Interstitial Lung Disease II

Question 1

50yo F, dyspnea, cough, bibasilar fine crackles, clubbing, CXR basilar opacities, calcified pleural plaques

Answer 1

asbestosis

Question 2

calcified pleural plaques

Answer 2

asbestosis

Question 3

BOOP

Answer 3

on CXR - looks like pneumonia

won’t get better with antibiotic

Question 4

kaplans syndrome

Answer 4

rheumatoid arthritis and pneumoconiosis

Question 5

22yo M Hx asthma, mild intermittent, albuterol 1x/week, runs 2 miles/day

PFT reveal?

Answer 5

greater than 20% decline in FEV1 on methacholine challenge test

Question 6

restrictive lung disease

Answer 6

reduced FEV1 and FVC

with elevated FEV1/FVC ration

Question 7

25yo severe asthma, cold on day of exacerbation, chemical fume inhalation, unable to breathe

RR 44
diaphoretic, suprasternal retractions, bialteral wheezes, , given albuterol and IV corticosteroids

Answer 7

next step - inhaled corticosteroids

Question 8

65yo M, CXR rounded opacities upper lung zones, egg shell calcifications, increasing SOB last 2 years, accesory mm respiration, fine crackles end expiration

Answer 8

silicosis

• risk fx for TB
• so do a PPD skin test

Question 9

65yo M, mine worker, increasing SOB, sleeps on sofa, right side HF, 2+ pretibial edema, diffuse qheezing

Answer 9

coal workers pneumoconiosis

pulmonary HTN > cor pulmonale

Question 10

anti-GBM

Answer 10

goodpastures

Question 11

non-caseating granulomas

Answer 11

sarcoidosis

Question 12

fibrous plaques, pleural fibrosis

Answer 12

asbestosis

Question 13

chronic mucopurulent infections causing dilation of resp bronchioles

Answer 13

bronchiectasis

Question 14

coalescence of particle containing macules that form discrete areas of interstitial fibrosis causing distention of resp bronchioles, forming focal areas of emphysema

Answer 14

coal workers pneumoconiosis

Question 15

35yo coal miner rheumatoid arthritis

-calcified pulmonary nodules on CXR

Answer 15

dx - kaplans syndrome

Question 16

silicosis

Answer 16

egg shell calcifications

Question 17

miliary TB

Answer 17

spots all over CXR

Question 18

47yo roofer, increased SOB, 30py tobacco, roofing industry worker, CXR irregular shadows lower lung zones, thickened pleural plaques under diaphragms

Answer 18

asbestosis

decreased DLCO
decreased total lung capacity

Question 19

asbestosis

Answer 19

golden brown, fisuform rods with translucent center consisting of particulat fibers coated with iron containing proteinaceous material

ferruginous bodies**

Question 20

ferruginous bodies

Answer 20

asbestosis

Question 21

65yo M increasing SOB, weight loss last 3 months, positive JVD, distant heart sounds, pulsus paradoxus, diminshed breath sounds base of lung on left

right side pleural effusion and pericardial effusion

works on shipyard

thoracentesis reveals?

Answer 21

pleural fluid analysis with malignant mesothelioma

asbestosis

Question 22

berrylium

Answer 22

nuclear exposure

like sarcoidosis

Question 23

transudate vs. exudate

Answer 23

exudate if:
-pleural protein/serum protein > 0.5

• pleural fluid LDH/serum LDH > 0.6
• pleural fluid LDH more than 2/3 normal upper limit for serum

Question 24

35yo M, dyspnea, anorexia, night sweat, weight loss, nuclear technician, decreased breath sounds b/l, CXR bilateral fibrosis with hilar adenopathy, normal ACE and Ca levels, positive for mumps and trichophyton

Answer 24

beryllium exposure

BAL for beryllium lymphocyte proliferation test

Question 25

heerfordts syndrome

Answer 25

variant of sarcoidosis parotitis, uveitis, mild fever, facial nerve paralysis

Question 26

25yo M, upholstery industry, polyurethane exposure, wheezing episodes at work spirometry shows?

Answer 26

wheezing - FEF25-75 decreased- obstructive pattern dx - TDI lung disease - polyurethane business

Question 27

CXR with dextrocardia not surprised to find?

Answer 27

no children - kartagener syndrome - primary ciliary dyskinesia

Question 28

25yo male, dry cough, malaise, fevers, wheezing, weight loss, eosinophilia, LgE elevations, charcot leyden drystals, multiple nodules on CXR treat with?

Answer 28

eosinophilia pneumonia? - parasite - tx diethylcarbamazine wuchereria bancrofti

Question 29

wuchereria bancrofti

Answer 29

elephantitis | -parasitic infection

Question 30

14yo F, blood eosinophilia, fever, pulmonary infiltrates, episodic, abdomen pain, N/V, X-ray acute GI obstruction diagnosis?

Answer 30

loefflers syndrome parasite life cycle - strongyloides - lung phase an GI phase of life cycle

Question 31

churg strauss

Answer 31

asthma like sx progressive dx diarrhea, abdominal pain

Question 32

loefflers syndrome

Answer 32

intermittent disease - parasites in GI and lungs - strongyloides

Question 33

38yo F, tx for breast ca mastectomy, low grade fever, night sweats, dyspnea, increased sputum, occasional cough suspect?

Answer 33

chronic remodeling of lung tissue resulting in pulmonary fibrosis radiation treatment effect on lungs

Question 34

30yo rancher, fever, chills, cough, progressive SOB, wheezing increased over past 4 hours, diffuse infiltrates on CXR

Answer 34

learn more about ranch duties, surmise his problem is result of? allergy to thermophylic actinomycetes farmers lung

Question 35

farmers lung

Answer 35

thermophylic actinomycetes

Question 36

50yo M, sinusitis, allergies, persistent asthma, beta agonists, steroids, cromolyin, resp difficulty, pain legs, arms, hands, erythematous maculopapules, abdominal pain with rebound, decreased urination right side infiltrates, elevated eosinos, p-ANCA elevated, IgE elevated, BUN/Cr elevated

Answer 36

diagnosis -churg strauss syndrome looked like wegeners - but no hematuria

Question 37

pANCA

Answer 37

churg strauss

Question 38

25yo hodgkins, chemotherapy, fever 3 days, dry cough and hemoptysis with pleuritic chest pain BAL - suggest aspergillosis

Answer 38

most appropriate therapy - amphotericin B | -antifungal

Question 39

amphotericin B

Answer 39

antifungal

Question 40

27yo ranchhand, resp distress, cleaning at farm, CXR all white, see air bronchograms

Answer 40

diagnosis | -silo fillers disease

Question 41

nitrogen dioxide

Answer 41

silo-fillers disease can be fatal