Fill-In-The-Blank: these statements are conceptual; as such there may be other correct answers in addition to the ones provided.
Pulmonary edema can be due to either or .
Visible bronchi on a background of pulmonary edema are called .
Pleural effusions are commonly associated with pulmonary edema or .
Either diffuse or injury can cause ARDS.
Obstructive lung diseases lower the ability to .
Asthma is characterized by airways with episodic and mucin production.
Severe acute asthma attacks can lead to .
Both and are primarily seen in tobacco users.
The pulmonary pathology of cystic fibrosis is diffuse, severe .
Restrictive lung diseases lower .
Asbestos exposure can lead to , , or .
is a systemic autoimmune disease with granulomas. It often involves the lungs and hilar .
The two classic pneumoconioses are and . The first is also associated with coal-dust.
Allergic reactions to inhaled organic materials are called .
Idiopathic pulmonary fibrosis is not responsive, and is a diagnosis of .
Chronic lung disease can lead to and/or .
End-stage pulmonary disease is also called lung.
The pattern of bacterial infections can be , , , or .
Viral pneumonias are typically bilateral pneumonias.
Primary T.B. typically occurs in , is often and results in PPD .
Primary T.B. consists of a Ghon complex: a caseating granulomas in the and .
Reactivation T.B. can occur decades later in patients. These patients are PPD .
Primary lung cancer is divided into and types.
NSCLC is further divided into and carcinomas.
Multiple Choice Questions:
1) You see a patient with bibasilar crackles in the lower lobes on auscultation through your stethoscope. This is a new finding, suggesting fluid buildup in the lower portion of the lungs. What are the top TWO causes on your differential? Heart failure Interstitial lung disease (pulmonary fibrosis) Pulmonary infection (pneumonia or bronchitis) Chronic obstructive pulmonary disease (COPD)
Explanation: Heart failure and pneumonia are two common causes of pulmonary edema. Given this is a new finding, a chronic lung disease is less likely.
2) You see a patient with metastatic cancer to the lungs, with new onset cough and bloody sputum. Which of the following is in your differential? Reactivation TB Erosion of bronchus with tumor Granulomatosis with polyangiitis Angio-invasive aspergillus infection All of the above
Explanation: All three of these are potential causes for bloody sputum (granulomatosis with polyangiitis would be by far the most uncommon). Patients with metastatic cancer are often immunosuppressed and at risk for reactivation TB (assuming they have be exposed to TB in the first place!).
3) You see a patient with a history of chronic shortness of breath and dry cough. As part of your clinical history you should ask about: Occupational exposure to organic materials Pets Smoking history Travel history All of the above
Explanation: Chronic shortness of breath has a long differential, and any of these may help pin down an etiology.
4) You are viewing a chest x-ray of a patient that shows enlarged hilar lymph nodes and multiple small nodular opacities in the lung fields. Top on your differential would be: Acute respiratory distress syndrome (ARDS) Silicosis Sarcoidosis Asbestosis
Explanation: Sarcoidosis in the lung typically involves non-necrotic granulomatous inflammation of the pulmonary parenchyma as well as the hilar lymph nodes. These changes may be visible on a chest x-ray. Silicosis and asbestosis don't involve the lymph nodes.
5) Patients with asthma are frequently treated with inhalers containing drugs like beta-agonists, anticholinergics, and steroids. What do you think these drugs do to minimize symptoms? Decrease inflammation Decrease mucin production Relax bronchial smooth muscle All of the above
6) The vast majority of cases of chronic obstructive pulmonary disease (COPD) are strongly associated with tobacco-use, with the exception of: Emphysema Chronic Bronchitis Asthma Asbestosis
Explanation: Asthma often occurs in non-smokers (e.g., children); although it can be exacerbated by smoking. Tobacco can exacerbate the effects of asbestosis; however asbestosis is a restrictive, not an obstructive lung disease.