Pulmon:

Question 1

Pulmonary HTN: RHF. prominent S2.
​​​​​​​Definitive diagnosis with right heart catheterization is required, with mean pulmonary arterial pressure >25 mm Hg (Echo allows estimation) providing confirmation.

Answer 1

1

Question 2

Multiple/recurrent episodes of bacterial pneumonia, which respond to antibiotics.
-Most likely due to a partial obstruction of the bronchus or a branch of the bronchus supplying the lobe.

Answer 2

1

Question 3

TB: Active pulmonary tuberculosis: at risk of transmitting Mycobacterium tuberculosis to close contacts for up to 3 months prior to the onset of symptoms!
Dx: Potential exposure: tuberculin skin testing, interferon-gamma release assay is required.
-If initial screening is negative, repeat testing at 8-10 weeks can confirm whether transmission.
*TB is positive: chest x-ray and sputum testing for acid-fast bacilli are required to evaluate for active TB.
-If both of these additional tests are negative (and no symptoms of TB are present), patients are usually treated for latent TB with isoniazid and pyridoxine.

Answer 3

2

Question 4

*PE: Although most patients with PE should be started on anticoagulation (eg, heparin), those with hemodynamic instability should have anticoagulation held until after thrombolytic therapy (tissue plasmiogen activator (tPA) to minimize bleeding risk.

Answer 4

3

Question 5

HIV with Pneumocystis pneumonia: CD4: <200, steroid use. *Indolent. Inc LDH, diff bilat reticulonod infiltrate
Dx: Bronchoalveolar lavage
Tx: TMP-SMX +- corticosteroid
*Corticosteroids in addition to antimicrobials
-if arterial blood gas analysis shows alveolar-arterial oxygen gradient >35 mm Hg and/or arterial oxygen tension <70 mm on room air.

Answer 5

4