Pulmonary/Critical Care - random topics

Question 1

criteria for diagnosis of ABPA (allergic bronchopulmonary aspergillosis)

Answer 1

recurrent, hard to treat asthma
productive cough
expectoration of mucus plugs
chest imaging findings of bronchiectasis or infiltrates

Question 2

tests for confirmation of ABPA (allergic bronchopulmonary aspergillosis)

Answer 2

serum IgE against A.fumigatus
positive aspergillus skin test

Question 3

treatment options for exercise induced asthma

Answer 3

SABA + ICS before exercise
LABA + ICS before exercise

Question 4

Group 1 pulmonary HTN

Answer 4

Pulmonary artery HTN
Idiopathic and heritable
congenital heart disease
HIV
connective tissue disorders (scleroderma, SLE, RA, mixed CTD, Raynaud’s)
Drugs (appetite suppressants, toxic rapeseed oil, benfluorex, amphetamines, cocaine, interferon therapy, dasatinib, St. John’s wort)
Portal HTN/porto-pulmonary HTN from chronic liver disease
Schistosomiasis

Question 5

Group 2 pulmonary HTN

Answer 5

left heart disease

Question 6

Group 3 pulmonary HTN

Answer 6

chronic lung disease/chronic hypoxia

Question 7

Group 4 pulmonary HTN

Answer 7

CTEPH

Question 8

Group 5 pulmonary HTN

Answer 8

Multifactorial:
hematologic disorders (chronic anemia, thalassemia, multiple myeloma, myeloproliferative neoplasms)
sarcoidosis
neurofibromatosis
metabolic disorders, glycogen storage disorders
chronic renal failure, hemodialysis

Question 9

Diagnosis of pulmonary HTN

Answer 9

TTE
Right heart catheterization
- showing:
mPAP (mean pulmonary artery pressure) >20 mmHg
PASP >35 mmHg (with presence of RV dysfunction, hypertrophy, increased wall thickness)

Question 10

Diagnosis of CTEPH

Answer 10

v/q scan

Question 11

Diagnosis of group 2 pulmonary HTN

Answer 11

TTE showing left heart dysfunction or left atrial dilation
PCWP >15 mmHg on RHC
LHC with elevated LVEDP

Question 12

Diagnosis of group 3 pulmonary HTN

Answer 12

abnormal lung imaging, abnormal PFTs, abnormal sleep study, abnormal polysomnography, etc.