Mksap 16 Q&a Pulmo Cc

Front 1

These patients are at high risk for vent failure

Back 1

VC>20ml/kg; NIF <30 cm H20; declining values

Front 2

best method to predict in-flight hypoxemia in COPD patients

Back 2

HAST or hypoxia altitude simulation test (patient breathes a hypoxic gas x 20mins)

Front 3

how to interpret the HAST?

Back 3

PaO2 <50, give in-flight O2; PaO2 >55, no supplemental O2; 50-55 borderling; measure HAST during activity

Front 4

mechanism of AAT disease

Back 4

AAT is antiproteolytic enzyme; it neutralizes neutrophil elastase, deficiency results in excessive amounts of neutrophil elastase --> destruction of elastin --> early COPD (panacinar emphysema with basilar predominance)

Front 5

diagnostic test for CF; hallmarks of CF?

Back 5

sweat chloride testing; bronchiectasis, purulent sputum

Front 6

Initial treatment of anaphylaxis

Back 6

IM or SQ epinephrine + inhaled albuterol

Front 7

young woman with dyspnea; CXR shows hyperinflation; comes with spontaneous pneumothorax and/or chylothorax, what diagnosis to consider?

Back 7

lymphangioleiomyomatosis

Front 8

Pathophysiology of LAM or lymphangioleiomyomatosis

Back 8

smooth muscle cells that infiltrate the lung with inactivating tuberous sclerosis complex gene mutations resulting in constitutive activation of the mammalian target of rapamycin (mTOR) signaling pathway.

Front 9

characteristic high res CT abnormalities seen in RB-ILD (respiratory bronchiolitis–associated ILD)

Back 9

centrilobular nodules with air-trapping and scattered ground-glass attenuation

Front 10

Lesions located in the anterior mediastinum

Back 10

thyroid tumors, thymic tumors, and lymphomas

Front 11

tumors in the middle mediastinum

Back 11

bronchogenic cysts, pericardial cysts, LAD

Front 12

when is pulmonary rehabilitation indicated?

Back 12

symptomatic patients with FEV1 < 50%

Front 13

Most patients require a tissue diagnosis, but there are some exceptions that do not warrant histologic confirmation such as

Back 13

Löfgren syndrome (fever, erythema nodosum, polyarthralgia, and hilar lymphadenopathy) and Heerfordt syndrome (uveitis, parotid gland enlargement, and fever)

Front 14

PDE-4 inhibitor indicated for chronic treatment of severe and very severe COPD with recurrent exacerbations. (not used for acute exacerbations)

Back 14

Roflumilast

Front 15

The newest National Asthma Education and Prevention Program guidelines - which asthma patients need ICU admission?

Back 15

symptomatic, even with mild CO2 retention (PCO2 >= 42) or severely decreased PFTs despite bronchodilator (FEV1 or PEF <40%)

Front 16

primary indication for thrombolysis in PE

Back 16

persistent hypotension and hemodynamic instability

Front 17

confirmatory diagnosis of cystic fibrosis

Back 17

measurement of sweat chloride (>60mEq/L)

Front 18

flow-volume loop in cystic fibrosis

Back 18

flattening of inspiratory and expiratory limbs (fixed airway obstruction)

Front 19

The only intervention shown to improve survival in selected patients with IPF

Back 19

lung transplantation

Front 20

Indications for LTOT

Back 20

PaO2 </= 55 mm Hg (7.3 kPa) or O2 sats <= 88% on RA

Front 21

What is the Nocturnal Oxygen Therapy Trial (NOTT)?

Back 21

continuous O2 better than nocturnal O2 in enhancing survival

Front 22

Delirium types

Back 22

hyperactive, hypoactive, and mixed

Front 23

key feature of AMS

Back 23

headache, along with fatigue, nausea, and sleep disturbance (usually due to high-altitude periodic breathing [HAPB], an altitude-associated respiratory change

Front 24

most effective therapy to prevent AMS and HAPB when gradual ascnet is not possible

Back 24

acetazolamide 24-48 hours before ascent

Front 25

when to start treatment with omalizumab in asthma exacerbatoins?

Back 25

severe asthma + allergies, elevated IgE + symptomatic despite high-dose inhaled CS and LABA

Front 26

young, never smoker, with endobronchial obstruction, recurrent pneumonia, smoothly bordered mass; what is the most likely tumor?

Back 26

A carcinoid tumor

Front 27

Contraindications to noninvasive ventilation

Back 27

resp arrest, CV instability (hypotension, arrhytmias, MI), AMS, high aspiration risk, copious secretions; recent face/GI surgery; craniofacial trauma, fixed nasopharyngeal abnormalities, burns, extreme obesity

Front 28

how to interpret allergy skin test in ABPA

Back 28

if negative, high NPV; if positive indicates sensitization but not necessarily ABPA, check IgE levels, if >1000 IU/ml, suggests ABPA; if <500, prob not ABPA

Front 29

When should LVRS be considered?

Back 29

severe COPD, maximal med therapy, completed pulmo rehab + criteria: bilateral emphysema on CT; postbronch TLC >150% and RV >100%; FEV1 max <45%; PaCO2 <60 and PaO2 at least 45 on RA

Front 30

treatment for stable but symptomatic COPD and FEV1 <60%

Back 30

inhaled bronchodilator

Front 31

NOTE: Methylprednisolone and epinephrine are useful in upper airway obstruction from croup and anaphylaxis,

Back 31

but they do not have a clear role in the treatment of angioedema associated with ACE inhibitors.

Front 32

condition characterized by cyclic central apneas and hyperpneas during sleep upon ascension to high altitude

Back 32

HAPB or high-altitude periodic breathing (HAPB)

Front 33

best guess for a diagnosis in a former smoker with mediastinal mass and ]probable myasthenic syndrome (Lambert-Eaton syndrome)

Back 33

small cell lung cancer

Front 34

Lambert-Eaton myasthenic syndrome is a rare neuromuscular junction transmission disorder caused by antibodies directed against

Back 34

presynaptic voltage-gated P/Q-type calcium channels

Front 35

when to start vasoactive agents in hypotension

Back 35

fluid challenge 1L and MAP still <65 or CVP <8-12

Front 36

The mean arterial pressure is calculated with the following equation

Back 36

(2*DBP + SBP) / 3

Front 37

diagnostic criteria for sepsis

Back 37

known or suspected infection + 2 of SIRS criteria: T>38 <36; WBC >12 or <4; RR>20; HR>90

Front 38

septic patient; central venous O2Sat <70% after fluid challenge, next step?

Back 38

transfusion

Front 39

normal DLCO

Back 39

>/=80% predicted

Front 40

indications for chest tube placement

Back 40

effusions >1/2 hemithorax; loculation; (+) GS/CS; PF glu <60; PF pH <7.2

Front 41

how is asbestosis diagnosed?

Back 41

pulmo fibrosis + exposure history + appropriate latency period (10-15 years)

Front 42

goal plateau pressure

Back 42

<30 cm H20

Front 43

in victims of smoke inhalation, which test is sensitive to determine cyanide poisoning?

Back 43

lactate >90

Front 44

antidote for inhaled cyanide toxicity

Back 44

sodium thiosulfate

Front 45

NOTe: ARDS + normal BP and normal crea -- when treated with aggressive diuresis

Back 45

spent less time on the venilator compared to usual care.

Front 46

NOTE: Early use of cisatracurium (to paralyze patients) in severe lung injury

Back 46

improves mortality and shortens ventilation

Front 47

recommendations for PEEP

Back 47

no absolute number, look for PEEP # that achieves FiO2 <0.6 and doesn't cause hypotension

Front 48

target BP for hypertensive emergency

Back 48

no more than 25% in the first hour; then down to 160/100-110 in next 2-6h

Front 49

envelope shaped crystals in urine

Back 49

calcium oxalate, ethylene glycol ingestion

Front 50

how to identify benign or malignant nodules in the Xray

Back 50

borders: smooth benign, spiculated malignant; calcification pattern: popcorn, lamellar, central, diffuse are all benign

Front 51

when to start oxygen therapy in COPD?

Back 51

PaO2 <55 or O2sats >/= 88% +/- hypercapnea; or PaO2 56-59 or O2 sats <89% + one of the ffg: pulmo HTN, cor pulmonale or edema, Hct >56

Front 52

when is alteplase indicated in PE?

Back 52

persistent hypotension (SBP <90 or drop in SBP >40)

Front 53

changes in the 2012 Berlin consensus definition for ARDS

Back 53

Echo or PAWP not necessary; Acuity defined as 1 week; CT chest can be used; classify into mild mod severe based on hypoxemia and ALI term no longer used

Front 54

index for assessing severity of COPD; what socre to refer for evaluation for lung transplantation?

Back 54

BODE index (BMI, Obstruction, Dyspnea, Exercise) ; score >5 indicates referral for possible lung transplantation

Front 55

when is lung transplantation indicated?

Back 55

BODE index 7-10 + one of the ffg: hospitalization for hypercapnea / exacerbation; Pulmo HTN, cor pul despite O2 therapy; FEV1 <20% predicted; homogenous emphysema

Front 56

radiographic description most consistent with BOOP

Back 56

bilateral, diffuse, alveolar opacities in the presence of normal lung volume

Front 57

consistent with a transudative process

Back 57

serum:PF alb gradient >1.2 or serum:PF total Pr >3.1

Front 58

Ideal body weight formula

Back 58

50 Kg + (2.3Kg for every inch >60) in MEN; 45.5 Kg + (2.3Kg for every inch >60) in WOMEN

Front 59

most common diagnoses for patients with chronic cough and normal CXR

Back 59

BA, PND, GERD

Front 60

ACCP guidelines for pulmonary nodules follow-up

Back 60

repeat CT in 1 year if (former and current) smoker and <4mm nodule; if unchanged, no further CT

Front 61

what is a benign / stable nodule

Back 61

solid nodule on CXR or CT, stable x 2 years

Front 62

what is the apnea-hypopnea index (AHI)?

Back 62

apnea + hypopnea per hour of sleep

Front 63

how to interpret AIH? An AHI of 5 to 15

Back 63

5-15, 16-30, > 30 corresponds to mild, moderate and severe OSA

Front 64

idiopathic form of BOOP

Back 64

COP

Front 65

form of bronchiolitis that occurs in most smokers

Back 65

Respiratory bronchiolitis–associated interstitial lung disease (RB-ILD)