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Flashcards in ILD case history Deck (20)
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1
Q

Interstitial filtrates acronym is

SHIT FACED, what does that stand for?

A

S: sarcoid

H:Hypersensitivity penumonitis

I:interstitial lung disease

T: tumor, TB

F: fungal

A: asbestosis

C: collagen vasc

E: eosinophil granuloma

D: drugs

2
Q

Chest xray: scratchy lung fields =

A

interstitial involvement of suppporting tissue of lung parenchyma: see fine or coarse reticular opacities or small nodule

3
Q

With interstitial infiltrates on xray, what kind of biopsy will we do?

A

we will use transbronchioal biopsy and do 6, get 95% dx of interstitial infiltrates

4
Q

Diagnostically we see granuloma and you can see large granuloma

Submucosa dominated by granulomas. See interstitium w/ granulomas as well. Look like sarcoidosis but call it non-necrotizing granulomas. Pathologists can’t call this sarcoidosis, need what two things to compare it to?

A

Need microbiology correlation before you make definitive dx as well as comparing to clincal picture

5
Q

What do you see on histology?

A

Well circumscribed, non-necrotizing epitheliod cell granuloma with multinucleate giant cells

6
Q

Descibe this open lung biopsy

A

Granulomas w/ lymphatic distribution pattern; discreate and well-circumscribed following broncovascular bundles and interstitial septa

7
Q

Describe Stage I Sarcoidosis:

Nodes: looks like jumbo shrimp.. get lateral chest xray

A

Jumbo shrimp = Stage I

8
Q

Describe Stage II sarcoid on xray

A

Stage II sarcoid: nodes and scrathy lungs

9
Q

Describe Stage III sarcoidosis

A

Very scratchy, NO NODES

10
Q

What do we see in stage IV sarcoidosis

A

very bad fibrosis

11
Q

Therapy recommendation for sarcoidosis?

dyspnea, with decreased FVC below 70% and cough/wheezing

A

prednisone or inhaled corticosteroids

12
Q

What do fluffy markings on xray indicate?

A

Consolidation- any pathologic process that fills the alveoli

13
Q

What is the pneumonic for alveolar infiltrates?

A

Pecan Pie:

PCPIE

P = pus

C- cells (RBS/eosinos/tumor)

P-protein

I-inflammatory

E-edema (cardiac or non cardiac)

14
Q

Berlin Criteria for ARDS

A

ARDS while on PEEP >/= to 5 cm H20

Timing: acuteness of illness 7 days

Fluid overload assessed by clinical judgement- echo if no risk factor

CXR or CT findings: bilateral infiltrates

15
Q

What does Lung Protective Ventilation consist of?

A

Low Tidal Volume and Low Plateau Pressure

16
Q

In the Acute Lung injury randomized trial, patients were given two different tidal volumes:

12 ml/kg or 6 ml/kg

Which patients faired better?

A

Patietns with 6 ml/kg did better. Mortality prior to hospital discharge when from 40% in the 12 ml/kg group to 30% in the 6 ml/kg group and had more ventiliatory free days

17
Q

In ventilator protocol our tital volume is 6 ml/kg, but what about PEEP? Do you want lower PEEP/Higher FiO2 OR

higher PEEP/lower Fi02?

A

Doesn’t matter, PEEP being high or low doesn’t contribute significanlty to overall mortality

16 is a nice sweet spot

18
Q

FACTT; Fluid and Catheter Treatement Trial compared LIBERAL (up to 6 L/day) vs Conservative (no fluid other than daily)

What did we see in ventilatory free results?

A

Tx with conservative fluid therapy resulted in 14.5 ventilator free days vs 12 ventilator free days in pts with liberal fluid

19
Q

Key points:

____ tidal volumes preferred

____ fluid management after ‘just right’ early resuscitation is preferred

_____ positioning for more sever ARDS

_____ for pts with severe ARDS

A

small tidal volumes

conservative fluid volumes

Prone position for more severe ARDS

Paralysis for severe ARDS

20
Q

Key point on

PEEPS

Nutrition

B-agonists

Surfactant

Statins and salmon

A

choose your peep, no right or wrong

nutrition; both grandmas right

B-agonists shouls stay in OLD

Surfactant for children, not adults

Statis and fluids shouldn’t be in the water