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