Pulmonary

Question 0

Indications for corticosteroid use in pregnancy

Answer 0

L:S < 2

or

NO phosphatidyl glycerol present in the amniotic fluid

*between 24-34 weeks gestation

Question 1

Painful red nodules on anterior tibias bilaterally, cough, sneezing, hepatosplenomegaly on exam, +- ulcers on palate & pancytopenia

• Dx?
• Tx?

Answer 1

Histoplasmosis

PO itraconazole (normal pt)
IV amphotericin B (IC or HIV+)

Question 2

HIV + patient with cough, RR 32, dense circular pulmonary consolidation and bilateral diffuse infiltrates on CXR, recent onset hemoptysis, PMH of sarcoidosis and TB

• Dx
• Tx

Answer 2

Dx: invasive aspergillosis (definitive Dx via tissue Bx)

Tx: IV Amphotericin B or Voriconazole or Caspofungin

Question 3

Most common fungal infection in the US, presents with CXR: hilar LA +/- pneumonitis, flu like Sx, painful red nodules on anterior tibias, and hepatosplenomegaly.

• Dx
• Tx

Answer 3

Dx: histoplasmosis (Mississippi and Ohio river valleys)

Tx: PO Itraconazole
IV Amphotericin B if severe or IC, HIV+ etc

Question 4

Filipino patient recently visited Las Vegas 3 weeks ago, presents with non specific respiratory symptoms, night sweats, fever

• Dx
• Tx

Answer 4

Dx: Coccidiodomycosis (Valley Fever)
Tx: PO fluconazole or itraconazole
(or IV AmphoB if severe or IC)

Question 5

PNA in a 7 yo with CF

-Likely organism responsible?

Answer 5

-S. aureus

Question 6

Indications for thrombolysis in PE

Answer 6

Unstable patient with massive PE

RHF (loud S2, DOE, fatigue, lethargy, exertional syncope, R sided S4)

Question 7

Acid base disturbance seen in PE

Answer 7

⬆️A-a gradient Respiratory Alkalosis

Question 8

Sosm < 270
Uosm > Sosm
UNa > 20
Euvolemic 
Normal Cr, TSH
2.5 cm peripheral nodule on CXR
-Dx?

Answer 8

Small cell carcinoma (SIADH)

SIADH or ACTH

Question 9

Paraneoplastic syndrome associated with Squamous cell carcinoma (also centrally located)

Answer 9

Hypercalcemia (PTHrP)

Question 10

Most common nonsmall cell cancer and its paraneoplastic syndromes

Answer 10

Adenocarcinoma
*also the most common lung cancer in NONsmokers

DIC/Thrombophlebitis/MAHA

Question 11

Superior sulcus tumor (pancoast tumor)

• likely neoplasm?
• nerve root involvement

Answer 11

Squamous cell carcinoma (⬆️Calcium)

C8 & T1-T2 nerve roots
Causing shoulder pain radiating down the arm