Pulmonary 1

Question 1

What percentage of decreased FEV1/FVC is needed to diagnosed airway obstruction related to COPD?

Answer 1

< 70%

Question 2

What is the most common cause of bronchiectasis in US?

Answer 2

CF - Pseudomonas aeruginosa

Question 3

What is the treatment for CF?

Answer 3

Azithromycin or clarithromycin.

Question 4

What are the CT scan findings of CF?

Answer 4

Thickened bronchial walls, airway dilatation, and lack of tapering of the airway. Tram-track appearance, signet ring sign.

Question 5

Chest x-ray shows bilateral hilar lymphadenopathy.
PFT’s are restrictive pattern.
Tissue biopsy is noncaseating granulomas
Labs show increased ACE levels.

Answer 5

Sarcoidosis

Can by asymptomatic, cough, dyspnea, rales.
Skin shows erythema nodosum, lupus pernio.

Question 6

What is the management of asymptomatic sarcoidosis vs symptomatic?

Answer 6

Asymptomatic is observation

Symptomatic you use oral corticosteroids as first line management.

Question 7

Progressive scarring of the lungs due to an unknown causes.
MC in men > 40 years of age.
CT and CXR show reticular opacities (honeycombing) , reticular honeycombing focal ground-glass opacities.
PFT’s show a restrictive pattern - normal or increased FEV1/FVC, Decreased lung volumes.

Answer 7

Idiopathic fibrosing interstitial pneumonia (pulmonary fibrosis)

Question 8

What is the managment for pulmonary fibrosis?

Answer 8

Lung transplant

Question 9

Occupational pulmonary disease from coal mining, quarry work with granit, slate, quartz, pottery, sandblasting, glass, cement, masonry, hydraulic fracturing.
Multiple small round nodular opacities primarily in the upper lobes. Eggshell calcifications of hilar and mediastinal nodes.

Answer 9

Silicosis

Question 10

Tx for silicosis

Answer 10

Removal from exposure, supportive management: steroids, oxygen, rehab.

Question 11

What is Caplan syndrome?

Answer 11

RA + coal worker pneumoconiosis

Question 12

What pattern is shown on PFT’s for coal worker’s pneumoconiosis?
What will the CXR show?

Answer 12

Obstructive

small nodules in upper lung with hyperinflation of lower lobes.

Question 13

Ocupational pulmanary disease in those who work in aerospace, electronics, ceramics, tool and dye manufacturing, jewelry making, fluorescent light bulbs. Anything with nickel, aluminum and copper industries.
PFT shows restrictive pattern.
Non caseating granulomas.

Answer 13

Berylliosis

Question 14

What is the management for berylliosis?

Answer 14

Steroids (prednisone), oxygen.

Second line is methotrexate.

Question 15

Lung disease due to cotton, flax or hemp dust.

Symptoms get worse at the beginning of work week then improve later in the week. Monday fever.

Answer 15

Byssinosis