respiratory pt 3.2

Question 1

1. What is the ddx for hemoptysis?

Answer 1

1. irritant gas inhalation injury, Wegener’s Granulamatosis, Goodpasture’s syndrome, lupus/SLE, pulmonary amyloidosis, pulmonary embolism

Question 2

2. Which condition will have pulmonary nodular opacities on a CXR?

Answer 2

2. pulmonary amyloidosis (they will be low density with irregular contours); also rheumatoid lung disease

Question 3

3. Which condition will have decreased lung volume on a CXR?

Answer 3

3. lupus/SLE

Question 4

4. Which disease is caused by long-term exposure to the chemicals in fluorescent light bulbs?

Answer 4

4. beryllosis

Question 5

5. What are the three defining symptoms of Churg-Straus Syndrome?

Answer 5

5. allergic rhinitis, asthma, alveolar hemorrhage

Question 6

6. Which disease will have hematuria and proteinuria on a UA?

Answer 6

6. Wegener’s Granulomatosis

Question 7

7. In which disease will a person have ANAs (anti-nuclear antibodies) in their blood?

Answer 7

7. lupus/SLE

Question 8

8. What is the ddx for pleuritic chest pain (from this week’s notes only)?

Answer 8

8. acute eosinophilic pneumonia, Wegener’s, rheumatoid lung disease, lupus/SLE

Question 9

9. Which diseases may include pleural effusion as a possible complication?

Answer 9

9. acute eosinophilic pneumonia, rheumatoid lung disease

Question 10

10. Which disease includes recurrent URI as a symptom?

Answer 10

10. lupus/SLE

Question 11

11. Which disease has eggshell calcifications of the hilar lymph nodes on CXR?

Answer 11

11. silicosis

Question 12

12. Which diseases may show honeycombing on a CXR?

Answer 12

12. all environmental causes of ILD (pneumoconiosis, irritant gas, occupational asthma, air pollution-related illness)

Question 13

13. Which diseases have rhinitis or rhinosinusitis as symptoms?

Answer 13

13. Wegener’s, Churg-Strauss

Question 14

14. Which diseases have alveolar hemorrhage as possible complications?

Answer 14

14. Wegener’s, Churg-Straus. (Goodpasture’s also has pulmonary hemorrhage, not sure if that’s alveolar or not)

Question 15

15. Which diseases include bibasilar crackles?

Answer 15

15. idiopathic interstitial pneumonias; acute eosinophilic pneumonia

Question 16

16. Which lung disease can also cause vomiting?

Answer 16

16. irritant gas inhalation

Question 17

17. Which disease show Kerley B lines on a CXR and what are they?

Answer 17

17. acute eosinophilic pneumonia; short, parallel lines at the lung periphery, often at the lung bases or the costophrenic angle. They are thing, linear pulmonary opacities caused by fluid in the interstitium.

Question 18

18. What is the ddx for SOB and stridor?

Answer 18

18. everything from last week including sarcoidosis

Question 19

19. What is the ddx for high serum Ca+?

Answer 19

19. sarcoidosis (granulomas can secrete vitamin D), lung cancer (Squamous Cell Carcinoma)

Question 20

20. A lung tumor has begun to spread. What are the symptoms?

Answer 20

20. other than obvious ones (SOB, chest pain) there may be superior vena cavae obstruction, Horner’s syndrome, pericardial effusion, dysphagia, and hoarseness from the recurrent laryngeal nerve being pressed on by the tumor

Question 21

21. What is a tumor that imposes on the brachial plexus called?

Answer 21

21. Pancoast tumor aka superior sulcus tumor

Question 22

22. What are clubbing and Trousseau’s syndrome symptoms of?

Answer 22

22. adenocarcinoma (Trousseau’s syndrome: adenocarcinomas and gliomas can secrete things which cause hypercoagulability; blood clots can form which are actually palpable. These may be the first indication of cancer. )

Question 23

23. What is the ddx for cyanosis?

Answer 23

23. ARDS, atelectasis, COPD

Question 24

24. What is middle lobe syndrome?

Answer 24

24. enlarged lymph nodes or a tumor can compress the right middle bronchus, causing RML atelectasis and chronic, unresolving RML pneumonia

Question 25

25. In a pulmonary embolism, how much of the pulmonary vascular bed must be occluded before symptoms occur?

Answer 25

25. 50%

Question 26

26. What condition has the following cardiac conditions as symptoms: S2 split, S4 gallop, and ventricular heave?

Answer 26

26. pulmonary embolism

Question 27

27. How do you differentiate between pulmonary embolism and an MI with blood tests?

Answer 27

27. In a pulmonary embolism, CPK will be normal, while LDH will be high. In an MI, both CPK and LDH will be elevated.

Question 28

28. What is Well’s criteria?

Answer 28

28. Used to diagnose a pulmonary embolism, patient must have greater than 4 points to be likely to have a PE. These include: clinical symptoms of DVT, previous DVT or PE, no other diagnosis that could explain symptoms, heart rate>100bmp, immobile > 3 days, hemoptysis or malignancy

Question 29

29. What is the gold standard for diagnosing pulmonary embolism?

Answer 29

29. pulmonary angiography

Question 30

30. What condition has a wide split S2, S3, and tricuspid murmur as symptoms?

Answer 30

30. pulmonary hypertension

Question 31

31. What would a CXR of a pt with pulmonary hypertension reveal?

Answer 31

31. enlarged hilar vessels (and spirometry would show restrictive changes)

Question 32

32. Cardiac or pulmonary conditions cause what kind of cyanosis?

Answer 32

32. central cyanosis

Question 33

33. What are the symptoms of sleep apnea?

Answer 33

33. morning HAs, daytime somnolence, loud snoring, low libido, tossing and turning