Pulmonology

Question 1

4 types of CT scans

Answer 1

1. cCT (conventional)
2. HRCT (high-resolution)
3. hCT (helical): single-section and multidetector (MDCT)
4. electron beam

Question 2

used to see anatomy, but not great for lungs

Answer 2

conventional CT

Question 3

used when dz is suspected by H&P, but CXR is either normal or only slightly abnormal (ILD, emphysema (from a1-antitrypsin deficiency), bronchiectasis, lymphangitic spread of malignancy)

Answer 3

HRCT (high-resolution)

Question 4

first place to start when you suspect ILD or BRONCHIECTASIS

Answer 4

HRCT (high-resolution)

Question 5

does hCT (helical): single-section use IV CONTRAST?

Answer 5

yes

Question 6

best method for performing CT-pulmonary angiography, and why

Answer 6

• multidetector (MDCT)

- see subsegmental emboli better than single-section

Question 7

3 advantages of multidetector (MDCT)

Answer 7

1. scan large sections on single breath
2. collecting images of specific blood vessels
3. “high resolution”

Question 8

CT buzzwords:

• diagnose ILD or bronchiectasis

Answer 8

HRCT (high-resolution)

Question 9

CT buzzwords:

• w/u solitary pulmonary nodule

Answer 9

hCT or HRCT

Question 10

CT buzzwords:

• diagnose PE

Answer 10

CTPA (which can be done by MDCT)

Question 11

when is MRI useful when evaluating pulmonary disease?

Answer 11

• evaluating tumors near adjacent blood vessels or nerves

- for determining what is TUMOR and what is NOT

Question 12

• ATYPICAL clinical features and NON-diagnostic HRCT
• need to exclude neoplastic and infectious causes of an interstitial pattern
• what test should be done?

Answer 12

lung biopsy

Question 13

when should a lung bx be done?

Answer 13

• ILD
• lymphangitic spread of cancer
• eosinophilic PNA
• vasculitis
• certain infections

Question 14

is NO LONGER routinely used in evaluating ILDs

Answer 14

lung bx

Question 15

when is lung bx used in evaluating ILDs?

Answer 15

atypical cases when HRCT is NOT diagnostic

Question 16

findings in bronchoalveolar lavage:

• normal findings

Answer 16

• < 1% neutrophils
• < 16% lymphocytes
• no eosinophils

Question 17

findings in bronchoalveolar lavage:

• IPF
• collagen vascular disease
• asbestosis
• suppurative infections
• granulomatosis w/ polyangiitis
• ARDS

Answer 17

increased neutrophils

Question 18

findings in bronchoalveolar lavage:

• hypersensitivity pneumonitis
• sarcoidosis

Answer 18

increased lymphocytes

Question 19

findings in bronchoalveolar lavage:

• acute and chronic eosinophilic PNA
• some ARDS
• Churg-Strauss
• Loffler syndrome
• tropical eosinophilia
• parasite infection (esp. ascariasis)
• TB
• collagen vascular disease
• malignancy
• drug reactions

Answer 19

increased eosinophils

Question 20

• 95% sensitive for PJP in AIDS pts
• CMV PNA (inclusion bodies)
• disseminated TB
• fungal infection
• diagnosing PNA in ARDS pts

Answer 20

diagnosis of specific types of PNAs

Question 21

findings in bronchoalveolar lavage:

• alveolar proteinosis

Answer 21

• turbid

- PAS-positive material

Question 22

findings in bronchoalveolar lavage:

• Langerhans cell histiocytosis

Answer 22

Langerhans cells

Question 23

findings in bronchoalveolar lavage:

• diffuse alveolar hemorrhage

Answer 23

• bloody

- large amount of hemosiderin in alveolar macrophages

Question 24

findings in bronchoalveolar lavage:

• cytotoxic lung injury

Answer 24

hyperplastic and atypical type 2 pneumocytes

Question 25

findings in bronchoalveolar lavage:

• amiodarone-induced disease

Answer 25

“foamy” changes w/ lamellar inclusions

Question 26

• gold standard for PE

- RARELY REQUIRED anymore

Answer 26

pulmonary angiogram

Question 27

partial pressure O2 =

Answer 27

FiO2 x Pb

fraction of inspired oxygen
(atmospheric pressure)

Question 28

ALVEOLAR GAS EQUATION

Answer 28

PAO2 = [(Pb - PH2O) x FiO2] - [PaCO2/0.8]