ACCP pulmonary medicine board review by American College of Chest Physicians

By American College of Chest Physicians

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Long-term treatment with corticosteroids is often required for management. Itraconazole may be effective as a corticosteroid-sparing agent. Unusual Lung Infection, Bronchiectasis, and Cystic Fibrosis (Moores) 7/10/09 8:00:07 PM Yankaskas JR, Marshall BC, Sufian B, et al. CF adult care: consensus conference report. Chest 2004; 125(suppl):1S–39S This supplement is the most up-to-date summary of the diagnosis and management of CF in the adult but is based on a CF Foundation consensus conference held in 1999.

Typical micrograph of a lung from a patient with PAH. The patient has normal alveolar structures but a small PA, in which the lumen is occluded by concentric fibrosis. The artery also has increased medial smooth muscle and a reactive adventitia. Dilated small vessels border the airway above the artery. From Newman JH, Phillips JA, Loyd JE. Pulmonary hypertension. Ann Intern Med 2008; 148:278−283. 29 7/10/09 8:03:54 PM is a key contributor. Platelets likely play an important role as procoagulants by increasing the platelet release of serotonin, vascular endothelial growth factor, and platelet-derived growth factor.

Ventilation/perfusion . (V/Q ) scanning is the screening investigation of choice because many chest radiologists are not familiar with the distinguishing features of CTEPH seen on CT angiography. Patients who are surgical candidates should be referred to a specialty center for the consideration of pulmonary endarterectomy. All patients should receive life-long anticoagulation therapy. Diagnosis of PE Clinical Suspicion: The clinical suspicion of PE is often arrived at using an unstructured approach based on a combination of factors, including the presence or absence of identifiable risk factors (eg, surgery in the past, obesity, or previous VTE); symptoms (eg, dyspnea, pleuritic chest pain, and hemoptysis); physical examination findings (eg, tachypnea); the results of basic laboratory studies (eg, hypoxemia); and the likely presence of alternative diagnoses (eg, asthma, pneumonia, or congestive heart failure).

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