Pulmonology

Question 1

Retired construction worker, cough and DOB
100packyear smoker
Sputum w golden brown beaded rods
CXR interstitial infiltrates, calcified plaques

Answer 1

Asbestosis
HR for malig mesothelioma and bronchogenic ca
Tx: O2, bronchodil, antibiotics, smoking cessation

Question 2

Child, intermittent dyspnea, worse w exercise and exposure to cats and pollen
tachypnea, wheezing, hyperresonant

Answer 2

Bronchial asthma
Curshmann, Charcot leyden, hyperactive airways, bronchospasm edema mucus
Tx: SABA, steroids, cromolyn, zafirlukast

Question 3

Fever 24 hours post op

Scattered rales, decreased BS, tachypnea

Answer 3

Post op atelectasis

Tx: chest physiotherapy, mucolytics

Question 4

Exertional dyspnea, productive cough, hemoptysis
Hx of CF, recurrent pulmo infections
Dec FEV1/FVC, CXR Honeycomb, dilated bronchioles wit signet ring appearance

Answer 4

Bronchiectasis
Kartagener’s, CF, Bordetella, RSV, TB
Tx: supportive, bronchodil, antibiotics

Question 5

Late onset asthma, unresponsive to meds
Chest pain, claudication, mild HPN, purpura
Proteinuria, granular casts

Answer 5

Churg strauss

Tx: prednisolone

Question 6

Farmer exposed to moldy hay, dyspnea, fatigue
Tachypnea, bilateral fine rales
Serum antibodies vs Actinomyces

Answer 6

Hypersensitivity pneumonitis

Question 7

80packyear smoking hx, wt loss, loss of appetite
Cachexia, clubbing, no BS, dullness
CXR hilar mass, obstructive atelectasis ipsi

Answer 7

Lung cancer
Keratin pearls, pancoast tumor can lead to horner’s
Tx: surgical resection

Question 8

Mining and quarrying, dyspnea, dry cough
Reduced chest expansion, dry crackles
CXR eggshell calcification of LN, hilar LN (+)

Answer 8

Silicosis
HR for TB
Tx: Avoid exposure