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Pulm by Minnie: AH Update > Pulm SAS and Misc. Review > Flashcards

Pulm SAS and Misc. Review Flashcards

Equations are in the lectures for which they are relevant

1
Q

Is the following consistent with hypersensitivity pneumonitis?

Upper lobe nodules

A

Yes

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2
Q

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

A
  • H. influenzae*
  • S. pneumoniae*
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3
Q

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?

A

IPF

Idiopathic = no clear cause of the lung disease

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4
Q

Is the following consistent with a UIP pattern on HRCT?

Diffuse ground glass

A

No

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5
Q

Is this consistent with sarcoidosis?

Occurs exclusively in smokers

A

No

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6
Q

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?

A

Lymphatics and pulmonary veins

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7
Q

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

A

Aspergillosis

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8
Q

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

A

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

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9
Q

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 V̇A

B. Nothing, V̇E is unchanged

C. You have lowered V̇D

D. You have increased V̇E

A

A. You have lowered V̇A

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10
Q

Is the following consistent with hypersensitivity pneumonitis?

Lymphocystic infiltrate

A

Yes

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11
Q

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 Palv (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

A

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 = Palv - Pip

Normal: 20 - (-5) = 25

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

Palv should be increased in order to maintain transpulmonary pressure

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12
Q

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

A

Amiodarone

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

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13
Q

How does hypoalbuminemia cause edema?

A

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

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14
Q

Is this pattern nodular or reticular

A

Nodular

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15
Q

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

A

Loosly formed, non-caseating granulomas

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16
Q

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?

A

Most likely = ARDS

Most likely if no inciting incident = Acute Interstitial Pneumonia

(AIP = Idiopathic ARDS)

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17
Q

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

A

Hypersensitivity Pneumonitis (HP)

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18
Q

Neutrohpilic exudate in a pleural effusion is associated wtih…

A

Infection (ex: bacterial pneumonia)

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19
Q

Which PH group affects location C?

A

Group 3 - Pulmonary Hypertension Owing to Lung Disease

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20
Q

What is lymphangitic carcinomatosis?

A

Dilation of lymphatic channels

May indicate widespread malignancy or pulmonary venous hypertension

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21
Q

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

What is causing the edema?

A

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

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22
Q

Is vomiting associated with metabolic acidosis or metabolic alkalosis?

A

Metabolic alkalosis (chloride responsive)

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23
Q

Which PH group affects location A?

A

Group 4 - Chronic Thromoboembolic Pulmonary HTN

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24
Q

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

A

Squamous cell carcinoma

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25
Q

What are the common driver mutations of adenocarcinoma?

A

ALK and EGFR

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26
Q

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

A

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

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27
Q

What causes “high pressure” aka “cardiogenic” pulmonary edema?

A

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

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28
Q

What is the DDx for hypoxemia with a large A-a difference?

(A-a > 10 is abnormal)

A
  • 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
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29
Q

Which vessels in the lung become enlarged when a patient has left heart failure?

What will you see on an HRCT?

A

Left heart failure = increased left atrial pressure

  • > Increased pulmonary vein size
  • > Interlobular septal thickening
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30
Q

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

A

Starling equation:

QE = KF [(Pmv - Pis) - σ (πmv - πis)]

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

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31
Q

Is this consistent with sarcoidosis?

Multi-system involvement

A

Yes

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32
Q

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

A

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

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33
Q

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

A

Silhouette Sign

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

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34
Q

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

A

Sillicosis with progressive massive fibrosis

or

Coal miners pneumocosis with progressive massive fibrosis

Diagnose based off of clinical histor

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35
Q

What usually mediates indirect injury to the lung?

A

Cytokines

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36
Q

Is the following consistent with a UIP pattern on HRCT?

Diffuse nodules

A

No

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37
Q

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

A

Acute respiratory distress syndrome (ARDS)

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38
Q

Which pulmonary hypertension group is most prevalent?

A

Group 2 - Pulmonary venous hypertension

Group 2 > Group 3 > Group 4 > Group 1

(owing to left heart disease)

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39
Q

Which PH group affects location B?

A

Group 1 - Pulmonary Arterial Hypertension

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40
Q

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?

A

Obtain a D-dimer

If >500 ng/mL, start anticoagulants and order CTPA

If <500 ng/mL, no further testing is needed

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41
Q

Which variable is most strongly correlated with outcome in CF?

A. Genetics

B. Number of affected organs

C. Severity of diabetes

D. Lung function

A

D. Lung function

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42
Q

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?

A

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

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43
Q

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

A

For the purposes of the pulmonary module, pneumonia is defined as inflammation of the pulmonary parenchyma

(Not necessarily caused by infection)

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44
Q

Name the type of PH:

35 y/o male with systemic sclerosis and mPAP 55 mmHg

A

Group 1

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45
Q

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?

A

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

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46
Q

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

A

Low protein

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

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47
Q

Is the following consistent with a UIP pattern on HRCT?

Basilar, sub-pleural predominance

A

Yes

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48
Q

Is diarrhea associated with metabolic acidosis or metabolic alkalosis?

A

Metabolic acidosis (Non-anion gap)

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49
Q

This HRCT is often associated with which exposure?

A

Asbestos

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

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50
Q

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.

What is the predominant mechanism of hyoxemia?

A

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

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51
Q

What is the difference between bronchiectasis and traction bronchiectasis?

A
  • Bronchiectasis
    • Any dilation the airways
      • Ex: honeycombing
  • Traction bronchiectasis
    • Dilation of the airways due to fibrosis betwen the alveoli
    • A type of bronchiectasis
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52
Q

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

What is causing the edema?

A

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

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53
Q

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

A

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”

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54
Q

Name the type of PH:

40 y/o female with progressive dyspnea, mPAP 20 mmHg

A

Not PH

mPAP must be above 25 mmHg to be classified as PH

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55
Q

Which finding is specific for pneumothorax?

  1. Lung sliding
  2. Lung point
A

b. Lung point

Both are usually seen in pneumothorax, but lung point is specific for PTX

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56
Q

How can respiratory distress syndrome be prevented?

A

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

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57
Q

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

A

Mineralcorticoid excess

58
Q

Where is the consolidation?

A

Lingula

59
Q

Is the following consistent with a UIP pattern on HRCT?

Peribronchovascular disease

A

No

60
Q

What SaO2 would be expected in a febrile acidemic patient with a PaO2 of 60 mmHg?

A. 96%

B. 93%

C. 90%

D. 87%

A

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

61
Q

Is the following consistent with a UIP pattern on HRCT?

Traction bronchiectasis

A

Yes

62
Q

What blood vessels supply the majority of oxygen to the pulmonary parenchyma?

What structure do they follow?

A

Bronchial arteries, follow the airway

63
Q

Which of the following is NOT a target of Pulmonary Hypertension therapy for group I PAH

A. Prostacylin pathway

B. Nitric oxide pathway

C. Leukotriene pathway

D. Endothelin pathway

A

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
64
Q

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

A

RA-ILD

UIP pattern, but clear cause

65
Q

Where is the consolidation?

A

Right middle lobe

66
Q

Which of the following is not associated with granulomas on lung pathology?

A. Sarcoidosis

B. Blastomycosis

C. Idiopathic pulmonary fibrosis

D. Hypersensitivity pneumonitis

A

C. Idiopathic pulmonary fibrosis

67
Q

Is this consistent with sarcoidosis?

Lower lobe predominant

A

No

68
Q

Is this consistent with sarcoidosis?

Can occur in younger patients

A

Yes

69
Q

What is the treatment for eosinophilic lung disease?

A

Corticosteroids

70
Q

At the following PO2 values, what is SO2?

  • 95 mmHg
  • 60 mmHg
  • 40 mmHg
A
  • 95 mmHg -> 98%
  • 60 mmHg -> 90%
  • 40 mmHg -> 75% (
71
Q

What cells will you see in the bronchi?

What cells you see in the bronchioles?

A
  • 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!
72
Q

Which parts of the lung abut the heart?

A

Right middle lobe

Lingula

73
Q

What are the major causes of cholride unresponsive metabolic alkalosis?

A

Too much aldosterone

74
Q

What pattern is present in this HRCT?

A

UIP Pattern

75
Q

Is this consistent with sarcoidosis?

Loosely-formed granulomas

A

No

76
Q

Describe the differneces between alveolar type I and type II pneumocytes

A
  • Type I
    • Thin
    • Make up 95% of surface area
  • Type II
    • Secrete surfactant
    • Not as thin
77
Q

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

A
  • Vomiting
  • NG suctioning
  • Diuretics
78
Q

Is this consistent with sarcoidosis?

Hilar adenopathy

A

Yes

79
Q

Is the following consistent with a UIP pattern on HRCT?

Honeycombing

A

Yes

80
Q

Kerley B lines are caused by…

This could indicate…

A

Kerley B lines are caused by dilated pulmonary veins

This may indicate decompensated left heart failure or pulmonary venous hypertension

81
Q

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?

A

Sarcoidosis

  • Multi-system involvemnt
  • No significant exposures
  • Nodular HRCT pattern
82
Q

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

A

Small cell carcinoma

(lots of blue cells)

83
Q

What features of asbestosis distinguish it from other ILDs?

A
  • Calcified pleural plaques on HRCT
  • History of asbestos exposure
  • Difficult to diagnos ILD
84
Q

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

A

Drug-induced ILD

UIP pattern, but clear cause

85
Q

Is the following consistent with hypersensitivity pneumonitis?

Eosinophilic infiltrate

A

No

86
Q

Give 2 examples of dead space diseases

A

Emphysema (chronic)

Pulmonary Embolism (acute)

87
Q

Which PH group affects location D?

A

Group 2 - Pulmonary Venous Hypertension

(Pulmonary HTN owing to heart disease)

88
Q

Name the type of PH:

75 y/o male with severe O2-depedent COPD and mPAP 35 mmHg

A

Group 3

89
Q

What is the pathopneumonic finding for ARDS?

A

Diffuse alveolar damage (DAD)

90
Q

Which group of pulmonary hypertension patients should recieve pulmonary vasodilators?

A

Group 1

(Pulmonary arterial hypertension)

91
Q

What causes “low pressure” aka “non-cardiogenic” pulmonary edema?

A

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

92
Q

Compared to a patient with cardiogenic pulmonary edema, pulmonary edema caused by ARDS occurs at a…

A. Lower hydrostatic pressure

B. Higher hydrostatic pressure

C. The same hydrostatic pressure

A

A. Lower hydrostatic pressure

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

93
Q

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

A

High protein

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

94
Q

What is bronchiectasis?

A

Bronchiectasis is the dilation and scarring of the larger airways

95
Q

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

FRC:

Pip:

A

FRC will decrease - will be

Pip will decrease - will be

96
Q

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

A

Diffuse alveolar damage

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

97
Q

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

A

Bicarbonate-wasting state

Diarrhea

Renal Tube Abnormality

NaCl

98
Q

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

A

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.

99
Q

Is the following consistent with a UIP pattern on HRCT?

Consolidation

A

No

100
Q

What is the definition of pulmonary edema?

A

Extravascular water in the interstitium of the lung

(Caused by fluid leaving the microvasculature, thus flooding the interstitial space between alveoli)

101
Q

Which of the following is the most likely pathogen to explain the X-ray finding?

A. Strep pneumoniae

B. Mycoplasma

C. Legionella

D. Haemophilus influenzae

A

D. Haemophilus influenzae

Causes epiglotitis - cxr finding = thumb sign

102
Q

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

A

Low Patm - High altitude

Low FiO2 - Fire

High PaCO2 - Hypoventilation

103
Q

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

A
  • Can occur in younger patients
  • Involvement of other systems
    • Skin, nerves, kidneys, liver, heart
  • Upper lobe predominant
  • Hilar adenopathy
  • Well-formed, non-caseating granulomas
104
Q

What is the predominant finding of this HRCT?

A

Diffuse ground glass opacities

105
Q

At the following SO2 values, what is PO2?

  • 98%
  • 90%
  • 75%
A

At these SO2 values, PO2 is…

  • 98% = 95 mmHg
  • 90% = 60 mmHg
  • 75% = 40 mmHg (
106
Q

What is Acute Respiratory Distress Syndrome (ARDS)?

A

Direct or indirect injury destroys the alveolar-capillary barrier.

Protein-rich edema fluid fills the lung, leading to severe hypoxemic respiratory failure

107
Q

Is this consistent with sarcoidosis?

Well-formed, noncaseating ganulomas

A

Yes

108
Q

The predominant finding in this CT image is which of the following?

A. Ground glass opacities

B. Consolidation

C. Honeycombing

D. Emphysema

A

C. Honeycombing

109
Q

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

A

DLCO will be low in a patient with emphysema,

but normal in a patient with asthma

110
Q

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

A

Viruses

  • Mycoplasma pneumoniae*
  • Chlamydia pneumoniae*
  • Legionella pneumophila*
111
Q

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

A

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

112
Q

What does this HRCT show a UIP pattern?

How do you know?

A

Yes

Basilar predominant sub-pleural fibrosis and honeycombing

113
Q

Which fungal pneumonia should be treated with trimethoprim sulfamethoxazole?

A

Pneumocystosis

(Caused by Pneumocystis jirovecii)

114
Q

What are the two categories of bronchiectasis?

A
  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
115
Q

Lymphocytic exudate in a pleural effusion is associated with…

A

Malignancy, TB, or autoimmune disease

116
Q

What is the definition of respiratory distress syndrome?

What causes it?

A

Respiratory failure in premature infants

Caused by lack of surfactant

(if it continues, it is called bronchopulmonary dysplasia)

117
Q

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?

A. MRSA

B. E. Coli

C. Legionella pneumophila

D. Acinetobacter baumanni

A

C. Legionella pneumophila

118
Q

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
A

c. Class III

119
Q

COPD is characterized by ________ remodeling

Asthma is characterized by ________ remodeling

A

COPD is characterized by small airway remodeling

Asthma is characterized by basement membrane remodeling

120
Q

Name the type of PH:

55 y/o female with prior PE, abnormal V/Q scan 2 years later, and mPAP 45 mmHg

A

Group 4

121
Q

Is this consistent with sarcoidosis?

Upper lobe predominant

A

Yes

122
Q

What are the major causes of respiratory acidosis?

A

Either…

  • The patient can’t breathe
    • Muscles not strong enough
    • Obstruction/obstructive physiology
  • The patient won’t breathe
    • CNS dysfunction
    • Traumatic injury
123
Q

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?

A

Hypersensitivity pneumonitis

124
Q

An acutely ill child has PFTs performed.

What is the likely viral pathogen?

A

PIV-1 or PIV-2

These pathogens cause croup, which results in upper airway obstruction. Inhibits inspiration

125
Q

Name the type of PH:

75 y/o male with HFpEF and mPAP 35 mmHg

A

Group 2

126
Q

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?

A

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)

127
Q

What are the main causes of primary respiratory alkalosis?

A

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
128
Q

What lung disease reduces tethering of the alveoli?

A

Emphysema -> more likely to collapse more parts of the lung during expieration

(creating obstruction to airflow exiting the lung)

129
Q

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

FRC:

Pip:

A

FRC will increase - will be > 2 L

Pip will increase - will be > -5 cmH2O

130
Q

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

A
  • Honeycombing
  • Traction bronchiectasis
  • Basilar predominant
  • Sub-pleural
131
Q

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

A

Eosinophilic lung disease

  • Acute eosinophilic pneumonia
  • Chronic eosinophilic pneumonia
132
Q

What is the recommened treatment for IPF?

A

Anti-fibrotic agent

Nintedanib or Pirfenidone

133
Q

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

A

Vomiting

Diuretic therapy

134
Q

In “airways diseases,” the pathology is centered in the __________ airways”

A

In “airways diseases,” the pathology is centered in the larger airways”

135
Q

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

A

Functional Residual Capacity (FRC)

Normal ~2L

136
Q

In a normal BAL, which cells are most common?

A

Alveolar macrophages

137
Q

What breathing pattern is this?

What pathologyis it associated with?

A

Cheyne-stokes breathing

Apnea/fast breathing/apnea/fast breathing etx.

Associated with chronic heart failure

138
Q

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

A
  • Clear exposure
  • Upper lobe nodules and air trapping
  • Loose granulomas on biopsy
139
Q

Is the following consistent with a UIP pattern on HRCT?

Apical predominance

A

No

140
Q

∆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
A

b. Class II

141
Q

What pattern is present in this biopsy?

What is circled in white?

What is circled in red?

A

UIP pattern

Red = fibrotic area: no air space

White = fibroblastic foci

Look for temporal and spatial heterogeneity. Microscopic honeycombing may also be present

142
Q

Where is the radiographic abnormality?

A. Pleura

B. Parenchyma

C. Lymph nodes

D. Airway

A

C. Lymph Nodes

Pulm by Minnie: AH Update (34 decks)

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