Interstitial Lung Disease DSA II Flashcards Preview

RESP II Exam 2 > Interstitial Lung Disease DSA II > Flashcards

Flashcards in Interstitial Lung Disease DSA II Deck (50):
1

churg strauss syndrome

systemic necrotizing vasculitis
-upper and lower resp tracts

preceded by allergic disorders

peripheral and lung eosinophilia

IgE increase

rashes

2

CXR for churg strauss

bilateral patchy, fleeting infiltrates

diffuse nodular infiltrates

diffuse reticulonodular infiltrates

3

biopsy for churg strauss

granulomatous angiitis or vasculitis

4

Tx for churg strauss

corticosteroids

5

chronic eosinophilic pneumonia

pulmonary interstitium and alveolar spaces are infiltrated by eosinos and to lesser extent macrophages

6

clinical for chronic eosinophilic pneomonia

over weeks to months
-fever, weight loss, dyspnea, productive cough

pulmonary infiltrates with peripheral distribution

increased eosinophils in peripheral smear

BAL with increased eosinophils

7

Tx of chronic eosinophilic pneumonia

dramatic response to corticosteroids within days to weeks

therapy - prolonged for months - prevent recurrence

8

pulmonary alveolar proteinosis

primary path process affects alveolar spaces

filled with proteinacious phospholipid material
-components of surfactant

9

clinical for pulmonary alveolar proteinosis

dyspnea, cough, bilateral alveolar infiltrates

10

high res CT for pulmonary alveolar proteinosis

crazy paving pattern

thickened interlobular septa accompanied by groundglass alveolar filling

11

nocardia

superimposed resp infection

with pulmonary alveolar proteinosis

12

Tx for pulmonary alveolar proteinosis

whole lung lavage

good prognosis

13

whole lung lavage

gold standard treatment for pulmonary alveolar proteinosis

-saline into lungs with percussion to dislodge material in lungs

fluid then removed

repeated until no more material is recovered (when fluid is clear)

14

hypersensitivity pneumonitis

hyperimmune respiratory syndrome caused by inhalation of wide variety of allergic antigens that are usually rganic

bacteria, fungi, protozoa, animal proteins, reactive chemicals

15

Tx for hypersensitivity pneumonitis

avoid exposure

corticosteroids speed resolution

16

intermittent pulmonary and systemic symptoms, progressive interstitial CXR changes, non-resolving pneumonia

suspect hypersensitivity pneumonitis

agriculture, cattle farming, bird keeping, contaminated home ventilation, hot tubs

17

abrupt onset of cough, dyspnea, fever, chest pain, following heavy exposure to offending antigen, Sx 4-6 hours after exposure

subsides 24 hours after removal from exposure

acute hypersensitivity pneumonitis

18

gradula development of symptoms and less severe intensity

subacute hypersensitivity pneumonitis

19

insidious progressive dyspnea, cough, weight loss, fatigue, pulmonary fibrosis and resp failure

chronic hypersensitivity pneumonitis

20

thermophilic actinomycetes

moldy hay, grain, silage - farming - dairy cattle

hypersensitivity pneumonitis

also from ventilation - water-related contamination
-humidifier, hot tub, air conditioner

21

mycobacterium avium intracellular complex

hypersensitivity pneumonitis

from ventilation and water-related contamination

22

CXR for hypersensitivity pneumonitis

acute disease
-diffuse reticulonodular infiltrates

chronic disease
-diffuse interstitial fibrosis

23

high res CT for hypersensitivity pneumonitis

ground glass opacities early

chronic - with traction bronchiectasis, honeycombing, and fibrosis

24

PFT for hypersensitivity pneumonitis

restrictive, small lung volume, decreased diffusion capacity

25

sarcoidosis

systemic granulomatous disease
-non-caseating granuloma

can effect any organ

unknown etiology

age 40-60yo
-peak 20-40yo

3.5x higher than african americans

more in women

26

sarcoidosis

pulmonary not necessary for Dx

abnormal CXR with mediastinal and hilar adenopathy

may lead to chronic disease
-pulmonary fibrosis

27

lofgrens syndrome

acute manifestation of sarcoidosis

-erthyema nodosum
-arthritis
-bilateral hilar lymphadenopathy

favorable prognosis

28

fatigue, night sweats, fever, weight loss, cough, dyspnea, wheeze, rash, macules, hyper/hypopigmentation, erythema nodosum, dry eyes, pain, redness, blurry vision, arrhythmia, palpitations, syncope, HAs, numbness, epigastric pain, RUQ pain, jaundice, swelling and joint stiff, muscle pain, nasal congestion, sinus pressure

sarcoidosis

29

rales, exp whezing, infiltration of old scars/tattoos, macolopapular lesions, erythema nodosum uveitis, iritis, scleral plaque, irregular cardiac rhythm, CN II, VII, VIII neuropathies, hepatomegaly, arthritis, palpable adenopathy

sarcoidosis

30

lupus pernio

affect nose, cheeks, ears in sarcoidosis

31

yellow nodules in eyes

can be bx to make dx of sarcoidosis

32

calcium in sarcoidosis

disorder of vit D

nephrolithiasis, nephrocalcinosis, hypercalcuria

33

Dx of sarcoidosis

clinical, radiographic, histologic evidence of noncaseating granuloma in one or more organs

bronchoscopy with transbronchial lung bx

also elevated ACE - but this is nonspecific

34

pathognomonic for sarcoidosis

lofgrens syndrome

35

staging of sarcoidosis

CXR

0 normal
1 bilateral hilar adenoapthy
2 bilateral hilar adenopathy and parenchymal infiltrates
3 parenchymal infiltrates without lymphadenopathy
4 advanced parenchymal disease with fibrosis

36

PFT for sarcoidosis

restrictive ventilatory defect
-concurrent obstruction
-decrased DLCO

37

other testing for sarcoidosis

opthalmology exam
EKG
CVC
CMP
serum ACE level
Bx of involved organ

38

Tx of sarcoidosis

only for symptomatic patient**

prednisone - daily for 3 months
-monitor with FVC

taper off if improvement

39

sarcoidosis prognosis

spontaneous remission in 50% of patients at 3 years

lofgrens - best prognosis

2/3 remission after 10 years

1/3 with unrelenting disease

less than 5% die

40

silicosis

fibrotic lung disease cased by inhalation of crystalline silica in form of quartz

41

risk for silicosis

mining
tunneling
excavating
quarrying
stonework
foundries
sandblasting
ceramics

42

chronic silicosis

most common

20 or more years after exposure

silicotic nodule
-whorled hyalinized collagen fibers with peripheral zone of dust laden macrophages

asymptomatic - or complain of dyspnea and productive cough

43

accelerated silicosis

nodules after 3-10 years after exposure
-progressive clinical course

44

acute silicosis

6 months to 2 years after exposure

dyspnea, cough, weight loss, resp failure and death

alveolar filling process

45

progressive massive fibrosis

with silicosis

lesions are at least 1 cm in diameter and often larger

upper lobes

resp failure, cor pulmonale, weight loss, death

46

diseases associated with silicosis

TB
COPD
chronic bronchitis
collagen vascular disease
rheumatoid arthritis
scleroderma
lung cancer

47

CXR for silicosis

symmetric nodular pattern involving upper lobes

hilar lymphadenopathy with eggshell calcification is strongly suggestive

progressive massive fibrosis - coalescence of nodules with larger mass lesions

acute silicosis displays air space and interstitial pattern on x-ray

48

PFT for silicosis

normal early in chronic silicosis

later mixed pattern obstructive and restrictive

49

Dx of silicosis

x-ray changes and history of exposure

50

Tx of silicosis

irreversible
avoid further exposure
TB test
smoking cessation

consider lung transplant