Interstitial Lung Disease DSA II

Question 1

churg strauss syndrome

Answer 1

systemic necrotizing vasculitis
-upper and lower resp tracts

preceded by allergic disorders

peripheral and lung eosinophilia

IgE increase

rashes

Question 2

CXR for churg strauss

Answer 2

bilateral patchy, fleeting infiltrates

diffuse nodular infiltrates

diffuse reticulonodular infiltrates

Question 3

biopsy for churg strauss

Answer 3

granulomatous angiitis or vasculitis

Question 4

Tx for churg strauss

Answer 4

corticosteroids

Question 5

chronic eosinophilic pneumonia

Answer 5

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

Question 6

clinical for chronic eosinophilic pneomonia

Answer 6

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

pulmonary infiltrates with peripheral distribution

increased eosinophils in peripheral smear

BAL with increased eosinophils

Question 7

Tx of chronic eosinophilic pneumonia

Answer 7

dramatic response to corticosteroids within days to weeks

therapy - prolonged for months - prevent recurrence

Question 8

pulmonary alveolar proteinosis

Answer 8

primary path process affects alveolar spaces

filled with proteinacious phospholipid material
-components of surfactant

Question 9

clinical for pulmonary alveolar proteinosis

Answer 9

dyspnea, cough, bilateral alveolar infiltrates

Question 10

high res CT for pulmonary alveolar proteinosis

Answer 10

crazy paving pattern

thickened interlobular septa accompanied by groundglass alveolar filling

Question 11

nocardia

Answer 11

superimposed resp infection

with pulmonary alveolar proteinosis

Question 12

Tx for pulmonary alveolar proteinosis

Answer 12

whole lung lavage

good prognosis

Question 13

whole lung lavage

Answer 13

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)

Question 14

hypersensitivity pneumonitis

Answer 14

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

bacteria, fungi, protozoa, animal proteins, reactive chemicals

Question 15

Tx for hypersensitivity pneumonitis

Answer 15

avoid exposure

corticosteroids speed resolution

Question 16

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

Answer 16

suspect hypersensitivity pneumonitis

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

Question 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

Answer 17

acute hypersensitivity pneumonitis

Question 18

gradula development of symptoms and less severe intensity

Answer 18

subacute hypersensitivity pneumonitis

Question 19

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

Answer 19

chronic hypersensitivity pneumonitis

Question 20

thermophilic actinomycetes

Answer 20

moldy hay, grain, silage - farming - dairy cattle

hypersensitivity pneumonitis

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

Question 21

mycobacterium avium intracellular complex

Answer 21

hypersensitivity pneumonitis

from ventilation and water-related contamination

Question 22

CXR for hypersensitivity pneumonitis

Answer 22

acute disease
-diffuse reticulonodular infiltrates

chronic disease
-diffuse interstitial fibrosis

Question 23

high res CT for hypersensitivity pneumonitis

Answer 23

ground glass opacities early

chronic - with traction bronchiectasis, honeycombing, and fibrosis

Question 24

PFT for hypersensitivity pneumonitis

Answer 24

restrictive, small lung volume, decreased diffusion capacity

Question 25

sarcoidosis

Answer 25

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

Question 26

sarcoidosis

Answer 26

pulmonary not necessary for Dx abnormal CXR with mediastinal and hilar adenopathy may lead to chronic disease -pulmonary fibrosis

Question 27

lofgrens syndrome

Answer 27

acute manifestation of sarcoidosis - erthyema nodosum - arthritis - bilateral hilar lymphadenopathy favorable prognosis

Question 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

Answer 28

sarcoidosis

Question 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

Answer 29

sarcoidosis

Question 30

lupus pernio

Answer 30

affect nose, cheeks, ears in sarcoidosis

Question 31

yellow nodules in eyes

Answer 31

can be bx to make dx of sarcoidosis

Question 32

calcium in sarcoidosis

Answer 32

disorder of vit D nephrolithiasis, nephrocalcinosis, hypercalcuria

Question 33

Dx of sarcoidosis

Answer 33

clinical, radiographic, histologic evidence of noncaseating granuloma in one or more organs bronchoscopy with transbronchial lung bx also elevated ACE - but this is nonspecific

Question 34

pathognomonic for sarcoidosis

Answer 34

lofgrens syndrome

Question 35

staging of sarcoidosis

Answer 35

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

Question 36

PFT for sarcoidosis

Answer 36

restrictive ventilatory defect - concurrent obstruction - decrased DLCO

Question 37

other testing for sarcoidosis

Answer 37

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

Question 38

Tx of sarcoidosis

Answer 38

only for symptomatic patient** prednisone - daily for 3 months -monitor with FVC taper off if improvement

Question 39

sarcoidosis prognosis

Answer 39

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

Question 40

silicosis

Answer 40

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

Question 41

risk for silicosis

Answer 41

``` mining tunneling excavating quarrying stonework foundries sandblasting ceramics ```

Question 42

chronic silicosis

Answer 42

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

Question 43

accelerated silicosis

Answer 43

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

Question 44

acute silicosis

Answer 44

6 months to 2 years after exposure dyspnea, cough, weight loss, resp failure and death alveolar filling process

Question 45

progressive massive fibrosis

Answer 45

with silicosis lesions are at least 1 cm in diameter and often larger upper lobes resp failure, cor pulmonale, weight loss, death

Question 46

diseases associated with silicosis

Answer 46

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

Question 47

CXR for silicosis

Answer 47

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

Question 48

PFT for silicosis

Answer 48

normal early in chronic silicosis later mixed pattern obstructive and restrictive

Question 49

Dx of silicosis

Answer 49

x-ray changes and history of exposure

Question 50

Tx of silicosis

Answer 50

irreversible avoid further exposure TB test smoking cessation consider lung transplant