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Clinical Medicine II > Pulm: ILD > Flashcards

Pulm: ILD Flashcards

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1
Q

What is the most common cause of ILD?

A

idiopathic

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2
Q

This class of pulmonary disorders cause progressive scarring of lung tissue

A

ILD

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3
Q

This disease is a process of fibrosis and aberrant healing response. It is NOT infectius

A

ILD

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4
Q

A patient presents with the following:

Progressive DOE

Persistent non-productive cough

A

ILD

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5
Q

What two signs/sxs are uncommon in ILD?

A

wheezing, CP

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6
Q

What is the duration of sxs for the following ILDs?

Acute idiopathic interstitial pneumonia

eosinophilic pneumonitis

hypersensitivity pneumonitis

Cryptogenic organizing pneumonia

A

Acute (days/weeks)

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7
Q

What is the duration of sxs for the following ILDs?

Sarcoidosis

Alveolar hemorrhage

Cryptogenic organizing pneumonia

Connective tissue disease

A

Subacute (weeks/months)

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8
Q

What is the duration of sxs for the following ILDs?

IPF

Sarcoidosis

Pulmonary langerhans cell histiocytosis

Chronic hypersensitivity pneeumonitis

A

Chronic (months-years)

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9
Q

Digital clubbing is a sign usually associated with _______

A

advanced disease

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10
Q

Erythema nodosum can be seen in what type of ILD?

A

sarcoidosis

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11
Q

Grottron’s papules can be seen in what type of ILD?

A

dermatomyositis

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12
Q

What lung sound is usually heard with ILD and where?

A

crackles at lung bases

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13
Q

What specialties should be involved in diagnosing ILD?

A

pulmonology

radiology

pathology

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14
Q

What imaging and diagnostic test are used to diagnose ILD?

A

HRCT

Tissue biopsy

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15
Q

What three signs present on CXR indicate ILD?

A

ground glass

reticular opacity

honeycombing

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16
Q

Honeycombing indicates a _______ prognosis

A

poor prognosis

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17
Q

What is the most common finding on CXR in ILD?

A

reticular opacity

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18
Q

On HRCT, you notice the distribution of disease in the upper zones of the lungs. This indicates what etiology?

A

inhalation related diseases (except asbestosis)

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19
Q

On HRCT, you notice the distribution of disease among the lower zones, this indicates…

A

IPF, connective tissue dz, asbestosis

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20
Q

What serologic studies can be ordered to rule out subclinical autoimmune disease?

A

ANA, RF ,CCP

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21
Q

What serologic studies would be useful for pulmonary hemorrhage or suspicious systemic symptoms/vasculitis?

A

ANCA

antiphospholipid Abs

Antistreptococcal Abs

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22
Q

Describe the results of PFTs in ILD (TLC, FEV-1, FVC)

A

Decreased TLC

Decreased FEV-1 and FVC

FEV-1/FVC ratio normal/increased

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23
Q

What PFT is sometimes the only finding of early ILD?

A

Decreased DLCO

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24
Q

What results can be expected on ABG with ILD?

A

hypoxemia

Respiratory alkalosis

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25
What is the gold standard for dx of ILD?
lung biopsy
26
What is the contraindication to lung biopsy?
honeycombing
27
What are the three types of lung biopsy?
Transbronchial Surgical biopsy EBUS-TBNA
28
For what suspected condition should EBUS-TBNA be performed?
sarcoidosis
29
Transbronchial biopsy is helpful to biopsy what locations?
central
30
Which condition has the following characteristics? MC ILD Age > 50 Male TOBB use
Idiopathic pulmonary fibrosis
31
A patient has the following S/S... What are these concerning for? Inspiratory velcro crackles digital clubbing gradual onset of DOE non-productive cough
Idiopathic pulmonary fibrosis
32
What test offers a good baseline for IPF?
6 minute walk test
33
You receive the following results after running diagnostic tests... what condition should you be concerned for? CXR: - peripheral reticular opacities - honeycombing HRCT: - bibasilar reticulonodular opacity - traction bronchiectasis - honeycombing PFTs: -restrictive pattern
IPF
34
IPF has what pattern on HRCT?
UIP
35
What condition should be treated (even if asymptomatic) in patients with IPF?
GERD
36
What two pharmacologic interventions can help manage IPF? Are they curative?
Nintedanib Pirfenidone not curative
37
what condition presents with the following characteristics? multisystem inflammatory dz non-caseating granulomas secretes ACE Mostly african american female predominance
Sarcoidosis
38
What type of ILD can present with the following extrapulmonary findings? erythema nodosum lupus pernio granulomatous uveitis arthralgias
Sarcoidosis
39
A patient presents with: ``` DOE CP Cough Hemoptysis Systemic complaints fever anorexia ```
Sarcoidosis
40
The following diagnostic study results indicate... PFTs: restrictive, can be obstructive CXR: Hilar adenopathy Labs: elevated serum ACE elevated calcium hypercalciuria Biopsy: EBUS-TBLB
Sarcoidosis
41
Stage 1 Sarcoidosis CXR:
hilar adenopathy
42
Stage 2 Sarcoidosis CXR:
hilar adenopathy + diffuse infiltrates
43
Stage 3 Sarcoidosis CXR:
diffuse parenchymal infiltrates
44
Stage 4 Sarcoidosis CXR:
pulmonary fibrosis
45
What is the treatment for stage 2+ sarcoidosis?
high dose CS immunosuppressants if relapsing/multisystem Lung transplant in stage 4
46
Silicosis Coal worker's asbestosis These are types of...
pneumoconiosis
47
Which pneumoconiosis has the following characteristics: - inhalation of quartz - occupational risk, esp. mining - smoking increases risk
Silicosis
48
What can be seen on HRCT in acute silicosis?
crazy paving pattern
49
What diagnostics should be ordered to assess silicosis and coal worker's pneumonconiosis
CXR, HRCT PFTs
50
A miner presents with: CXR: - eggshell calcifications - angel's wing appearance - pleural abnormalities PFTs showing restrictive pattern
silicosis and coal worker's pneumonconiosis
51
What signs/sxs are common physical exam with silicosis and coal worker's pneumonconiosis?
tachypnea prolonged expiration rhonchi, wheezing, rales
52
What two sxs indicate advanced silicosis/coal worker's pneumonconiosis?
cyanosis | cor pulmonale
53
What is an important question to ask on hx for asbestosis?
occupational hx
54
A patient presents with: digital clubbing dry cough end-inspiratory rales insidious onset of: dyspnea reduced exercise tolerance nonspecific chest discomfort
Asbestosis
55
You receive the following results from diagnostic studies: CXR: - opacity in lower lungs - calcified pleural plaques PFTs: restrictive pattern
Asbestosis
56
Where are calcified pleural plaques typically found on CXR in asbestosis?
diaphragmatic/parietal pleura of 6-9th ribs
57
Will immunotherapeutic drugs or CS be effective tx for asbestosis?
no
58
What will greatly increase the already high risk for CA . with asbestosis?
smoking (6x)
59
This condition is defined as: inflammatory syndrome of lungs caused by repetitive inhalation of antigens
Hypersensitivity pneumonitis
60
Is hypersensitivity pneumonitis reversible?
yes
61
What are three classifications of exposures that can cause hypersensitivity pneumonitis?
bacteria, fungi, mold proteins/chemicals Environmental exposures
62
Acute, subacute or chronic hypersensitivity pneumonitis? flu-like syndrome w/in hours of exposure
acute
63
Acute, subacute or chronic hypersensitivity pneumonitis? insidious onset productive cough dyspnea fatigue occurring over period of weeks
subacute
64
Acute, subacute or chronic hypersensitivity pneumonitis? progressive dyspnea, cough, fatigue, malaise
chronic
65
On physical exam, a patient with the following findings should be concerning for... ``` diffuse, fine bibasilar crackles fever teachypnea muscle wasting clubbing weight loss ```
Hypersensitivity pneumonitis
66
A patient presents with the following results from imaging... interstitial inflammation honeycombing centrilobular fibrosis peribronchiolar fibrosis
Hypersensitivity pneumonitis
67
What is the best course of tx for hypersensitivity pneumonitis?
avoidance +/- CS
68
What ILD has the following characteristics? Necrotizing granuloma systemic vasculitis of small-medium vessels common in northern european descent men = women
GPA
69
A patient presents with the following signs and symptoms: - recurrent respirator infx - nonspecific sxs: fever, weight loss, night sweats, low appetite Pulm: -Infiltrates, cough, hemoptysis, dyspnea, stridor Renal: failure, erythrocyte casts Skin: palpable purpura, ulcers HEENT: saddle nose deformity
GPA
70
Tissue biopsy shows vasculitis, granulomatous inflammation...
GPA
71
CXR shows: nodules +/- cavitation CT Chest: -stellate shaped peripheral pulmonary arteries (vasculitis sign) - feeding vessels leading to nodules - Diffuse hemorrhage
GPA
72
What labs should be ordered for evaluating GPA? (5)
``` ESR/CRP CBC CMP UA C-ANCA ```
73
The prognosis of GPA is improved with...
cyclophosphamide
74
What are the two main categories of treatment-related ILD?
drug induced radiation induced
75
What connective tissue disorders are associated with ILD? (5)
``` RA SLE Poly/dermatomyositis Sjogrens Scleroderma ```
76
The following conditions are associated with... respiratory bronchiolitis ILD desquamative interstitial pneumonitis pulmonary langerhans cell histiocytosis
Smoking related ILD
77
What is a major complication of ILD?
cor pulmonale/CVD

Clinical Medicine II (31 decks)

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