Clinical Cases - Asthma, COPD, Bronchitis, Interstitial Lung Disease, Lung Nodules

Question 1

What typical pattern is seen on CXR in someone that has pulmonary fibrosis?

Answer 1

Honeycombing
-mostly in the periphery and base

Note: it will also appear this way on a tissue sample

Question 2

Pt is 88% sat on room air. What is their likely PaO2?

Answer 2

58

On the oxygen dissociation curve, 90% is 60, so 88% will be just below that

Question 3

How is pulmonary fibrosis distinguished from emphysema on PFT?

Answer 3

Lung volumes

Question 4

What is the Schamroth sign?

Answer 4

Its used to determine if someone has nail clubbing. Have them put first knuckles together and see if the full nail touches or if it flares out

Clubbing is when the nail flares out

Question 5

What is the main cause of decreased diffusing capacity in pulmonary fibrosis?

Answer 5

Thickened interstitium

Question 6

What is alpha-1 antitryspin deficiency?

Answer 6

Misfolded gene product aggregates in hepatocellular ER

Cirrhosis w/ PAS+ globules in liver

Lungs have lack of enzyme function causing decreased in elastic tissue leading to PANACINAR EMPHYSEMA

Expect lower lobe bullous airspace disease and decreased DLCO

Question 7

What is the difference between an asthmatic bronchiole and a normal bronchiole?

Answer 7

As asthmatic bronchiole is inflamed and there is smooth mm hypertrophy leading to the obstruction

Question 8

What are important outdoor aeroallergens?

Answer 8

Molds
Grass pollen
Tree pollen
Weed pollen

Question 9

What are important indoor aeroallergens?

Answer 9

Molds
Animal dander
Cockroaches
Dust mites
Latex

Question 10

What three disease processes cause airway obstruction?

Answer 10

Emphysema
Chronic bronchitis
Asthma

Question 11

Explain how emphysema causes airway obstruction

Answer 11

Neutrophil elastase –> destroy alveoli and elastic recoiling leading to hyperinflation (irreversible)

Question 12

Explain how chronic bronchitis cause airway obstruction

Answer 12

Mucus hypersecretion (irritants) –> physical obstruction & chronic productive cough (3 mo > 2 yr)

Question 13

Explain how asthma causes airway obstruction

Answer 13

airway inflammation + bronchial hypersensitivity –> constriction leading to air-trapping (reversible)

Question 14

Asthma is inducible. Explain

Answer 14

Can use

• METHACHOLINE CHALLENGE
• exercise challenge
• eucapnic hyperventilation

These tests induce bronchocontriction

In someone with asthma, will see the FEV1 drop suddenly (see the chart in the notes)

Question 15

Distinguishing features of emphysema

• CXR
• Spirometry
• PFT

Answer 15

CXR - increased AP diameter

Spirometry - does not change much from pre to post

PFT - low pre drug % predicted for diffusion capacity

Question 16

What are the hallmarks of squamous cell carcinoma?

Answer 16

Cavitary lesions
Endobroncheal lesions
PTHrP +

on histology - keratin pearls and intercellular bridges

Question 17

Sarcoidosis Hall marks

Answer 17

ACE levels high

Worsening cough
Erythema Nodosum

Bilateral hilar lymphadenopathy

Question 18

Which electrolyte is most likely to abnormal in sarcoidosis?

Answer 18

calcium

Question 19

What three things need to be checked routinely in someone with sarcoidosis?

Answer 19

Heart
–cardiac conduction defect

Lungs
–PFTs can vary

Eyes
–can get iritis, uveitis

Question 20

Shipbuilder – assoc with?

Answer 20

mesothelioma

Question 21

Foundry worker – assoc with?

Answer 21

silicosis