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Flashcards in Restrictive Lung Disease Deck (38)
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1
Q

Coal Workers Pneumoconiosis is caused by

A
  • Inhalation of coal mine dust
  • Coal is inhaled into alveolus and engulfed by macrophages.
  • Macrophages release reactive O2 species, triggering release of cytokines (interleukins, tumor necrosis factor) responsible for inflammation and fibrosis.
  • This leads to the development of coal macules.
  • These enlarge to coal nodules
2
Q

Pneumoconiosis Symptoms

A

Cough, sputum production, SHOB/DOE

3
Q

What is found on CXR for pneumoconiosis?

A

Small nodules that predominate the upper lungs

4
Q

Pneumoconiosis treatment

A

Supportive- O2 supplementation and rehab

5
Q

Silicosis is caused by

A

prolonged inhalation and retention of silica particles

6
Q

What is the hallmark lesion of silicosis?

A
  • Silicotic nodule
  • Small, rounded opacities in upper and mid lungs, 3-5 mm
  • 1st involve hilar lymph nodes and may calcify or erode the airway.
  • The lung parenchyma is subsequently involved, usually upper lobes.
7
Q

Silicosis symptoms

A

Tachypnea, fine crackles, SHOB

8
Q

Diagnosis of silicosis

A

need open lung biopsy for definitive diagnosis

9
Q

Silicosis treatment

A

avoid exposure, stop smoking, lavage if needed

10
Q

What is increased in silicosis patients?

A

Increase in TB

11
Q

Asbestosis characteristics

A
  • Interstitial fibrosis and pleural thickening, similar to Silicosis
  • Can be seen 15-20 years after lengthy exposure
  • Exposure via renovation/destruction of old buildings, ship building
12
Q

Asbestosis symptoms

A

DOE, Non-productive cough

13
Q

What is found on asbestosis CXR?

A

Fibrosis, pleural plaques.

*Make sure to get CT to evaluate plaque. The fewer the opacities, the better the prognosis.

14
Q

Asbestosis treatment

A
  • Oxygen if needed and pulmonary rehab
  • Must stop smoking.

Risk of lung cancer in nonsmoking asbestosis worker, 5.2 –> risk of lung cancer in smoking asbestosis worker, risk increases 53 fold

15
Q

Risks in asbestosis patients

A

increased risk of developing Mesothelioma of the pleura, bronchogenic carcinoma, and TB

16
Q

Sarcoidosis definition

A
  • Multisystem granulomatous disorder of unknown etiology

- Can effect: lungs (90%), lymph nodes, eyes, skin, liver, spleen, heart, joints, and nervous system

17
Q

Sarcoidosis is most commonly seen in…

A

young African American females, 20-40 y/o, and Northern Europeans

18
Q

A sarcoidosis pathology report will read…

A

“non caseating granulomatous inflammation”

19
Q

Sarcoidosis symptoms

A

Cough, SHOB, fever, wt loss, sweats, or nothing

20
Q

What will be seen on CXR for sarcoidosis?

A
  • Bilateral hilar adenopathy, interstitial infiltrates or both
  • Get a chest CT for closer evaluation
21
Q

Sarcoidosis diagnosis

A

Bases on pathology from a TBB (transbronchial biopsy) or FNA (fine needle aspiration)

22
Q

Sarcoidosis treatment

A
  • is based on symptoms
  • 90% respond to corticosteroids
  • 50-60% have spontaneous remissions
23
Q

What baseline labs should you draw for sarcoidosis?

A

Complete PFTs, BNP, ECHO, 24 hour urine Ca, Bilateral hand Xrays, ACE level, and refer to Ophthalmology
-Follow pt with serial PFTs and CXR or HRCT

24
Q

What joint is affected first in sarcoidosis?

A

The wrist joint

25
Q

Nonspecific Interstitial Pneumonitis (NSIP) characteristics

A
  • Younger patients, 40-50 y/o

- Onset usually gradual, 6 months to 3 years before dx

26
Q

NSIP symptoms

A

cough, wt loss, breathlessness

27
Q

NSIP physical exam

A

diffuse fine basilar crackles

28
Q

What will be seen on CT for NSIP?

A
  • diffuse, symmetrical GG changes w/wo traction bronchiectasis
  • confluent and homogenous pattern.
  • Honeycombing is rarely seen
29
Q

NSIP treatment

A

corticosteroids

30
Q

Cryptogenic Organizing Pneumonia (COP) characteristics

A
  • Organizing pneumonias
  • Most common in nonsmokers, roughly 50-60 y/o.
  • Males = Females
  • Short duration, <3 month history of SHOB, dry cough, may have malaise, wt loss, myalgias
  • Chest infection that it slow to resolve after several rounds of antibiotics
31
Q

COP physical exam

A

may be normal or hear crackles

32
Q

What will be seen on imaging studies in COP?

A
  • CXR: patchy consolidations or even a solitary mass

- HRCT: areas of consolidation with air bronchogram, GGO (these areas can migrate spontaneously)

33
Q

Definitive diagnosis of COP

A

TBB (transbronchial biopsy) or open lung biopsy

34
Q

COP treatment

A

long steroid taper over months, may need 6-12 months of therapy.
*Follow with CT

35
Q

Idiopathic Pulmonary Fibrosis

A
  • Diffuse lung disease of unknown etiology
  • Involves the interstitium of the lung the fibrous framework of the lung
  • Onset of 9-24 months
  • MC in males
  • Mean age is 65
36
Q

Idiopathic Pulmonary Fibrosis exam findings

A

fine basal and late inspiratory crackles

37
Q

What would you find on imaging for idiopathic pulmonary fibrosis?

A

CXR: peripheral and basal reticular shadowing

HRCT: bilateral, peripheral, and subpleural reticulation with honeycombing and traction bronchiectasis

38
Q

What is the prognosis for idiopathic pulmonary fibrosis?

A
  • Very poor prognosis
  • Stable vs. decline over years vs. decline rapidly
  • Median survival is 2.5 to 3.5 years at time of diagnosis
  • Prior to 11/2014 there were no treatment options other than supplemental oxygen.
  • -2 new medication to help slow down progression –> Ofev and Esbriet