Bonus Material-13_High Yield Top 10_Day1

Pdf Summary

This document presents a high-yield review of key pulmonary medicine topics prepared for the CHEST Pulmonary Board Review by Dr. Saadia Faiz, MD FCCP, ATSF, August 2025. It covers critical updates and management strategies across a range of pulmonary conditions.<br /><br />Asthma: Use of as-needed ICS-formoterol significantly reduces exacerbations in mild asthma compared to SABA alone. Maintenance and reliever therapy (MART) with ICS-formoterol lowers exacerbations by 30% in moderate-severe asthma. Biologics targeting the T2 pathway, except tezepelumab, reduce exacerbations and some are approved for related conditions like chronic rhinosinusitis with nasal polyps and eosinophilic granulomatosis with polyangiitis.<br /><br />Cystic Fibrosis (CF): Management includes pancreatic enzyme replacement, insulin for CF-related diabetes, and recognition of adult CF clues such as recurrent sinusitis and bronchiectasis. Sputum pathogens vary with disease progression; Pseudomonas aeruginosa is common later. CFTR modulators are indicated based on genotype. Lung transplant is considered when FEV1 drops below 40% despite therapy.<br /><br />Respiratory Failure: Focus on the physiology of gas exchange with attention to alveolar ventilation and V/Q matching. Non-invasive ventilation shows benefit in pulmonary edema and COPD exacerbations. ARDS management includes low tidal volume ventilation, early dexamethasone, paralysis in select cases, fluid management, and consideration of ECMO.<br /><br />Mechanical Ventilation: Emphasizes adjusting FiO2, PEEP, and mean airway pressure, and the significance of driving pressure on mortality, especially in ARDS. Ventilator troubleshooting includes causes for high and low peak and plateau pressures.<br /><br />Eosinophilic Lung Diseases: Covers acute and chronic eosinophilic pneumonia, allergic bronchopulmonary aspergillosis (ABPA), eosinophilic granulomatosis with polyangiitis (EGPA), and hypereosinophilic syndrome (HES). Treatments vary from steroids to targeted therapies depending on etiology and severity.<br /><br />Pregnancy: Highlights physiologic respiratory changes, asthma management (safe use of ICS, beta-agonists), venous thromboembolism evaluation and treatment during pregnancy, amniotic fluid embolism recognition, and other pulmonary concerns such as sleep apnea and pulmonary hypertension.<br /><br />Mediastinal Tumors: Lists anterior (thymoma, lymphoma, thyroid, germ cell), middle (adenopathy), and posterior (neurogenic tumors) mediastinal masses and their clinical considerations.<br /><br />Interstitial Lung Disease (ILD): Presents UIP features on imaging, and new antifibrotic therapies (neratinodast, nintedanib, pirfenidone) that slow FVC decline in IPF and progressive fibrosing ILD.<br /><br />Infections and Pneumonia: Summarizes various fungal, viral, bacterial, and atypical pathogens by exposure risk or host status, their diagnostic clues, and treatments including agents like ganciclovir, itraconazole, amphotericin, TMP-SMX, and doxycycline.<br /><br />Vasculitis and Diffuse Alveolar Hemorrhage (DAH): Reviews new evidence on biologics (benralizumab vs mepolizumab) in EGPA, limited benefit of plasma exchange, glucocorticoid dosing, and therapies for DAH, particularly in ANCA-associated vasculitis.<br /><br />Overall, this concise review synthesizes recent clinical trials, management guidelines, and diagnostic criteria to support evidence-based pulmonary medicine practice for board preparation and clinical application.

Meta Tag

Concept Asthma

Concept Cystic Fibrosis

Concept Respiratory Failure

Concept Inhaled Corticosteroid

Concept Acute Respiratory Distress Syndrome

Keywords

asthma

cystic fibrosis

CF

respiratory failure

mechanical ventilation

eosinophilic lung disease

pregnancy pulmonary care

mediastinal tumors

interstitial lung disease

pulmonary infections

vasculitis diffuse alveolar hemorrhage

Asthma

Cystic Fibrosis

Respiratory Failure

Inhaled Corticosteroid

Acute Respiratory Distress Syndrome