Mixed Flashcards by Berni Mariño

Cessation of smoking for at least __ weeks BEFORE and until _ days after surgery to reduce perioperative complications

8 weeks; 10 days

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Pulsus paradoxus

Decrease in systolic pressure > 20 in inspiration

-Seen in conditions with increase in intrathoracic pressure
(COPD, Asthma, Tamponade, Pericardial dse

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Causes of peripheral cyanosis?

Reduced cardiac output
Cold exposure
Redistribution of blood flow from extremities
Obstruction - arterial and venous

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What level of CO2 would predispose to impending respiratory failure?

Normal or increasing

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Characterize the 2 different types of asthma

Type I Brittle - persistent decline, OCS requiring, need for continuous Beta agonist infusion

Type II Brittle- may have precipitous, unpredictable falls
in lung function which may result in death? (HPIM

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Causes of Loffler Syndrome?

“HAS”

Hookworm
Ascaris
Schistosomiasis

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What is the suspected offending agent in a
patient presenting with symptoms similar to
pulmonary alveolar proteinosis and chest CT
demonstrates that characteristic crazy paving
pattern? (HPIM 20th ed. C283 P1979)

Silica

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PaO2 will start to decrease in COPD px when FEV1 decreases to what percent? PaCO2 will increase when FEV1 decreases to what percent

O2 - 50%
CO2- 25%

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Indication to NIPPV for COPD?

PaCO2 > 45 with absence of contraindications

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What is the characteristic of pleural effusion seen
1 week post CABG? (HPIM 20th ed. C288 P2008,

Left sided and bloody
(with findings of eosinophils)

Weeks after post op
-Left sided, yellowish, with lymphocytes

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Examples of drugs causing exudative pleural effusion?

DAN-B

Dasatinib
Amiodarone
Nitrofurantoin
Bromocriptine

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Indications for NIPPV for Hypoventilation

PACO2 >= 45%
O2 sats <= 88% for consecutive 5 mins
FEV1 pred <= 50%
Inspiratory pressure < 60
Sniff pressure < 40

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Risk factors for CA MRSA

Summer months
Young
Concurrent influenza
Erythematous rash
Gross hemoptysis
Cavitary infiltrate
Neutropenia

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Critical risk factors for VAP development

-colonization
-Aspiration
-compromised immune response

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SOFA scoring components

PFR
MAP
TB
Crea
UO
Plt

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Which phase of ARDS is associated with rapid
recovery and liberation from mechanical ventilation?

Proliferative phase

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What are non-B graded recommendation for ARDS

-Low tidal volume (A)
-Recruitment maneuvers (C) - indeterminate evidence
-Inhaled vasodilators (C)
-High frequency ventilation (D)
-Surfactant (D)
-Steroids (D)

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Most common cause of transudative pleural effusion

Cirrhosis

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MC cause of exudative PF?

Pneumonia

2nd malignancy

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MC cause exudative PF

Pneumonia
Malignancy

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Differentials for PF Glucose < 60

Bacterial infection
Malignancy
RA

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DOC for Type 2 Brittle Asthma

SC epinephrine

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DOC for Aspirin induced asthma

Inhaled corticosteroids
Anti leukotrienes can also be effective

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Direct causes of ARDS

PAP-DT

Pneumonia
Aspiration
Pulmonary contusion
Drowning
Toxic inhalational injury

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Close contact definition (2 or more)

Less than 1 meter Exposure more than 15 mins Poorly ventilated area

Formula for ROX INDEX

Sats/fio2 div RR

ROX index cutoffs

<2.8 at 2 hrs <3.47 at 6 hrs <3.85 at 12 hrs

Only agents in high risk CAP

S. Aureus Pseudomonas aerginosa

What percentage of homogeneous deficiency of alpha 1 anti tryptase is homogeneous deficiency likely?

<20%

Percentage level when alpha tryptase deficiency should be treated?

<11%

CAT cut off that differentiates COPD functional capacity?

10 >= 10 means B or D

Differentials for platypnea

Left atrial myxoma Hepatopulmonary disease

Definition of massive hemoptysis

400 mL in 24 hours OR 100-150 mL expectorated at one time

Atypical pathogen more common in VAP than CAP?

Legionella

According to HPIM, what is the target O2 sat in asthma?

>90%

Describe dyspnea of EIA

occurs at end of exercise and continues until 30 mins after prevented by B2 agonist and anti leukotrienes and ICS

Duration of witholding -SABA -ICS + LABA

-4 hrs -24 hrs

Suspect this disease entity if suspecting asthma but refractory to conventional treatment

Allergic bronchopulmonary aspergillosis

MC cancer associated with asbestosis

Lung CA

Threshold for taking ABG

< 92%

Next step if pleural effusion shows negative cytology for malignancy?

Thoracoscopy

Most cases of chronic mediastinitis are due to which underlying disease?

Parameters for failed SBT

HR > 140 or 20% inc/dec from baseline RR > 35 for > 5 mins O2 < 90% SBP < 90 or > 180 Diaphoresis or increased anxiety RR/TV > 105

Evidence grade C and D for ARDS

Grade C -Inhaled vasodilators -Recruitment maneuver Grade D -Steroids -High frequency vent -Surfactant

Good response with prone positioning

PF ratio > 20 of baseline PaO2 > 10 of baseline

What antibiotics to add to CAP if with active or prior influenza infection during the past 2 weeks

Cover for MRSA Linezolid 600 mg IV q12 Vancomycin 15 mg/kg IV q8-12

Diagnostic thresholds for endotracheal aspirate and protected brush specimen method?

Endotracheal -10^6 Protected specimen - 10^3

Repeat CXR sched for hospitalized CAP patients

After 4-6weeks

Treatment duration for - bacteremic - Mycoplasma Chlamydia - LegionellA

-28 days - 10-14 -14-21

Timeline regarding pneumonia progression

1 wk: resolution of fever 4 wks: chest pain and sputum production (4=pain) 6 weeks: cough and breathlessness 3 months: fatigue 6 months almost no symptoms

CURB 65 components and implications

Confusion Urea >7 mmol/L RR >= 30 BP <=90/60 Age 65

Positive sputum microscopy on the 2nd and 5th month of PTB treatment, what to do next?

2nd - do Gene Xpert then continue while waiting 5th - treatment failure. Stop meds. Refer to PMDT

Post bronchodilator spirometry med and time interval

SABA 400 mcg 10-15 mins SAMA 160 mcg 30-45 mins FEV1/FVC <0.7

Alpha 1 antitrypsin deficiency percentage defect

<20%

Indications for long time oxygen therapy in COPD

<= 88% O2 sat confirmed 2x over 3 week period PaO2 <= 55 2x over 3 week period PaO2 55-60 or 88% sar if with pulmo htn, polycythemia, edema

Parameters for clearance for air travel

O2sat >95% 6 MW > 84%

Next step of treatment if on max LABA LAMA ICS on COPD

Roflumilast if FEV1 <50 and with hx of exacerbation year before Macrolide if prior smoker (erythromycin 250 mg BID OR Azithromycin 250 mg daily/500 mg 3 days a week)

Candidates for LVRS in COPD

Upper lobe emphysema with low post rehab exercise capacity

No benefit from LRVS in what subsept of population

FEV1 <20% and FeNO <20% Diffusely distributed emphysema on CT

Indications for catheter related thrombolysis

If with extensive femoral, iliofemoral and Ue DVT

2 parenteral direct thrombin inhibitors

Argatroban Bivalirudib

Acute isolated distal DVT management

If with symptoms = anticoagulation If no symptoms and high bleeding risk = serial monitoring 2 weeks

Preferred access for thrombolysis

Peripheral over catheter

Mixed Flashcards

(63 cards)