I. PULMONARY DISEASES AND DISORDERS

Transcription

1 Association of Pulmonary and Critical Care Medicine I. PULMONARY DISEASES AND DISORDERS A. Asthma Recognize a. aspirin-sensitive asthma b. cough-variant asthma 2. Differentiate asthma from a. allergic bronchopulmonary aspergillosis b. vocal cord dysfunction syndrome c. upper airway obstruction d. exercise-induced bronchospasm 3. Recognize and manage the care of a patient with a. an acute asthma exacerbation b. status asthmaticus 4. Recognize and manage the care of a patient diagnosed with asthma a. mild intermittent b. mild persistent c. moderate persistent d. severe persistent 5. Describe the method of action, desired effects, and side effects of common medications a. bronchodilators 1) short-acting 2) long-acting b. steroids 1) inhaled 2) systemic c. non-steroid 1) leukotriene modifiers 2) anti-ige 3) theophylline 6. Identify risk factors for fatal asthma B. Bronchiectasis Recognize etiologies a. congenital b. infectious c. collagen vascular d. aspiration e. other 2. Describe the method of action, desired effects, and side effects of common therapies a. pharmacologic b. non-pharmacologic Page 1

2 Page 2 C. Congenital, Neuromuscular, and Skeletal Abnormalities Recognize and/or manage the care of a patient with a. an azygous fissure b. a bronchogenic cyst c. ciliary dyskinesia d. a cystic adenomatoid malformation e. sequestration f. a diaphragmatic disorder g. immunodeficiencies h. mediastinum disorders i. neurofibromatosis j. sickle cell anemia k. thoracic cage abnormalities 2. Recognize and/or manage the care of a patient with cystic fibrosis a. genetics b. pulmonary manifestations c. medical therapies D. COPD Differentiate chronic bronchitis, bronchiectasis, and emphysema 2. Recognize and manage the care of a patient with a. an exacerbation b. GOLD staging 3. Describe the method of action, desired effects, and side effects of common therapies a. bronchodilators 1) short-acting 2) long-acting b. steroids 1) inhaled 2) systemic c. theophylline d. oxygen e. non-invasive ventilation f. pulmonary rehabilitation g. smoking cessation h. surgical options (e.g., bullectomy, LVRS, transplantation) 4. Recognize non-tobacco etiologies (e.g., alpha-1-antitripsin deficiency, occupational exposures) E. Infections Manage the care of a patient with acute bronchitis a. bacterial b. viral 2. Manage the care of a patient with pneumonia a. aspiration b. CAP 1) atypical 2) bacterial

3 3) drug resistant 4) viral c. HCAP 1) bacterial 2) drug resistant 3) ventilator-associated 4) viral 3. Manage the care of a patient with mycobacterial disease a. tuberculosis 1) latent 2) active b. non-tuberculous 4. Manage the care of a patient with fungal disease a. endemic b. opportunistic 5. Recognize the spectrum of infections in an immunocompromised host a. HIV infected patient b. solid organ transplantation c. bone marrow transplantation d. other 6. Recognize and manage the care of a patient with a. a lung abscess b. septic emboli c. parasitic infections d. upper airway infections F. Interstitial and Inflammatory Lung Diseases Recognize and manage the care of a patient with a. idiopathic pneumonia 1) acute interstitial 2) desquamative interstitial 3) lymphocytic interstitial 4) non-specific interstitial 5) respiratory bronchiolitis-associated interstitial lung disease 6) usual interstitial b. pulmonary alveolar proteinosis c. interstitial lung disease associated with 1) collagen vascular disease 2) drugs 3) radiation 4) eosinophilic syndromes 5) hypersensitivity pnuemonitis 6) vasculitis (e.g., Churg-Strauss, microscopic PAN, Wegener s, Goodpasture s) 7) Langerhans cell histiocytosis 8) Lymphangioleimyomatosis / Tuberous Sclerosis Page 3

4 2. Recognize and manage the care of a patient with sarcoidosis a. pulmonary b. extrapulmonary 3. Recognize and manage the care of a patient with a. organizing pneumonia b. bronchiolitis obliterans G. Neoplasms Recognize and manage the care of a patient with a. benign neoplasms b. lung cancers 1) bronchoalveolar 2) carcinoid 3) non-small cell 4) small cell 5) superior sulcus c. lymphoma 1) Hodgkin s 2) Non-Hodgkin s d. metastases 1) intrathoracic primary 2) extrathoracic primary e. nodules 1) multiple 2) solitary pulmonary f. paraneoplastic syndromes 2. Recognize and manage the care of a patient with a disorder in the a. mediastinum 1) anterior 2) middle 3) posterior b. pleura 1) benign tumors 2) malignant tumors 3. Assess and classify (e.g., TNM) a patient before treatment a. Staging 1) non-invasive studies 2) invasive studies b. physiologic evaluation H. Occupational and Environmental Diseases Recognize and manage the care of a patient with an acute exposure a. nitrogen dioxide b. carbon monoxide c. toxic chemicals d. barometric injuries e. thermal injuries Page 4

5 2. Recognize and manage the care of a patient with a. occupational asthma b. RADS c. pneumoconiosis linked to exposure to 1) asbestos 2) berrylium 3) coal dust 4) textiles 5) heavy metals 6) silica 7) other 3. Recognize and manage the care of a patient exposed to agents of terrorism a. chemical b. biologic c. nerve d. radioactive 4. Manage the care of a patient with an altitude / diving injury 5. Evaluate a worker for impairment / disability secondary to occupation-related pulmonary disease I. Pleural Diseases Differentiate transudative from exudative effusions 2. Manage the care of a patient with a transudative effusion secondary to a. congestive heart failure b. hypoalbuminemia c. cirrhosis 3. Recognize and manage the care of a patient with an exudative effusion a. infectious 1) parapneumonic 2) empyema b. malignant c. asbestos related d. hemothorax e. chylous f. other 4. Recognize and manage pneumothoraces a. primary b. secondary J. Sleep Disorders Describe normal sleep respiratory physiology 2. Recognize and manage a patient with sleep disordered breathing a. obstructive sleep apnea b. central sleep apnea / Cheyne-Stokes respirations c. alveolar hypoventilation Page 5

6 3. Recognize a patient with a. hypersomnia (e.g., narcolepsy) b. insomnia c. restless legs syndrome d. sleep disorders associated with other medical conditions K. Transplantation Identify actions and toxicities of immunosuppressive drugs 2. Recognize and refer patients for whom lung transplantation is indicated 3. Recognize and manage patients after lung transplantation a. infectious b. non-infectious (e.g., rejection) 4. Recognize and manage the care of a patient after solid organ transplantation a. infectious b. non-infectious (e.g., rejection) 5. Recognize and manage the care of a patient after bone marrow transplantation a. infectious b. non-infectious (e.g., rejection) L. Vascular Disorders Recognize and manage the care of a patient with venous thromboembolic disease a. diagnosis b. method of action, desired effects, and side effects of common therapies 1) heparins 2) vitamin K antagonists 3) direct thrombin inhibitors 4) synthetic pentasaccharides 5) filters 6) thrombolytics c. prevention 2. Recognize and manage the care of a patient with pulmonary hypertension a. primary b. secondary c. method of action, desired effects, and side effects of common therapies 1) anticoagulants 2) calcium channel blockers 3) prostacyclins 4) endothelin receptor antagonists 5) phosphodiesterase inhibitors 3. Recognize and manage the care of a patient with a pulmonary vascular abnormality Page 6

7 Page 7 M. General Evaluate and manage a patient with a. dyspnea at rest and on exertion b. cough c. hemoptysis d. wheezing e. stridor 2. Recognize the significance of pulmonary and extrapulmonary signs and symptoms a. abnormal breathing patterns (e.g., Kussmaul, Cheyne-Stokes) b. chest wall abnormalities (e.g., kyphosis, scoliosis, pectus excavatum and carinatum, barrel chest, ankylosis) II. CRITICAL CARE A. Pulmonary Evaluate and stabilize a patient with acute respiratory failure a. airway control 1) non-invasive 2) intubation b. oxygenation 2. Recognize and manage the acute care of a patient with respiratory failure secondary to a. hypercapnia 1) obstructive lung disease 2) drug induced 3) neuromuscular b. hypoxia 1) ARDS 2) pneumonia c. upper airway obstruction 3. Define settings of mechanical ventilation 4. Initiate and adjust mechanical ventilation settings in patients with respiratory failure secondary to a. ARDS b. obstructive lung disease c. status asthmaticus d. neuromuscular disease e. other 5. Recognize and manage complications of mechanical ventilation a. auto-peep b. baro- and volutrauma c. hypotension 6. Recognize timing and techniques for liberation from mechanical ventilation 7. Identify appropriate candidates for non-invasive ventilation 8. Manage the care of a patient who is receiving noninvasive ventilation 9. Manage the care of a patient with massive hemoptysis

8 B. Cardiovascular Recognize and manage the care of a patient during shock a. acute allergic or anaphylactic reaction b. cardiovascular c. septic d. hemorrhagic e. hypovolemic 2. Manage the care of a patient during cardiopulmonary resuscitation a. basic and advanced protocols b. cardioversion and follow-up 3. Recognize and manage the care of a patient with a cardiovascular disorder a. acute coronary syndromes b. acute valvular disorders c. myocardial infarction d. congestive heart failure e. aortic dissection f. arrhythmias g. hypertensive emergency h. pericarditis and tamponade 4. Describe the method of action, desired effects, and side effects of a. vasopressors b. inotropes c. antiarrhythmics d. antihypertensives e. thrombolytics f. antiplatelet agents g. other cardiovascular agents C. Renal, Endocrine, and Metabolic Recognize and manage the care of a patient with renal failure including renal replacement therapy 2. Recognize and manage the care of a patient with fluid and electrolyte imbalance 3. Recognize and manage the care of a patient with acid-base imbalance 4. Recognize and manage the care of a patient with an endocrine disorder a. thyroid disease b. adrenal insufficiency c. diabetes and ketoacidosis D. Neurologic and Toxicologic Disorders Recognize and manage the care of a patient with a neurologic disorder a. status epilepticus b. CNS infections c. Stroke d. muscular paralysis syndromes e. altered sensorium Page 8

9 2. Recognize and manage the care of a patient with an overdose or poisoning a. ethanol b. ethylene glycol c. salicylates d. acetaminophen e. cocaine / stimulants f. opiates g. other 3. Manage the care of a patient with a. near drowning b. hyper- and hypothermia E. Gastrointestinal, Hepatologic, Hematologic, and Oncologic Disorders Recognize and manage the care of a patient with a gastrointestinal disorder a. acute pancreatitis b. hepatic failure c. GI hemorrhage 1) lower 2) upper 2. Recognize and manage the care of a patient with a hematologic complication or disorder a. DIC b. transfusion reactions c. HIT d. TTP e. acute chest syndrome f. other 3. Recognize and manage the care of a patient with oncologic disorders a. superior vena cava syndrome b. tumor lysis syndrome c. toxicity of chemotherapy d. other F. Surgical, Trauma, Neurosurgical, and Obstetrics-Gynecology Manage the care of a patient after a. surgery b. burn / inhalational injury c. trauma 1) rhabdomyolosis 2) fat emboli 3) flail chest 4) pulmonary contusion 2. Recognize and manage the critically ill pregnant patient 3. Recognize and manage the care of a patient with intracranial hypertension 4. Recognize a patient with an intracerebral bleed Page 9

10 G. General Recognize changes in pharmacokinetics and pharmacodynamics in critically ill patients 2. Manage nutrition for a critically ill patient 3. Describe the method of action, desired effects, and side effects of a. sedatives b. paralytics c. analgesics d. antipsychotics e. anxiolytics III. GENERAL CARE A. Quality and Safety Describe and apply principles of standard health precautions 2. Describe and apply essential infection control practices to prevent a. catheter-related blood stream infections b. VAP 3. Describe the manner in which errors in the conduct of patient care should be handled B. Preventive Care Identify appropriate patients for a. influenza vaccination b. pneumococcal vaccination c. nutrition counseling d. smoking cessation 2. Identify appropriate patients for early detection of a. COPD b. lung cancer C. Palliative and End-of-Life Care Apply principles of palliative and end-of-life care 2. Apply principles of withholding and withdrawing life support IV. PRACTICE SKILLS A. Diagnostic Testing Interpret physiologic test results a. exercise 1) 6-minute walk test 2) cardiopulmonary exercise testing b. pulmonary function 1) spirometry and pre- and post-bronchodilator tests 2) flow-volume loop 3) inhalation challenge studies 4) lung volumes 5) diffusing capacity c. sleep studies 1) complete polysomnography 2) multiple sleep latency Page 10

11 Page 11 d. cardiopulmonary monitoring 1) arterial blood gas analysis 2) pulse oximetry 3) pulmonary artery catheter measurements and waveforms 4) arterial catheter measurements and waveforms 5) capnography 2. Interpret radiological images a. chest roentgenograms (e.g., anterior-posterior, lateral) b. computerized axial tomography B. Procedures Identify elements of appropriate informed consent 2. Identify indications, contraindications, and complications and manage complications of a. airway management b. flexible bronchoscopy 1) bronchoalveolar lavage 2) endobronchial biopsy 3) bronchial brushing 4) transbronchial biopsy 5) transbronchial needle aspiration c. pleural procedures 1) thoracentesis 2) closed pleural biopsy 3) tube thoracostomy 4) pleurodesis d. catheter insertions 1) central venous 2) arterial 3) pulmonary artery e. emergency cardioversion f. intracranial pressure monitoring g. pericardiocentesis h. percutaneous needle aspiration and / or cutting needle biopsy i. transvenous pacemakers V. BIOLOGY, PHYSIOLOGY, AND RESEARCH A. Biology of Cells and Molecules Describe cell and molecular biology related to pulmonary and critical care diseases 2. Describe genetic abnormalities related to pulmonary and critical care diseases 3. Describe immune function related to pulmonary and critical care diseases B. Physiology and Metabolism Describe normal a. cardiopulmonary changes during exercise b. cardiovascular anatomy and physiology c. control of breathing

12 d. gas exchange e. oxygen content and transport f. lung mechanics 2. Describe changes associated with a. pregnancy b. obesity c. aging C. Research Describe typical details associated with clinical trials related to a. sample size and power b. number needed to treat c. relative risk 2. Distinguish incidence and prevalence 3. Describes strengths and weaknesses of research designs (e.g., case-control, cohort, controlled) 4. Explain the following regarding diagnostic / predictive research a. likelihood ratios b. predictive values c. receiver operating characteristic curve d. sensitivity and specificity TOTALS * Each new scored form will include one 25-item pretest set. Target one ethics item with a limit of two per pretest set. Page 12