ILD, Infections, Inflammation

Question 1

What are common symptoms of ILD?

Answer 1

Progressive dyspnea, dry cough, crackles on exam, and clubbing in chronic cases.

Question 2

What are common causes of ILD?

Answer 2

1. Idiopathic pulmonary fibrosis (IPF)
2. Connective tissue disease (RA, scleroderma)
3. Drug-induced (Amiodarone, Methotrexate)
4. Occupational (Asbestos, Silica) & Sarcoidosis

Question 3

What is the typical spirometry pattern in ILD?

Answer 3

Restrictive pattern: ↓ TLC, ↓ FVC, normal or increased FEV1/FVC, and ↓ DLCO.

Question 4

What is the treatment for idiopathic pulmonary fibrosis?

What about advanced cases?

Answer 4

Antifibrotic agents like Pirfenidone or Nintedanib

Referral for lung transplant in advanced cases

Question 5

What are types of pneumothorax?

Answer 5

Spontaneous (primary or secondary), traumatic, and iatrogenic (e.g., central line, barotrauma).

Question 6

How do you treat a Tension Pneumothorax?

Answer 6

Immediate Needle Decompression (2nd intercostal space, midclavicular line) followed by Chest Tube Placement.

Question 7

What is Pneumomediastinum and how does it differ from Pneumothorax?

Answer 7

Air in the Mediastinum instead of Pleural Space

Causes
1. Trauma
2. Barotrauma
3. Esophageal rupture

Question 8

What are risk factors for Multidrug-Resistant pneumonia (e.g., Pseudomonas, MRSA)?

Answer 8

1. Recent Hospitalization 🏥
2. Prior antibiotic use 💊
3. Structural Lung Disease 🫁
4. Immunosuppression 🤕👨🏿‍🦳

Question 9

Outpatient Treatment for CAP?

Wha if atypical coverage is needed?

Answer 9

1. Amoxicillin or Doxycycline;
2. Consider Azithromycin if Atypical coverage is needed

Question 10

What is the Initial diagnostic test in Low and High Probability PE?

Answer 10

Low risk → D-dimer

High risk or Unstable → CT pulmonary angiography (CTPA)

Question 11

When is Thrombolysis indicated for PE?

Answer 11

In massive PE causing Hypotension or Shock

Question 12

What is the main presentation of Allergic Bronchopulmonary Aspergillosis (ABPA)?

Answer 12

1. Moderate to Severe Persistent Asthma that’s won’t resolve like a bad pneumonia
2. ⬆️Serum IgE ➕Eosinophilia
3. Central bronchiectasis on CT ➕ Sputum cultures (Aspergillus)

Question 13

What are the Symptoms concerning for Alpha-1 antitrypsin (A1AT) deficiency?

Answer 13

1. Early-onset pulmonary emphysema
2. Liver disease 🍔
3. Rarely skin disease

Question 14

What condition should be suspected in patients with Repeated infections and Culture growth of an encapsulated organism?

Answer 14

Common variable immunodeficiency

Question 15

1. What is Bronchiectasis?
2. Common Symptoms?
3. Initial Test ?
4. Best Imaging test ?

Answer 15

1. Permanent destruction and abnormal dilation of the conducting bronchi or airways
2. Chronic Cough ➕Mucopurulent/💪🏾 Strong Sputum production
3. • CBC + differential
   • IgA, IgG, and IgM Quantitation
   • Sputum culture ➕ Smear for Bacteria, Fungi, and Mycobacteria3.
4. High resolution CT (Bronchial Wall thickening and Airway Dilatation

Question 16

What is often found in the pmhx of patients with Bronchiectasis?

Answer 16

Repeated Respiratory Tract Infections Requiring antibiotics

Question 17

What is Hypersensitivity Pneumonitis (HP)?

Answer 17

Hypersensitivity Pneumonitis (Extrinsic Allergic Alveolitis)

• ILD casued by Inhaling Organic Allergens (e.g., microbes, bird proteins).

Chronic exposure can lead to irreversible fibrosis.

Question 18

1. What are the CT findings and Diagnostics for chronic HP?
2. What can a BAL show?
3. What about Biopsy?

Answer 18

1. Ground-glass opacities, mid-upper lobe emphysema
2. BAL (collects cells and fluid) shows lymphocytosis
3. Biopsy (tissue sample) reveals Non- Caseating granulomas in the periphery

Question 19

1. What is Benign Asbestos-Related Pleural Effusion (BAPE)?
2. When does it occur?
3. Management?

Answer 19

1. An early Asbestos-Related condition
2. Small bloody 🩸, Eosinophilic Exudative Effusion occurs usually 10–15 years post-exposure.
3. Often self-limiting.

Question 20

1. Management of Ucomplicated Parapneumonic effusions?
2. Management Complicated OR Empyema Parapneumonic effusions?
3. What to do if no response to drainage

Answer 20

1. Uncomplicated: Antibiotics only 💊 ☝️
2. Complicated or empyema: Chest tube + antibiotics
3. Surgery if not responsive to drainage

Question 21

How does Aspiration Pneumonia differ from Aspiration Pneumonitis?

Answer 21

Pneumonia happens gradually with infectious signs

Pneumonitis —> chemical injury with Acute distress

Both may show lower lobe infiltrates.

Question 22

How do you confirm proper endotracheal tube placement?

Answer 22

1. Bilateral breath sounds
2. chest wall movement,
3. depth (21 cm for women, 23 cm for men from the mouth).

Question 23

How can VAP incidence be reduced?

Answer 23

1. Use Semi-Recumbent Positioning
2. Oral antiseptics 👄
3. Avoid PPIs

Question 24

1. What is Radiation Pneumonitis?
2. When does it occur?
3. How is it treated?

Answer 24

1. Presents like NON-responsive pneumonia
   - doesnt respond to abx
2. Occurs 1-3 months post-radiation
3. Treated with Prednisone and Taper

Question 25

1. What is transfusion-related acute lung injury (TRALI)? 2. Management

Answer 25

1. Acute SOB and Pulmonary infiltrates ≤6 hrs s/p Transfusion. 2. Supportive care and donor investigation are key.

Question 26

1. Symptoms of Fat embolism syndrome (FES)? 2. When does it occur? 3. What can be shown on CXR?

Answer 26

1. Neurologic changes, Hypoxemia, Petechiae. 2. Onset 24–72 hrs Post trauma/Surgery. CXR may be normal early

Question 27

Signs of Transfusion-Associated Circulatory Overload (TACO)?

Answer 27

Volume overload after transfusion; Elevated JVD, S3, and BNP.

Question 28

What is Reactive Airway Dysfunction Syndrome (RADS)?

Answer 28

A form of Occupational Asthma due to a single, high-dose irritant exposure (e.g., bleach, ammonia) Positive Methacholine Test Confirms diagnosis.

Question 29

What is anti-GBM disease (Goodpasture’s disease)?

Answer 29

A Autoimmune Disease --> Hemoptysis + Glomerulonephritis Patients ➕ Anti-GBM antibodies. CXR ----> Patchy Basilar Infiltrates

Question 30

What symptoms are uncommon in anti-GBM disease?

Answer 30

Fever and Joint pain. Constitutional symptoms are Unusual and Suggest alternative ---> like vasculitis.

Question 31

What is Eosinophilic Granulomatosis with polyangiitis (EGPA or Churg-Strauss)?

Answer 31

An ANCA-associated vasculitis ------> 1. Severe asthma 2. Peripheral Eosinophilia 3.Neuropathy 4. Renal disease

Question 32

How does EGPA differ from GPA?

Answer 32

EGPA has more eosinophils, less upper airway involvement, and lacks cavitating lung nodules.

Question 33

What is anti-GBM disease (Goodpasture’s disease)?

Answer 33

A rare autoimmune disease causing hemoptysis and glomerulonephritis, associated with anti-GBM antibodies. CXR typically shows patchy basilar infiltrates.

Question 34

What symptoms are Uncommon in anti-GBM disease?

Answer 34

Fever, arthralgia, and constitutional symptoms are unusual and suggest alternative diagnoses like vasculitis.

Question 35

What is eosinophilic granulomatosis with polyangiitis (EGPA or Churg-Strauss)?

Answer 35

An ANCA-associated vasculitis presenting with severe asthma, peripheral eosinophilia, neuropathy, and migratory infiltrates; renal disease may occur.

Question 36

How does EGPA differ from GPA?

Answer 36

EGPA has more eosinophils, less upper airway involvement, and lacks cavitating lung nodules.

Question 37

What are the 2 pain Differences between Reactive Airway Dysfunction and Hypersensitivity Pneumonitis?

Answer 37

Question 38

What is the typical spirometry pattern in ILD?

Answer 38

Restrictive pattern: ↓ TLC, ↓ FVC, normal or increased FEV1/FVC, and ↓ DLCO.