Pulm CC I - Truwit

Question 1

What are the imaging findings seen in interstitial diseases?

What is the mnemonic used to recall these diseases (just the abbreviation, not each disease)?

Answer 1

“Scratchy” appearing infiltrates.

SHITFACED

Question 2

Recall the interstitial infiltrates referred to in the mnemonic “SHITFACED”.

Answer 2

S - Sarcoidosis

H - Hypersensitivity pneumonitis

I - Interstitial lung dz

T - Tumor or TB

F - Fungal

A - Asbestosis

C - Collagen vascular dz

E - Eosinophilic granuloma

D - Drugs

Question 3

How does sarcoidosis appear on histology of lung biopsy?

Answer 3

Granulomas (epithelioid histiocytes, giant cells) in a “lymphatic” distribution. Relatively normal alveoli.

Question 4

Recall the four stages of Sarcoidosis as determined by imaging findings.

Answer 4

Stage I - Hilar lymphadenopathy

Stage II - Hilar lymphadenopathy & Lung infiltrate

Stage III - Lung infiltrate

Stage IV - Fibrosis

Question 5

What other organs are involved in sarcoidosis?

Answer 5

Eyes (Uveitis), skin (lupus pernio & erythema nodosum), CNS, heart, liver, joints, kidney…

Question 6

How does ARDS appear on CXR?

Answer 6

Diffuse “white-out”.

Question 7

Recall the mnemonic used to recall alveolar infiltrates.

(and what it stands for)

Answer 7

PeCan PIE;

P - Pus

C - Cells (RBC, eosinophil, tumor)

P - Protein

I - Inflammatory elements

E - Edema

Question 8

Recall the criteria needed for an ARDS diagnosis.

Answer 8

Acute onset (<7days), fluid overload, bilateral infiltrates.

Question 9

With respect to assisted ventilation:

Is a higher or lower tidal volume better?

Is a higher or lower PEEP better?

Is liberal or conservative fluid resuscitation better?

Answer 9

For maximum survival and shortest time on the ventilator:

Low tidal volume

(PEEP not significant)

Conservative fluid resuscitation

Question 10

What other techniques are helpful in managing ventilated ARDS patients?

What techniques do not make a difference?

Answer 10

Pronation, paralysis (maybe).

Short-term diet control and statins do not help. Beta-agonists (older) and surfactant (neonates) on a specific basis.