Pulmonary Board Review Workshop-1. Joaquim S.Tavares,MD,FCCP,FAASM. Questions to review. 2,11,12,20,46,49,58,65,82,87,89,103.
A 73 y/o female has a 2 week hx of worsening dyspnea and dry cough.She has not had fever or any recent travel.Idiopathic pulmonary fibrosis was diagnosed 2 years ago by open lung biopsy. She also has hx of HTN and GERD.Her medications are prednisone,diltiazem,HCTZ,and omeprazole.
Gram Stain of the sputum is negative.;culture is pending.CT scan of the chest is negative for PE but shows new areas of alveolar infiltrates superimposed on previous areas of honeycombing changes.
A 71 y/o woman has a 3-week hx of mild pain in the shoulders and thighs and weakness when rising from a seated position.She also has a new rash on her hands.Eight months ago she was evaluated for dyspnea and new interstitial lung infiltrates that resulted in a lung biopsy and a diagnosis of idiopathic interstitial pneumonia.She was treated with prednisone,60mg/day,for 1 month;the dose was then tapered to 10mg/day.
Of interphalangeal joints of both hands.There is symmetric weakness of the proximal hip flexors and shoulder girdle muscles.Hand strength is normal
A 74 y/o man is evaluated for a 5 year hx of gradually progressive dyspnea and dry cough without wheezing or hemoptysis. For the past 2 years he has had pain and occasional swelling in both knees.He has not had fever or lost weight.He smoked one pack of cigarettes a day from age 18 to 60 years.He worked as an insulator for 40 years. PE shows no clubbing or cyanosis. Auscultation of the lungs reveals bilateral end-inspiratory crackles.PFT’s: TLC=67% of predicted. RV=72% predicted;FEV1/FVC=89% predicted; DLCO=52% predicted
A 36 y/o woman with an 18-month history of diffuse cutaneous systemic sclerosis is evaluated for a 6-month hx of dry cough and decrease in exercise capacity.She is otherwise healthy and takes no medications.
Which of the following is the most appropriate management for this patient’s pulmonary disease?
A 64 y/o woman is evaluated for a 6-week hx of dyspnea,dry cough,fever,chills,night sweats,and fatigue,which have not responded to treatment with azithromycin and levofloxacin;she has lost 2.2 kg(5lbs) during that time.
PE: Temperature is 37.8;other vital signs are normal;There are scattered crackles in the mid-lung zones.There is no clubbing and skin examination is normal.
A 36 year-old woman is evaluated in the office after having had a small(less than 2cm) spontaneous pneumothorax. The patient had a 6-month hx of worsening dyspnea and dry cough. She has never smoked and has a hx of bilateral breast augmentation.PE: no clubbing or crackles.
D)-Pulmonary Langherans cell histiocytosis
A 77 y/o woman is evaluated for a 1 year hx of progressive dyspnea and dry cough.She has had previous evaluations for these symptoms and has had abnormal chest radiographs and HRCT scans. She also has Hx oh heart failure,systolic HTN,Sjogren syndrome,and monoclonal gammopathy of unknown significance;her medications are metoprolol,lisinopril,furosemide,hypromellose artificial tears,potassium and a multivitamin.
Interstitium within the alveolar septa with fibrotic changes,including rare honeycombing consistent with lymphocytic interstitial pneumonia.HRCT showed scattered ground-glass opacification,rare subpleural reticular changes and tiny pulm nodules. PE:ankle edema.no digital clubbing. Which of the following is the most likely diagnosis?
A 60 y/o woman is evaluated for progressive shortness of breath and a dry cough.She was diagnosed with idiopathic pulmonary fibrosis 3 years ago.
A 55 y/o woman with a long standing Hx of moderate to severe asthma is evaluated for worsening productive cough,dyspnea,and wheezing.She has not had fever,chills,or chest pain.Her current medications are low-dose inhaled corticosteroids,a long acting beta agonist,and albuterol.
Which of the following is the most appropriate next step in the evaluation of this patient?
A 28 y/o man is evaluated for an abnormal chest radiograph done for chronic intermittent nonproductive cough of 6 months duration.The radiograph showed bilateral hilar lymphadenopathy and normal lung parenchyma.The patient has fatigue and intermittent mild central chest discomfort when he coughs.He has not had weight loss,fever,night sweats,or recent respiratory illness.There is no cervical or axillary lymphadenopathy.
Which of the following is the most appropriate next test in the evaluation of this patient?
A 44 y/o man is evaluated for a 4-month Hx of progressive dyspnea and cough.The patient is otherwise healthy and takes no medications.He has smoked 2 packs of cigarettes a day for 20 years.