Master the board step 3

Pulmonology
Diagnostic Testing
A chest x-ray shows dilated bronchi with “tram tracking,” which are parallel
lines consistent with dilated bronchi. The most accurate diagnostic test is a
high-resolution CT scan of the chest.
Treatment
There is no curative therapy. Treat the infectious episodes as they occur.
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Chest physiotherapy with “cupping and clapping” will help dislodge
secretions.
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Rotating antibiotics are tried to avoid the development of resistance.
Interstitial Lung Disease (ILD)
ILD can be idiopathic, such as a form of pulmonary fibrosis secondary to
occupational or environmental exposure and medications (e.g., trimethoprim/
sulfamethizole [Bactrim], or nitrofurantoin). If no cause is found, the diagnosis
is “idiopathic pulmonary fibrosis” by exclusion.
Nitrofurantoin is associated
with lung fibrosis.
The following table shows the causes of interstitial lung disease:
Cause
Asbestos
Glass workers, mining, sandblasting,
brickyards
Coal worker
Cotton
Electronics, ceramics, fluorescent light
bulbs
Mercury
Disease
Asbestosis
Silicosis
Coal worker’s pneumoconiosis
Byssinosis
Berylliosis
Pulmonary fibrosis
ILD presents with shortness of breath with a dry, nonproductive cough and
chronic hypoxia. ILD is a long-term disease and is often punctuated by episodes
of bronchitis and pneumonia.
Physical findings are the following:
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Dry, “Velcro” rales
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Loud P2 heart sound as a sign of pulmonary hypertension
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Clubbing
In ILD, the EKG will show
pulmonary hypertension
with right atrial and right
ventricular hypertrophy.
ILD does not give fever or systemic findings.
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