Pulmonary causes

Question 1

Causes of apical lung fibrosis

Answer 1

• Tuberculosis (TB)
• Extrinsic allergic alveolitis
• Ankylosing spondylitis
• Allergic bronchopulmonary aspergillosis
• Radiation
• Sarcoidosis
• Histiocytosis X

Question 2

Causes of lower lung fibrosis

Answer 2

• Cryptogenic fibrosing alveolitis
• Asbestosis
• Aspiration pneumonia
• Rheumatoid arthritis
• Drug-related pulmonary fibrosis
• Systemic sclerosis
• Sarcoidosis

Question 3

Tracheal deviation - Pulled toward pathology (inside lung)

Answer 3

• Atelectasis
• Pneumonectomy
• Diaphragmatic paralysis

Question 4

Tracheal deviation - Pulled away from pathology (outside lung)

Answer 4

• Massive pleural effusion
• Tension Pneumothorax
• Neck or thyroid mass
• Large mediastinal mass

Question 5

Raised TLCO

Answer 5

• Asthma
• Pulmonary haemorrhage (Wegener’s, Goodpasture’s)
• Left-to-right cardiac shunts
• Polycythaemia
• Hyperkinetic states
• Male gender, exercise

Question 6

Lower TLCO

Answer 6

• COPD (much trapped air)
• Emphysema
• Pneumonia
• Pulmonary oedema
• Pulmonary fibrosis
• Pulmonary emboli
• Anaemia
• Low cardiac output

Question 7

Bronchiectasis

Answer 7

• Post-infective: tuberculosis, measles, pertussis, pneumonia
• Allergic bronchopulmonary aspergillosis (ABPA)
• Immune deficiency: selective IgA, hypogammaglobulinaemia
• Bronchial obstruction e.g. lung cancer/foreign body
• Cystic fibrosis
• Ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome
• Yellow nail syndrome (lymphoedema, pleural effusion & yellow nail)

Question 8

Most common organisms isolated from patients with bronchiectasis

Answer 8

• Haemophilus influenzae (most common)
• Pseudomonas aeruginosa
• Klebsiella spp.
• Streptococcus pneumoniae

Question 9

Causes of false positive sweat test

Answer 9

• Malnutrition
• Glycogen storage diseases
• G6PD
• Adrenal insufficiency
• Nephrogenic diabetes insipidus
• Hypothyroidism, hypoparathyroidism

Question 10

Pulmonary eosinophilia

Answer 10

• Churg-Strauss syndrome
• Allergic bronchopulmonary aspergillosis (ABPA)
• Loffler’s syndrome
• Eosinophilic pneumonia
• Hypereosinophilic syndrome
• Tropical pulmonary eosinophilia
• Nitrofurantoin, sulphonamides, daptomycin

Question 11

Causes of mismatch in V/Q

Answer 11

• PE
• Old pulmonary embolisms
• AV malformations
• Vasculitis
• Previous radiotherapy

Note: COPD gives matched defects

Question 12

Oxidant drugs (can cause methemoglobinemia)

Answer 12

• Metoclopramide
• Dapsone
• Sulfonamides
• Local anesthetics (lidocaine)
• Nitrates

Link

Question 13

Pleural glucose < 3.3 MMOL

Answer 13

Low:

• Tuberculous effusion (typically around 80’s)
• Malignant effusion (typically around 60’s)
• Esophageal rupture
• Lupus pleuritis

Very low:

• Parapneumonic effusion/Empyema
• Rheumatoid effusion (VERY low, typically < 30’s)

Question 14

Causes of elevated pleural fluid amylase

Answer 14

• Malignancy
• Esophageal rupture
• Pancreatic disease

Question 15

Causes of low pH < 7.2 in pleural fluid

Answer 15

In exudates:
* Complicated parapneumonic effusion/ empyema
* Malignancy
* RA
* TB.

In transudates:
* Urinothorax

Question 16

Most common causes of malignant effusion

Answer 16

• Lung cancer 30 %
• Breast cancer 25 %
• Lymphoma 20 %

Question 17

Eosinophilic pleural effusion

Answer 17

• Air or blood in the pleural space (e.g., pneumothorax, hemothorax)
• Infectious processes (particularly parasitic)
• Malignancy (especially Hodgkin lymphoma)
• Pulmonary embolism
• Benign asbestos

Link

Pearl: Presence of eos and > 5% mesothelial cells makes TB unlikely

Question 18

> 50% lymphocytes in pleural effusion

Answer 18

• TB
• Fungal
• Malignancy

Question 19

PMN predominance in pleural effusion

Answer 19

• Parapneumonic
• Pancreatitis
• PE
• Peritonitis

Question 20

Differential of turbid, pale or whitish pleural fluid

Answer 20

• Chylothorax
• Pseudochylothorax
• Complicated parapneumonic effusions (empyema)

Question 21

Chemicals associated with occupation-related asthma

Answer 21

• Diisocyanates
• Persulfates
• Aldehydes
• Amines

Question 22

Differential diagnosis of bilateral hilar adenopathy

Answer 22

• Sarcoidosis
• Lymphoma
• Tuberculosis
• Pneumoconiosis
• Berylliosis
• Fungal diseases like histoplasmosis.

Note: no amyloidosis

Question 23

Bacterial causes of postinfluenza pneumonia

Answer 23

• Streptococcus pneumoniae
• Staphylococcus aureus

Question 24

Disorders associated with increase D-dimer

Answer 24

• Arterial thromboembolic disease
• Venous thromboembolic disease
• DIC / severe sepsis
• Preeclampsia and eclampsia
• Vaso-occlusive episode of sickle cell disease
• Systemic inflammatory response syndrome
• Severe liver disease /Renal disease
• Malignancy
• Normal pregnancy

Question 25

Causes of central sleep apnea

Answer 25

* Heart failure * Left heart disease * CNS * Medications (opioids) * Hypercapnia * High altitude

Question 26

Causes of increased vocal resonance

Answer 26

* Consolidation * Bronchiectasis * Cavitation * Mass

Question 27

Causes of decreased vocal resonance

Answer 27

* Pleural effusion * Pneumothorax * Lung fibrosis * Lobectomy * Pneumonectomy

Question 28

Drugs that can cause pneumonitis and/or pulmonary fibrosis

Answer 28

* Amiodarone * Nitrofurantoin * Methotrexate * Cyclophosphamide * Bleomycin

Question 29

Cavitating lung lesion in x-ray

Answer 29

* Staphylococcus aureus * Klebsiella pneumoniae * Squamous Cell Lung Cancer * Tuberculosis (TB) * Granulomatosis with Polyangiitis (formerly known as Wegener's Granulomatosis) * Aspergillosis * Histoplasmosis * Coccidioidomycosis

Question 30

Bilateral interstitial infiltrates

Answer 30

* Pneumocystis jirovecii (formerly known as Pneumocystis pneumonia or PCP) * Mycoplasma pneumoniae * Chlamydophila pneumoniae (formerly known as Chlamydia pneumoniae) * Various Viral infections

Question 31

Lobar pneumonia

Answer 31

* Streptococcus pneumoniae (Pneumococcus) * Haemophilus influenzae * Klebsiella pneumoniae

Question 32

Interventions in COPD with survival benefit

Answer 32

* Smoking cessation: The most effective intervention. Reduces the rate of decline in lung function and improves survival rates significantly. * Long-term oxygen therapy (LTOT): Improves survival in severe COPD with chronic hypoxemia. * Pulmonary rehabilitation: Improves quality of life and exercise tolerance, and can decrease hospitalizations, but direct impact on survival is less clear in the literature. * Lung Volume Reduction Surgery (LVRS): Has shown survival benefit in selected groups of patients, particularly those with upper lobe predominant emphysema and low exercise capacity. * Lung transplantation: Provides survival benefit in selected patients, usually those with advanced disease not responding to other treatments.

Question 33

Causes of opaque hemithorax

Answer 33

* Pleural effusion * Lung collapse * Mass * Pneumonectomy * Consolidation

Question 34

Situations in which pulse oximetry may give misleading values

Answer 34

[Link](https://drive.google.com/file/d/1AmnlDOu-AzZqkNWDjCJ5T-P50n0bjPqB/view?usp=drivesdk)