Flashcards in Interstitial Lung Disease CIS I Deck (36):
1
75yo M abnormal CXR, 60py tobacco, myalgias in shoulder and neck, fatigue, sinus infection, hemoptysis, weight loss, T 99F, crackles b/l, b/l lung nodules - cavitated, WBC 10,000
most likely diagnosis
-wegners granulomatosis
2
wegners granulomatosis
sinusitis
lung
kidney
3
DDx for cavitary lung lesions
CAVITY
c - carcinoma
a - autoimmune - wegners
v - vascular
i - infection 9 TB, fungal, bacterial
t - trauma
y - young - congenital lesions
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61yo M increasing SOB last year, hacking non-prod cough, a-fib, HTN, rheumatoid arthritis, velcro-like crackles, split S2, pitting lower extremity edema, clubbing
FVC 50%, FEV1 50%, FEV1/FVC 98%
appropriate next step in management
-stop amiodarone and methotrexate
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amiodarine and methotrexate
can cause restrictive lung disease
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methacholine challenge
for asthma
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amiodarone lung
2-4 months at doses greater than 400mg/day
lipid laden foamy alveolar macrophages
organizing pneumonia - 25% of cases - mimics infectious pneumonia
ARDS - post-surgical
diffuse alveolar damage
solitary lung mass
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50yo M increasing SOB with exercise, no fever, hemoptysis, weight loss, dry cough, no smoking, lungs crackle, clubbing, diffuse linear opacities, restrictive PFT, decreased diffusion capacity
most likely diagnosis
-idiopathic pulmonary fibrosis
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27yo F SOB reently, exercise tolerance dwindled, occasional dry cough, no smoking, O2 90% after exercise, bilateral hilar lymph nodes, restrictive PFT
next appropriate step
-obtain transbronchial lymph node biopsy
diagnostic for sarcoidosis**
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61yo F 3 day history of SOB, non-prod cough, fever, hemoptysis 3mL maroon, hx of SLE, cerebritis, lupus nephritis
T 100.4
CXR diffuse b/l infiltrates
PFT increased DLCO - most likely diagnosis
diffuse alveolar hemorrhage
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causes of increased DLCO
diffuse alveolar hemorrhage
polycythemia
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30yo M syncope, no fever, nonsustained V-tach, positive skin test for anergy, bilateral hilar adenopathy, elevated serum calcium, echo wall abnormality
bx of myocardium
upon receiving biopsy results you will
-begin tx for disorder associated with noncaseating granulomas
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noncaseating granulomas
sarcoidosis
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22yo F severe dyspnea on exertion, over last 6 months, O2 desat with exercise, enlarge pulmonary vasculature, V/Q normal, right heart strain, DLCO and PFT normal
next test to order for Dx?
right heart cath
-assess cause of pulmonary HTN
15
30yo M 15py tobacco, URI tx with azithromycin 3 weeks ago, 3 days ago SOB, cough hemoptysis, lips cyanotic, 2 + edema, BUN 60, Cr 4, microscopic hematuria
most help confirm dx
C-ANCA
wegners
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C-ANCA
wegners
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anti-GM BM antibodies
goodpastures
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kveim test
sarcoidosis
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alpha1 antitrypsin
early emphysema
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goodpastures vs. wegners
history of URI - possible sinus involvement
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37yo AA M raised red lesions on anterior both legs, SOB, dry cough, no fever, never smoked, dry rales b/l, irregular heart rhythm, AV block, hilar adenopathy, noncaseating granulomas, PFT restrictive, elevated Ca and ACE
erythema nodosum
-sarcoidosis
Tx plan - high dose systemic corticosteroids
treat a patient that is symptomatic**
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hilar adenopathy without symptoms
sarcoidosis
-tx watchful waiting
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75yo M severe dyspnea 1 year, 100py tobacco, stone engraver, expiratory crackles b/l, clubbing, eggshell calcifications of hilar lymph nodes
most likely dx
-silicosis
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eggshell calcifications
silicosis
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asbestosis CXR
pleural plaques
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TB CXR
hilar adenopathy
upper lung fields
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50yo F acute dyspnea, dry cough, SOB, malaise, fever, pH 7.3, diffuse alveolar infiltrates - suggest ARDS, CT b/l ground glass with little honeycombing, septal thickening and subpleural distribution of opacities
lung bx - diffuse alveolar damage
ventilation, steroids, antibiotics, death
acidosis - respiratory
ground glass - alveolar filling - more treatable
most likely dx
-acute interstitial pneumonia
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38yo M, albuterol, salmeterol, ipratropium, steroid inhaler, steroid taper for aspergillus elevated IgE, hack and cough, purulent blood tinged sputum, cough for years, 60yr tobacco, four teacups of sputum/day, dyspnea over years, crackles and rhonchi
CXR findings in this disease?
mucus filled dilated bronchi with parallel linear opacities
bronchiectasis
allergic pulmonary aspergillosis - can lead to bronchiectasis
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bronchiectasis with aspergillus
allergic pulmonary aspergillosis
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49yo M CXR pre-op workup, small nodules left lung field laterally, high res CT, pleural based opacities, pleural plaques, restrictive PFT, decreased DLCO
most important to know
-occupational history
sounds like asbestosis
brake lines, house work, insulation, mining, ship building
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37yo M - 2-3 weeks dyspnea, hemoptysis, sinusitis, epistaxis
UA RBC and WBC
CXR - bilateral nodular infiltrates - one is cavitary
positive for C-ANCA likely
wegners
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tuberculosis
fever, chills, night sweats, malaise, weight loss, lymphadenopathy, cavitary lung lesions - upper lobes
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goodpasture
renal and lung involvement
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elevated ACE
sarcoidosis
-nonspecific
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29yo M chronic cough and sputum production, 3 courses of antibiotics per year, recurrent chronic sinusitis and otitis media, grain storage facility, CT thick/dilated peripheral airways in lower lobes
evaluation should include
-sweat chloride - CF
-serum Ig levels
-nasal mucosal Bx - with electron microscopy (for kartageners)
-serum protein electrophoresis
Dx - cystic fibrosis
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