Dubin Interstital Lung Disease

Question 1

Acute interstitial Pneumonia v. Idiopathic interstitial Fibrosis

Answer 1

Acute - fast onset (within 7 days)

Idiopathic - progression over a year

Question 2

50yo with increasing DOE over the past year. Clubbing CXR shows diffuse linear opacities. HRCT shows bilateral abnormalities. Abn PFTs.

Answer 2

Idiopathic interstitial Fibrosis

Question 3

50yo with acute dyspnea. 7 days of dry cough, SOB, fever, malaise. ABG: pH7.30, PaCO2 65, PaO2 55 on 100% O2. CXR - ground glass, septal thickening.

Answer 3

Acute interstitial Pneumonia

Question 4

Pathogenesis of Drug Induced Pulmonary Injury - name of injury.

Answer 4

• AMIODARONE results in Acute Interstitial Pneumonitis (also, Organizing Pneumonia, ARDS, Hypersensitivity pneumonia)
• Methotrexate results in interstitial fibrosis

Question 5

Lipid-laden foamy alveolar macrophages are caused by what @ what dose?

Answer 5

Amiodarone, (over 400mg/day)

Question 6

Loosely formed, noncaseating epithelioid cell granulomas in interstitium indicative of what?

Answer 6

Hypersensitivity pneumonitis

Question 7

CXR - (centrilobular) focal patchy consolidation or diffuse ground glass appearance

Answer 7

Acute hypersensitivity pneumonitis

Question 8

Dx and pathogenesis:

Pet shop owner has EPISODIC (every 4wks for past 6mo) coughing attacks, SOB, recurrent fever.

Answer 8

Hypersensitivity pneumonitis: Bird Fancier’s Lung - IgG mediated hypersensitivity due to exposure to feathers and bird droppings.
- episodic

Question 9

PFTs in Hypersensitivity pneumonitis

Answer 9

FEV1/FVC increased

FVC reduced

Question 10

35yo dairy farmer, never smoked, presents with wheezing, mild decrease in FEV1, decreased FVC. CXR normal. Labs reveal eosinophilia and clusters of eosinophils in sputum.

Answer 10

Bronchial asthma - IgE and eosinophilia.

- NOT episodic

Question 11

22yo sheep and turkey farmer. Episodic periods of wheezing, dyspnea, low grade fever of 100F. Serum precipitans with fungus.

Answer 11

Hypersensitivity Pneumonitis: Farmer’s Lung - IgE and IgG, Type 3
- episodic, fever

Question 12

What do serum precipitans indicate?

Answer 12

Type 3 hypersensitivity reaction.

Question 13

Thermophilic actinomycetes, think what?

Answer 13

Farmer’s lung

Question 14

Bilateral infiltrates, think what?

Answer 14

Farmer’s lung

Question 15

Describe Silo Filler’s lung

Answer 15

Respiratory distress due to nitric oxide in grain filled silos

Question 16

SANDBLASTER, foundry worker, granite worker

Answer 16

Silicosis

Question 17

CXR: bilateral Eggshell calcifications.

In what regions?

Answer 17

Silicosis - in hilar and mediastinal regions

Question 18

75yoM with severe dyspnea for a year. No weightloss, chest pain, cough, or hemoptysis. 50 pack year hx. Foundry worker.
Always do what after this diagnosis? Why?

Answer 18

Silicosis

- ALWAYS administer PPD test because TB is increased by 30(?) in silicosis pts

Question 19

What is a postive PPD test in silicosis pt?

Answer 19

10+mm

TB is increased by

Question 20

35yoM with PMG of RA. Treated with gold injections, methotrexate, and aspirin. CXR shows multiple calcified pulmonary nodules in both lungs. Dx?

Answer 20

Caplan’s Syndrome = RA + smooth pulmonary nodules.

Question 21

CXR: Localized pleural fibrous plaques/opacities

Answer 21

asbestosis

Question 22

ferruginous bodies, mesothelioma

Answer 22

asbestosis

Question 23

Occupation: autofactory worker, house builder, shipyard worker

Answer 23

asbestosis

Question 24

47yo roofer and wife of roofer with a 30 pack year hx. Chronic, non-productive cough, DOE. CXR shows thickened, calcified opacities in lateral chest wall and under diaphragm. Clubbing

Answer 24

Asbestosis - can be secondary!

Question 25

Describe ferruginous bodies

Answer 25

Brown fusiform rods with translucent center with iron-containing material.

Question 26

CXR: pleural thickening and possible pleural effusion in a shipyard worker who smokes.

Answer 26

Malignant mesothelioma

Question 27

Coalescence of particles containing macules that form discrete areas of interstitial fibrosis, causing distention of resp bronchioles, forming areas of emphysema.

Answer 27

Coal Worker's Pneumoconiosis

Question 28

Prolonged expiratory phase and miner occupation.

Answer 28

Coal Worker's Pneumoconiosis

Question 29

Nuclear technician moved to Fort Worth. 35yo DOE, dry cough, anorexia, night sweats. Bilateral lymphadenopathy. Sarcoidosis, but no anergy, no elevated ACE, so look for what with what test?

Answer 29

Berylliosis with beryllium lyphocyte proliferation test.

Question 30

anti-glomerular basement membrane

Answer 30

Goodpastures

Question 31

Symptoms in Goodpastures

Answer 31

Hemoptysis, hematuria. Fibrosis secondary to anti-GBM - NO URT problems

Question 32

Two alveolar filling disorders.

Answer 32

Goodpastures, Chronic Eosinophilic Pneumonia

Question 33

Systemic necrotizing granulomatous inflammation in URT as chronic rhinitis or sinusistis, gingival hyperplasia, or serous otitis media. CXR: multiple nodular or cavitating infiltrates or ulcerative lesions

Answer 33

Wegner's

Question 34

Three important Wegner's associations.

Answer 34

1. C-ANCA 2. Hematuria 3. Upper respiratory problem (*differentiates from Goodpastures)

Question 35

P-ANCA

Answer 35

Churg Strauss

Question 36

Necrotizing vasculitis in URT and LRT, preceded by allergic disorders. - abdominal pain

Answer 36

Churg Strauss

Question 37

Three phases of Churg Strauss

Answer 37

1. Allergic stage - Frequent allergic rhinitis/sinusitis 2. Eosinophilc Stage - Asthma and IgE 3. Vasculitic Syndrome - erythematous maculopapules

Question 38

CXR: bilateral patchy infiltrates

Answer 38

Churg Strauss

Question 39

Kevim, serum Ca, serum ACE tests for what?

Answer 39

Sarcoidosis

Question 40

Associations of sarcoidosis.

Answer 40

- Elevated ACE - Hypercalciuria, hypercalcemia - Anergy - Erythema Nodosum - Noncaseating granulomas - Bilateral hilar lymphadenoapthy (HRCT=possibly see fibrosis or alveolitis) - Decreaed DLCO

Question 41

Treatment for sarcoidosis

Answer 41

- Short term, high dose steroids (but NOT INHALED) - sarcoidosis is a systemic disease

Question 42

transbronchial lymphoid biopsy used for what?

Answer 42

Sarcoidosis

Question 43

Quantiferron Gold test used for what?

Answer 43

Immigrants who have received TB vaccine with positive PPD, to determine if they actually need TB therapy.

Question 44

Acute form of Sarcoidosis is called what and what are the three acute presentations?

Answer 44

Lofgren Syndrome: 1. Hilar adenopathy 2. Erythema Nodosum 3. Arthritis (men); fever (women)

Question 45

What four things comprise of Heerfodt's syndrome?

Answer 45

Unveoparotid fever - 1. Uveitis 2. Parotid gland involvement 3. Fever 4. Possible facial nerve

Question 46

Differential for cavitary lung lesions.

Answer 46

``` CAVITY: Carcinoma - squamous cell, melanoma, cervical, sarcoma metastasis Autoimmune - Wegner's, Rheumatoid Lung Vascular - bland/septic emboli Infection - TB, fungal, bacterial Trauma Young ```

Question 47

68yoM with SOB increasing for 2 years. PMH includes psoriasis, taking methotrexate to treat. PFT's reduced, FEV1/FVC 95+%.

Answer 47

Methotrexate induced interstital fibrosis

Question 48

JVD, murmur increases with inspiration, pulse ox reveals desat with exercise. V/Q normal. 22yo. What is this and what tx?

Answer 48

Primary pulmonary HTN. | R-hearted catheter

Question 49

Obese person, falls asleep easily throughout the day, has obstructive sleep apnea.

Answer 49

Pickwickian Syndrome