2 - Pulmonology and Critical Care 2025

FEV1/FVC <0.7

Diagnostic of obstructive pulmonary diseases

TLC <0.8

Diagnostic of restrictive pulmonary diseases

Centrilobular emphysema

Type of emphysema associated with smoking, involving the upper lobes and superior segments of the lower lobes

Panlobular emphysema

Type of emphysema associated with alpha-1 antitrypsin deficiency, involving the lower lobes prominently

Paraseptal emphysema

Type of emphysema associated with inflammation, distributed along pleural margins

Smoking

Major risk factor of COPD

Cough, sputum production, exertional dyspnea

3 most common symptoms of COPD

Wasting

Independent prognostic factor in COPD

Hoover sign (seen in COPD)

Paradoxical inward movement of the ribcage during inspiration

• Lung malignancy

• Bronchiectasis

• Right-to-left shunting from cyanotic heart diseases

• (never COPD)

Conditions presenting with clubbing

Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae

Most common causes of COPD exacerbations

FEV1

Marker of airflow limitation in COPD

• Smoking cessation

• Oxygen therapy in chronically hypoxemia patients

• Lung volume reduction surgery in emphysematous patients

3 interventions with demonstrated decrease in morality among COPD patients

Eosinophils >300 cells/uL in the complete blood count with differential count

An indication for starting inhaled corticosteroids (ICS) for COPD patients

Roflumilast

Add-on therapy in COPD considered for those with FEV1 <0.50 and/or chronic bronchitis

Azithromycin

Add-on therapy in COPD considered for former smokers

Atopy

Major risk factor of asthma

House dust mites

Most common allergen causing perennial asthma

All beta-blockers, Aspirin

Contraindicated drugs in asthma

>12% and 200 mL increase in FEV1 after salbutamol (15 minutes) or oral corticosteroids (2-4 weeks)

Indicator of reversibility in asthma

Inhaled corticosteroids (ICS) + formoterol (LABA)

Preferred controller and reliever medication for asthma

Poor adherence to controller medications

Important cause of exacerbations in asthma

Anaphylaxis

Most common side effect of Omalizumab

3 months

Asthma control is assessed every:

• Pleural fluid adenosine deaminase (>40 IU/L)

• Pleural fluid interferon-gamma (>140 pg/mL)

Tests done to rule out TB pleuritis

NT-proBNP (>1500 pg/mL)

Test done to rule out heart failure causing pleural effusion

Congestive heart failure, Cirrhosis, Nephrotic syndrome, Peritoneal dialysis, Urinothorax, SVC obstruction, Myxedema

Etiologies of transudative pleural effusion

Left ventricular failure

Most common cause of pleural effusion

Left ventricular failure

Most common cause of transudative pleural effusion

Tuberculosis

Most common cause of exudative pleural effusion worldwide

Bacterial pneumonia

Most common cause of exudative pleural effusion in developed nations

Tuberculosis

Most common cause of exudative pleural effusion in developing nations

Lung carcinoma

Breast carcinoma

Lymphoma

3 tumors causing 75% of all malignant pleural effusions

Pulmonary embolism

Most commonly overlooked cause of undiagnosed pleural effusion

Trauma (usually iatrogenic from thoracic surgery) > Mediastinal tumors

Most common cause of chylothorax

• COPD in acute exacerbation

• Pulmonary congestion

Strong indications for noninvasive positive pressure ventilation (NIPPV)

Proliferative phase

Most patients with ARDS recover and are liberated from mechanical ventilation at this phase

Pulmonary fibrosis

Presence of this finding in ARDS patients is associated with increased mortality risk

Low tidal volume

(at most 6 mL/kg PBW)

Only class A recommendation in the management of ARDS

Distributive shock

Only type of shock with increase in cardiac output and decrease in systemic vascular resistance causing "warm extremities"

CNS, kidneys, skin

3 important organ systems in the assessment of a shock patient

Septic shock

Most common cause of distributive shock and the most common form of shock in the ICU and ED

Trauma

Most common cause of external hemorrhage

Gastrointestinal bleeding

Most common cause of internal hemorrhage

Norepinephrine

First-line vasopressor for either septic or cardiogenic shock

Pneumonia

Most common infection causing sepsis in the hospital

Gram-negative bacteria

Most common type of isolate when blood culture is done among septic patients

Diarrheal disease

Most common infection causing sepsis worldwide

Lactated Ringer’s solution 30 mL/kg within the first 3 hours

Recommended fluid resuscitation in a septic patient

At least 65 mmHg

Target mean arterial pressure in a septic shock patient

Norepinephrine

First-line vasopressor in septic shock

Vasopressin

Second-line vasopressor in septic shock

First 1 hour of diagnosis

Empiric antibiotics in septic shock should be initiated within: