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ILD Flashcards

1
Q

______ primarily due to deficiency of surfactant in immature lungs

A

Respiratory distress syndrome (RDS)

*common in preterm infants

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2
Q

the more _____ the infant is, the more likely to suffer RDS

A

preterm

32 weeks more likely to have RDS than 36 weeks

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3
Q

what is the physical exam of RDS?

A

presents within minutes-hours after birth
worsens over 1st 48 hrs of life
tachypnea
nasal flaring
expiratory grunting
intercostal, subxiphoid, subcostal retractions
cyanosis
urine output in 1st 24-48 hr is low due to increased vasopressin
peripheral edema

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4
Q

what is the first line of treatment for baby with RDS?

A

CPAP

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5
Q

what are common CXR findings with RDS?

A

low lung volume

classic reticulograndular ground glass appearance with air bronchograms

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6
Q

what labs may you see with RDS?

A

ABG - hypoxemia

hyponatremia due to water retention

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7
Q

what other diseases must you distinguish RDS from?

A 
transient tachypnea of the newborn (more mature infant)
bacterial PNA
pneumothorax
cyanotic congenital heart disease
ILD
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8
Q

how to prevent RDS?

A 
prevent preterm birth
antenatal steroids (given to all women 23-34 weeks gestation at risk of preterm delivery in next 7 days)
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9
Q

how to manage RDS?

A

nasal CPAP
OR
intubation + surfactant therapy + mechanical ventilation

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10
Q

if CPAP not working in baby, what do you do next?

A

intubate baby and administer surfactant therapy

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11
Q

non-TB mycobacteria infections (NTM) can cause what 4 clinical syndromes?

A 
pulmonary disease (MAC and mycobacterium kansaii)
superficial lymphadenitis (MAC)
disseminated disease (MAC)
skin and soft tissue infection (mycobacterium marinum and mycobacterium ulcerans)
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12
Q

unlike TB, NTM are not due to ______?

A

human-to-human or animal-to-human transmission

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13
Q

what are S&S of MAC?

A

looks like TB but less severe
fatigue, malaise, weakness
cough
dyspnea, chest discomfort

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14
Q

what is the clinical presentation in those with underlying lung disease and MAC?

A

primarily white, middle-aged, or elderly men, often alcoholics and/or smokers with underlying COPD

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15
Q

what is the clinical presentation in those without underlying lung disease and MAC?

A

nonsmoking women over age 50 who have interstitial pattern on CXR

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16
Q

what diagnostic test distinguishes MAC vs TB?

A

positive skin test

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17
Q

what antibiotics recommended for MAC?

A

azithromycin + rifampin + ethambutol

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18
Q

how long is antibiotic treatment for MAC usually?

A

15-18 months

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19
Q

what are etiologies to ILD?

A

sarcoidosis
exposures (asbestos, coal dust, aluminum)
drugs (macrobid, amiodarone)
idiopathic

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20
Q

what is the common S&S for ILD?

A

progressive DOE and nonproductive (dry) cough

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21
Q

what are physical exam findings for ILD?

A

crackles

inspiratory squeaks

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22
Q

what are CXR findings for ILD?

A 
abnormal CXR
ground-glass apperance
hazy opacity
reticular "netlike" MOST COMMON
honeycombing
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23
Q

what PFTs will you note with ILDs?

A

decreased TLC
decreased FEV1 and FVC
normal FEV1/FVC ratio or increased

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24
Q

what are PFTs of an obstructive disease (i.e. asthma)?

A

TLC increased
FVC normal
FEV1/FVC ratio decreased

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25
what is the bronchodilator challenge?
for obstructive diseases give pt bronchodilator (beta agonist inhaled) if FEV1 improves over 12%, obstruction may be reversible or partially reverisble
26
what may be the only PFT finding in early ILD?
reduced diffusing capacity of lung for carbon monoxide (DLCO)
27
what is the gold standard for diagnosing ILD?
lung biopsy
28
what are the indications for lung biopsy?
atypical or progressive symptoms age < 50 y/o fever, weight loss, hemoptysis ILD symptoms with normal or atypical CXR
29
what are the types of lung biopsies?
fiberoptic bronchoscopy with transbronchial lung biopsy thoracoscopy open lung biopsy
30
what are complications of ILD?
PH leading to cor pulmonale pneumothorax elevated cancer risk progressive respiratory insufficiency
31
you determine ILD, but no clinical recovery or specific systemic disease yet? what are your next steps and what are steps after those?
bronchoalveolar lavage or transbronchial lung biopsy (TLB) THEN if no specific dx HRCT, if still nothing THEN lung biopsy
32
define pneumoconiosis
any disease of the respiratory tract due to inhalation of dust particles (asbestotis, silicosis)
33
list facts about pneumoconiosis
asbestotis presents after 10-15 years of exposure age of dx at 40-75 y/o construction is high risk occupation asbestos linked to lung cancer and malignant mesothelioma
34
what is almost always associate with asbestos exposure?
mesothelioma
35
what is the physical exam findings for asbestosis?
no specific S&S insidious onset - dyspnea, reduced exercise tolerance digital clubbing (30-40% pts)
36
what are CXR findings for asbestosis?
opacities in lower lungs and pleural plaques
37
what is needed to diagnose asbestosis usually?
consistent H&P, symptoms, and CXR
38
what are the PFT findings of asbestosis?
decreased TLC | FEV1/FVC ratio normal
39
most important preventative measures against asbestosis?
smoking cessation avoid exposure protective mask
40
list facts on sarcoidosis
``` multisystem inflammatory disease with unknown etiology noncaseating granulomas in lungs prevalence in African Americans 20-40 y/o female predominance asymptomatic to multi-system disease ```
41
what are physical exam findings for sarcoidosis?
fever, anorexia, arthralgias (MOST COMMON 3) DOE and dry cough arthritis, cranial nerve palsies, visual disturbances, and erythema nodusum
42
classify the different stages on CXR for sarcoidosis (stage 0-4)
stage 0: normal stage 1: hilar adenopathy stage 2: hilar adenopathy + diffuse infiltrates stage 3: only diffuse parenchymal infiltrates stage 4: pulmonary fibrosis
43
what are the PFTs for sarcoidosis?
decreased DLCO decreased TLC decreased FEV1 FEV1/FVC ratio normal
44
what are lab findings with sarcoidosis?
hypercalcemia increased ESR increased serum protein increased serum ACE
45
how to diagnose sarcoidosis?
fiberoptic bronchoscopy with transbronchial biopsy
46
how to manage sarcoidosis?
consult pulmonologist NSAIDS corticosteroids - MAINSTAY for severe disease monitor CXR and ACE level
47
list facts on granulomatosis with polyangiitis (aka Wegener's granulomatosis)
``` immune-mediated, systemic vasulitis necrotizing granulomas of upper/lower respiratory tracts renal involvement/glomerulonephritis multiple organ system involvement 40-50 y/o (men or women) can result in ESRD ```
48
what are common upper airway symptoms associated with Wegener's granulomatosis?
rhinorrhea, purulent/bloody nasal discharge | oral/nasal ulcers, sinus pain
49
what are PFT findings in Wegener's granulomatosis?
restrictive/obstructive pattern decreased DLCO decreased lung volume if diffuse interstitial involvement present
50
what does CXR look like with Wegener's granulomatosis?
opacities | nodules which may cavitate
51
what does CT look like with Wegener's granulomatosis?
irregular and stellate-shaped peripheral pulmonary arteries (vascultitis sign)
52
what are lab findings with Wegener's granulomatosis?
increased ESR (greater than 100) leukocytosis, thrombocytosis, normocytic anemia increased BUN/Cr + ANCA
53
how to diagnose Wegener's granulomatosis?
difficult to distinguish | compatible clinical presentation and histopathology
54
how to manage Wegener's granulomatosis?
consult rheumatologist | treat with immunosuppressant (methotreaxate or cyclophosphamide) and glucocorticoid
55
lists facts about idiopathic pulmonary fibrosis
most common of the 7 idiopathic interstitial PNAs inflammation and fibrosis of lung parenchyma diagnosis made efter excluding other causes of ILD 70% are current/former smokers slight male predominance insidious onset
56
what is most common symptom of IPF?
DOE
57
what are physical exam findings with IPF?
inspiratory crackles | digital clubbing
58
what are CXR findings with IPF?
bilateral diffuse reticular or reticulonodular infiltrates, periphery and bases
59
what diagnostic tool to meet criteria for dx of IPF?
lung biopsy (thoracoscopy or open)
60
what are PFT findings for IPF?
decreased TLC | normal FEV1/FVC ratio
61
how to manage IPF?
consult pulmonologist | evaluated for lung transplant (most common indication = IPF)

foundations pulm exam (10 decks)

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