Airway Disease
This/these vaccination(s) is indicated for patients with COPD
What are the pneumococcal polysaccharide (PPSV23) and influenza vaccines.
flu vax shown to reduce serious illness and death in COPD patients
This is the most common benign lung neoplasm and its classic appearance on CT.
Hamartomas
"popcorn" calcification (only occurs 25% of the time)
These are characteristics of obesity hypoventilation syndrome.
What are daytime hypercapnia of Pco2 >45mmHg (compensated hypercapnic respiratory failure), hypoxemia during wakefulness but more pronounced during sleep, polycythemia.
These are the qSOFA criteria.
Respiratory rate >22/min
SBP <100mmHg
Mental status altered from baseline
This treatment is indicated in patients with severe COPD and frequent exacerbations.
Macrolide
Grade 2A
anti-inflammatory and antimicrobial effects
This is the criteria by the USPSTF for annual lung cancer screening.
Low dose CT for those age 55-80 who have at least 30 pack year smoking hx, and either current smoker or have quit smoking w/in past 15 years.
This is the definitive therapy for chronic thromboembolic pulmonary hypertension?
What is thromboendarterectomy.
These two ventilation methods/techniques have demonstrated mortality benefit in the treatment of severe acute respiratory distress syndrome
What are low tidal volume ventilation and prone positioning of patient
This is the definition of pulmonary hypertension
What is a resting mean pulmonary artery pressure of 25 mmHg or greater measured during right heart cath
normally is <20mmHg.
These two measurements using spirometry are necessary in the evaluation of asthma
Reduced FEV1/FVC ratio (obstruction)
and
the FEV1/FVC ratio showing an increase from baseline of ≥12% and ≥200 mL (reversibility)
This is the recommended follow-up in a 7 mm single, solid pulmonary nodule in a 1) low-risk patient and 2) a high-risk patient.
1) What is CT at 6-12 months then consider CT at 18-24 months
2) What is CT at 6-12 months then CT at 18-24 months
That is the most appropriate management of a patient after the first occurrence of secondary spontaneous pneumothorax.
Quit smoking.
Pleurodesis (chemical or mechanical).
These are criteria for extubation success. (3)
- tolerate SBT for 30 min
- following commands
- clearing secretions
- patent airway
These peripheral, ground-glass, wedge shaped opacities signify the presence of infarcted lung and surrounding atelectasis on CXR or chest CT in PE
What is Hampton hump sign
These three characteristics define patients at high risk for recurrent acute exacerbations of COPD
- two or more acute exacerbations w/in the last year
- FEV1 of less than 50% of predicted
- have ever been hospitalized for an acute exacerbation
These factors help determine risk of malignancy when evaluating a solitary pulmonary nodule. (3)
- age >50
- hx of past/present smoking
- environmental/occupational exposures
- diagnosis of COPD
- hx of radiation therapy
These are characteristics of drained complicated parapneumonic effusions.
pH < 7.2 and glucose < 60 mg/dL
Also remember that bacteria can be rapidly cleared from pleural space so your gram staining could be negative/cultures sterile.
If you meet above criteria, thoracostomy drainage to speed clinical recovery and hospital discharge -- Chest Physicians
If pH >7.2 and glucose >60, no drainage, resolves on Abx alone (uncomplicated)
These are classic features of serotonin syndrome and this is the treatment.
What are hyperthermia, tremor, hyperreflexia, ocular clonus (slow, continuous, horizontal eye movements), other clonus (spontaneous or induced), and anxiety.
What is supportive care with benzodiazepines (for calm, control BP & HR)
Confusion with hyperthermic syndromes and toxic ingestions - but hyperreflexia and clonus are unique to SS.
Malignant hyperthermia - need hx of inhaled anesthetic or neuromuscular blockade
NMS - unlikely w/o hx of neuroleptic med like haloperidol. Develops subacutely over days/weeks. Rigidity and hyporeflexia more common.
These are two therapies for the treatment of Idiopathic Pulmonary Fibrosis. (1)
pirfenidone and nintedanib
- they target the fibroblast, they help slow the rate of progression
- ultimately lung transportation would be the goal and a patient really should not be mechanically vented if this is not an option
This treatment is indicated in patient with moderate to severe uncontrolled asthma with the eosinophilic phenotype.
Mepolizumab
*Can reduce ED visits, hospitalizations, requirements for inhaled and oral glucocorticoids. Monoclonal Ab to IL-5.
These are known as the Terrible T's of anterior mediastinal masses.
What are Thymoma, Teratoma/germ cell tumor, "terrible" lymphoma, and thyroid.
These are the five classifications of Pulmonary Hypertension.
1) Pulmonary Arterial HTN (idiopathic, heritable, CTD, HIV, shistosomiasis, portal HTN)
2) due to L-sided heart disease
3) due to lung disease and/or hypoxia
4) CTEPH and other pulm artery obstructions
5) w/ unclear or multifactorial causes.
This is the definition of Hypertensive Emergency, an example of an IV agent used to treat it, and the guidelines for decreasing pressure. (Without compelling condition, i.e. aortic dissection, severe preeclampsia, or eclampsia, pheo crisis)
What is SBP >180, DBP >120 or both, with end organ damage
Fenoldopam, nicardipine, or nitroprusside
Lower the SBP by no more than 25% in first hour - if stable, go down to 160 w/in next 2-6 hours - then down to normal in the following 24-48hrs
For those compelling ones -- down to <140 in first hour and to <120 in aortic dissection -- per ACC/AHA 2017.
These are Berlin Criteria for ARDS and this is the measurement/ratio used to measure its severity.
Criteria:
- onset w/in 1 week of known insult (most cases occur w/in 72hrs)
- B/L opacities on chest imaging consistent w/ pulm edema
- Respiratory failure not related to cardiac failure or volume overload
- Arterial PO2/FIO2 <300 on at least 5cm H2O PEEP from noninvasive or invasive mech vent
Severity based on Arterial PO2/FiO2