Pulm SAS and Misc. Review

Question 1

Is the following consistent with hypersensitivity pneumonitis?

Upper lobe nodules

Answer 1

Yes

Question 2

Community acquired pneumonia with dense consolidation is most likely caused by…

Answer 2

• H. influenzae*
• S. pneumoniae*

Question 3

If a patient with this CT had a history of smoking but no other exposures or significant laboratory findings, what is the most likely diagnosis?

Answer 3

IPF

Idiopathic = no clear cause of the lung disease

Question 4

Is the following consistent with a UIP pattern on HRCT?

Diffuse ground glass

Answer 4

No

Question 5

Is this consistent with sarcoidosis?

Occurs exclusively in smokers

Answer 5

No

Question 6

You are rounding on the pulmonary consult service and asked to evaluate a patient with an abnormal chest CT. The CT shows diffuse interlobular septal thickening. This radiographic abnormality can be caused by pathology in which structures?

Answer 6

Lymphatics and pulmonary veins

Question 7

Would uremia cause anion gap nor non-anion gap metabolic acidosis?

Answer 7

Anion gap metabolic acidosis

Question 8

Which fungal pneumonia is characterized by “halo sign” on CT?

Answer 8

Aspergillosis

Question 9

The patient with the solid flow-folume loop has isovolume flows that are _____ compared to a healthy lung (dotted line)

Answer 9

The patient with the solid flow-folume loop has isovolume flows that are high compared to a healthy lung (dotted line)

This is indicative of restrictive physiology

Question 10

You are caring for a mechanically ventilated patient in the ICU with pneumonia. She is deeply sedated and paralyzed. Her tidal volume is set to 600 mL and her RR is 10. What happens if you change her settings to a tidal volume of 200 mL and a RR of 30?

A. You have lowered V̇_A

B. Nothing, V̇_E is unchanged

C. You have lowered V̇_D

D. You have increased V̇_E

Answer 10

A. You have lowered V̇_A

Question 11

Is the following consistent with hypersensitivity pneumonitis?

Lymphocystic infiltrate

Answer 11

Yes

Question 12

For mechanically ventilated patients, we try to keep transpulmonary pressure < 25 – 30 cmH2O to not injure the delicate alveolar capillary barrier.

You are managing a patient whose P_alv (plateau pressure) is set to 20 cm H2O. Over the course of the day, he develops large bilateral pleural effusions

What is true about the patient’s management?

A. Palv can likely be safely raised

B. Palv should be lowered

C. Palv should be kept the same

Answer 12

A. Palv can likely be safely raised

• The patient has pleural effusion - fluid in the pleural space
  
  • Alveolar pressure should be raised to compensate

Transpulmonary pressure = P_alv - P_ip

Normal: 20 - (-5) = 25

This paient: 20 - (some number >-5) = <25

Palv should be increased in order to maintain transpulmonary pressure

Question 13

What drug is most often implicated (as far as this module goes) in drug-induced ILD?

Answer 13

Amiodarone

Any patient with an abnormal HRCT who is taking amiodarone can be assumed to have drug-induced ILD

Question 14

How does hypoalbuminemia cause edema?

Answer 14

Hypoalbuminemia = few proteins in the serum, resulting in low oncotic pressure in the capillaries. This can cause leakage of fluid out of the capillaries into the interstitium, leading to edema

Question 15

Is this pattern nodular or reticular

Answer 15

Nodular

Question 16

In a patient with hypersensitivity pneumonitis, what would you expect to find on lung biopsy?

Answer 16

Loosly formed, non-caseating granulomas

Question 17

If this x-ray is from a 68-year-old male in the MICU with septic shock following cholangitis has this chest x-ray. He is refractory to oxgyen, does not have elevated filling pressures, and is not taking drugs toxic to the heart.

What is the most likely diagnosis?

If he had the exact same thing without the cholangitis, what would be the most likely diagnosis?

Answer 17

Most likely = ARDS

Most likely if no inciting incident = Acute Interstitial Pneumonia

(AIP = Idiopathic ARDS)

Question 18

Pathologic findings of loosely formed, non-caseating granulomas would increase suspicion for which ILD?

Answer 18

Hypersensitivity Pneumonitis (HP)

Question 19

Neutrohpilic exudate in a pleural effusion is associated wtih…

Answer 19

Infection (ex: bacterial pneumonia)

Question 20

Which PH group affects location C?

Answer 20

Group 3 - Pulmonary Hypertension Owing to Lung Disease

Question 21

What is lymphangitic carcinomatosis?

Answer 21

Dilation of lymphatic channels

May indicate widespread malignancy or pulmonary venous hypertension

Question 22

A patient is experiencing pulmonary edema. The edema fluid is low in proteins

What is causing the edema?

Answer 22

If the edema fluid is low in proteins, fluid is leaking out of the microvasculature due to high intravascular hydrostatic pressure

Proteins are prevented from crossing the intact endothelial barrier, resulting in low-protein fluid in the interstitial space

Question 23

Is vomiting associated with metabolic acidosis or metabolic alkalosis?

Answer 23

Metabolic alkalosis (chloride responsive)

Question 24

Which PH group affects location A?

Answer 24

Group 4 - Chronic Thromoboembolic Pulmonary HTN

Question 25

A lung cancer with lots of bright pink keratin is most likely which kind of cancer?

Answer 25

Squamous cell carcinoma

Question 26

What are the common driver mutations of adenocarcinoma?

Answer 26

ALK and EGFR

Question 27

What is the most worrisome pathology if a patient has high minute ventilation but normal to high PaCO₂?

Answer 27

Pulmonary embolism High ventilation usually results in low CO₂ because you breathe it off However, if CO₂ is normal or elevated when a patient is hyperventilating, it indicates the presence of **dead space**. There are a number of cuases for this, but the most worrisome is dead space

Question 28

What causes "high pressure" aka "cardiogenic" pulmonary edema?

Answer 28

High intravascular hydrostatic pressure pushes fluid out of the microvasculature, usually due to left heart problems

Question 29

What is the DDx for hypoxemia with a large A-a difference? (A-a \> 10 is abnormal)

Answer 29

* Shunt * Pulmonary: V/Q = 0 * Blood, pus, water, atelectasis * Ventilation/Perfusion mismatch * V/Q is low but not zero * COPD * Asthma * PE * Diffusion impairment * ILD * Emphysema

Question 30

Which vessels in the lung become enlarged when a patient has left heart failure? What will you see on an HRCT?

Answer 30

Left heart failure = increased left atrial pressure - \> Increased pulmonary vein size - \> Int**er**lobular septal thickening

Question 31

How does the Starling Equation change in ARDS vs. normal?

Answer 31

Starling equation: QE = K_F [(P_mv - P_is) - σ (π_mv - π_is)] In ARDS, σ -\> 0; there is no oncotic pressure sucking fluid back into the capillary Hydrostatic pressure pushes fluid out of the capillary into the interstitial space

Question 32

Is this consistent with sarcoidosis? ## Footnote **Multi-system involvement**

Answer 32

Yes

Question 33

Based on this volume-time curve, what medication will this patient likely need?

Answer 33

This patient is showing signs of obstructive physiology **If COPD**: LAMA or LABA (bronchodilators), combine if symptoms persist, add ICS if high risk of exacerbation **If asthma:** Control with ICS, add LABA if poorly controlled on ICS

Question 34

When fluid starts to fill a normally air-filled structure, what sign are you likely to see on x-ray?

Answer 34

Silhouette Sign You will not see a clear border between the heart and the fluid-filled lung

Question 35

Which occupational lung disese is this chest x-ray significant for?

Answer 35

Sillicosis with progressive massive fibrosis or Coal miners pneumocosis with progressive massive fibrosis **Diagnose based off of clinical histor**

Question 36

What usually mediates indirect injury to the lung?

Answer 36

Cytokines

Question 37

Is the following consistent with a UIP pattern on HRCT? ## Footnote **Diffuse nodules**

Answer 37

No

Question 38

What is the prototypical example of non-cardiogenic pulmonary edema?

Answer 38

Acute respiratory distress syndrome (ARDS)

Question 39

Which pulmonary hypertension group is most prevalent?

Answer 39

Group 2 - Pulmonary venous hypertension Group 2 \> Group 3 \> Group 4 \> Group 1 | (owing to left heart disease)

Question 40

Which PH group affects location B?

Answer 40

Group 1 - Pulmonary Arterial Hypertension

Question 41

A 35-year-old woman presents to the Emergency Department with pleuritic chest pain. She has had symptoms of a viral respiratory tract infection for the past 5 days. She is tachycardic with a heart rate of 110 beats per minute. Her other vital signs are normal and she appears comfortable. Based on your history and physical exam, you calculate a Wells score of 1.5. **What is the appropriate next step to evaluate for pulmonary embolism?**

Answer 41

Obtain a D-dimer If \>500 ng/mL, start anticoagulants and order CTPA If \<500 ng/mL, no further testing is needed

Question 42

Which variable is most strongly correlated with outcome in CF? ## Footnote A. Genetics B. Number of affected organs C. Severity of diabetes D. Lung function

Answer 42

D. Lung function

Question 43

A patient with the following chest x-ray has a shunt of some kind He has no JVD and his lower extermities are without edema. **Does he have ARDS or cardiogenic edema?** **Is the fluid likely to be high or low in protein?**

Answer 43

The patient has **ARDS.** The fluid will be **high in protein** Normal filling pressures indicate that the cause of the patient's edema is not cardiogenic; rather the capillaries are leaky or damaged. The result is **high protein fluid** in interstitial spaces

Question 44

For the purposes of the pulmonary module, **pneumonia** is defined as…

Answer 44

For the purposes of the pulmonary module, **pneumonia** is defined as **inflammation of the pulmonary parenchyma** (Not necessarily caused by infection)

Question 45

Name the type of PH: 35 y/o male with systemic sclerosis and mPAP 55 mmHg

Answer 45

Group 1

Question 46

A 50 y/o healthy male has spirometry performed (dark line). What would he have to do to generate the curve shown with the dashed red line?

Answer 46

The curve with the red line is impossible due to dynamic airway compression You will never have faster flow at the end of expiration than at the beginning; the end is effort-independent

Question 47

In cardiogenic pulmonary edema, is the fluid flooding the lungs high-protein or low-protein? Why?

Answer 47

**Low protein** Fluid flooding the lungs crosses an intact endothelial barrier; proteins cannot cross, so the fluid is low in proteins

Question 48

Is the following consistent with a UIP pattern on HRCT? ## Footnote **Basilar, sub-pleural predominance**

Answer 48

Yes

Question 49

Is diarrhea associated with metabolic acidosis or metabolic alkalosis?

Answer 49

Metabolic acidosis (Non-anion gap)

Question 50

This HRCT is often associated with which exposure?

Answer 50

Asbestos Calcified pleural plaques (bright pleura) are characteristic of asbestos exposure

Question 51

A 40-year-old patient with influenza is admitted to the MICU with hypoxemic resp failure. He is receiving 90% FiO2 via high-flow nasal cannula. ABG is 7.45/46/60. ## Footnote **What is the predominant mechanism of hyoxemia?**

Answer 51

Shunt If the patient has a PaO2 of 60 even when breathign 90% oxygen, they are refractory to oxygen Shunt is the only cause of hypoxemia that is completely refractory to increased oxygen

Question 52

What is the difference between bronchiectasis and traction bronchiectasis?

Answer 52

* Bronchiectasis * Any dilation the airways * Ex: honeycombing * Traction bronchiectasis * Dilation of the airways **due to fibrosis betwen the alveoli** * A type of bronchiectasis

Question 53

A patient is experiencing pulmonary edema. The edema fluid is high in proteins What is causing the edema?

Answer 53

If the edema fluid is high in proteins, fluid is leaking out of the microvasculature due to **injury of the alveolar-capillary barrier** Proteins are not prevented from crossing the barrier, resulting in high-protein fluid in the interstitial space

Question 54

If a patient with this CT had a 30 pack-year history of smoking and notable silica exposure, what is the most likely diagnosis?

Answer 54

Occupational lung disease UIP pattern with clear occupational exposure Even though smoking may have contributed as well, the occupational exposure only has to contribute to or exacerbate a lung disease to be considered an "occupational lung disease"

Question 55

Name the type of PH: 40 y/o female with progressive dyspnea, mPAP 20 mmHg

Answer 55

Not PH mPAP must be above 25 mmHg to be classified as PH

Question 56

Which finding is specific for pneumothorax? 1. Lung sliding 2. Lung point

Answer 56

b. Lung point Both are usually seen in pneumothorax, but **lung point is specific for PTX**

Question 57

How can respiratory distress syndrome be prevented?

Answer 57

Give steroids to moms at risk for pre-term delivery prior to 34 weeks

Question 58

What is the major cause of chloride-unresponsive metabolic alkalemia?

Answer 58

Mineralcorticoid excess

Question 59

Where is the consolidation?

Answer 59

Lingula

Question 60

Is the following consistent with a UIP pattern on HRCT? **Peribronchovascular disease**

Answer 60

No

Question 61

What SaO2 would be expected in a febrile acidemic patient with a PaO2 of 60 mmHg? ## Footnote A. 96% B. 93% C. 90% D. 87%

Answer 61

D. 87% Under normal conditions, you would expect 90% SaO2 at PaO2 = 60 mmHg However, this patient si **acidemic and febrile**, which would lower her SaO2. This is a result of the Bohr effect

Question 62

Is the following consistent with a UIP pattern on HRCT? ## Footnote **Traction bronchiectasis**

Answer 62

Yes

Question 63

What blood vessels supply the majority of oxygen to the pulmonary parenchyma? What structure do they follow?

Answer 63

Bronchial arteries, follow the airway

Question 64

Which of the following is NOT a target of Pulmonary Hypertension therapy for group I PAH ## Footnote A. Prostacylin pathway B. Nitric oxide pathway C. Leukotriene pathway D. Endothelin pathway

Answer 64

C. Leukotriene pathway Group 1 = pulmonary arterial hypertension Recommended therapies: * Endothlin receptor antagonists * Endothilin is a vasoconstrictor * Phosphodiesterase inhibitors * Phopshodiesterase breaks down NO * Soluble guanate cyclase stimulators * Stimulates NO receptors * Prostacyclins

Question 65

If a patient with this CT had clinicla and serologic markers of rheumatoid arthritis, what is the most likely diagnosis?

Answer 65

RA-ILD UIP pattern, but clear cause

Question 66

Where is the consolidation?

Answer 66

Right middle lobe

Question 67

Which of the following is not associated with granulomas on lung pathology? ## Footnote A. Sarcoidosis B. Blastomycosis C. Idiopathic pulmonary fibrosis D. Hypersensitivity pneumonitis

Answer 67

C. Idiopathic pulmonary fibrosis

Question 68

Is this consistent with sarcoidosis? ## Footnote **Lower lobe predominant**

Answer 68

No

Question 69

Is this consistent with sarcoidosis? **Can occur in younger patients**

Answer 69

Yes

Question 70

What is the treatment for eosinophilic lung disease?

Answer 70

Corticosteroids

Question 71

At the following PO₂ values, what is SO₂? * 95 mmHg * 60 mmHg * 40 mmHg

Answer 71

* 95 mmHg -\> 98% * 60 mmHg -\> 90% * 40 mmHg -\> 75% (\<- venous blood)

Question 72

What cells will you see in the bronchi? What cells you see in the bronchioles?

Answer 72

* Bronchi * Pseudostratified columnar epithelium w/cilia * Mucus secreting cells * Bronchioles * Club cells * Produce a surfactant-like protein * We don't want mucus here! There is no cilia to clear it!

Question 73

Which parts of the lung abut the heart?

Answer 73

Right middle lobe Lingula

Question 74

What are the major causes of cholride unresponsive metabolic alkalosis?

Answer 74

Too much aldosterone

Question 75

What pattern is present in this HRCT?

Answer 75

UIP Pattern

Question 76

Is this consistent with sarcoidosis? ## Footnote **Loosely-formed granulomas**

Answer 76

No

Question 77

Describe the differneces between alveolar type I and type II pneumocytes

Answer 77

* Type I * Thin * Make up 95% of surface area * Type II * Secrete surfactant * Not as thin

Question 78

What are the 3 major causes of chloride-responsive metabolic alkalemia?

Answer 78

* Vomiting * NG suctioning * Diuretics

Question 79

Is this consistent with sarcoidosis? ## Footnote **Hilar adenopathy**

Answer 79

Yes

Question 80

Is the following consistent with a UIP pattern on HRCT? ## Footnote **Honeycombing**

Answer 80

Yes

Question 81

Kerley B lines are caused by... This could indicate...

Answer 81

Kerley B lines are caused by **dilated pulmonary veins** This may indicate **decompensated left heart failure** or **pulmonary venous hypertension**

Question 82

A 35-year-old female presents with a subacute cough * Never smoker * No occupational exposures * No pets * Uveitis 2 years ago * Bells Palso 2 months ago * No medications * Diffuse ronchi * CN VII Palsy * Rheum screen negative **What is the most likely diagnosis?**

Answer 82

Sarcoidosis * Multi-system involvemnt * No significant exposures * Nodular HRCT pattern

Question 83

An aggressively-growing tumor with neuroendocrine differentation is most likely...

Answer 83

Small cell carcinoma | (lots of blue cells)

Question 84

What features of asbestosis distinguish it from other ILDs?

Answer 84

* Calcified pleural plaques on HRCT * **History of asbestos exposure** * Difficult to diagnos ILD

Question 85

If a patient with this CT was taking amiodarone, what is the most-likely diagnosis?

Answer 85

Drug-induced ILD UIP pattern, but clear cause

Question 86

Is the following consistent with hypersensitivity pneumonitis? ## Footnote **Eosinophilic infiltrate**

Answer 86

No

Question 87

Give 2 examples of dead space diseases

Answer 87

Emphysema (chronic) Pulmonary Embolism (acute)

Question 88

Which PH group affects location D?

Answer 88

Group 2 - Pulmonary Venous Hypertension | (Pulmonary HTN owing to heart disease)

Question 89

Name the type of PH: 75 y/o male with severe O2-depedent COPD and mPAP 35 mmHg

Answer 89

Group 3

Question 90

What is the pathopneumonic finding for ARDS?

Answer 90

Diffuse alveolar damage (DAD)

Question 91

Which group of pulmonary hypertension patients should recieve pulmonary vasodilators?

Answer 91

Group 1 | (Pulmonary arterial hypertension)

Question 92

What causes "low pressure" aka "non-cardiogenic" pulmonary edema?

Answer 92

A problem with the integrity of the alveolar-capillary barrier due to direct or indirect injury.

Question 93

Compared to a patient with cardiogenic pulmonary edema, pulmonary edema caused by ARDS occurs at a... ## Footnote A. Lower hydrostatic pressure B. Higher hydrostatic pressure C. The same hydrostatic pressure

Answer 93

A. Lower hydrostatic pressure The driving force of the edema in ARDS is a loss of capillary endothelium integrity, rather than high pressure

Question 94

In non-cardiogenic pulmonary edema, is the fluid flooding the lungs high-protein or low-protein? Why?

Answer 94

**High protein** Intravascular proteins can freely exit the microvasculature due to injury to the alveolar-capillary barrier.

Question 95

What is bronchiectasis?

Answer 95

Bronchiectasis is the dilation and scarring of the larger airways

Question 96

A 75 year-old smoker has IPF. How will the following change relative to normal? FRC: P_ip:

Answer 96

FRC will decrease - will be \< 2 L P_ip will decrease - will be \< -5 cmH2O

Question 97

What si the pathologic correlate for Acute Interstitial Pneumonia (AIP)?

Answer 97

Diffuse alveolar damage DAD = ARDS if a cause is identified, AIP if not, Acute Eosinophilic Pneumonia if \>25% eosinophils

Question 98

What are the most relevant causes of non-anion gap metabolic alkalosis?

Answer 98

**Bicarbonate-wasting state** Diarrhea Renal Tube Abnormality NaCl

Question 99

A patient with ARDS has a PaO2 of 60 mmHg despite breathing 90% FiO2 Which of the following is likely to increase his PaO2? A. Increase FiO2 to 100% B. Decrease ScVO2 C. Intravenous fluid D. Decrease the length of his endotracheal tube E. Increasing airway pressure

Answer 99

E. Increasing airway pressure Increasing airway pressure would help to pop open some alveoli, which are likely getting crushed by the fluid in the interstitial spaces.

Question 100

Is the following consistent with a UIP pattern on HRCT? ## Footnote **Consolidation**

Answer 100

No

Question 101

What is the definition of pulmonary edema?

Answer 101

Extravascular water in the interstitium of the lung (Caused by fluid leaving the microvasculature, thus flooding the interstitial space between alveoli)

Question 102

Which of the following is the most likely pathogen to explain the X-ray finding? ## Footnote A. Strep pneumoniae B. Mycoplasma C. Legionella D. Haemophilus influenzae

Answer 102

D. Haemophilus influenzae Causes epiglotitis - cxr finding = thumb sign

Question 103

What is the DDx for low PAO₂ with a normal (\<10) A-a difference?

Answer 103

Low Patm - High altitude Low FiO₂ - Fire High PaCO₂ - Hypoventilation

Question 104

What factors distinguish the presentation of sarcoidosis from other interstitial lung diseases?

Answer 104

* Can occur in younger patients * Involvement of other systems * Skin, nerves, kidneys, liver, heart * Upper lobe predominant * Hilar adenopathy * Well-formed, non-caseating granulomas

Question 105

What is the predominant finding of this HRCT?

Answer 105

Diffuse ground glass opacities

Question 106

At the following SO₂ values, what is PO₂? * 98% * 90% * 75%

Answer 106

At these SO₂ values, PO₂ is... * 98% = 95 mmHg * 90% = 60 mmHg * 75% = 40 mmHg (\<- venous blood)

Question 107

What is Acute Respiratory Distress Syndrome (ARDS)?

Answer 107

Direct or indirect injury destroys the alveolar-capillary barrier. Protein-rich edema fluid fills the lung, leading to **severe hypoxemic respiratory failure**

Question 108

Is this consistent with sarcoidosis? ## Footnote **Well-formed, noncaseating ganulomas**

Answer 108

Yes

Question 109

The predominant finding in this CT image is which of the following? A. Ground glass opacities B. Consolidation C. Honeycombing D. Emphysema

Answer 109

C. Honeycombing

Question 110

How can you differentiate between asthma and emphysema on lung function tests?

Answer 110

**DLCO** will be **low in a patient with emphysema**, but **normal in a patient with asthma**

Question 111

Community acquired pneumonia with interstitial opacities is most likely caused by…

Answer 111

Viruses ## Footnote * Mycoplasma pneumoniae* * Chlamydia pneumoniae* * Legionella pneumophila*

Question 112

The **\_\_\_\_\_\_\_\_\_\_\_** is the thin area of connective tissue that runs between alveoli

Answer 112

The **_interstitium_** is the thin area of connective tissue that runs between alveoli

Question 113

What does this HRCT show a UIP pattern? How do you know?

Answer 113

Yes Basilar predominant sub-pleural fibrosis and honeycombing

Question 114

Which fungal pneumonia should be treated with trimethoprim sulfamethoxazole?

Answer 114

Pneumocystosis | (Caused by *Pneumocystis jirovecii*)

Question 115

What are the two categories of bronchiectasis?

Answer 115

1. Caused by cystic fibrosis 2. Not caused by cystic fibrosis * May be caused by recurrent infections, non-TB mycobacterial disease, and secondary to connective disease

Question 116

Lymphocytic exudate in a pleural effusion is associated with...

Answer 116

Malignancy, TB, or autoimmune disease

Question 117

What is the definition of respiratory distress syndrome? What causes it?

Answer 117

Respiratory failure in **premature infants** Caused by **lack of surfactant** (if it continues, it is called **bronchopulmonary dysplasia**)

Question 118

An 85-year-old female develops a fever and thick purulent secretions on day 6 of her ICU stay. Which of the following is unlikely to be a causative pathogen? ## Footnote A. MRSA B. E. Coli C. Legionella pneumophila D. Acinetobacter baumanni

Answer 118

C. Legionella pneumophila

Question 119

G551D is what type of CFTR mutation 1. Class I 2. Class II 3. Class III 4. Class IV 5. Class V 6. Class VI

Answer 119

c. Class III

Question 120

COPD is characterized by ________ remodeling Asthma is characterized by ________ remodeling

Answer 120

COPD is characterized by **_small airway_** remodeling Asthma is characterized by **_basement membrane_** remodeling

Question 121

Name the type of PH: 55 y/o female with prior PE, abnormal V/Q scan 2 years later, and mPAP 45 mmHg

Answer 121

Group 4

Question 122

Is this consistent with sarcoidosis? ## Footnote **Upper lobe predominant**

Answer 122

Yes

Question 123

What are the major causes of respiratory acidosis?

Answer 123

Either... * The patient can't breathe * Muscles not strong enough * Obstruction/obstructive physiology * The patient won't breathe * CNS dysfunction * Traumatic injury

Question 124

A 68 year old female presents with a subacute cough * Never smoker * No occupational exposures * Lives in an old house w/mold damage, recently renovated * No medications * Upper zone crackles * No rash * Rheum screen negative **What is the most likely diagnosis?**

Answer 124

Hypersensitivity pneumonitis

Question 125

An acutely ill child has PFTs performed. What is the likely viral pathogen?

Answer 125

PIV-1 or PIV-2 These pathogens cause croup, which results in upper airway obstruction. Inhibits **inspiration**

Question 126

Name the type of PH: 75 y/o male with HFpEF and mPAP 35 mmHg

Answer 126

Group 2

Question 127

A patient with a massive PE is stabilized with lytic therapy. 5 days later she is nearing discharge. There is no clear reason why she developed a PE. What would you recommend for duration of anticoagulation?

Answer 127

3 month minimum, consider indefinite therapy if low bleeding risk (This was an unprovoked PE, because a clear cause of the PE was not identified)

Question 128

What are the main causes of primary respiratory alkalosis?

Answer 128

Anything that "ramps up" your system Even though some of these things would initially cause increaed CO2 production, our body's response is to hyperventilate * Pain * Anxiety * PE * Fever * Stimulants * Sepsis * Pregnancy * Cirrhosis * Mild lung disease

Question 129

What lung disease reduces tethering of the alveoli?

Answer 129

Emphysema -\> more likely to collapse more parts of the lung during expieration (creating obstruction to airflow exiting the lung)

Question 130

A 75 year-old smoker has severe emphysema. How will the following change relative to normal? FRC: P_ip:

Answer 130

FRC will increase - will be \> 2 L P_ip will increase - will be \> -5 cmH2O

Question 131

What are the key features of a UIP pattern on CT?

Answer 131

* Honeycombing * Traction bronchiectasis * Basilar predominant * Sub-pleural

Question 132

A BAL with \>25% eosinophils indicates the presence of which ILD?

Answer 132

Eosinophilic lung disease * Acute eosinophilic pneumonia * Chronic eosinophilic pneumonia

Question 133

What is the recommened treatment for IPF?

Answer 133

Anti-fibrotic agent Nintedanib or Pirfenidone

Question 134

What are the major causes of chloride-responsive metabolic alkalosis?

Answer 134

Vomiting Diuretic therapy

Question 135

In "airways diseases," the pathology is centered in the __________ airways"

Answer 135

In "airways diseases," the pathology is centered in the **_larger_** airways"

Question 136

The point at which the recoil force of the chest wall equals the recoil force of the lung is called what?

Answer 136

Functional Residual Capacity (FRC) Normal ~2L

Question 137

In a normal BAL, which cells are most common?

Answer 137

Alveolar macrophages

Question 138

What breathing pattern is this? What pathologyis it associated with?

Answer 138

Cheyne-stokes breathing Apnea/fast breathing/apnea/fast breathing etx. Associated with chronic heart failure

Question 139

What features of hypersensitivity pneumonitis help distinguish it from other ILDs?

Answer 139

* Clear exposure * Upper lobe nodules and air trapping * Loose granulomas on biopsy

Question 140

Is the following consistent with a UIP pattern on HRCT? ## Footnote **Apical predominance**

Answer 140

No

Question 141

∆F5O8del is what type of CFTR mutation 1. Class I 2. Class II 3. Class III 4. Class IV 5. Class V 6. Class VI

Answer 141

b. Class II

Question 142

What pattern is present in this biopsy? What is circled in white? What is circled in red?

Answer 142

UIP pattern **Red** = fibrotic area: no air space **White** = fibroblastic foci Look for temporal and spatial heterogeneity. Microscopic honeycombing may also be present

Question 143

Where is the radiographic abnormality? ## Footnote A. Pleura B. Parenchyma C. Lymph nodes D. Airway

Answer 143

C. Lymph Nodes