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CHEST SEEK

CHEST SEEK™ resources stimulate and challenge your clinical thought processes related to recall, interpretation, and problem-solving skills. Developed from the content blueprints for the board examinations, CHEST SEEK resources feature cases and multiple-choice questions and answers with rationales to test your knowledge. The case-based questions include histories, lab results, and images, and provide education on current diagnostic and treatment strategies. CHEST SEEK resources are a valuable study tool for anyone preparing for certification and recertification examinations sponsored by the medical specialty board.

Goals

  • Provide a self-assessment program to reinforce training and experience, disseminate important new knowledge in the field, and identify areas of strengths and weaknesses within specific areas of disease and/or procedural knowledge.
  • Assist clinicians and physicians-in-training with preparation for certification and recertification examinations sponsored by the medical specialty board.

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The CHEST SEEK™ Library subscription combines pulmonary, pediatric pulmonary, critical care, and sleep medicine in a library of questions, answers, and explanations.

The library can be accessed via mobile app or a Web browser. To access via mobile app, download the CHEST App for Android or Apple. For computer access, log in with the email associated with your CHEST ID account and password at eseeklibrary.chestnet.org.

The CHEST SEEK Library includes more than 1,500 questions from the following editions in a 1-year subscription:

  • CHEST SEEK Pulmonary Medicine: 27th Edition
  • CHEST SEEK Critical Care Medicine: 26th Edition
  • CHEST SEEK Pulmonary Medicine: 25th Edition
  • CHEST SEEK Critical Care Medicine: 24th Edition
  • CHEST SEEK Pediatric Pulmonary Medicine: 1st Edition
  • ACCP-SEEK Volume XXII: Critical Care Medicine
  • ACCP-SEEK Volume XXIII: Pulmonary Medicine
  • CHEST SEEK Sleep Medicine: 4th Edition
  • ACCP-SEEK Sleep Medicine: Second Edition
  • ACCP-SEEK Sleep Medicine: Third Edition

Complete CHEST SEEK Library Details

CHEST SEEK resources are available in print. Rationales provide thorough explanations and reasoning for the correct and incorrect answers.

What's available?

CHEST SEEK Pulmonary Medicine: 27th Edition

CHEST SEEK Pulmonary Medicine: 27th Edition
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CHEST SEEK Critical Care 26th Edition

CHEST SEEK Critical Care Medicine: 26th Edition
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CHEST SEEK Pulmonary Medicine 25th Edition

CHEST SEEK Pulmonary Medicine: 25th Edition
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CHEST SEEK Sleep Medicine 4th Edition CHEST SEEK Sleep Medicine: 4th Edition
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SEEK Critical Care 24
CHEST SEEK Critical Care Medicine: 24th Edition
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SEEK Pediatric Pulmonary 1st Edition CHEST SEEK Pediatric Pulmonary Medicine: 1st Edition
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Purchase CHEST SEEK in our Store

To the purchasers of the CHEST SEEK Pediatric Pulmonary Medicine: 1st Edition book:

There is an error in the explanation to the answer of question 2 (pages 39-40 in the Response Key, Rationale, and References section). The red text is the corrected information.

View the correct information

To the purchasers of the CHEST SEEK Sleep Medicine: 4th Edition book: 

There is an error in the explanation to question 81. In the third paragraph, it reads:

When RLS/WED occurs in the absence of a known risk or predisposing factor, it is deemed to be secondary. In cases where there is no discernible predisposing factor, RLS/WED is sometimes referred to as primary.

The bolded phrase above should be the following: 

When RLS/WED occurs in the presence of a known risk or predisposing factor, it is deemed to be secondary. In cases where there is no discernible predisposing factor, RLS/WED is sometimes referred to as primary.

There is an error in the explanation to the answer of question 129. The last sentence in the first paragraph reads:

In a randomized crossover study by Spiegal et al (examining measures of leptin, ghrelin, hunger, and appetite) comparing two nights of 4 h in bed vs two nights of 10 h in bed, leptin levels were decreased by 18%, ghrelin levels decreased by 28%, hunger increased 23%, and appetite for nutrients with high carbohydrate content was increased by >30% when sleep was restricted (choice D is correct).

The bolded phrase above should be the following: "...ghrelin levels increased by 28%, hunger increased 23%, and appetite for nutrients with high carbohydrate content was increased by >30% when sleep was restricted [choice D is correct]).

The rationale answer explanation is correct for question 143, but the correct answer callout on top should read, "B: Schedule a formal PSG to assess the presence of central apneas." 

To the purchasers of the CHEST SEEK Pulmonary Medicine: 25th Edition book:

Question 34 is no longer accurate. The following article (Cowie MR, Woehrle H, Wegscheider K, Angermann C, d'Ortho MP, Erdmann E, Levy P, Simonds AK, Somers VK, Zannad F, Teschler H. Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. New Engl J Med. 2015;373(12):1095-105) was posted after the book was published, which showed an increase in all-cause mortality in patients with a left ventricular ejection fraction of 45% or less, New York Heart Association class II or greater heart failure, and >50% central events on a diagnostic study who were treated with adaptive servo- ventilation.

To the purchasers of the CHEST SEEK Pulmonary Medicine: 25th Edition book: 

There has been a content update since the book has been published. See bolded revisions to question 144.

This patient has mild immunosuppression from his chronic lymphocytic leukemia, with ongoing symptoms of a cough, fevers, night sweats, and weight loss. Chest radiograph and CT scan show a reticular-nodular infiltrate, predominately in the right lung. Gram stain of BAL shows gram-positive rods that are branching and filamentous with aerobic growth on culture. These findings are all consistent with severe pulmonary infection with Nocardia species and given his severe sulfa allergy, therapy with meropenem and amikacin should be initiated (choice A is correct).

Nocardia species are aerobic, gram-positive organisms that cause pulmonary and systemic disease. They are part of the order Actinomycetes, which contains both aerobic and anaerobic species. Aerobic Actinomycetes include the genera Nocardia, Mycobacteria, Streptomycetes, Rhodococcus, and Corynebacteria. Despite this diverse group, there are some initial microbiologic characteristics that can distinguish among genera, which becomes particularly important for early treatment. All Actinomycetes can exhibit filamentous branching with fragmentation into coccoid forms. However, Nocardia species can be distinguished by their unique characteristics of aerobic growth and weakly acid-fast staining. Mycobacteria species are difficult to detect on routine sputum Gram stain and, thus, acid-fast staining is used. On the other hand, Nocardia species will stain weakly in comparison. Actinomyces species will have an identical Gram stain to Nocardia species, but will not grow aerobically and take up acid-fast stain. A modified acid-fast stain (1% sulfuric acid, instead of acid alcohol for wash) is optimal for identifying the weak staining of Nocardia species. Thus, the combination of gram-positive filamentous rods that weakly take up acid-fast stain and grow aerobically is unique to Nocardia species.

Early treatment for Nocardia infection has been shown to reduce complications (cavity formation and dissemination) and increase the likelihood of eradication. Thus, recognition of this microbiologic pattern is important for early treatment. Nocardia species infection is variably resistant to antibiotics, but trimethoprim/sulfamethoxazole (TMP/SMX) is generally the first-line therapy for limited and less severe cases (limited pulmonary disease). For cases in which sulfa-based therapy is intolerable (eg, allergy) (choice B is incorrect), then treatment with a carbapenem plus amikacin can be used. Meropenem (or imipenem) is preferred given its microbiologic activity. Ertapenem was once used given its daily administration, but its activity is limited and meropenam or imipenem is the preferred carbopenem. Amikacin is also acceptable as monotherapy but is often added to carbopenem therapy for severe cases, such as central nervous system disease in the presence of immunosuppresion, as with this case. Linezolid has shown increasing susceptibility but is largely reserved for cases when TMP/sulfa, carbopenems, and amikcanin cannot be used or for less severe, limited disease (choice C is incorrect).  

Susceptibility testing should always be performed, since some species, particularly N asteroides sensu stricto and N transvalensis, can have variable susceptibility to amikacin and TMP/SMX. Treatment length is for at least 3 months, depending on site of infection. IV treatment is preferred for disseminated disease or cases of immunosuppression. This patient has early Nocardia infection, based on the length of symptoms and the small nodules on radiographic studies but remains immunocompomised, and, thus, early treatment would prevent further progression to larger nodules and cavities. Due to his severe sulfa allergy, he received 90 days of meropenem with amikacin intravenously with resolution of symptoms.

To the purchasers of the CHEST SEEK Critical Care Medicine: 26th Edition book: 

There is an error in the explanation to question 14. In the fourth paragraph, it reads:

Treatment is similar to that of acute CHF from other causes, including oxygen, noninvasive ventilation, diuretics, nitrates, and inotropic agents. The management of chronic CHF due to PPCM is also similar to nonpregnancy-related CHF, with particular care to some contraindicated medications such as angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers while still pregnant. Bromocriptine blocks procalcitonin and has been used in the management of PPCM.

The bolded phrase should be the following:

Treatment is similar to that of acute CHF from other causes, including oxygen, noninvasive ventilation, diuretics, nitrates, and inotropic agents. The management of chronic CHF due to PPCM is also similar to nonpregnancy-related CHF, with particular care to some contraindicated medications such as angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers while still pregnant. Bromocriptine blocks prolactin and has been used in the management of PPCM.

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