Pulmonary

Question 1

What are the top 5 most prevalent interstitial lung diseases? (In no order).

Answer 1

1) Idiopathic pulmonary fibrosis
2) Chronic hypersensitivity pneumonitis
3) Connective tissue disease-related ILD (CTD-ILD)
4) Sarcoidosis
5) Pneumoconioses

Question 2

2 drugs to treat idiopathic pulmonary fibrosis (as of 2018):

Answer 2

1) Nintedanib

2) Pirfenidone

Question 3

The “rheum panel” for interstitial lung disease (according to a NEJM review article from 2018):

[Hint: looking for SLE, RA, systemic sclerosis, Sjogren’s, MCTD, inflammatory myopathies]

Answer 3

ANA
RF, Anti-CCP 
Anti-Scl-70 
Anti-Ro, Anti-La 
Anti-U1-RNP 
Anti-Jo-1, CK, myoglobin

Question 4

Important spirometry definitions:

1) Airway obstruction
2) Reversibility
3) Positive metacholine challenge

Answer 4

1) FEV1/FVC <70%
2) Improvement in FEV1 of 12% or greater (must be >200mL)
3) FEV1 falls by 20% from baseline

Question 5

What does DLCO measure (in one sentence)?

Answer 5

Gas exchange across the alveolar-capillary membrane

Question 6

Pathological changes of airway remodeling in asthma:

Answer 6

Subepithelial fibrosis, increased smooth muscle mass, mucus gland hyperplasia

Question 7

Light’s criteria.

Pleural fluid most likely an exudate if:

Answer 7

Pleural fluid total protein / serum total protein >0.5
Pleural fluid LDH / serum LDH >0.6
Pleural fluid LDH > 2/3 ULN of serum LDH

Question 8

Sensitivity of pleural fluid cytology for malignancy (according to MKSAP):

Answer 8

60%

Question 9

A chylous pleural effusion will have a pleural triglyceride level greater than:

Answer 9

110 mg/dL

Question 10

Preferred treatment of malignant pleural effusion and rapid reaccumulation of pleural fluid?

Answer 10

Indwelling pleural catheter.

(50-70% have spontaneous pleurodesis after 2 to 6 weeks)

(Talc pleurodesis is also very effective but associated with increased pain and longer length of hospital stay)