Vent Management
Chest Radiography
Sleep Medicine
Shock and Resuscitation
Misc
100
Initial tidal volume that should be started for most patients
6-8 ml/kg
(Low tidal volume ventilation)
100
Filling defect in pulmonary artery
Saddle pulmonary embolus
100
First line treatment for insomnia
Cognitive behavior therapy-insomnia
This multicomponent treatment includes cognitive therapy (to address maladaptive beliefs and expectations about sleep), educational interventions (such as sleep hygiene), and behavioral interventions (such as sleep restriction therapy, stimulus-control therapy, and relaxation techniques)
100
What is the initial dose of fluids required for the sepsis bundle, and what type of fluids are preferred
30 ml/kg within at least the first 3 hours, preferably the first hour. Balanced crystalloids are preferred, IV albumin may be given as well
100
Medication that can be used as prophylaxis for high altitude illness
Acetazolamide
200
What basic parameters can be adjusted to increase oxygenation?
increase FiO2, increase PEEP
200
Name for this sign, and what disease it most commonly is associated with
Halo sign, usually occurs with angioinvasive aspergillosis (although is not totally specific)
200
Preferred test when there is a high probability that the patient has OSA
Home sleep test (sensitive, but not specific)
200
First choice of pressor in cardiogenic, (most types of) distributive, and hypovolemic shock
Norepinephrine (levophed)
200
Transfusion threshold for patients with CAD
Hgb 8 g/dL
300
What basic parameters can be used to adjust ventilation
Increase TV, increase RR
300
Be careful!
Pneumonectomy
Note the tracheal displacement. Fresh pneumonectomy look like a pneumothorax, mature pneumonectomy will be white outs due to the cavity being filled with fluid
300
A patient with a normal BMP and CBC, and no other past family or medical history presents with night time urges to move his legs. These urges are disruptive to his sleep. What is the first laboratory evaluation you would like to do
Iron studies (you can have iron deficiency without anemia)
300
What counts as a stress dose of steroids
Practice varies widely for steroid dosing. However, 2016 surviving sepsis campaign guidelines recommend hydrocortisone 200 mg daily for refractory shock. Most attendings here use hydrocortisone 100 mg q8h (300 daily). SCCM recommends a maximum dose of 400 mg hydrocortisone daily
300
When should you prescribe oxygen for patients with COPD who want to fly?
If SpO2 < 92% resting at sea level, or if SpO2 is < 84% during 6MWT at sea level
(There are other options too, so I recommend that these patients should see a pulmonologist. But these are numbers you should know)
400
Name of the pictured phenomenon on this flow vs time graph
This is air trapping. Leads over time to hyperinflation of the lung and volutrauma, even if tidal volumes are low
400
Patient with erythema nodosum, arthritis, fever, and this chest X-ray
Please answer as specifically as possible
Löfgren syndrome, a presentation of sarcoidosis
400
Crescendo decrescendo breathing pattern, and the most common condition associated with this breathing pattern
Cheyne Stokes Breathing, severe heart failure
400
What is the most sensitive ultrasound view for cardiac tamponade?
Subxiphoid view
400
Cause of group 4 pulmonary hypertension?
Chronic PE leads to chronic thromboembolic pulmonary hypertension (CTEPH)
500
Formula for driving pressure, and threshold below which it reduces mortality
Driving pressures of <15 have demonstrated the greatest benefit in mortality by helping to avoid barotrauma and volutrauma
Concept most used in ARDS
500
Diagnosis?
Basal and peripheral reticular opacities with honeycombing and traction bronchiectasis
Idiopathic Pulmonary Fibrosis
500
Correct symptomatic and disease modifying treatment for obesity hypoventilation syndrome (one of each)
Symptomatic: BiPAP (with or without a backup respiratory rate) or volume-targeted pressure support. CPAP is not the correct answer
Disease modifying: Weight loss (will accept bariatric surgery) or tracheostomy
500
What is the ratio needed for RBC:platelets:plasma when patients require massive transfusion protocol?
1:1:1
(MTP usually activated when 4-10 units RBC are transfused)
500
Indication for and benefit of roflumalast
Reduces number of COPD exacerbations in patients with chronic bronchitis or frequent exacerbations