Interstitial Lung Diseases
What is the interstitial lung disease presents with "Honey comb" lungs on HRCT?
What is Idiopathic pulmonary fibrosis?
A postoperative patient develops sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia. Vitals are stable. What is the best next diagnostic test?
What is CT pulmonary angiography?
What is the most common cause of malignant effusion?
What is Lung Cancer?
What is the normal A-a gradient?
What is 10-15 mmHg?
This Hall of Fame NFL Quarterback developed a Traumatic pneumothorax secondary to breaking several ribs while being tackled. He played for the Saints. Who is he?
Drew Brees
Every fall a farmer develops recurrent cough, dyspnea, and fever several hours after working around moldy hay. His symptoms improve when away from work. What is the diagnosis?
What is Hypersensitivity pneumonitis?
46 y/o man travels from U.S. to Japan via plane. Getting off in Japan he complains of leg pain and shortly develops left sided weakness. Man later dies in the hospital. Which cardiac anomaly lead to his death?
What is Patent Foramen Ovale?
A trauma patient becomes hypotensive with absent breath sounds on one side and tracheal deviation away from that side. What is the immediate best next step?
What is Needle decompression?
Which brain structure is responsible for respiratory control?
What is the Medulla Oblongata
This 6'11'' NBA legend suffered from a PE in 2015 and later a DVT in 2016 resulting in his early retirment. He was apart of a historic trio and won back to back championships in 2012 and 2013. Who is he?
Who is Chris Bosh?
A stonecutter with chronic dyspnea has upper-lobe nodules and eggshell calcification of hilar lymph nodes. What infection is he at increased risk of developing?
What is Tuberculosis?
Why? Silica "siliences" macrophages and disrupt phagolysosome formation, increasing susceptibility to TB (b/c cannot wall TB off in granulomas)
A patient with an acute pulmonary embolism is hemodynamically stable with no contraindications to treatment. What medication should be initiated?
What is Heparin?
"acute PE should receive systemic anticoagulation unless contraindicated, initially with unfractionated heparin or LMWH, followed by long-term anticoagulation such as apixaban or rivaroxaban."
A 58-year-old man with ascites and lower-extremity edema develops dyspnea. Chest x-ray shows a right-sided pleural effusion. Thoracentesis reveals a pleural fluid-to-serum protein ratio of 0.40 and LDH ratio of 0.45. Where did the effusion come from?
What is the liver?
Lights Criteria: Fluid-to-Serum > 0.5, LDH ratio > 0.6 = Exudative
Pathophys: Cirrhosis → ascites → increased intra-abdominal pressure pushes low-protein ascitic fluid through small defects in the right hemidiaphragm → fluid enters the pleural space → right-sided transudative pleural effusion (hepatic hydrothorax).
A patient with pneumonia remains severely hypoxemic despite receiving high-concentration supplemental oxygen. What mechanism best explains the hypoxemia that is unresponsive to supplemental O2?
What is Pulmonary Shunt?
Why? Low V/Q (in this case Shunt V/Q = 0) because this is a ventilation problem. Blood flow is good but there is no oxygen delivered to it because alveoli is filled with fluid from pneumonia. Supplemental O2 does not correct this because this is a structural alveoli problem.
Contrast to PE which can improve with supplemental O2 (High V/Q ratio > 0.8) b/c ventilation normal but perfusion is inadequate
NFL Hall of Famer Merlin Olsen died from a rare cancer associated with inhaltion of this inorganic dust. He worked on a construction site growing up. Ferruginous bodies were found on histology. What is the diagnosis?
What is mesothelioma?
A patient with sarcoidosis develops recurrent calcium kidney stones. What abnormality is responsible for his hypercalcemia?
What is noncaseating granulomas
Why? noncaseating granulomas express 1α-hydroxylase -> increased Ca2+ activation
In the absence of severe right heart failure, patients with a positive response to pulmonary vasodilator testing should be given a trial of which medication class (medication name works)?
What is Nifedipine?
Why nifedipine?
Nifedipine = dihydropyridine calcium-channel blocker
MOA: blocks L-type Ca²⁺ channels in vascular smooth muscle
↓ Ca²⁺ entry → ↓ smooth-muscle contraction → pulmonary vasodilation → ↓ PVR → ↓ RV afterload
Therefore, patients who demonstrate that their pulmonary vasculature responds to acute vasodilation are the small subgroup likely to benefit from long-term CCB therapy
At which degree does idiopathic kyphoscoliosis result in pulmonary compromise?
What is a Cobb angle > 50 degrees?
A septic patient develops ARDS requiring mechanical ventilation. Which ventilator strategy has been shown to reduce mortality?
What is Low Tidal Volume?
Why? We want to avoid volumtrauma.
ARDS -> diffuse alveolar injury (atelectasis / edema in some of the alveoli) -> functionally smaller quantitiy of alevoli to reciveve O2 from vent -> low tidal volume prevents volumtrauma
Star Wars actress Carrie Fisher suffered a pulmonary embolism. If the embolus causes areas of lung that are ventilated but not perfused, which component of ventilation increases?
What is Physiologic dead space?
A 48-year-old man presents with hemoptysis, dyspnea, rapidly progressive glomerulonephritis, and constitutional symptoms. Lung biopsy demonstrates necrotizing small-vessel vasculitis but no granulomatous inflammation. What is the most likely diagnosis?
What is Microscopic polyangiitis (MPA)?
MPA -> p-ANCA, no granulomas or nasopharyngeal pathology
GPA -> c-ANCA, present granulomas and nasopharyngeal pathology
A patient has progressive exertional dyspnea several months after a pulmonary embolism despite adequate anticoagulation. Right heart catheterization shows precapillary pulmonary hypertension, and imaging reveals persistent organized pulmonary artery thrombi. What is the most likely diagnosis?
What is Chronic thromboembolic pulmonary HTN?
A patient with bacterial pneumonia has a pleural effusion with pH 7.10. Antibiotics have already been started. What additional treatment is required?
What is Chest tube drainage?
high-yield: parapneumonic effusion + pleural pH <7.2 → complicated effusion → drain it, not antibiotics alone
Pt is in the ICU. According to Cecil, the current literature supports that daily use of this procedure has not only been proven to be safe but also helps reduce weaning times from ventilators when compared to gradual lowering of ventilator settings over time. What is the procedure?
What is Spontaneous Breathing Trials?
For a SBT to be successful, a patient needs to be able to spontaneously breathe with no or minimal ventilator support for at least 30 mins, not be apneic, not be persistently tachypneic (>35 breaths/min), and remain hemodynamically stable without increased work of breathing.
The GOAT of women's tennis suffered from a PE after her 2017 C-section. What risk factor increased her chances for PE?
What is postpartum hypercoaguability?