Second-MKSAP Flashcards
what to avoid in a patient with amphetamine toxicity
BBlocker
because of unopposed alpha agonist
never use _____ as bronchotherapy in COPD unless _____
ICsteroid
unless cannot tolerate bronchodilator or>300 eosinophil
risk factor for OSA
overweight
snoring
MALE gender
risk factors for central sleep apnea
afib
heart failure
opioid use
overnight oximetry a reliable test for OSA?
no, but in patients with low pre-test probability, it is OK to use to r/o further testing for sleep apnea
gold standard test OSA
in lab polysomnography
**in COPD, supplemental O2 is necessary if RESTing pO2 is _____ or RESTing O2 saturation is _____
ALTERNATIVE thresholds ______
55 or under
88 or less
ALTERNATIVE thresholds:
EXCEPTION: if co-morbidities like CHF, Cor pulmonale, can give supplemental O2 if
pO2<59
O2sat<89
good test for CHRONIC PE
v/q
predominant upper lobe emphysema and pulm rehab with still having exercise intolerance, what is next step?
lung reduction surgery
succinylcholine can cause_____ and symptoms are ______ and treatment is _______
malignant hyperthermia
Symptoms: hyperthermia
Rigidity
rhabdo
arrhythmias
Tx: dantrolene
on polysomnography in Central sleep apnea, ____ breathing is seen due to _____ pathophysiology
cheyne stokes
loss of output from central respiratory generator in brainstem
sepsis bundle contents
FLUIDS
ABx
BCx
Lactate
AGE to start lung cancer screening ___
Criteria for lung cancer screening____
*******
50-80
criteria:
- at least 20 pack year
- <15years of last use
most appropriate initial test imaging for cardiogenic shock
TTE
most appropriate initial imaging test for pleural effusion that was caught on CXR
u/s
venous a wave, think___
pulmonary HTN
when in ICU and started on enteral nutrition, by day 7 or after unable to achieve AT LEAST____% of goal protein/calorie requirement, do ____
60%
TPN
Tx for opioid related sleep apnea
alter pain mgmt regimen/pain rehab
Upper vs Lower lobe NODULE is higher risk?
UPPER
in ______ COPD, methylxanthene like Theophylline can be used but ____-
advanced
has narrow theraputic window therefore can become toxic in dosage
normal pulmonary arter pressure
40-60mmHg
_____ confirms diagnosis of and is GOLD standard for Pulm HTN
R heart cath
(TTE does NOT confirm but can estimate pulm a pressure)
measure _____ lab test in suspected eosinophilic asthma
Nitric Oxide
**patietn had PE 3mo ago and was treated with eliquis, now 3mo later has symptoms of RHfailure, you are suspicous of the existent PE being the cause of cor pulmonale, what is the imaging of choice? and why?
V/Q scan to detect chronic PE causing RHFailure
if normal—>look for other causes of RHFail
if ABNORMAL—->do RHCath to CONFIRM dx of chronic PE for cause of Pulm HTN
if a patient has 6mm lung nodule incidentally found on CT, no Hx of smoking, famHx lung cancer, asbestos exposure, lower lobe nodule, should you order repeat CT?
NO repeat CT in 12 mo or ever!
- no risk factors AND it is <7mm
in COPD, you started patient on short acting bronchodilator, COPD still not conrolled, next step?
LONG acting bronchodilator
NOT ICS
in COPD, patient on SABA, LAMA, still not controlled, next step?
what is something to keep in mind about this next step?
ICS
NEver use ICS as monotherapy in COPD…unless cannot tolerate bronchodilator
patient on trelegy for copd exac still having hospitalizations, next pharmacological step?
next non-pharmacological step?
roflumilast(PDE-4 inhibitor-good for bronchitis like phenotype)
-or-
azithro(if current non-smoker)
Non-pharm: lung reduction surgery (if emphysema type)
theophylline, used in ____ copd, is known for these benefits ____ and _____
refractory
benefits: INCREASES functional capaicity, DECREASES number of exacerbations
signs of smoke inhalation injury
specific signs of THERAMAL injury to airway
stridor
dysphagia
sooty sputum
singed nasal hairs
THERAML INJURY: dysphonia, stridor, edematous oropharynx
INTUBATE IN ALL THE CONDITIONS ABOVE
patient already has diagnosis of pulmHTN
how do you diagnose Chronic PE as cause of pulm HTN
v/q scan—>if negative, Chronic PE excluded
if positive–>do RHcath for further workup
