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Flashcards in Dubin Interstital Lung Disease Deck (49):
1

Acute interstitial Pneumonia v. Idiopathic interstitial Fibrosis

Acute - fast onset (within 7 days)
Idiopathic - progression over a year

2

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

Idiopathic interstitial Fibrosis

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.

Acute interstitial Pneumonia

4

Pathogenesis of Drug Induced Pulmonary Injury - name of injury.

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

5

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

Amiodarone, (over 400mg/day)

6

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

Hypersensitivity pneumonitis

7

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

Acute hypersensitivity pneumonitis

8

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

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

9

PFTs in Hypersensitivity pneumonitis

FEV1/FVC increased
FVC reduced

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.

Bronchial asthma - IgE and eosinophilia.
- NOT episodic

11

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

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

12

What do serum precipitans indicate?

Type 3 hypersensitivity reaction.

13

Thermophilic actinomycetes, think what?

Farmer's lung

14

Bilateral infiltrates, think what?

Farmer's lung

15

Describe Silo Filler's lung

Respiratory distress due to nitric oxide in grain filled silos

16

SANDBLASTER, foundry worker, granite worker

Silicosis

17

CXR: bilateral Eggshell calcifications.
In what regions?

Silicosis - in hilar and mediastinal regions

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?

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

19

What is a postive PPD test in silicosis pt?

10+mm
TB is increased by

20

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

Caplan's Syndrome = RA + smooth pulmonary nodules.

21

CXR: Localized pleural fibrous plaques/opacities

asbestosis

22

ferruginous bodies, mesothelioma

asbestosis

23

Occupation: autofactory worker, house builder, shipyard worker

asbestosis

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

Asbestosis - can be secondary!

25

Describe ferruginous bodies

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

26

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

Malignant mesothelioma

27

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

Coal Worker's Pneumoconiosis

28

Prolonged expiratory phase and miner occupation.

Coal Worker's Pneumoconiosis

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?

Berylliosis with beryllium lyphocyte proliferation test.

30

anti-glomerular basement membrane

Goodpastures

31

Symptoms in Goodpastures

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

32

Two alveolar filling disorders.

Goodpastures, Chronic Eosinophilic Pneumonia

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

Wegner's

34

Three important Wegner's associations.

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

35

P-ANCA

Churg Strauss

36

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

Churg Strauss

37

Three phases of Churg Strauss

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

38

CXR: bilateral patchy infiltrates

Churg Strauss

39

Kevim, serum Ca, serum ACE tests for what?

Sarcoidosis

40

Associations of sarcoidosis.

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

41

Treatment for sarcoidosis

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

42

transbronchial lymphoid biopsy used for what?

Sarcoidosis

43

Quantiferron Gold test used for what?

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

44

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

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

45

What four things comprise of Heerfodt's syndrome?

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

46

Differential for cavitary lung lesions.

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

47

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

Methotrexate induced interstital fibrosis

48

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

Primary pulmonary HTN.
R-hearted catheter

49

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

Pickwickian Syndrome