Interstitial Lung Disease CIS I Flashcards Preview

RESP II Exam 2 > Interstitial Lung Disease CIS I > Flashcards

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

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

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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

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

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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**

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hilar adenopathy without symptoms

sarcoidosis
-tx watchful waiting

23

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

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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

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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

36

27yo F cough, fever, night sweats, weight loss, marked eosinos, non-cavitating lung lesions, CXR nonsegmental alveolar infiltrates

Tx with albuterol and oral corticosteroids - infiltrates resolve in 2 days - becomes asymptomatic

returns 3 weeks with diarrhea and same symptoms

churg strauss syndrome

vasculitis with initial asthma symptoms

also get GI sx, possible heart disease