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U World Step 2 > Pulmonary & Critical Care > Flashcards

Pulmonary & Critical Care Flashcards

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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
Superior pulomonary sulcus tumor (Pancoast tumor)
26
Tuberculosis (reactivation)
27
Aspergilloma
28
Cryptogenic organizing penumonia Dry cough and systemic symptos Bilateral ground-glass infiltrates on CT
29
Lung abscess Thick-walled cavitary lesion with air-fluid level Cough, hemoptysis, fever, purulent sputum
30
Mesothelioma Cough, chest pain, dyspnea in patients with significant asbestos exposure. CT shows pleural thickening with effusion.
31
Oxygenation goal of mechanical ventilation
PaO2 50-80 mm Hg O2 Saturation \>=88%-95%
32
Pulmonary infarction (and effusion)
33
Bacterial pneumonia
34
Lung cancer
35
Treating pneumonia in cystic fibrosis patients
Vancomycin for staph aureus (younger patients \<20 years) Ciprofloxacin for Pseudomonas (older patients \> 20 years)
36
Elevated or normal partial pressure of CO2 in a patient with acute asthma exacerbation
Suggests impending respiratory collapse Indication for endotracheal intubation and mechanical ventilation
37
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)
38
Modified Wells criteria for pretest probability of pulmonary embolism
39
Diagnostic strategy in suspected pulmonary embolism
40
Nonallergic rhinitis versus allergic rhinitis 1. Clinical features 2. Treatment
41
Calculation of the A-a gradient
For patients breathing room air at sea level 150 - (PaCO2/0.8) General equation (FiO2 x [Patm - PH2O]) - (PaCO2/0.8)
42
Solitary pulomary nodule (SPN) 1. Definition 2. Management
1. Definition Rounded opacity \<3 cm Completely surrounded by pulmonary parenchyma No associated lymph node enlargement
43
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
44
Aspirin-exacerbated respiratory disease
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
Pulmonary aspergilloma
46
Invasive aspergillosis and chronic pulmonary aspergillosis 1. Risk factors 2. Findings 3. Management
47
Actinomyces israelii
Anaerobic bacterium causing cervicofacial infections
48
Bacterial lung abscess Indolent symptoms of fever, cough, dyspnea, weight loss CT finding: infiltrate with a cavity (air-fluid levels)
49
Differential diagnosis based on carbon monoxide diffusing capacity of the lung 1. Low 2. Normal 3. Increased
50
Common causes of hemoptysis 1. Pulmonary 2. Cardiac 3. Infectious 4. Hematologic 5. Vascular 6. Systemic diseases
51
Evaluation of hemoptysis
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
Clinical features of cystic fibrosis 1. Respiratory 2. GI 3. Reproductive 4. Musculoskeletal
Almost all males with CF are infertile from obstructive aspermia due to bilateral lack of vas deferens
53
Hyponatremia 1. Serum osmolality 2. ECV 3. Urine findings 4. Cause
54
Lung cancer
55
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
Postoperative pulmonary complications 1. Risk factors 2. Preoperative strategies (to reduce risk) 3. Postoperative strategies
57
APGAR | (Sign, 0 points, 1 point, 2 points)
Scores \< 7 may require evluation and resuscitation
58
Primary ciliary dyskinesia versus cystic fibrosis 1. Respiratory tract features 2. Extrapulmonary features
Detection of an elevated sweat chloride concentration is the gold standard for diagnosis
59
Characteristic findings of cor pulmonale 1. Common etiologies 2. Symptoms 3. Examination 4. Imaging
Cor pulmonale: Isolated right-sided heart failure (RHF) from pulomary hypertension, most commonly due to COPD
60
Obesity hypoventilation syndrome 1. Diagnostic criteria 2. Workup 3. Treatment
61
Parapneumonic effusions (Uncomplicated versus Complicated) 1. Etiology 2. Pleural fluid gram stain & culture 3. Treatment
62
Acute respiratory distress syndrome 1. Risk factors 2. Pathophysiology 3. Diagnosis 4. Management
63
First-line treatment for anaphylaxis
Intramuscular epinephrine
64
Hilar lymphadenopathy Raises concern for malignancy, infection, or inflammation.
65
Right upper-lobe atelectasis Linear density with associated shifting of mediastinum toward the collapsed lung
66
Epiglottitis 1. Microbiology 2. Clinical features 3. X-ray 4. Managment 5. Prevention
67
Clinical features of asbestosis 1. Clinical presentation 2. Diagnostic evaluation
Cor pulmonale can develop eventually
68
Common etiologies of chronic cough 1. Upper ariway disorder 2. Lower airway and parenchymal disorders 2. Other causes
69
Evaluation of subacute (3-8 weeks) of chronic (\>8 weeks) cough
70
Sign of impending respiratory failure in acute asthma exacerbation
Normal or elevated PaCO2 Patients with an acute asthma exacerbation usually have respiratory alkalosis with a low PaCO2 due to hypoventilation.
71
Acute Respiratory Distress Syndrome
72
Risk factors
Respiratory distress syndrome **Prematurity** Male sex Perinatal asphysxia **Maternal** diabetes Cesarean section without labor
73
Management of a patient with subcutaneous emphysema secondary to severe coughing paroxysms
Chest X rays to rule out pneumothorax Air leaks from chest due to high intraalveolar pressure generated by cough
74
SIADH 1. Etiologies 2. Clinical features 3. Laboratory findings 4. Management
75
What improves survival in patients with COPD and hypoxemia?
Long-term supplemental oxygen therapy
76
Mediastinal masses Anterior Middle Posterior
Anterior: Thymoma Middle: Bronchogenic cyst Posterior: Neurogenic tumor

U World Step 2 (22 decks)

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