Pulmonary

Question 1

Bilateral Hilar Lymphadenopathy
Increased ESR and ACE
Maculopapular Rash
Non-Caseating Distal Granulomas with Ground Glass on CT
Panda Sign

Answer 1

Sarcoidosis: Idiopathic increase in CD4 and decrease CD8. Presents like TB with SOB but skin is the second most commonly affected site

Panda Sign on Brain CT is pathopneumonic

Question 2

Clubbing of Fingers & Toes

Answer 2

Decreased Perfusion:

Lung Cancer  (NOT COPD!! if a COPD pt has clubbing, look 
          for another cause)
Cystic Fibrosis
Endocardidtis (specifically left sided)
Cyantotic Congenital Heart Diseases

Question 3

Rx for mild persistent Asthma

Answer 3

Inhaled Steroids is the backbone of Rx for persistent asthma.
Budesonide (Pulmocort)
Triamsinolone (Asthmacort)

Albuterol is an add on for all stages but intermittent Asthma

Question 4

Differentiates Dyspnea due to Respiratory Causes from that due to Cardiac Causes

Answer 4

BNP

If elevated, look to heart failure/pulmonary edema as opposed to a respiratory cause for shortness of breath.

Normal BNP is age dependent, higher in elderly. If BNP is normal, we exclude heart failure for SOB cause.

Question 5

Long term risk of steroid use

Answer 5

Osteoporosis

Question 6

MAIN Risk of discontinuing Steroids abruptly

Answer 6

Adrenal Insufficiency even to emergency

Question 7

ARDS Sxs Rx & Causes

Answer 7

Use low tidal volumes with positive pressure PEEP to oxygenate

Opacification of both lung fields

Trauma Sepsis & Trauma leading etiology but transfusion can do it.

Multiple organ failure, esp kidney

Question 8

Most common organism causing community acquired pneumonia in children under 5

Answer 8

1 = RSV in under 5s

VIRUSES!

Question 9

Prolonged Expiration & FEV1 should make you think:

Answer 9

Asthma & COPD

Question 10

placement for a needle aspiration in tension pneumo

Answer 10

2nd ICS mid-clavicular line

Question 11

Rx for pneumocysistis Jerovecci

Answer 11

Bactrim DS

Question 12

Unilateral Apical/Supraclavicular Mass, think:

Answer 12

Lung Cancer specifically Squamous Cell

Metastisizes to regional lymph nodes and causes pleural effusion

Question 13

Exudative vs Transudative Pleural Effusion

Answer 13

Exudative: fluid moves from peritoneal to pleural space
High protein content. TB & Lung Cancer, INFLAMMATION of lung tissue.

Transudative: Occurs in the Absence of pleural disease, low protein, heart failure, low serum protein, hypothyroid, pulmonary embolism CHF, Nephrotic Syndrome

Question 14

Use Amantidine for

Answer 14

Parkinsons but no longer for Flu due to resistance. Replaced by Tamiflu.

When used for Parkinsons it’s called Mimantidine

Question 15

Diagnosed with Guillion Barre, get tested for:

Answer 15

HIV

Question 16

Kerly B Lines are seen in

Answer 16

Pleural Effusion

Think either CHF or Fluid Overload if you have an IV in.

Question 17

TB Drug with Vision Loss effect:

Answer 17

Ethambutol

E for Eye

Causes scotoma - loss of red/green vision and decreased acuity

Question 18

PopCorn Lesion of the lung

Answer 18

Lung Haratoma

Haratomas are benign neoplasms and grow in various tissues. Usually made of connective tissue or adipose, They’re just extra tissue and are only problematic when they press on things.

Lung haratomas are the most common sort and are white and look popcorn shaped.

Question 19

Panda Sign on MRI

Answer 19

Sarcoidosis

Question 20

Pleural Fluid Contents in Bacterial Pneumonia

Answer 20

High Protein - we’re third spacing fluid in the
lobes, likely holes drilled by bugs

High LDH - as compared with serum.
LDH ratio over 0.6 is EXUDATIVE
meaning its from Inflammation
i.e. from INFECTION

             LDH ratio under 0.6 is 
                    TRANSUDATIVE i.e. from low
                    serum protein and 3rd spacing
                    NO Infection

High Specific Gravity means there’s lots of stuff
in it - as in bacteria…

Question 21

TB usually appears where in the lung?

Answer 21

Apices

Night Sweats/ Fever/ Cough, Wt. Loss

Question 22

Increased Tactile Fremitus vs Decreased

Answer 22

Increased vibration on touch 99 with DULNESS TO PERCUSSION indicates consolidation (as do increases in all special pneumo tests). This indicates Consolidation

DEcreases in vibration and pitch/intensity on special testing and DULLNESS TO PERCUSSION indicate Fluid in the lung, think
Effusion, like a sponge dampening the sound and vibration.

Asthma would also be decreased but percussion would increase as the lung would be full of air, like a drum. Anything in there but air reduces percussion. Since normally there’s a nice balance of moist tissue and air, normal is not drum-like.

Question 23

TB vs Sarcoidosis

Answer 23

TB: Uni or BiLateral Caseating Granuloma
      Apical Cavitations before hilar
       Bacterial, Airborne
       Cavity formation in the lung tissue
       No particular ethnicity
       Chronic cough, may be bloody
       Fever, Malaise 
       NIGHTSWEATS + WEIGHT LOSS
       Rx is INRE Abx regimen
             Isoniazid
             N 
             Rifampin
             E... has eye side effect
PPD + for TB is 15mm or 5mm for HIV+

Sarcoidosis: BiLateral NON-Caseating Hilar
Granuloma
AutoImmune
No Cavities but Lymph Node Granuloma
SOB more than cough
cough is mild +unproductive
low fever malaise
African American prevalence
Rx is corticos

Question 24

Female, African American + Short of Breath, maybe a mild cough… Hilar/peritracheal lymphadenopathy and increased Ace levels
think:

Answer 24

Sarcoidosis

Question 25

Thickened Bronchi on CXR, look like train tracks or rings

Cough, Foul Sputum and SOB

Answer 25

Bronchiectasis

Antibiotic + Chest Physiotherapy, might need to go in and scoop that stuff out of there with an endoscope and basket

Question 26

Hampton’s Hump

Answer 26

On a CXR it is an opaque wedge attached to the lateral lung. In reality, it is a wedge of infarcted (dead/necrotic) tissue killed off by a massive Pulmonary Embolism in the artery leading to that particular wedge of lung parenchyma.

Shortness of breath, usually sudden, leg swelling, cancer or other hyper coagulable state - all clues that you need a CXR.

If you really think you have a PE but just can’t find it and don’t have a hump in CXR, you’ll need a spiral CT to pick it up.

Anticoagulation Therapy is the Rx, though necrotic tissue can be a lingering problem