Restrictive & Obstructive Lung Diseases Flashcards
(195 cards)
1
Q
What is the qualitative definition of Interstitial Lung Disease?
A
inflammatory-fibrotic infiltration of the alveolar septa
2
Q
What are the biophysical consequences of Chronic diffuse ILD?
A
decrease in diffusion capacity, FVC, lung volume, lung compliance
3
Q
What are radiographic hallmarks of chronic diffuse ILD?
A
hazy gray shadows; glass opacities; End-stage: honey-comb” lung
4
Q
Compare & contrast differences b/t COPD & pulmonary fiborsis?
A
Emphysema (COPD): pt. can’t exhale b/c lungs have decreased ability to recoil (lungs prefer to stay inflated); Pulmonary fibrosis: pt. can’t inhale b/c recoil pressure is too high (lungs prefer to stay deflated)
5
Q
Describe the epidemiology of Idiopathic pulmonary fibrosis?
A
most common in elderly men > 60 yrs. especially those w/ familial risk for pulmonary fibrosis
6
Q
what are the clinical presentations of IPF?
A
insidious progressive onset of unexplained dyspnea on exertion; bibasilar inspiratory crackles; cyanosis, myositis & clubbing may also be present; PE findings: augmented P2, S3 gallop
7
Q
What are the histological hallmarks of IPF?
A
follows a UIP pattern: honeycombing cysts w/ reticular septal thickening; minimal glass opacities & basal predominance
8
Q
What would a pulmonary function test show for a pt. w/ suspected IPF?
A
reduced VC, increased FEV1/FVC ration; decreased DLCO
9
Q
What are pre-existing risk factors for pulmonary fibrosis?
A
neoplasm; mutations of TGF-beta; collagen vascular diseases including RA, SLE, & progressive systemic sclerosis
10
Q
What are environmental factors of pulmonary fibrosis?
A
smoking; metal fumes; wood dust; occupational exposure
11
Q
How do fibroblasts contribute to IPF?
A
fibroblasts are activated in response to epithelial injury and deposit collagen in interstitial spaces leading to interstitial fibrosis and respiratory failure; abnormal increased signaling through PI3K/AKT
12
Q
Describe the pathogenesis of Familial IPF?
A
mutant telomerase: mutations in TERT & TERC leading to pathologically short telomeres; MUC5B mutation: increases secretion of mucin and alter mucociliary clearance
13
Q
What histological findings can be used to distinguish UIP & IPF from other restrictive lung diseases?
A
honeycomb interstitial fibrosis w/ fibroblast hyperplasia; no necrosis or substantial inflammation; mostly lymphocytes and very few neutrophils
14
Q
What are major histological distinctions b/t IPF & NSIP?
A
NSIP: no fibroblastic foci; notable inflammation & diffuse fibrotic lesions rather than honeycomb
15
Q
What are clinical hallmarks of desquamative interstitial pneumonia?
A
large collections of pigmented macrophages containing remnants of necrotic type 2 pneumocytes; Smoking is the biggest risk factor; presents in 4th & 5th decade of life
16
Q
What other interstitial lung disease is assoc. w/ smoking
A
respiratory bronchiolitis: similar histological patterns as DIP
17
Q
What is the proposed etiology of sarcoidosis?
A
cell-mediated response to an unidentified Ag
18
Q
what lab findings are indicative of sarcoidosis?
A
increased CD4/CD8 ratio; increased levels of TH1 cytokines (IL-2 & IFN-gamma) promotes T-cell expansion and macrophage activation; increased levels of IL-8 & TNF promotes formation of granulomas; polyclonal hypergammaglobulinemia (manifestation of helper T-cell dysregulation; impaired dendritic cell function
19
Q
What histologic characteristics would you expect to find if sarcoidosis is suspected?
A
GRANULOMATOUS INFLAMMATION; giant cell nodular aggregates; NO NECROSIS
20
Q
What are other more non-specific histological findings that can also be found for sarcoidosis?
A
schaumann bodies: basophilic laminated concretions of calcium & proteins; asteroid bodies: stellate inclusions enclosed in giant cells
21
Q
What other lung abnormality is commonly seen in pts. w/ sacoidosis?
A
bilateral hilar lymphadenopathy
22
Q
What are other conditions besides sarcoidosis that are assoc. w/ pulmonary granulomas?
A
Histoplasmosis; TB; neoplasm; lymphoma; foreign bodies
23
Q
What skin test is performed for diagnosis of sarcoidosis?
A
cell mediated immunity to tuberculin
24
Q
What are clinical presentations of sarcoidosis?
A
progressive dry cough & dyspnea; polyarthralgia; T-cell alveolitis w/ activated Mo-Ma
25
What is the proposed mechanism for increased ACE activity in sarcoidosis?
thought to be produced by epithelioid cells and macrophages of the granulomas
26
Sarcoidosis-induced lung disease can progress to what?
pulmonary fibrosis & cor pulmonale
27
What is the major pathological hallmark of Pulmonary Langerhans Cell Histiocytosis?
involves langerhans cells (immature dendritic cells); +S100 stain for langerhans
28
How does progressive PLCH present on a CXR?
reticulonodular infiltrate predominantly distributed to upper & middle lobes only
29
What is the proposed pathogenesis of PLCH?
cigarette-smoke induced activation of langerhans cells to lungs
30
What is the qualitative definition of hypersensitivity Pneumonitis?
immune mediated interstitial lung disorder caused by long-term exposure to inhaled organic dusts
31
What are distinctive histological features of hypersensitivity pneumonitis?
interstitial pneumonitis w/ lymph, plasma cells, & macrophages
32
What type of hypersensitivity is assoc. w/ hypersensitivity pneumonitis?
t cell-mediated delayed type hypersensitivity reaction against the Ag
33
Pulmonary eosinophilic syndromes are characteristic of what?
elevated alveolar levels of IL-5
34
What is the criteria for diagnosis of AEP vs. CEP?
>25% is acute; > 40% for chronic; parameter is increased eosinophils in BALF
35
What are common secondary causes of pulmonary eosinophilic syndrome?
parasitic, fungal & bacterial infections; durg allergies; churg-strauss syndrome (vasculitis)
36
What is the pathogenesis of pulmonary alveolar proteinosis?
deficient GM-CSF resulting in macrophage dysfunction; Macrophage dysfunction causes accumulation of alveolar precipitates containing surfactant proteins in intra-alveolar spaces
37
PAP precipitates stains are positive for what?
PAS+
38
What is the qualitative definition of pneumoconiosis?
macrophage activation
39
Describe the pathogenesis of asbestosis.
pneumoconiosis induced by inhalation of asbestos fibers
40
Asbestos are naturally occuring fibers composed of what substance?
hydrated magnesium silicates
41
Why are serpentine asbestos less toxic than amphibole asbestos?
Aerodynamics: serpentine fibers are more susceptible to removal by mucociliary defense mechanisms; amphibole fibers are more pathogenic due to shape & greater solubility
42
Pts. w/ amphibole asbestosis are at increased risk for what neoplasm?
mesothelioma
43
What occupations increase risk of development of asbestosis?
Mining; Construction; any other occupation where pt. comes into contact on a daily basis including but not limited to cement,, insulation, shipbuilding, & textiles
44
Describe the molecular mechanisms of asbestosis?
asbestos are toxic to pulmonary parenchymal cells; these toxic fibers stimulate release of mediators by inflammatory cells; chronic deposition of asbestos leads to interstitial pulmonary fibrosis
45
why are pts. w/ asbestosis at increased risk for developing cancer?
build up of ROS: byproduct of inflammatory response; free radicals can reaact w/ and damage the structure of DNA
46
What is the neoplastic derivative of mesothelioma?
bronchogenic adenocarcinoma
47
What are common clinical presentations of asbestosis?
cor pulmonale, clubbing, peripheral edema, JVD, hepatojugular reflux; gallops; respiratory failure
48
what are radiographic hallmarks of asbestosis?
visceral fibrosis & exudative pleural infiltrates
49
what are histologic hallmarks of asbestosis?
ferruginous bodies w/ hemosiderosis in bronchoalveolar lavage
50
Asbestosis starts at which level of the lung?
lower lobes
51
what are gross characteristics of malignant mesothelioma?
thick sheath that surrounds the entire lung; looks like sirloin steak encased in a ring of fat
52
Berylliosis is caused by exposure to what toxic chemical?
beryllium
53
What occupations increase risk for development of chronic berylliosis?
nuclear plants; smelting (working around metal); alloys; ceramics
54
Describe the criteria of acute beryllium disease in humans?
dose-related acute lung injury characterized by acute inflammatory reactions in upper airways causing bronchiolitis, pulmonary edema, & chemical pneumonitis
55
Describe the criteria for chronic beryllium disease.
multisystem disease: noncaseating granulomas throughout the body and upper lung lobes
56
Berylliosis has similar clinical presentations of what other restrictive lung disease?
sarcoidosis
57
What is the gold standard for diagnosis of berylliosis?
beryllium lymphocyte proliferation test
58
What states have the most cases of coal workers pneumoconiosis?
west regions: NM, CO, UT, WY; east regions: KC, TN, AL, MI, WV, VA, PA, OH, IN
59
In which region of the lungs would you expect to find most of the gross pathology of CWP?
upper lobes
60
describe the histologic findings of CWP?
CWP = focal centriacinar emphysema + coal macules; thick layers of haphazard aligned collagens
61
describe the pathogenesis of CWP?
as lung burden of dust increases, alveolar macrophages are activated and ROS is released and triggers inflammation cascade leading to fibrogenesis
62
What are common clinical presentations of CWP?
chronic bronchitis; palpable coal macule nodules; CXR: opacities within the lung parenchyma itself
63
CWP has ben shown to cause both obstructive & restrictive lung diseases; what would you expect to find on a pulmonary function test in both scenarios?
64
What occupations increase risk of developing silicosis?
foundries; quarrying; glass making; ceramics
65
Describe the histologic characteristics of silicosis.
whorled hyalinized collagen fibers w/ dust-laden macrophages; weak birefringent on polarization
66
Describe the pathogenesis of silicosis.
silica particles are phagocytosed by macrophages; they stimulate release of IL-1 & IL-18 which activates interstitial fibroblasts to lay down collagen
67
Freshly fractured silica generated during sandblasting is more toxic than aged silica. Why?
freshly made silica has a greater redox potential
68
What are radiographic hallmarks of silicosis?
eggshell calcification around hilar lymph nodes
69
What is the proposed explanation for why there is such a high correlation b/t silicosis & TB?
silica is thought to inhibit ability of pulmonary macrophages to kill phagocytosed mycobacteria
70
If a person is exposed daily to 30% crystalline silica how long it take before they start showing symptoms of silicosis?
10-30 yrs.; referred to as chronic silicosis
71
If a person is exposed daily to dust > 30% crystalline silica, how long will it take to start showing symptoms?
heavier exposure to the silica crystals is referred to as accelerated silicosis; typically present within decade of initial exposure
72
A pt. presents to your clinic w/ symptoms of dyspnea on exertion & bronchitis; when you ask about their occupation, they tell you they work at a sandblasting factory. Based on this information alone, what would be at the top of your DDx?
silicoproteinosis (AKA acute silicosis); follows intense exposure to dust with very high silica content; although rare, it usually occurs within weeks or months after the exposure rather than years later
73
both acute & chronic silicosis can progress to what disease?
Progressive massive fibrosis; AKA complicated silicosis
74
Why is the FEV1;FVC ratio decreased for obstructive lung diseases?
airflow is limited due to epithelial destruction
75
TLC is increased for OLDs b/c air bubbles get trapped in the alveolar spaces; Knowing this, what gross findings would you expect to see on CXR of a pt. w/ OLD?
Increased AP diameter (barrel chest); widened intercostal spaces, hyperlucency of lung tissue; narrow heart alignment
76
Compare & contrast gross findings of panacinar vs. centriacinar emphysema?
Panacinar: pathology of the lower lobe; centriacinar: pathology of the upper lobes
77
Gold Stage I COPD is diagnosed If FEV is....
>80%; Mild
78
Gold Stage II Moderate COPD is diagnosed as FEV greater than......but less than.....
>50 but <80%
79
Gold Stage III severe COPD is diagnosed as FEV greater than .......... but less than .......?
>30% but <50%
80
Gold Categories A & B have what criteria in common?
not leading to hospital admission
81
Gold categories A & C have what criteria in common?
mMRC 0-1 or CAT > 10; lower symptom burden
82
Gold Stage IV of very severe COPD is clinically defined as.......
FEV < 30%
83
Gold Categories B & D have what criteria in common?
mMRC > 2 or CAT < 10; higher symptom burden
84
What do Gold categories A & B criteria have in common?
H/O 0-1 exacerbations
85
What do Gold categories C & D criteria have in common?
H/O > 2 exacerbations
86
What nonpharmacological treatments can reduce risk of COPD?
smoking cessation; oxygen supplementation decreases mortality and increases survival outcomes
87
compare & contrast the clinical presentations of Blue bloaters & pink puffers.
Blue bloaters: cyanosis, purulent sputum, chronic productive cough, crackles & wheezes
Pink puffers: pink skin, minimal cough, decreased breath sounds
88
compare & contrast complications that arise from chronic bronchitis & emphysema.
Chronic bronchitis: polycythemia vera, PHTN, Cor pulmonale (Right-sided HF)
Emphysema: pneumothorax (due to bullae), weight loss due to consistent labored breathing
89
What are the histologic hallmarks of asthma?
curschmann spirals & charcot-leyden crystals
90
What are complications that can arise from asthma?
pulsus paradoxus & status asthmaticus
91
List the differences of Flow-Volume parameters assoc. w/ OLD & RLD.
For OLD: FEV1, FVC, & FEV1/FVC are decreased; RV, FRC, & TLC are increased
For RLD: all parameters are decreased except FEV1/FVC which is normal or increased in advanced stages
92
What pt. population is commonly assoc. w/ IPF?
50-70 yr. old males
93
IPF can also be assoc. w/ what OLD?
bronchiectasis
94
What complications are assoc. w/ IPF?
lung cancer; PHTN; RHF; arrhythmias; CAD, RF
95
Extrinsic allergic alveolitis (AKA hypersensitivity pneumonitis) encompasses which types of hypersenstivites?
III & IV
96
Sarcoidosis is more common in what pt. populations?
african american & scandinavian females 30-55 yr. of age
97
What kind of WBCs would you expect to find in the lymph nodes of a pt. w/ suspected sarcoidosis?
activated dendritic cells
98
How do pulmonary alveolar macrophages contribute to sarcoidosis?
pulmonary alveolar macrophages increases expression & activity of 1-alpha hydroxylase involved in synthesis of calcitriol
99
What immunoglobin is naturally elevated in pts. w/ sarcoidosis?
IgG
100
What are complications assoc. w/ sarcoidosis?
lung cancer, malignant lymphomas, bronchiectasis, PHTN, aspergilloma, Chronic kidney failure
101
Caplan syndrome is assoc. w/ what pulmonary disease and pt. population?
pneumoconiosis; pts. w/ h/o rhermatc diseases
102
What would you expect to see on a CXR of a suspected sarcoidosis pt.?
"Ivory white" calcified subdiaphragmatic and pleural plaques
103
Define inspiratory reserve volume
The amount of inspiratory volume with exertion Minus the tidal volume
104
Define tidal volume
Volume of passive respiration
105
Define exploratory reserve volume
The amount of exploratory volume with exertion minus the tidal volume
106
Define inspiratory capacity
Title volume plus inspiratory reserve volume
107
Define residual volume
Volume of air that remains in lungs after maximum expiration
108
Define functional residual capacity
Residual volume plus exploratory reserve volume
109
Define vital capacity
Total volume of maximal respiration
110
What does a spirometry measure
Measures the rate of change in lung volume during forced breathing maneuvers
111
Define forced vital capacity
Total volume of air that can be exhaled forcefully from the total lung capacity
112
For a normal lung what is the average fvc
Less than three seconds
113
What are the normal parameters for forced vital capacity
80 - 120%
114
What is the definition of forced exploratory volume
It's the volume of air forcefully expired from full inflation in the first second
115
what are the normal parameters for Fev
75 to 80%
116
What are the parameters for an obstructive pattern
decreased FEV, decreased FVC and decreased FEV to FVC ratio defined as less than 70%
117
What parameter is used to measure the severity of COPD
FEV
118
what are the parameters for a restrictive pattern
decreased fev, decreased fvc, and normal or increased fev to fvc ratio
119
What are common extra thoracic conditions of restrictive lung disease
Obesity, pregnancy, ascites, and peritonitis
120
What is an example of fixed obstruction
asphyxiation; Tracheostenosis, Tracheo Gorditer, Hypertrophy tonsils, Large foreign body
121
Give an example of variable extra thoracic obstruction
Vocal cord dysfunction
122
Give an example of variable intra thoracic obstruction
Endo bronchial carcinoma
123
What are variable extra thoracic causes of airway obstruction
Edema of Epiglottis, vocal cord paralysis, vocal court adhesions, and foreign body
124
what are variable intra thoracic causes of upper airway obstruction
polypoid tumor, tracheomalacia, and polychondritis
125
Spirometry cannot measure total lung capacity. Additionally FVC is decreased for both obstructive and restrictive lung disease Therefore the way to tell the difference is by assessing the TLC And how is this done
Obtaining a lung volume reading
126
What are the lung volume parameters for an obstructive pattern
TLC greater than 120%; in other words residual volume greater than 120%
127
What are the volume parameters for a restrictive pattern
less than 80%; In other words residual volume less than 80%
128
What variables influence diffusing capacity?
Surface area of Alveoli, thickness of alveolar membrane, Volume of blood in capillary bed
129
How is diffusing capacity measured?
DLCO; this is defined as the reaction rate of the test gas with hemoglobin
130
Decrease DLCO is clinically defined by what parameter?
Less than 80%
131
What diseases are associated with decreased DLCO?
emphysema, Interstitial fibrosis, pulmonary hypertension, and anemia
132
Increased DLCO is defined by what parameter?
Greater than 120 to 140 percent of the predicted value
133
what are diseases associated with increased DLCO?
Asthma, pulmonary hemorrhage, polycythemia, left to right shunt
134
Why is DLCO usually normal for chronic bronchitis?
because chronic Bronchitis affects the more proximal Airways which is not where the gas exchange takes place
135
If a patient comes to you with complaints of asthma but has a normal pulmonary function test what is the next best thing to do?
Bronco provocation: methacholine challenge
136
What is a classic example of idiosyncratic asthma?
Exercise induced
137
Exercise induced asthma can be managed by what?
longer warm up periods and beta agonist
138
What is another example of idiosyncratic asthma?
aspirin intolerance: Symptoms typically appear after three hours of taking aspirin
139
Asthma is categorized under which type of hypersensitivity reaction?
Type I
140
What are typical clinical presentations of asthma?
Wheezing, breathlessness, chest tightness, nighttime and early morning coughs
141
describe the pathophysiology of asthma.
Airway obstruction due to smooth muscle dysfunction and increased edema and mucus in the airway
142
What are the three characteristics of acute response to asthma?
Bronchial hyperactivity, mucosal edema, and airway secretions
143
What are the three characteristics of chronic response to asthma?
Increased inflammatory cell numbers, epithelial damage, airway remodeling
144
What would you expect to find histologically for a patient with suspected chronic asthma?
Basement membrane thickening, vascular dilation, edema, inflammatory cell infiltration, Epithelial damage, smooth muscle hypertrophy, mucus gland hypertrophy, perankyema intact
145
What are the histologic hallmarks of asthma?
Charcot Leyden crystals: needle-like structures formed from breakdown of eosinophils; curschmann spirals: coiled basophilic plugs of mucus formed in lower airways
146
What chromosomes are directly involved in risk factors for asthma?
chromosome 5 and 12
147
What cytokines are encoded on the 5th chromosome?
IL 4, 5, 9, 13
148
what are potential receptors encoded on chromosome 5 that are involved in asthma?
Beta adrenergic receptors and glucocorticoid receptors
149
Genetic induced asthma associated with genes on chromosome 12 Encode what?
atopy and hyper responsiveness
150
Besides aero allergies, what are other factors that can cause IgE induced asthma?
Neoplasia, chronic adrenal insufficiency, and parasites
151
What are risk factors for asthma?
occupational exposure to toxic chemicals, smoking, RSV
152
What history findings indicate asthma?
Coughing at night or after physical activity, colds that last over 10 days, history of a topic dermatitis, family history, relief with medication
153
How is diffusion capacity affected For asthma?
Normal or elevated: elevated indicates recruitment of capillaries
154
Although rare how does hypoxemia affect the aa gradient for asthma?
AA is elevated
155
what would you expect to find on arterial blood gas of a suspected asthma patient?
Hypercapnia and respiratory alkalosis
156
List the asthma classifications.
See slide 49 on clinical asthma powerpoint
157
What are common biological agents associated with increased risk for asthma?
Cat, Cockroaches, house dust mite, mold, dog, RSV, domestic birds, chlamydia, mycoplasma pneumonia
158
what are common chemical agents associated with increased risk for asthma?
tobacco products, nitrous oxide exposure, formaldehyde, and fragrances
159
Common factors that exacerbate asthma?
Menstrual cycle, pregnancy, aspirin and nsaids, Beatty adrenergic blockers, sulfate
160
Circadian induced asthma episodes is associated with what neurotransmitters?
decreased levels of Catecholamines; increased levels of histamine
161
The gastroesophageal reflux & nasal secretions are mediated by which cranial nerve?
Vegas
162
What are asthma and COVID 19 regulations?
Slides 50 to 60 on the clinical asthma powerpoint
163
What recommendations can you give to reduce house exposure to dust mites?
Use bed encasements, wash bedlines weekly, limits stuffed animals, reduce humidity
164
What are the medication guidelines for asthma?
Slide 68 of the clinical asthma powerpoint
165
What is the MOA of omalizumab?
anti-IgE
166
what is the MOA of mepolizumab & reslizumab?
anti-IL-5
167
What does PCWP assess?
Assesses left ventricular function and pressure
168
What is the normal parameter for PCWP?
Four to 12 milligrams of Mercury
169
A PCWP greater than 18 milligrams of Mercury indicates what?
Heart failure
170
A PCWP greater than 12 but less than eighteen millimeters of mercury is indicative of what?
ARDS
171
What risk factors account for over 85% of ARDS cases?
Pneumonia, aspiration of gastric contents, and sepsis
172
What chest x-ray findings would indicate ARDS rather than CHF and vice versa?
For ARDS: bilateral infiltration with a wideout appearance; for CHF: bilateral plural effusions
173
Would you expect PCWP to be normal decreased or elevated for ARDS?
Left ventricular function is normal hence PCWP is also normal
174
For congestive heart failure would you expect pcwp to be normal decreased Or increased?
elevated
175
Make sure to know the phases of ARDS
Slides 15 and 16 of the ARDS powerpoint
176
What genes are thought to be involved in ARDS?
Ace, il-10, TNF, VEGF
177
Why do you want to lower tidal volume for ARDS patients?
to avoid barotrauma
178
Describe the mechanism of COVID nineteens involvement in Ards?
Ace 2 protein is the receptor for Covid 19 Stimulation of this protein can can activate RAAS
179
How is acute respiratory failure type 1 clinically defined?
Hypoxemia without hypercapnia
180
what are risk factors for acute respiratory failure?
Pulmonary embolism, alveolar hypoventilation, parenchymal disease, right to left shunt
181
how is acute respiratory failure type 2 clinically defined?
hypoxemia with hypercapnia
182
What physiological consequences contribute to type 2 ARF?
Increased airway resistance; reduced breathing effort; decreased surface area of the lungs; neuromuscular disease; musculoskeletal rigidity
183
what is an example of ARF caused by increased airway resistance?
Chronic obstructive pulmonary disease
184
What are examples of acute respiratory failure induced by reduced breathing effort?
Opioid induced respiratory depression, brainstem lesion
185
what is a classic example of acute respiratory failure induced by decreased surface area of the lawn?
ARDS
186
what neuromuscular disease is commonly associated with ARF?
Gillian bear disease
187
What are common musculoskeletal deformities associated with ARF?
Kyphoscoliosis, ankylosing spondylitis
188
How is ARF type one Quantitatively defined?
Decrease partial pressure of oxygen and carbon dioxide; increased AA gradient; normal PH
189
How is ARF type 2 quantitatively defined?
Decreased partial pressure of oxygen; increased partial pressure of carbon dioxide; normal AA gradient; decreased PH
190
Decreased partial pressure of oxygen as quantitatively defined as
less than sixty millimeters of Mercury
191
Increased partial pressure of oxygen or CO2 is quantitatively defined as
greater than fifty millimeters of Mercury
192
Under what circumstances would you suspect air conditioner lung?
Patient works around heated water reservoirs
193
A farmer presents to your clinic with symptoms indicative of an interstitial lung disorder. the farmer tells you that the symptoms started after harvesting hay for the season. what interstitial lung disorder does this patient most likely have?
Farmers lung: A type of hyper sensitivity pneumonitis
194
A patient with a parent respiratory distress presents to your clinic with symptoms indicating an interstitial lung disorder. the patient states that they are a pigeon breeder. what is the most likely interstitial disorder?
pigeon breeders lung: provoked by proteins from serum, excreta, or bird feathers; This is a type of Hypersensitivity pneumonitis
195
What kind of microbes would you suspect are involved in hypersensitivity pneumonitis of organic dust exposures?
thermophiles
