Pulm - interstitial Lung Disease Solitary Nodule & Sarcoid

Question 0

Patient with intermediate probability of malignancy on solitary pulmonary nodule – most appropriate next step?

If cytology is positive?

Answer 0

Bronchoscopy or transthoracic needle biopsy

Resection with positive sputum cytology

Question 1

When to get a biopsy of a solitary pulmonary nodule?

Answer 1

HPI: smoker over 40
PE: lymphadenopathy
Imaging: enlarging large (greater than sign 2 cm) spiculated, with sparse eccentric calcifications and abnormal PET scan

Question 2

Drugs that cause pulmonary fibrosis?

Answer 2

#Bleomycin
#Amiodarone
#nitrofurantoin
#Cyclophosphamide
#Busulfan
#Methylsergide

Question 3

Pneumoconiosis if exposed to:

1. Sandblasting, rock mining
2. Cotton
3. Electronic manufacture
4. Moldy sugarcane

Answer 3

1. Silicosis
2. Byssinosis
3. Beryllosis
4. Bagassosis

Question 4

All types of pulmonary fibrosis presents with?

Answer 4

#Dyspnea
#Crackles/Rales
#Loud P2
#Clubbing

Question 5

Best initial test if suspecting fibrosis?

Most accurate test?

Answer 5

Chest x-ray

Biopsy

Question 6

Pneumoconiosis in which biopsy will show granulomas?

Answer 6

Berylliosis

Question 7

Patient with suspected interstitial lung disease – biopsy finding that indicates reversibility? Permanence?

Answer 7

Inflammatory infiltrate with white blood cells

Fibrosis

Question 8

If biopsy of patient with interstitial lung disease shows WBC infiltrate – management?

Answer 8

Steroids

Question 9

Typical presentation of sarcoid?

Answer 9

Young African-American woman with:

1) shortness of breath, and rales without wheezing
2) erythema nodosum
3) lymphadenopathy

Question 10

Other, less common findings in sarcoidosis?

Answer 10

#Parotid gland enlargement
#Facial palsy
#Heart block with restrictive cardiomyopathy
#CNS involvement 
 #Uveitis

Question 11

Lab abnormalities in sarcoidosis?

Answer 11

#Elevated ACE
#Hypercalciuria
#Hypercalcemia