11 May

Question 1

What disease causes destruction and permanent damage to the conducting airways and a cough productive of large amounts of sputum?

Answer 1

Bronchiectasis

Question 2

Describe Bronchiectasis

Answer 2

Damage and dilation of the conducting portions of the lungs leading to decreased clearance of mucus leading to frequent infections and an obstructive disease like asthma and COPD.
Causes are varied and often unknown, though linked to inflammation leading to damage of the airways leading to dilatation.
Steroids not found to be helpful. Surgery sometimes done, but not extensively studied. Abx used for exacerbations.

Question 3

Is a cough associated with CHF productive or not?

Answer 3

Usually productive

Question 4

Mechanism of hypercalcemia in squamous cell carcinoma, and what is the concern with the appearance of high calcium with this disease?

Answer 4

Likely caused by production of parathyroid hormone-related protein (PHrP) which acts at PTH receptors signaling bone resorption and renal absorption.
Can also be caused by bone metastasis late in the disease, so its appearance can mean metastasis and late disease.

Question 5

What are some symptoms of hypercalcemia?

Answer 5

constipation, fatigue, increased thirst, anorexia

Question 6

What is the treatment for chronic pulmonary aspergillosis?

Answer 6

Tx depends on Sx. Common complication is hemoptysis and this is treated with surgery or embolization. Otherwise, itraconazole or voriconazole are used.

Question 7

Patient has 3 months of weight loss, fatigue, cough, hemoptysis, dyspnea, fever. CXR shows a cavitary lesion. Likely Dx?

Answer 7

Must think of Chronic Pulmonary Aspergillosis with these Sx for this duration.

Question 8

What does a bacterial lung abscess look like on CT that makes it distinguishable from a fungus ball?

Answer 8

It is an infiltrate with a cavity. There is usually necrotic tissue with air/fluid levels and do not have evidence of any sort of ball.

Question 9

What does granulomatosis with polyangiitis look like on CXR?

Answer 9

Cavitary nodules

Question 10

Does small cell lung cancer have cavitary lesions? How does it present?

Answer 10

Almost never has cavitary lesions

Hilar lung mass with LAD and widespread metastases due to aggressive nature of cancer.

Question 11

What criteria is used to assess pleural effusion to determine transudate or exudate?

Answer 11

Light's Criteria:
-Fluid protein/serum protein over 0.5
-Fluid LDH/serum LDH over 0.6
-Fluid LDH more than 0.6 of the upper limit of normal
These all indicate an exudate.

Question 12

Signs that a parapneumonic effusion has become complicated or empyemic?

Answer 12

Low glucose (below 60) or low pH (below 7.2) and often a very high LDH

Question 13

Management of parapneumonic effusions

Answer 13

Pulmonary effusions are common with pneumonia
Most are sterile and resolve with antibiotics
If signs of infection by bacteria or development into empyema, must be drained as well as treatment with ABX

Question 14

What are the classic features of ankylosing spondylitis?

Answer 14

Chronic inflammatory condition of the axial skeleton leading to stiffness of the spine and sacroiliitis and positive serology for HLA-B27
Chronic back pain of insidious onset in otherwise healthy young man that is better with exercise and worse at night and not relieved with rest
Some can also have IBD, uveitis, aortic regurgitation
Diminished chest wall mobility leads to restrictive lung pattern
Systemic Sx of fatigue, fever, chills, weight loss
Enthesitis

Question 15

What are the most common and less common causes of cough?

Answer 15

Top 3: Asthma, UACS, GERD

Others: ACEI, bronchitis, bronchiectasis, COPD, other lung diseases

Question 16

How is UACS treated?

Answer 16

First gen antihistamine

Question 17

How is asthma diagnosed if suspected?

Answer 17

PFT’s first
If normal, but still suspect, can do trial of bronchodilator or methacholine challenge test
Can also do two week trial of inhaled glucocorticoids assessing improvement of Sx