Pulmonology and Critical Care Medicine Flashcards by Aaron Sircy

What lung disease presents in patients between 50 to 70 years old, greater than 6 months duration, dry cough, dyspnea on exertion, velcro-like crackles, clubbing, honeycombing changes on HRCT scan?

Idiopathic Pulmonary Fibrosis

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How does one diagnosis chronic thromboembolic pulmonary hypertension?

V/Q scan

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Severe Asthma therapy that targets type 2 inflammation, what drug is this?

Mepolizumab (Nucala)

IL-5 inhibitor, decreases eosinophils

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A patient has sepsis, how does fluid resuscitation work?

What is the lactate level?

1st hour, 30 cc/kg LR given, ideally

Lactate above 2 if there is an active infection

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What is a good NIF number?

-20

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What is a good RSBI number?

What is the formula?

less than 105

RSBI = RR (Breaths per minute) / Tidal Volume (L)

Denominator should be example (0.450)

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Chronic Thromboembolic Pulmonary HTN what treatment should be what?

AC and Surgery

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What is the only Chronic Thromboembolic Pulmonary HTN medication if no surgery will be done?

Riociguat, soluble guanylate cyclase, primary receptor of nitric oxide

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Patients with Chronic Thromboembolic Pulmonary HTN, what is needed to rule out Pulmonary HTN?

V/Q scan, CTA not as sensitive
RHC and Pulmonary Angiography should be avoided in patients with a normal V/Q scan

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Pulmonary: Pre-flight, what testing should be done before?

Resting Pulse Oximetry

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Nitric Oxide Fraction looks at what?

Non-invasive measurement of eosinophils

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Severe temperatures below what number require internal rewarming methods?

Below 82.4 F

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How should active rewarming temperatures be taken?

Esophageal Probe

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If Pulmonary HTN is diagnosed on echo, what is the confirmatory test?

Right Heart Cath

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Group 1 Pulmonary HTN can be given what if a RHC shows improvement with nitric oxide?

Nifedipine

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What medication may be given in mild to moderate Pulmonary Artery Hypertension without vasoreactivity?

Sildenafil

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If a patient has COPD Gold criteria E, patient is already on LABA-LAMA-ICS, what is the next best step?

Roflumilast, PDE-4 inhibitor

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COPD Gold group A is what treatment?

Bronchodilator (LAMA +SABA), other opitions

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COPD Gold group B is what treatment?

LAMA-LABA, Anoro Ellipta, other opitions

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COPD Gold group E is what treatment?

LABA+LAMA+ICS, Trelegy Ellipta or Breztri

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COPD Gold group E, what is another thing to evaluate?

Eosinophils

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Dyspnea when hurrying or walking up a slight hill is what GOLD group?

GOLD group A

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Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace is what GOLD group?

GOLD group B

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2 or more moderate COPD exacerbations is what?

Gold Group E

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Montelukast can have what side effect?

Depression, black box warning

If patients have bad asthma and COPD what should be measured?

Eosinophils

When determining Lung Cancer staging, what size should the nodules be before a scan shows any benefit?

Greater than 8mm

If a CT chest shows a stable nodule after 6 months, when should the follow up CT scans be done?

Every 2 years for 5 years

Before an apical Lung mass can be removed, what should be done?

CT Chest Scan

Velcro like crackles at both lung bases, what is this, think autoimmune?

Idiopathic Pulmonary Fibrosis

Idiopathic Pulmonary Fibrosis, what should be done?

Pirfenidone and Ninedanib

PE in pregnancy, what could treat this problem?

Low Molecular Weight Heparin

A patient's asthma response to steroids can be seen with what?

Fractional Exhaled Nitric Oxide

The most common form of exudative effusions is what?

Infection and Malignancy

An exudate effusion that has a triglyceride level above 110 and primarily lymphocytic is what?

Chylothorax Lymphoma can cause

An inflammatory effusion from what has a low pH (<7.2), low glucose (40), an elevated LDH, what is this?

Inflammatory Effusion

An incidental ground glass lesion 6mm or larger, when found, will have a CT scan repeat in 6-12 months. Afterwards, how often?

Every 2 years for 5 years

Ethylene Glycol and Methanol should be treated with what?

Fomepizole or the ethanol

Ethylene Glycol poisoning and end organ damage, what should be done?

Fomepizole and Dialysis

Neutropenic fever, antibiotics can be stopped when?

Full course for antibiotics or absolute neutrophil count is above 500, whichever is longest. Patient should also be afebrile.

Spontaneous primary pneumothorax prevention in a patient with a risk occupation, is what?

Recurrence Prevention (pleurodesis)

Aspiration Pneumonitis, improve after 24 hours, what can be done if on abx?

Can stop antibiotics

COPD with thick purulent sputum, P. Aeruginosa history, what is the best antibiotic to give?

Ciprofloxacin, not azithyromycin

COPD and does not improve with albuterol, what should be given?

Inhaled Fluticasone Propionate-Salmeterol (LABA-LAMA)

Thermal injury 2/2 fire, patient has some oral swelling, oxygenating well, what procedure does the patient need?

Patient needs to have a Bronchoscopy

Low risk patient with a 6 mm nodule, what is the follow up CT scan advice?

No further follow up

What is the first test for a chronic PE?

V/Q scan

What meds can help modify the ALS disease?

riluzole, edaravone

Leukocytosis with an initial neutrophil predominance and elevated IgE, what is this associated with?

Acute Eosinophilic Pneumonia Usually with new or restarted smoking history consistent with a Hypersensitivity reaction

What will improve mortality with ALS?

Non-invasive Ventilation (BiPAP)

Cystic fibrosis has pancreatitis, chronic liver disease, and pulmonary symptoms, what will a chest xray show?

Cavitation, Bronchiectasis with GI symptoms, steatorrhea, diarrhea, or abdominal pain

Pulmonary Hypertension group #1 is due to what?

Idiopathic, hertiable

Pulmonary Hypertension group #2 is due to what?

Left Heart Disease

Pulmonary Hypertension group #3 is due to what?

Lung Disease

Pulmonary Hypertension group #4 is due to what?

Chronic Thromboembolic PH

Pulmonary Hypertension group #5 is due to what?

Multifactorial

What is anti-P/Q-type voltage-gated calcium channel antibodies? What disease may this be?

Lambert Eaton myasthenic syndrome

What is the first medication to start with Lambert Eaton?

Pyridostigmine

Incidental finding in the patient's middle mediastinum, what is the most likely finding?

Bronchogenic Cyst

What Pneumonia Vaccine should be given if no previous vaccine has been given, under the age of 65 with risk factors?

PCV 20

If Patient has PCV 15 vaccine given, what vaccine should be given one year later?

PCV 23

Common variable immunodeficiency, what are these people at risk of obtaining? (think cancer)

Risk of Lymphoma

What are CVID (common variable immunodeficiency disease) patients, pulmonary wise, at risk of obtaining? What will the CT scan show?

Bronchiectasis, tram track bronchi, can see a Signet ring

Patients with non-small cell lung cancer Stage I and II, what is the next best step?

Surgery and Adjuvant Chemotherapy (cisplatin based therapy)

Patient has a PFT done, FEV1/FVC increase from 10-12% with bronchodilator, what could that be?

Asthma

Patient has aspiration concerns, what is the test of choice?

CT chest with contrast, Contrast can help outline the abscess

For COPD patients, what should be done first before romflumilast and Azithyromycin?

LAMA, LABA, and ICS

Anti synthetase Syndrome has what positive antibody?

anti-Histidyl-transfer RNA synthetase antibodies

Post primary TB, what should be done if the patient has respiratory issues and is symptommatic?

Sputum Cx and acid fast bacilli

May Turner Syndrome is another name for iliac vein compression syndrome. Where is the compression?

Right Common Iliac Artery and 5th Lumbar Vertebrae. Will do Antiplatelet and compression stocking

What is a common Pneumocosis that can make TB worse?

Silicosis

What medication is contraindicated in active TB and Gout?

Pyrazinamide

What is central sleep apnea, via mechanism?

Loss of Brainstem central respiratory generator output precipitating airflow pauses and subsequent hyperventilation with low PCO2

What vaccine is recommended in COPD patients? Not PCV

Herpes Zoster, over the age of 50, two doses 2-6 months apart

Elevated cholesterol of what number in the pleural fluid gives a pertinent diagnosis?

Cholesterol above 200

Triglyceride level higher than what may indicate the patient has a chylothorax?

Above 110

What is Loeffler Syndrome?

A simple eosinophilic pneumonia/limited illness with fleeting infiltrates

What is LAM syndrome?

A lung disease that causes spontaneous pneumothorax and chylous effusions, usually women between 30-40s, Chest CT will show a cystic disease Usually a young female

A young male smoker with the following: Brownish-purple papules, erythematous papular rash Bone Pain with Lytic Lesions on Xray Polyuria Spontaneous Pneumothorax Lymphadenopathy What could this be?

Langerhans's Cell Histiocytosis XR chest will have thick-walled cysts and Pneumothorax

Acute Eosinophilic Pneumonia, has what characteristics?

Young Man who rapidly deteriorates and has to go on a ventilator

Chronic Eosinophilic Pneumonia, has what characteristics?

Middle Aged Female with chronic recurrences of an asthma flare

What are the histologic markers for Langerhans cell histiocytosis?

CD-1a, S-100, CD 207, and Birbeck Granules

Recurrent Pneumonias without eosinophils, what could this be?

Hypersensitivity Pneumonitis Tx: Antigen avoidance and Steroids

Immunocompromised HRCT of Chest that show a surrounding glass infiltrates ("halo sign") or an air-crescent sign or simple consolidation, what is this?

Invasive Pulmonary Aspergillosis

How is a REM sleep disorder treated? | Patient usually has vivid and scary dreams, may be violent, as well

Benzos are #1 usually, low dose clonazepam before bed, cause is unknown

What pulmonary disease has daytime hypercapnia and PCO2 > 45?

Obesity Hypoventilation Syndrome

Central Sleep Apnea is the loss of repiratory effort for at least how long on PSG?

At least 10 seconds