Flashcards in Interstitial Lung Disease CIS I Deck (36)
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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
4
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
5
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
8
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
9
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**
10
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
11
causes of increased DLCO
diffuse alveolar hemorrhage
polycythemia
12
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
14
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
21
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**
22
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
27
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
28
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
29
bronchiectasis with aspergillus
allergic pulmonary aspergillosis
30
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
31
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
32
tuberculosis
fever, chills, night sweats, malaise, weight loss, lymphadenopathy, cavitary lung lesions - upper lobes
33
goodpasture
renal and lung involvement
34
elevated ACE
sarcoidosis
-nonspecific
35
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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