Pneumologia

Question 1

vie aree superiori include

Answer 1

cavita nasali
pharynx
larynx
- to humidify air, first layer of immune protection.
- MALT (mucosa associated lymphoid tissue) - Waldeyer ring

Question 2

Waldeyer ring is located where and includes what?

Answer 2

at the pharynx
Includes: the mucosa of the posterior oropharynx covering a bed of lymphatic tissue that aggregates to form the palatine, lingual, pharyngeal, and tubal tonsils.

Question 3

the inferior viee area start from

Answer 3

the trachea
Number 23 (number of rami bronchiali)
zone of conduction: to conduct air
zone of respiration/transizione: to gas exchange (#17 is the first bronchial division here)
From #7 onwards you start to loose cartilagenous support

Question 4

PLSS mneumonic to divide the viee aree

Answer 4

principali
lobali
segmentali
sub-segmentali

Question 5

lung volumes

Answer 5

TV: 500ml
150ml remain in conduction zone: spazio morto anatomico

Question 6

Blood eosinophil count in acute eosinophilic pneumonia are normal?

Answer 6

T
SX: fever, cough, dyspnea, crackles (crepitii) for 1 month
Mainly affects smokers
CXR shows bilateral alveointerstitial infiltrates
DX: BAL eosinophilia >25%
TX: systemic corticosteroids

Question 7

Hypersentivity pneumonitis on CXR localisation

Answer 7

reticulo nodule pattern with apical dominance
CT: interstitial damage, nodular ground glass pattern

Question 8

Silicosis can be diagnosed on CXR?

Answer 8

yes
ground glass nodules

Question 9

The most common anatomic sites for the development of lung abscesses following inhalation include: the superior segment of the right lower lobe, the posterior segment of the right upper lobe, and the superior segment of the left lower lobe.

Answer 9

T

Question 10

What does step 3 of asthma treatment recommend?

Answer 10

Step 3 involves the combination of inhaled corticosteroid and low-dose long-lasting beta2-agonist.

Question 11

FISCHI (WHEEZING) SIBILI (WHISTLING)

Answer 11

T

Question 12

Multi-resistant tuberculosis (MDR TB) is defined as:

Answer 12

An active form of tuberculosis caused by germs resistant to at least rifampicin and isoniazid, more or less other resistance to first-line drugs

Question 13

Omalizumab role in asthma

Answer 13

in asthma not well controlled, with high igE count (above 30 IU/ml)

Question 14

DVT therapy

Answer 14

anticoagulants (initially heparin or LMWH, then warfarin or NOAC) for 3-6 months and then suspension.

Question 15

Tactile vocal fremitus is reduced in cases of pneumothorax, pulmonary edema, pulmonary emphysema, pleural effusion and laryngeal diseases.

Answer 15

t

Question 16

PNX facts

Answer 16

Catamenial pneumothorax originates coinciding with the menstrual cycle
B) In case of extensive pneumothorax > 30%, a chest drainage is indicated
C) Surgical intervention is always indicated in case of a second episode of pneumothorax

Question 17

Sarcoidosis is

Answer 17

an inflammatory dx
with non caseating granulomas
Sarcoidosis respiratory disease may be divided into four categories radiologically:
(1) Hilar and mediastinal node involvement
(2) Nodal and parenchymal involvement
(3) Parenchymal involvement
(4) Pulmonary fibrosis.
TX: high dose CS for acuzie
Schumann bodies are found in sarcoidosis. These are calcified, rounded, laminated concretions inside the non-caseating granuloma. The granulomas are formed of foreign body giant cells. Within the giant cells, there are star-shaped inclusions called asteroid bodies.

Question 18

It has been apparent that due to increased use of anti-TNF antibody medication for rheumatoid arthritis, tuberculosis infection can be re-activated

Answer 18

T
Most cases have been seen with infliximab

Question 19

calcified lymph nodes are associated with TB, SARCOIDOSIS, AND HISTOPLASMOSIS

Answer 19

T

Question 20

test for aspergillosis?

Answer 20

a serum galactomannan test can be performed, which is highly sensitive to aspergillosis infection.

Question 21

T/F hypercalcemia is associated with squamous cell carcinoma

Answer 21

T

Question 22

lung adenocarcinomas are least associated with smoking and present in lung periphery

Answer 22

T

Question 23

Silicosis is caused by the inhalation of silica dust, which is commonly seen in patients working in the tunnelling, quarrying and construction industry.

Answer 23

T

Question 24

what is plastic bronchitis?

Answer 24

The formation of gelatinous or rigid casts in airways, and their subsequent coughing out, is called plastic bronchitis. It is found in asthma, bronchiectasis, cystic fibrosis and some respiratory infections. It is also called Hoffman’s bronchitis or cast bronchitis. Treatment consists of bronchial washing, induction of sputum and prevention of infections. N-acetyl cysteine has been used with some success. The distal lung collapse due to bronchial obstruction by the cast can mimic malignancy. Hence bronchoscopy is needed urgently, which can also be therapeutic in removing the casts mechanically.

Question 25

asbestosis has pleural plaques

Answer 25

t

Question 26

Pneumoconiosis occurs in coal miners and those exposed to coal dust.

Answer 26

t

Question 27

If we were to observe a patient with a chest where the transverse diameter prevails over the longitudinal one, we would find ourselves faced with a type of chest:

Answer 27

Picnic chest
The athletic chest is wide and developed, while the paralytic one is elongated and with a depressed epigastric fossa.
The emphysematous chest is called “barrel chest” because the antero-posterior and lateral-lateral diameters are increased. The keeled thorax is characterized by the protrusion of the sternum and the flattening of the lateral ribs.

Question 28

The increase in bicarbonates does not exceed the expected compensation (1 mEq/L for every 10 mmHg of pCO2 increased), so there is no associated metabolic alkalosis

Answer 28

NOTE
normal HCO3: 22-26
Normal CO2: 35-45

Question 29

The use of low-dose inhaled antileukotriene and corticosteroids is particularly indicated for the treatment of pediatric asthma, since these drugs reduce the frequency and severity of wheezing episodes.

Answer 29

T

Question 30

In the management of the patient with suspected pulmonary embolism (ESC 2019 guidelines) we must first evaluate the patient’s hemodynamics: in fact, unstable patients must immediately perform a transthoracic echocardiogram in bed to evaluate any dysfunction of the right ventricle. If right ventricular dysfunction is present, CT angiography should be performed immediately if available. If CT angiography is not available, treat the patient as if he or she has a high-risk pulmonary embolism. In haemodynamically stable patients, however, we will calculate the probability of pulmonary embolism using appropriate scores, such as the Wells score. In the presence of a Wells score >4 points (probable TEP) it will be necessary to perform a CT angiography, while for a score ≤4 points we will first carry out the high sensitivity D-dimer assay and, only in the case of high values ​​of the latter, we will proceed to CT angiography.

Answer 30

T

Question 31

which drug causes interstitial pneumonia

Answer 31

amiodarone, a class III antiarrhythmic drug, which at the pulmonary level causes interstitial involvement generally in the upper lobes. Characteristic is the presence of foamy macrophages and pneumocytes with lamellar inclusions in the BAL.

Question 32

The use of azithromycin at low doses for long periods (a few weeks) has demonstrated effectiveness in reducing the frequency of COPD exacerbations. The effect appears to be mediated by immunomodulation at the bronchial level and not by the antibacterial effect of the antibiotic.

Answer 32

T

Question 33

Until a few years ago, lung ventilation/perfusion scintigraphy was the most used method for the diagnosis of TEP; nowadays, thoracic CT angiography is preferred. In the absence of perfusion defects on scintigraphy, TEP can be excluded; it is possible to make a diagnosis when two or more perfusion defects are present, without associated ventilation defect, with a greater probability the greater the size and number of perfusion defects. Results of low or intermediate probability (one or two perfusion defects not concordant with ventilation) or of indeterminate or inconclusive probability (perfusion defects associated with defects in ventilation) do not allow the diagnosis of TEP. Due to this gray area of ​​diagnostic uncertainty, in most cases chest CT angiography is used as the first diagnostic test.

Answer 33

T

Question 34

The patient presents with acute chest pain and shortness of breath, having factor V Leiden mutation and smoking history, both associated with clotting. There is a swollen, red lower extremity, normal ECG and troponins. Febrile, tachycardic, tachypnoeic, and hypoxaemic, suggesting deep vein thrombosis with pulmonary embolism (PE). Chest X-ray may show a wedge-shaped opacity indicating lung vessel occlusion and pulmonary infarction. Note that X-ray usually does not reveal PE except in massive cases. In this context, a likely X-ray finding is a wedge-shaped opacity in the right middle lobe.

Answer 34

t

Question 35

The presenting complaint and the patient’s history suggest a diagnosis of RADS. This condition is characterised by asthma-like symptoms that develop within 24 hours of exposure to irritant gases, vapours, or fumes. Diagnostic criteria for RADS include the absence of pre-existing respiratory conditions, symptom onset after a single exposure to high concentrations of irritants, symptoms occurring within < 24 hours of exposure, a positive methacholine challenge test (< 8 mg/ml) following exposure, possible airflow obstruction on pulmonary function tests, and exclusion of other pulmonary diagnoses.

Answer 35

t

Question 36

Rhinoviruses are estimated to be responsible for 30–50% of common cold cases annually, making it the most common causative organism. A common cold is likely, given the highlighted classic symptoms with acute onset accompanied by a normal body temperature. The patient’s son also recently recovered from similar symptoms, and children are known to spread the common cold due to close contact with other children and family members.

Answer 36

t

Question 37

The classical feature of P. jirovecii is desaturation on exercise. This may be demonstrated clinically on the ward by measuring pulse oximetry. This is measured both before and after walking up and down the ward. If a significant drop is noted, this must be recorded.

Answer 37

t

Question 38

The bottom of the fifth intercostal space in the mid-axillary line

Answer 38

The lower fourth or fifth intercostal space (i.e. just above the relevant rib) is chosen to avoid the intercostal neurovascular bundle, which runs through the costal groove on the lower inner surface of the rib above.

Question 39

Chronic obstructive pulmonary disease is a very common disease requiring admission to hospital. Exacerbations may be infective or non-infective in nature. The spectrum of disease ranges from those with a relatively limited exercise tolerance to patients requiring home oxygen and nebulisers, even to stay within the confines of their own homes. Respiratory reserve is poor and susceptibility to infection is high. A lower respiratory tract infection (LRTI) can quickly lead to a dramatic deterioration in breathing, which not infrequently warrants respiratory support in the form of non-invasive positive pressure ventilation (NIPPV) or High Dependency Unit (HDU)/Intensive Care Unit (ICU) admission. Type II respiratory failure can sometimes occur. Clinically, hypercapnia may manifest as warm, dilated peripheries with a flap (carbon dioxide retention asterixis) and papilloedema. An ABG in these patients may show a type II respiratory picture with acidosis (low pH) and a degree of metabolic compensation giving rise to a raised bicarbonate level (HCO3–). It is important to note that most patients with COPD will have a type I respiratory failure.

Answer 39

pH: 7.27, pa (O2): 7.1, pa (CO2): 8.9, HCO3–: 33.20, base excess (BE) 4.9 mmol