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interstitial/restrictive lung disease Flashcards

(54 cards)

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1
Q

asbestosis causes

A

asbestosis exposure at high levels

average latency is greater than 20 years

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2
Q

clinical features of asbestosis exposure

A

insidious exertional SOB, worsening of dyspnea, cough: usually paroxysmal and dry with late stage mucoid sputum

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3
Q

physical exam for asbestosis

A

dry/fine end expiratory crackles (rales/crepitation), clubbing, edema and JVD

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4
Q

diagnostic studies for asbestosis

A

CXR/CT: small irregular opacities in lower lungs; pleural plaques; costophrenic angle blunting; thickening pleural, honeycombing

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5
Q

asbestosis lateral hallmark

A

calcified hemidiaphragmatic plaques

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6
Q

asbestosis treatment

A 
smoking cessation
bronchodilators 
proper nutrition
exercise
home oxygen therapy
removal of further exposure
ID respiratory infection promptly
annual flu and pneumonia vaccine
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7
Q

asbestosis and risk and prognosis

A

DEATH FROM RESPIRATIRY FAILURE COR PULMONALE
increased risk of
mesothelioma, lung cancer or TB.
Survival is 4-6 years after diagnosis of mesothelioma

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8
Q

cause of coal workers pneumonoconiosis

A

coal dust deposits in the peribronchial tissue

but extent of exposure depends on rank of coal (fibrogenic vs bitominous)

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9
Q

divisions of coal workers pneumonoconiosis

A

simple and PMF

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10
Q

coal workers pneumonoconiosis physical exam

A

inspiratory crackles, clubbing and cyanosis

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11
Q

diagnostic study for coal workers pneumonoconiosis

A

CXR:
simple: small round nodules (<10mm) in upper lobes

PMF: confluence developing large opacities

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12
Q

treatment for coal workers pneumonoconiosis

A 
bronchodilators
avoidance of exposure
supplemental oxygen 
smoking cessation 
TB surveillance 
antibiotics for infections
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13
Q

key points for coal workers pneumonoconiosis

A

predisposition to develop COPD

chronic bronchitis 10 years after exposure

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14
Q

significant info for asbestosis

A

pleural fibrosis

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15
Q

idiopathic interstitial pneumonias causes

A

etiology unknown

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16
Q

idiopathic interstitial pneumonia history, signs and symptoms

A

hx: duration, speed and presence of:
fever: highly sensitive pneumonia
hemoptysis: diffuse alveolar bleeding (goodpastures)
pleuritic chest pain: inflammatory

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17
Q

idiopathic interstitial pneumonia physical exam

A

auscultation in basilar area
“wet” quality - alveolar filling
“dry” (velcro) quality- no alveolar fills

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18
Q

diagnostic studies for idiopathic interstitial pneumonias

A

ABG’s: normal or respiratory alkalosis
PFT’s: restricted pattern
CXR/CT: reticulonodular, ground glass, nodular, honeycombing

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19
Q

key points to idiopathic interstitial pneumonias

A

progression is common & insidious

refer to pulmonologist

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20
Q

significant info for sarcoidosis

A

african-american women and scandinavian descent

age: 20-45

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21
Q

sarcoidosis causes

A

multisystem disease

must has 2 organ system affected for diagnosis

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22
Q

signs and symptoms on sarcoidosis

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A

fever, malaise, fatigue, night sweats, weight loss, cough

23
Q

physical exam of sarcoidosis

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A

erythema nodosum, lupus pernio, kerititis, sicca, uveitis

lofgren’s: erythema nodosum & hilar adenopathy

24
Q

diagnostic study for sarcoidosis

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A

PATHOLOGIC HALLMARK:
noncaseated granuloma
CXR: hilar adenopathy
CT: hilar & mediastinal adenopathy with nodular infiltrates

25
sarcoidosis labs
Serum ACE Levels: ↑, BUT not specific LFT’s: ↑ Alk Phos = liver obstruction Bilirubin: ↑ = advanced liver disease
26
treatment for sarcoidosis
relieve symptoms prevent significant organ function impairment depends on symptomatology
27
key points to sarcoidosis
early disease: reverible chronic disease: irreversible end stage: cysts with connective tissue refer to pulmonology
28
significant info silica silicosis
african americans 2-7 times higher risk
29
causes of silica silicosis
crystaline silica or silicon dioxide
30
occupations for risk of silica silicosis
stone cutting, Mining, Glass & Cement manufacturing, Quarrying (Granite), Sandblasting, Foundry
31
3 clinical presentations of silica silicosis
acute chronic accelerated
32
diagnostic studies for silica silicosis
peribronchial location of silicotic nodules | impaired gas exchange in early stages
33
treatment for silica silicosis
smoking cessation | influenza and pneumococcal vaccinations for all types of silicosis
34
key points for silica silicosis
crystalline silica causes lung cancer
35
significant info for acute silicosis
AKA: acute silicoproteinosis rare: found in patients with extremely high crystalline silica can occur in weeks of months after exposure
36
acute silicosis causes
heavy exposure: tunneling through areas of high quartz content, sandblasting in confined spaces, manufacturing abrasive soaps
37
signs and symptoms of acute silicosis
RAPID ONSET | cough, dyspnea, wieght loss, fatigue
38
physical exam for acute silicosis
crackles | rapid development of cyanosis, cor pulmonale, respiratory failure
39
diagnosis studies for acute silicosis
ABGs: respiratory impairment CXR: bilateral diffuse ground glass opacities: perihilar or basilar CT: numerous bilateral centilobular nodular opacities, focal ground glass opacties
40
acute silicosis treatment
avoidance of exposure supplemental oxygen bronchodilators antibiotics for infections
41
key point for acute silicosis
prognosis very poor survival typically <4 yrs
42
significant info for chronic silicosis
subdivided into simple and progressive massive fibrosis
43
chronic silicosis causes
10 years after exposure to low levels of silica
44
clinical features for simple chronic silicosis
asymptomatic or chronic cough, exertional dyspnea, wheezes, fine/coarse crackles at the end of inspiration, rhonchi
45
clinical features of PMF chronic silicosis
severe cough, exertional dyspnea, decreased breath sounds | no crackles, signs of respiratory failure and cor pulmonale
46
diagnostic studies for simple chronic silicosis
PPD for latent TB (DDX) PFT's complete cardiopulmonary exercise test CXR: innumerable small round opacities (<10 mm) in upper lung fields
47
diagnostic studies for PMF chronic silicosis
PPD: for latent TB (DDX) PFT's complete cardiopulmonary exercise test PMF: small opacities that develop into larger opacities (>10 mm) in upper and middle fields
48
treatment for chronic silicosis
avoidance of exposure supplemental oxygen bronchodilators antibiotics for infections
49
significant info for accelerated silicosis
differentiated from chronic | ONLY by its MORE RAPID DEVELOPMENT
50
causes of accelerated silicosis
high level exposure: rapid development with 10 years of exposure greater risk for developing PMF and complications (TB, narcotizing aspergillosis, lung cancer, kidney dz, COPD, chronic bronchitis)
51
treatment for accelerated silicosis
avoidance of exposure supplemental oxygen bronchodilators antibiotics for infection
52
key points for accelerated silicosis
course: progressive respiratory failure & cor pulmonale
53
clinical features of accelerated silicosis
same as chronic silicosis SIMPLE: Asymptomatic or chronic cough, exertional dyspnea, wheezes, fine/coarse crackles @ end inspiration, rhonchi PMF: Severe cough, exertional dyspnea, < BS, no crackles, signs of respiratory failure & cor pulmonale
54
diagnostic studies for accelerated silicosis
same as chronic silicosis ``` PPD: for latent TB (DDx) PFT’s Complete cardiopulmonary exercise test CXR: Simple: Innumerable, small round opacities (<10mm) in upper lung fields ``` PMF: Small opacities that develop into larger opacities (>10mm) in upper and middle fields Same as Chronic Silicosis

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