Respirology

Question 1

FEV1, FVC, DLco and TLC in asthma

Answer 1

• FEV1: Decreased
• FVC: Normal or decreased (if severe asthma)
• DLco: Increased
• TLC: increased

Question 2

Sx’s and sg’s of chronic bronquitis

Answer 2

• Main risk fx smoking
• Exertional dyspnea
• Chronic and progressive cough
• end-expiratory wheezes
• obstructive lung pattern on spirometry,
• Morning expectoration

Pulmonary symptoms must be present for at least 3 months each year for 2 consecutive years

Question 3

Asbestosis vs COPD

Answer 3

Abstestosis has very long latent period, 15–20 years after significant exposure, before any signs of disease appear.
asbestosis typically manifests with end-inspiratory rales rather than wheezes on auscultation (which are more typical in COPD).

Both can have chronic cough and SOB

Question 4

Reason for accesory muscle use in COPD

Answer 4

Chronic hyperinflation (indicated by the increased TLC) due to loss of collapsing pressure of the lungs results in diaphragmatic flattening, which impairs this muscle’s normal function: expansion of the thoracic cavity and subsequent airflow into the lungs during inspiration. Consequently, the use of accessory respiratory muscles becomes necessary, resulting in labored breathing and dyspnea.

Question 5

Most common causes of SVC syndrome

Superior vena cava

Headache that worsens when leaning forward, engorged veins over the anterior chest, and swelling limited to the head, neck, and upper extremities

Answer 5

SVC syndrome is most commonly caused by lung cancer (usually small cell lung cancer or squamous cell carcinoma) or non-Hodgkin lymphoma (particularly in younger patients).

Question 6

What is the most common source of brain metastases

Answer 6

Lung cancer is also the single most common source of brain metastases

Several round lesions at the border of the gray and white matter of the brain.
variety of symptoms, including progressively worsening cognitive dysfunction and focal neurological deficits.

Question 7

What is Lambert-Eaton myasthenic syndrome

Answer 7

An autoimmune condition caused by antibodies against presynaptic voltage-gated calcium channels in the neuromuscular junction, which inhibits the release of acetylcholine. Manifests as muscle weakness that improves with repetitive stimulation and autonomic dysfunction. Often a paraneoplastic syndrome, most commonly from small cell lung cancer.

Question 8

Paraneoplastic(s) associated with Small cell lung cancer

Answer 8

• ACTH- Cushing
• SIADH
• Lambert-Eaton myasthenic syndrome

Question 9

most common type of lung cancer seen in nonsmokers

Answer 9

Adenocarcinoma

much more common in women (6:1), and is usually located peripherally.

Question 10

arthritis, digital clubbing, and periostitis of the distal diaphysis of long bone with symptoms and signs of lung cancer

Answer 10

Hypertrophic osteoarthropathy (HOA)

most commonly associated with adenocarcinoma of the lung.

Question 11

Pleural fluid glucose levels of XXXXX suggest exudative pleural effusion, and, in the context of pneumonia, a complicated parapneumonic effusion or pleural empyema.

Answer 11

Pleural fluid glucose levels **< 60 mg/dL ** suggest exudative pleural effusion, and, in the context of pneumonia, a complicated parapneumonic effusion or pleural empyema.

Question 12

Characteristics of chylothorax pleural effusion analysis

Risk factors: trauma, iatrogenic

Answer 12

• High lipids, i.e. triglycerides, cholesterol,
• Low LDH (even if it is an exudate)
• Centrifugation of pleural fluid allows for the distinction between chylothorax and empyema, with fluid from chylothorax remaining uniform after centrifugation and empyema developing into a clear supernatant overlying a precipitate

HypoNa+ also seen!

Question 13

ECG findings in PE

Answer 13

• Sinus tachycardia
• S1Q3T3
• New right bundle branch block (right heart strain)

Question 14

Most common vein orgin of thrombus causing a PE

Answer 14

PE is usually preceded by deep vein thrombosis (DVT), which in the vast majority of cases (≥ 90%) occurs in the iliac vein and other proximal deep veins of the lower extremities (e.g., femoral and popliteal vein).

Question 15

Prophylaxis therapy for DVT in post-op patients with high risk of thrombotic complications

Answer 15

LMWH (Enoxaparin)
Early mobilization

Question 16

Elevated CD4+ T-cell count in bronchoalveolar lavage.
Dx?

Answer 16

Sarcoidosis

Question 17

How is calcium in sarcoidosis?

Answer 17

Elevated

In sarcoidosis and other granulomatous diseases, the expression of 1α-hydroxylase is increased in macrophages. This enzyme hydroxylates 25-hydroxyvitamin D to its active form, which results in chronic, increased calcium resorption.

Question 18

Dx?

Positive interferon-γ release assay

Answer 18

Latent TB

For active TB : Collect sputum specimen

Question 19

Effect of right lateral decubitus in a patient with right pneumonia

Answer 19

increased A- a gradient
Increased V/Qmistmatch

Question 20

DX ?

Answer 20

Pulmonary embolism

A peripheral opacity (Hampton hump; green overlay) obscures the adjacent margin of the right hemidiaphragm. A Hampton hump is subpleural and is caused by pulmonary hemorrhage or infarction. The appearance is often wedge-shaped; however, it can alternatively be dome-shaped, if the apex is spared as a result of collateral bronchial arterial blood flow.

The differential diagnosis includes pneumonia and malignancy. Of note, the greater distance between the spinous processes and the medial edge of the clavicle on the right compared to the left indicates that the patient is rotated slightly to the right. The distances will be nearly equal when a patient is not rotated, whereas widening will be seen on the side to which a patient is rotated.