What's new in PCCM?
VTE and ME
Who's Who PCCM Faculty?
On This Day in Medical History
100
This July 2025 JAMA study found WHAT outcome comparing patient outcomes in the VA following a formulary change from budesonide-formoterol (Symbicort) to fluticasone-salmeterol (Wixela)?
What is "higher rates of prednisone use and increased all-cause and respiratory-related emergency department visits and hospitalizations"
100
A patient with a PE who has either RH strain on echo (or CTPE) OR a positive troponin/BNP but NOT BOTH will be considered what level of early mortality risk by ESC criteria? Where responses are "HIGH", "INTERMEDIATE HIGH", "INTERMEDIATE LOW" OR "LOW"
What is "intermediate low"
100
This attending graduated from Boston University Medical Center IM Residency in 2020 winning the "morale resident" award. Her favorite procedure from fellowship was arterial line placement and she can usually be found holding an US probe or waxing poetic on medical education
Who is Cassie Cramer-Bour of course!
100
This medication, now commonly used to treat alcohol withdrawal states, was the first effective therapy in epilepsy. Dr. Alfred Hauptmann used this therapy initially as a tranquilizer in Feb 1912 for patients, later discovering their seizures were under better control.
What is "phenobarbital"
The story goes that Dr. Hauptmann lived above an epilepsy ward and the patients ongoing seizures often kept him awake at night. He prescribed them 300mg doses of phenobarb and described in a paper that their seizures were under much better control. He also described the doses conventionally used for "nocturnal sedation" were up to 600mg.
200
This novel mechanism of action therapy for PAH was evaluated in a double blind RCT as "add on therapy" for patients already on maximal medical therapy and WHO FC III, IV disease. The trial was stopped early due to significant improvement in the intervention arm (hazard ratio, 0.24; 95% confidence interval, 0.13 to 0.43; P<0.001). (ZENITH trial, NEJM, 3/2025). What was the drug therapy?
What is "Sotatercept"
172 patients included in the trial, stopped early At least one primary end-point event occurred in 15 patients (17.4%) in the sotatercept group and in 47 patients (54.7%) in the placebo group. Primary outcome combined endpoint of mortality, lung transplant and hospitalization > 24 hrs.
200
In the PEITHO trial (NEJM 2014) of >1000 patients with PE with RH strain and without hypotension, what was the rate of hemodynamic decompensation in the patients randomized to heparin only? We will accept closest by absolute value.
What is "5%" - it's not as big of a risk as we might think!
200
This faculty said his favorite hospital meal is the spicy chicken deluxe from Chik Fil A, his favorite bedside procedure in fellowship was the percutaneous trach and a fun fact he is an undefeated amateur boxer in Minnesota!
Who is none other than Dr. Zubin Mukadam
200
This multistage cardiac stress test requires patients to walk on a treadmill with an incremental increase in workload was first published by this American physician and "father of exercise cardiology" in 1963. What is the name of the test?
What is "Bruce protocol"
As an aside, Dr. Bruce also established the guidelines for functional status NYHA classification in 1956
300
This May 2025 JAMA study utilizing 3 large hospital databases inclusive of 163,593 patients diagnosed with VTE from 2016 to 2024 compared outcomes of treatment with apixaban, rivaroxaban and warfarin. What was the primary outcome of the study?
What is Apixaban was associated with a lower risk of hospitalizations for recurrent VTE and major bleeding compared with rivaroxaban or warfarin
300
There are 3 circumstances that the CHEST VTE 2021 guidelines support use of catheter directed thrombolysis. List one circumstance.
300
This attending says her favorite procedure from fellowship was a dorsalis pedis arterial line. Her favorite hospital meal is a tuna fish sandwich from Subway. A fun fact about her - she played basketball in high school and in med school and her med school team made it to the finals!
Who is Dr. Amina Pervaiz!
300
In 1900, Solomon Solis-Cohen, a professor of clinical medicine in Philadelphia began treating patients with asthma and hay fever with a crude extract of desiccated adrenal glands. What was the substance that led to improvement in their respiratory symptoms?
What is "epinephrine"
Brian Melland, published in The Lancet in 1920. Melland claimed that the hypodermic route provided an effective treatment for asthma, and he supported this by publishing findings from his own cases. One such case was that of a 30-year-old woman, presenting with a 6-year history of asthma and “spasmodic attacks…present nightly”. Epinephrine injection relieved her symptoms for 7 days, and repeating this treatment for 5 weeks reduced the frequency of her asthma exacerbations.
400
This multicenter trial of 186 patients assessing ultrathin bronchoscopy (OD < 4.2 mm) with rEBUS or ROSE improve the diagnostic yield for peripheral pulmonary lesions compared with non-ultrathin bronchoscopy or no ROSE. What was the outcome of the study? (Vakil et al, CHEST 10/2025)
What is "no significant difference in diagnostic yield for either scope or for ROSE".
Malignancy prevalence was 84%. diagnostic yield was similar between non-ultrathin and ultrathin bronchoscopes ( 65.6% vs 58.2%, P = .36) and ROSE and no ROSE (60.4% vs 63.5% , P = .83).
400
The 2014 NEJM PEITHO trial evaluated fibrinolysis in patients with >1000 patients with intermediate high risk PE. There was no significant difference in mortality but there was a very significant difference in what outcome?
What is "hemodynamic decompensation" which was defined as use of vasopressors or invasive mechanical ventilation. Will also accept ICU admission.
400
This PCCM faculty member loved doing all procedures, especially nav bronchs, EBUS and pigtails. Their favorite hospital meal is Pad Thai or sushi and if they're not at the hospital you will likely find them watching TV or traveling.
Who is "Dr. Shefali Godara"
400
In 1943, an enthusiastic student Bengt Lundqvist pestered his mentor Nils Lofgren to be allowed to test compound LL30. He disappeared with the entire lab's supply of this compound and a textbook on nerve blocks he "borrowed" from Sweden's only anesthesiologist. He tested LL30 on himself using this textbook and rapidly attested to its benefits. What is the compound LL30?
What is "lidocaine"
500
This CHEST Oct 2025 study of 619 critically ill patients with respiratory failure is the largest trial to date evaluating this commonly used intervention for mechanical ventilation. Provide the clinical question in the trial as well as the primary outcome.
500
This meta analysis of 2115 patients from 16 trials of submassive PE published in JAMA in 2014 identified a mortality benefit of lytic therapy with a NNT of 59 but a significant increase in major bleeding (NNH 18) as well as ICH (NNH 78). However, these adverse outcomes were only seen in what major subgroup of people?
What is "those older than 65 years"
Spend some time reviewing this table as it nicely summarizes the main risks and benefits of lytics in this patient population. Most up to date research we have on this topic.
500
This faculty member states their most memorable procedure was their first bronch of fellowship where they caused so much trauma - their attending thought the patient had DAH. Favorite meal is Chick-fil-A nuggies. When not at work they are hanging out at Costco and between kindergarten and college - they attended 15+ different schools!
Who is Dr. Tanya Salimnia!
500
In 1960, 100,000 turkeys died in southern London from some unknown disease labeled "turkey X disease". Young birds collapsed and died quickly, older birds showed general malaise, nervous symptoms before death. A toxin was suspected. Post mortems identified liver damage and inflammation of the gut.
In humans, "turkey X disease" can manifest as acute liver failure with high level exposure, chronic exposure is associated with hepatocellular carcinoma. What substance caused "turkey X disease"?
What is "aflatoxin" produced by A. flavus.
