11.20: Pulm III Flashcards Preview

MHD VI: Pulm > 11.20: Pulm III > Flashcards

Flashcards in 11.20: Pulm III Deck (51)
Loading flashcards...
1

What is decreased TLC consistent with?

Restrictive lung disease

2

2 categories of restrictive lung disease?

1. Chest wall disorder
2. Chronic interstitial and infiltrative disease

3

Characteristics of interstitial lung diseases?

- Dyspnea
- End inspiratory crackles
- Hypoxia
- Nodules and irregular lines on cxr

4

2 Main categories and 3 main types of chronic interstitial lung disease?

1. Fibrosing
a. Usual interstitial pneumonia: 15%
b. Pneumoconiosis: 25%
2. Granulomatous
a. Sarcoidosis: 20%

5

What is interstitial lung disease?

- Inflammatory and fibrotic disease of alveolar walls and septa leading to reduced pulmonary compliance

6

What will interstitial lung disease lead to?

- Pulmonary htn.
- Cor pulmonale
"Honey comb lung" is end stage pathology

7

What is honeycomb lung characteristic of?

End stage restrictive interstitial lung disease

8

Difference between interstitial lung disease and emphysema?

There is fibrosis seen in interstitial disease but not in emphysema

9

What is idiopathic pulmonary fibrosis?

"IPF"
- Clinical term for "usual interstitial pneumonia"

10

Pathogenesis of IPF?

- Repeated epithelial injury leading to TGFbeta
- TGFB leads to fibroblasts
- Fibroblasts deposit collagen and ECM
- Pulmonary fibrosis ensues

11

Another name for idiopathic pulmonary fibrosis?

"IPF"
- Usual interstitial Pneumonia "UIP"

12

Another name for Usual interstitial Pneumonia "UIP"?

"IPF"
- Idiopathic pulmonary fibrosis

13

Characteristics of fibrosis in IPF?

- Non uniform pattern
- Varies in intensity and age
- Early "exuberant" fibroblastic proliferation

14

What is patchy interstitial fibrosis indicative of?

IPF

15

What is the impact of fibrosis in IFP?

- Patchy fibrosis destroys interstitial architecture
- Contraction of scarring pulls to destroy alveolar spaces
- Cystic spaces are created with Type II pneumocytes
"Honeycomb fibrosis"

16

What is cobblestone lung indicative of?

- IPF

17

Characteristics of IPF?

- Variable fibrosis more common in lower lobes
- "Cobblestone lung"
- Fibrosis more common in subpleural layers than in paraseptal

18

Clinical appearance of IPF?

- 40 - 70
- M > W
- Dyspnea on exertion
- Dry cough
- Velcro crackles

19

Prognosis of IPF/UIP? Treatment?

- Rapid deterioration with mean survival

20

What is pneumoconioses?

Accumulation of particulate, chemical fume, or vapor in lung and the reaction to its presence

21

3 main types of pneumoconioses?

1. Anthracosis: coal dust
2. Silicosis: silica from sand blasting
3. Asbestosis: ships, roofing, plumbing

22

What causes largest risk for development of pneumoconioses?

- Small 1 to 5 micrometer particles have greats danger of settle in linings of small airways and sacs and fester
- Too small to be caught by cilia and mucus
- Too big to be engulfed by macs

23

How is most inhaled particulate removed?

- Trapped in mucus and removed by ciliary elevator if > 1 microns

24

Pathogenesis of pneumoconiosis?

- Macs endocytose particles releasing inflammatory mediators
- Fibrogenesis and collagen deposition ensues

25

Presentation of anthracosis?

- Seen in coal, urban, and smokers
- Inhaled carbon pigment engulfed by interstitial macs
- Accumulates in tissues them moves to lymph
- Will see some black on autopsy but not other problems
** NO SYMPTOMS NOTES

26

Pathogenesis of simple coal workers pneumoconiosis?

- Same carbon irritant forms macules / nodules
- Patchy fibrosis noted but not extensive

27

Pathogenesis of progressive massive fibrosis?

"Black lung"
- Coalescence of coal nodules into large scars
- Fibrotic, bulky, heavily pigmented black tissue masses

28

Clinical course of coal workers pneumoconiosis?

Bening with progression to pulmonary dysfunction, pulm htn, or cor pulmonale

29

What is Caplan syndrome?

"Rheumatoid pneumoconiosis"
- Ptn. w/ rheumatoid arthritis exposed to coal
- Get fibrotic lesions with cavitating nodules on radiology
- Hints that RA alters bodies response to coal

30

Who is likely to get silicosis?

- Most prevalent occupational disease in world
- Workers in foundries, sandblasting, mines
- Caused by inhalation of crystalline silica engulfed by mac releasing fibrotic mediators