Pulm

Question 1

Silicosis

Answer 1

Caused by occupation exposure (foundries, mines, and sandblasting)
ILD part of pneumoconioses, most common in US
silica stimulates the release of fibrogenic factors from macrophages, resulting in lung fibrosis
Dx: documented exposure to an agent known to cause disease, a latent period between exposure to the aforementioned agent and the development of symptoms, clinical manifestations characteristic of the disease, and exclusion of other diseases that may be responsible for the patient’s condition, high resolution CT: numerous small nodules that may eventually coalesce, consolidation, “eggshell” calcifications in hilar lymph nodes, intralobular septal thickening, and diffuse ground glass opacities
From earth but affects the roof (UL)

Question 2

Asbestosis

Answer 2

shipping, roofing, insulation, plumbing exposure
SOB + nonproductive cough + chronic hypoxia
PFTs: reduced lung volumes
CXR: interstitial fibrosis, from roof but affects base (LL)
plerual calcified plaques/thickening, malignant mesothelioma, lower lobe predominant, LL bronchogenic carcinoma

Question 3

Berylliosis

Answer 3

aerospace, dental, computer, fluorescent bulbs exposure
SOB + nonproductive cough + chronic hypoxia
PFTs: reduced lung volumes
CXR: interstitial fibrosis, small rounded opacities that can calcify, upper lobe scarring, volume loss, bullae

Question 4

Byssinosis

Answer 4

cotton exposure
SOB + nonproductive cough + chronic hypoxia
PFTs: reduced lung volumes
CXR: interstitial fibrosis

Question 5

Coal workers lung

Answer 5

coal mining exposure
SOB + nonproductive cough + chronic hypoxia
PFTs: reduced lung volumes
CXR: interstitial fibrosis, upper lobe predominant, small rounded nodular opacities <1cm in diameter
Massive fibrosis and cavitation when mixed with silica

Question 6

Siderosis

Answer 6

Iron exposure
SOB + nonproductive cough + chronic hypoxia
PFTs: reduced lung volumes
CXR: interstitial fibrosis

Question 7

Stannosis

Answer 7

tin exposure
SOB + nonproductive cough + chronic hypoxia
PFTs: reduced lung volumes
CXR: interstitial fibrosis

Question 8

Talc

Answer 8

ceramic, plastic, rubber, paint, cosmetic industry exposure

upper lobe predominant, small rounded opacities

Question 9

Cobalt

Answer 9

small nodular miconodules and reticular opacities

LL predominance

Question 10

Alpha 1 antitrypsin deficiency

Answer 10

liver dysfunction and lung disease (basilar emphysema)
Sxs: dyspnea, chronic cough, obstructive pattern on spirometry testing, increased risk of lung dz with smoking, cirrhosis, HCC, necrotizing panniculitis
Dx: serum alpha 1-antitrypsin protein levels, protein phenotyping, and protein genotyping. COPD prior to age 30.
Txt: pneumococcal and influenza vaccinations and antibiotics for prevention of bacterial infections. Bronchodilators, ICS, and pulmonary rehabilitation. Lung reduction surgery( effect on lung function is not consistent). Alpha 1-antitrypsin augmentation (txt w/ plasma consisting of alpha 1-antitrypsin), double lung transplantation (controversial)

Question 11

SVT

Answer 11

AVNRT or AVRT (whether reentrant track is in AV node or in accessory bypass tract)
Sxs: acute onset palpitations, anxiety, chest pain, dyspnea, and sometimes presyncope. abrupt onset and termination
Txt: vagal maneuvers like a Valsalva, carotid sinus massage, and squatting. Immersing one’s face in cold water. Adenosine if in hospital

Question 12

Hypertensive urgency

Answer 12

> 180/110 mm Hg without signs or symptoms of end-organ damage
Dx: serum electrolytes, urinalysis, ECG, and chest radiography to check for end organ damage
Txt: oral clonidine, lower the blood pressure to a target of < 160/100 mm Hg, or 25% within the first 24 hours

Question 13

Hypertensive emergency

Answer 13

Hypertension with acute end-organ system injury
(Encephalopathy, cardiac ischemia, renal ischemia)
Txt: gradually reduce MAP by approximately 10-20% in the first hour and by a further 5-15% over the next 23 hours, Reduction of MAP > 25% may cause end-organ ischemia
IV antihypertensives (labetalol or nicardipine)

Question 14

Hypertensive emergency

Answer 14

Hypertension with acute end-organ system injury
(Encephalopathy, cardiac ischemia, renal ischemia)
Txt: gradually reduce MAP by approximately 10-20% in the first hour and by a further 5-15% over the next 23 hours, Reduction of MAP > 25% may cause end-organ ischemia
IV antihypertensives (labetalol or nicardipine)

Question 15

Pericardial effusion

Answer 15

infectious, malignancy, idiopathic
Sxs: Beck’s triad- hypotension, JVD, muffled heart sounds
Dx: echo- Diastolic collapse of the RA and RV and IVC plethora (IVC dilatation), EKG shows electrical alternans
Txt: NS bolus, pericardiocentesis or pericardial window if chance of recurring