1. Definition

Rounded opacity

<3 cm

Completely surrounded by pulmonary parenchyma

No associated lymph node enlargement

43
Q

Assessment of malignancy risk for solitary pulmonary nodule

  1. Nodule size (cm)
  2. Age (year)
  3. Smoking status
  4. Smoking cessation (year)
  5. Nodule margin characteristics
A
44
Q

Aspirin-exacerbated respiratory disease

A

Occurs in patients with asthma and chronic rhunosinusitis

Sudden worsening of asthma and nasal congestion 30 minutes to 3 hours after ingestion of NSAIDS

45
Q
A

Pulmonary aspergilloma

46
Q

Invasive aspergillosis and chronic pulmonary aspergillosis

  1. Risk factors
  2. Findings
  3. Management
A
47
Q

Actinomyces israelii

A

Anaerobic bacterium causing cervicofacial infections

48
Q
A

Bacterial lung abscess

Indolent symptoms of fever, cough, dyspnea, weight loss

CT finding: infiltrate with a cavity (air-fluid levels)

49
Q

Differential diagnosis based on carbon monoxide diffusing capacity of the lung

  1. Low
  2. Normal
  3. Increased
A
50
Q

Common causes of hemoptysis

  1. Pulmonary
  2. Cardiac
  3. Infectious
  4. Hematologic
  5. Vascular
  6. Systemic diseases
A
51
Q

Evaluation of hemoptysis

A

Patients should be placed with bleeding lung in the dependent position

Bronchoscopy is the initial procedure of choice: localize bleeding site, provide suctioning to improve visualization, and includes therapeutic interventions (balloon tamponade, electrocautery)

52
Q

Clinical features of cystic fibrosis

  1. Respiratory
  2. GI
  3. Reproductive
  4. Musculoskeletal
A

Almost all males with CF are infertile from obstructive aspermia due to bilateral lack of vas deferens

53
Q

Hyponatremia

  1. Serum osmolality
  2. ECV
  3. Urine findings
  4. Cause
A
54
Q
A

Lung cancer

55
Q
A

Radiation fibrosis

Chest X-ray shows volume loss with coarse opacities

Occurs in patients who have received lung field radiation.

Patients develop dyspnea, nonproductive cough, and chest pain 4-24 months after therapy

56
Q

Postoperative pulmonary complications

  1. Risk factors
  2. Preoperative strategies (to reduce risk)
  3. Postoperative strategies
A
57
Q

APGAR

(Sign, 0 points, 1 point, 2 points)

A

Scores < 7 may require evluation and resuscitation

58
Q

Primary ciliary dyskinesia versus cystic fibrosis

  1. Respiratory tract features
  2. Extrapulmonary features
A

Detection of an elevated sweat chloride concentration is the gold standard for diagnosis

59
Q

Characteristic findings of cor pulmonale

  1. Common etiologies
  2. Symptoms
  3. Examination
  4. Imaging
A

Cor pulmonale: Isolated right-sided heart failure (RHF) from pulomary hypertension, most commonly due to COPD

60
Q

Obesity hypoventilation syndrome

  1. Diagnostic criteria
  2. Workup
  3. Treatment
A
61
Q

Parapneumonic effusions (Uncomplicated versus Complicated)

  1. Etiology
  2. Pleural fluid gram stain & culture
  3. Treatment
A
62
Q

Acute respiratory distress syndrome

  1. Risk factors
  2. Pathophysiology
  3. Diagnosis
  4. Management
A
63
Q

First-line treatment for anaphylaxis

A

Intramuscular epinephrine

64
Q
A

Hilar lymphadenopathy

Raises concern for malignancy, infection, or inflammation.

65
Q
A

Right upper-lobe atelectasis

Linear density with associated shifting of mediastinum toward the collapsed lung

66
Q

Epiglottitis

  1. Microbiology
  2. Clinical features
  3. X-ray
  4. Managment
  5. Prevention
A
67
Q

Clinical features of asbestosis

  1. Clinical presentation
  2. Diagnostic evaluation
A

Cor pulmonale can develop eventually

68
Q

Common etiologies of chronic cough

  1. Upper ariway disorder
  2. Lower airway and parenchymal disorders
  3. Other causes
A
69
Q

Evaluation of subacute (3-8 weeks) of chronic (>8 weeks) cough

A
70
Q

Sign of impending respiratory failure in acute asthma exacerbation

A

Normal or elevated PaCO2

Patients with an acute asthma exacerbation usually have respiratory alkalosis with a low PaCO2 due to hypoventilation.

71
Q
A

Acute Respiratory Distress Syndrome

72
Q

Risk factors

A

Respiratory distress syndrome

Prematurity

Male sex

Perinatal asphysxia

Maternal diabetes

Cesarean section without labor

73
Q

Management of a patient with subcutaneous emphysema secondary to severe coughing paroxysms

A

Chest X rays to rule out pneumothorax

Air leaks from chest due to high intraalveolar pressure generated by cough

74
Q

SIADH

  1. Etiologies
  2. Clinical features
  3. Laboratory findings
  4. Management
A
75
Q

What improves survival in patients with COPD and hypoxemia?

A

Long-term supplemental oxygen therapy

76
Q

Mediastinal masses

Anterior

Middle

Posterior

A

Anterior: Thymoma

Middle: Bronchogenic cyst

Posterior: Neurogenic tumor

U World Step 2 (22 decks)

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