Pulm #6

Question 1

MC etiology for emphysema

Answer 1

-Smoking

Question 2

What is emphysema?

Answer 2

-Permanent enlargement of the terminal airspaces with no obvious fibrosis

Question 3

Pathophysiology of Emphysema

Answer 3

• Alveolar capillary destruction and alveolar wall destruction
• Loss of elastic recoil
• Increased compliance leads to airway destruction

Question 4

_____ involvement is most commonly seen with smoking

Answer 4

Centrilobar (proximal acinar)

–Not the entire acini as in alpha-1-antitrypsin deficiency

Question 5

Symptoms and PE findings of emphysema

Answer 5

• Dyspnea
• Chronic cough (with or without sputum)
• Hyperinflation: decreased breath sounds, increased AP diameter (barrel chest), hyper resonance to percussion, wheezing.
• Non-cyanotic: pink puffers
• Pursed-lip expiration and sitting forward to improve breathing

Question 6

Gold standard diagnostic to diagnose emphysema

Answer 6

• PFT (obstructive pattern)

- Decreased DLCO (diffusing capacity of lungs for carbon dioxide)

Question 7

Another diagnostic that can be done for emphysema?

Answer 7

-CXR: flattened diaphragms, increased AP diameter, decreased vascular markings, bullae

Question 8

Treatment for emphysema

Answer 8

• Low risk of exacerbation: SABA or SAMA as needed
• More symptomatic, low risk: LAMA (Tiotropium) vs LABA (Salmeterol)
• Minimal symptomatic on day to day basis: LAMA + LABA
• Higher symptom burden: LABA + LABA + glucocorticoid

Question 9

Which is more efficacious, LAMA or LABA?

Answer 9

LAMA

-Tiotropium

Question 10

Symptoms of Superior Vena Cava Syndrome

Answer 10

• face and/or neck swelling
• Facial plethora
• headache
• Dilated and prominent neck and chest veins

Question 11

MC etiology of superior vena cava syndrome

Answer 11

• Small cell bronchogenic carcinoma

- Hodgkin lymphoma

Question 12

Treatment for superior vena cava syndrome

Answer 12

• Supportive
• elevation of the head
• Endovascular management

Question 13

What is the best diagnostic for superior vena cava syndrome?

Answer 13

CT scan can show degree of obstruction

Question 14

What is Lambert-Eaton Myasthenic Syndrome

Answer 14

-Antibodies against presynaptic voltage-gated calcium channels prevent Acetylcholine release, leading to muscle weakness

Question 15

Lambert-Eaton Myasthenic Syndrome

Answer 15

-MC associated with small cell lung cancer

Question 16

Symptoms for Lambert-Eaton Myasthenic Syndrome

Answer 16

• proximal muscle weakness that improves with repeated muscle use
• Autonomic symptoms: dry mouth, postural hypotension, ED
• Hyporeflexia, No muscle atrophy

Question 17

Diagnostics for Lambert-Eaton Syndrome

Answer 17

• Voltage-gated calcium channel antibody assay
• Electrophysiology
• CT scan to assess for malignancy

Question 18

Treatment for Lambert Eaton Syndrome

Answer 18

• Treat underlying malignancy
• Pyridostigmine
• Second line: Plasmapheresis, IVIG, oral immunosuppressants

Question 19

MC foreign body ingested by children

Answer 19

Peanuts

Question 20

Main cause of death in a foreign body aspiration in a child

Answer 20

Hypoxic-ischemic brain injury and less commonly, pulmonary hemorrhage

Question 21

Why are foreign bodies MC on the right side?

Answer 21

Due to wider, more vertical and shorter right mainstem bronchus

Question 22

Symptoms of foreign body aspiration

Answer 22

• Sudden onset of choking, cough, and dyspnea

- Wheezing or asymmetric breath sounds, may be normal

Question 23

Definitive diagnostic for foreign body aspiration

Answer 23

Rigid bronchoscopy: therapeutic as well because object can be removed

-Flexible may be used in diagnostic cases when location of FB is unclear

Question 24

Treatment for foreign body aspiration

Answer 24

-Removal of foreign body via rigid bronchoscopy

Question 25

What is the difference between Tietze Syndrome and Costochondritis?

Answer 25

• In Tietze Syndrome, there is pleuritic chest pain, reproducible point chest wall tenderness WITH palpable edema.
• In Costochondritis, there is no palpable edema.

Both are diagnoses of exclusion, imaging is normal, and are treated with NSAIDs.