Master the board step 3

Master the Boards: USMLE Step 3
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Calcium and ACE levels may be elevated, but these are not specific enough
to lead to a specific diagnosis.
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Bronchoalveolar lavage shows increased numbers of helper cells.
Treatment
Steroids are the undisputed best therapy.
Pulmonary Hypertension
Primary pulmonary hypertension presents as an idiopathic cause of shortness
of breath, more often in young women, from overgrowth and obliteration of
pulmonary vasculature, leading to decreased flow out of the right ventricle.
Pulmonary hypertension can occur secondary to the following:
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Mitral stenosis
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COPD
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Polycythemia vera
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Chronic pulmonary emboli
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Interstitial lung disease
Physical findings are as follows:
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Loud P2
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Tricuspid regurgitation
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Right ventricular heave
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Raynaud’s phenomenon
Diagnostic Testing
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Transthoracic echocardiogram (TTE): Shows right ventricular hypertrophy
and enlarged right atrium
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EKG: Shows the same findings as well as right axis deviation
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Most accurate test: Right heart catheterization (Swan-Ganz catheterization)
with increased pulmonary artery pressure
Treatment
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Bosentan is an endothelin inhibitor that prevents growth of the vasculature
of the pulmonary system.
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Epoprostenol and treprostinil are prostacyclin analogs that act as pulmonary
vasodilators.
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Calcium channel blockers (weak efficacy)
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Sildenafil
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