ABIM Board Review: Pulmonary Medicine. Overview. Topics Respiratory Infections Airway Disease Restrictive Lung Diseases Pulmonary Vascular Disease Pleural Disease Sleep Potpourri. Hints. Stress certain topics ASTHMA, TB, SARCOID, ILD’s,PFT’s
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MDR TB Cases, 1993 - 1998 prolonged courses of therapy so effective drug levels are persistent for months as latent organisms reactivate, rendering themselves susceptible.
Is airflow obstruction at least partially
1. Start high and step down.
2. Start at initial level of severity; gradually step up.
1 – histologic confirmation
2 – assess extent and severity of organ involvement
3 – assess disease stability and whether will progress
4 – determine if therapy will benefit patient
Negative Pressure PE
General Anesthesia PE
Presents acutely like PNA/ARDS
CXR mimics PNA/ARDS
Peripheral Eosinophilia rare; High count on BAL
Prompt, lasting response to steroids
Presents subacutely with Mild Hypoxemia
CXR- ‘Photographic negative of CHF’
Peripheral Eosinophilia common; High count on BAL
Prompt response to steroids, but recurrence commonAcute vs. Chronic Eosinophilic PNA
Diagnostic Criteria Treatment
+ skin test to fungus
+ IgG precipitins
+ IgE precipitins
Eosinophilia with CXR ASO’s
‘Central or Proximal Bronchiectasis’
‘Coughs up brown, plugs’
‘Finger-in-gloves-’ X-rayAllergic Bronchopulmonary Mycosis
> 1 hr
Predicting the Severity of Pulmonary Embolism
PE Severity PA PA mean RA mean CI
obstruction pressure pressure
Mild <50 <20 <10 >2.5
Mod or Submassive 50-75 25-40 <10 >2.5
Massive >75 40-45 >10 <2.5
J Gen Intern Med, 1995.
Mayo Clin Proc 1989.
Ann Intern Med 1986.
(e.g. ‘FEF25-75’) is closer to 50%.
- an absolute increase of 200ml.
Venous Thromboembolic Disease