Pulmonology

Question 1

Aspirin-exacerbated respiratory disease (AERD)

Answer 1

Pseudoallergic reaction to NSAIDs–NOT IgE mediated but typically occurs in those with comorbid asthma, chronic rhinosinusitis, and nasal polyposis.

Occurs due to inhibition of COX-1/2 activity by NSAIDs and ASA to reduce PG production. Arachidonic acid then gets shunted down 5-lipoxygenase pathway to make leukotrienes that induces bronchospasm.

Treatment:

1) Avoid NSAIDs
2) Desensitization if NSAIDs are required
3) Leukotriene receptor antagonists (eg montelukast)

Question 2

Conditions with upper lobe involvement?

Answer 2

TB
Histoplasmosis
Silicosis

Question 3

ARDS diagnosis

Answer 3

New respiratory distress within 1 week of clinical insult
Bilateral lung opacities on imaging
Non-cardiogenic PE seen on CXR
Hypoxemia with PaO2/FiO2 ratio <= 300 mmHg

Question 4

Ideal ventilator setting for tidal volume?

Answer 4

6 mL/kg ideal body weight

Question 5

3 common causes of chronic cough?

Answer 5

1) Upper airway cough syndrome –> postnasal drip, dx by elimination of nasal discharge and cough with use of anti-histamine (H1 receptor antagonist like chlorpheniramine)
2) Asthma
3) GERD

Question 6

Hypertrophic pulmonary osteoarthropathy

Answer 6

Subset of hypertrophic osteoarthropathy where clubbing and arthropathy are attributable to undelrying lung disease like lung cancer, TB, bronchiectasis, or emphysema

Question 7

Bronchiectasis vs. chronic bronchitis

Answer 7

Chronic bronchitis = chronic productive cough => 3 months in 2 successive years, with cigarette smoking as leading cause. Can lead to expectoration of blood from lower respiratory tract.

Bronchiectasis involves IRREVERSIBLE dilation and destruction of bronchi, resulting in chronic cough and inadequate clearance. Compared to chronic bronchitis, more likely a/w hx recurrent RTIs and chronic cough w/ daily production of copious mucopurulent sputum.

Question 8

How does mucus plugging affect lung function?

Answer 8

Decreases airflow in affected part of bronchial tree –> collapse of downstream lung parenchyma (atelectasis) –> absent breath sounds in affected areas.

Question 9

Common causes of chronic cough (> 8 weeks)

Answer 9

Upper airway cough syndrome (postnasal drip), GERD, asthma, airway disease (eg chronic bronchitis), pulmonary parenchymal disease (eg abscess, ILD)

Question 10

Acute bronchitis

Answer 10

Common cause of cough that may be productive of purulent, blood-tinged sputum. Cough >5 days to weeks with absent systemic findings (fevers, chills). Wheezing or rhonchi, chest wall tenderness, malaise, sore throat.

URI is typical etiology and symptoms usually self-limiting.
Clinical dx, CXR only when pneumonia is suspected. CXR would show clear lung fields.

Symptomatic treatment (eg NSAIDs and/or bronchodilators) and close clinical f/u best management. Abx nOT recommended as they provide no significant benefit.

Question 11

Chronic bronchitis vs. bronchiectasis

Answer 11

Bronchiectasis is abnormal bronchial widening in setting of recurrent infection and inflammation (eg CF, ABPA), leading to difficulties with expelling air (eg blowing out through straw vs. big pipe).

Can present similarly to chronic bronchitis but sputum more prominent and FOUL smelling.

CXR would show dilated conducting airways and FVC often low from airway destruction.

Question 12

Aspirin-exacerbated respiratory disease

Answer 12

Non-IgE-mediated pseudoallergic drug reaction resulting from aspirin-induced PG/LTE imbalance (or NSAIDs).

Samter’s triad: asthma, aspirin sensitivity, nasal polyps.

Patients also often have history of chronic rhinosinusitis