Interstitial Lung Disease II Flashcards Preview

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Flashcards in Interstitial Lung Disease II Deck (41):
1

50yo F, dyspnea, cough, bibasilar fine crackles, clubbing, CXR basilar opacities, calcified pleural plaques

asbestosis

2

calcified pleural plaques

asbestosis

3

BOOP

on CXR - looks like pneumonia

won't get better with antibiotic

4

kaplans syndrome

rheumatoid arthritis and pneumoconiosis

5

22yo M Hx asthma, mild intermittent, albuterol 1x/week, runs 2 miles/day

PFT reveal?

greater than 20% decline in FEV1 on methacholine challenge test

6

restrictive lung disease

reduced FEV1 and FVC

with elevated FEV1/FVC ration

7

25yo severe asthma, cold on day of exacerbation, chemical fume inhalation, unable to breathe

RR 44
diaphoretic, suprasternal retractions, bialteral wheezes, , given albuterol and IV corticosteroids

next step - inhaled corticosteroids

8

65yo M, CXR rounded opacities upper lung zones, egg shell calcifications, increasing SOB last 2 years, accesory mm respiration, fine crackles end expiration

silicosis

-risk fx for TB
-so do a PPD skin test

9

65yo M, mine worker, increasing SOB, sleeps on sofa, right side HF, 2+ pretibial edema, diffuse qheezing

coal workers pneumoconiosis

pulmonary HTN > cor pulmonale

10

anti-GBM

goodpastures

11

non-caseating granulomas

sarcoidosis

12

fibrous plaques, pleural fibrosis

asbestosis

13

chronic mucopurulent infections causing dilation of resp bronchioles

bronchiectasis

14

coalescence of particle containing macules that form discrete areas of interstitial fibrosis causing distention of resp bronchioles, forming focal areas of emphysema

coal workers pneumoconiosis

15

35yo coal miner rheumatoid arthritis
-calcified pulmonary nodules on CXR

dx - kaplans syndrome

16

silicosis

egg shell calcifications

17

miliary TB

spots all over CXR

18

47yo roofer, increased SOB, 30py tobacco, roofing industry worker, CXR irregular shadows lower lung zones, thickened pleural plaques under diaphragms

asbestosis

decreased DLCO
decreased total lung capacity

19

asbestosis

golden brown, fisuform rods with translucent center consisting of particulat fibers coated with iron containing proteinaceous material

ferruginous bodies**

20

ferruginous bodies

asbestosis

21

65yo M increasing SOB, weight loss last 3 months, positive JVD, distant heart sounds, pulsus paradoxus, diminshed breath sounds base of lung on left

right side pleural effusion and pericardial effusion

works on shipyard

thoracentesis reveals?

pleural fluid analysis with malignant mesothelioma

asbestosis

22

berrylium

nuclear exposure

like sarcoidosis

23

transudate vs. exudate

exudate if:
-pleural protein/serum protein > 0.5

-pleural fluid LDH/serum LDH > 0.6

-pleural fluid LDH more than 2/3 normal upper limit for serum

24

35yo M, dyspnea, anorexia, night sweat, weight loss, nuclear technician, decreased breath sounds b/l, CXR bilateral fibrosis with hilar adenopathy, normal ACE and Ca levels, positive for mumps and trichophyton

beryllium exposure

BAL for beryllium lymphocyte proliferation test

25

heerfordts syndrome

variant of sarcoidosis

parotitis, uveitis, mild fever, facial nerve paralysis

26

25yo M, upholstery industry, polyurethane exposure, wheezing episodes at work

spirometry shows?

wheezing - FEF25-75 decreased- obstructive pattern

dx - TDI lung disease - polyurethane business

27

CXR with dextrocardia

not surprised to find?

no children
-kartagener syndrome
-primary ciliary dyskinesia

28

25yo male, dry cough, malaise, fevers, wheezing, weight loss, eosinophilia, LgE elevations, charcot leyden drystals, multiple nodules on CXR

treat with?


eosinophilia pneumonia?
-parasite
-tx diethylcarbamazine

wuchereria bancrofti

29

wuchereria bancrofti

elephantitis
-parasitic infection

30

14yo F, blood eosinophilia, fever, pulmonary infiltrates, episodic, abdomen pain, N/V, X-ray acute GI obstruction

diagnosis?

loefflers syndrome

parasite life cycle
-strongyloides
-lung phase an GI phase of life cycle

31

churg strauss

asthma like sx
progressive dx
diarrhea, abdominal pain

32

loefflers syndrome

intermittent disease
-parasites in GI and lungs
-strongyloides

33

38yo F, tx for breast ca mastectomy, low grade fever, night sweats, dyspnea, increased sputum, occasional cough

suspect?

chronic remodeling of lung tissue resulting in pulmonary fibrosis

radiation treatment effect on lungs

34

30yo rancher, fever, chills, cough, progressive SOB, wheezing increased over past 4 hours, diffuse infiltrates on CXR

learn more about ranch duties, surmise his problem is result of?

allergy to thermophylic actinomycetes

farmers lung

35

farmers lung

thermophylic actinomycetes

36

50yo M, sinusitis, allergies, persistent asthma, beta agonists, steroids, cromolyin, resp difficulty, pain legs, arms, hands, erythematous maculopapules, abdominal pain with rebound, decreased urination

right side infiltrates, elevated eosinos, p-ANCA elevated, IgE elevated, BUN/Cr elevated

diagnosis
-churg strauss syndrome

looked like wegeners - but no hematuria

37

pANCA

churg strauss

38

25yo hodgkins, chemotherapy, fever 3 days, dry cough and hemoptysis with pleuritic chest pain

BAL - suggest aspergillosis

most appropriate therapy - amphotericin B
-antifungal

39

amphotericin B

antifungal

40

27yo ranchhand, resp distress, cleaning at farm, CXR all white, see air bronchograms

diagnosis
-silo fillers disease

41

nitrogen dioxide

silo-fillers disease

can be fatal