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Unit 3-various lung diseases Flashcards

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1
Q

Sarcoidosis

A

systemic disease of unknown etiology

granulomatous inflammation of the lung

sx: skin, lung, eyes, peripheral nerves, liver, kidney, heart

onset- 30-40

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2
Q

sarcoidosis s/sx

A

insidious onset of malaise, fever, dyspnea

seek care d/t: erythema nodosum, lupus pernio, iritis, peripheral neuropathy, arthritis, cardiomyopathy

bilateral hilar and R paratracheal adenopathy on CXR

atypical interstitial lung disease

parotid gland enlargement, hepatosplenomegaly, lymphadenopathy

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3
Q

lab findings with sarcoidosis

A

leukopenia, elevated ESR, hypercalcemia, hypercalcemuria

angiotensin-converting enzyme (ACE) levels elevated

PFT: obstructive airflow
skin test anergy: present in 70%

dysrhythmia

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4
Q

diagnostic imaging stages

A
  1. blateral hilar adenopathy alone
  2. hilar adenopathy and parenchymal involvement
  3. parenchymal involvement alone by reticular infiltrates
  4. advanced fibrotic changes in upper lobe
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5
Q

Dx of sarcoidosis

A

requires histological demonstration of noncaseating granulomas in biopsy
*must exclude granulomatous disease

BAL>increase in lymphocytes and high CD4/CD8

**BIOPSY necessary w/ possibly alt dx

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6
Q

All pt with sarcoidosis require what kind of exam?

a. cardiac
b. gastrointestinal
c. pulmonary
d. opthalmogic

A

d. optho

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7
Q

tx for sarcoidosis

A

PO corticosteroids

long term therpay required

immunosuppressive medication (Methotrexate) used in those who cannot tolerage corticosteroids

20% have irreversible lung damage

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8
Q

Pulmonary metastes

A

spread of extrapulm malignant tumor through vascular of lymphatic channels

nodules on CXR

Most are INTRAPARENCHYMAL

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9
Q

Risk factors for pulm metastes

A

carcinoma of kidney, breast, rectum, colon, cervix, malignant melanoma , head and neck CA, lymphatic carcinomatosis

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10
Q

S/sx pulm metastes

A

uncommon, cough, hemoptysis, dyspnea, hypoxemia

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11
Q

Bronchiogenic carcinoma essentials of diagnosis

A

New cough, change in cough

dyspnea, hemoptysis, anorexia, weight loss

enlarging nodule or mass, persistent opacity, atelectasis, pleural effusion on cxr or CT

cytologic or histologic finding of lung CA in sputum, pleural fluid, or biopsy

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12
Q

Risk factors for bronchiogenic carcinoma

A

smoking, radon, asbestos, diesel exhaust, ionizing radiating, metals-arsenic/chromium/nickel/iron oxide

family hx of lung CA, (pulm fibrosis, COPD, sarcoidosis)

70 year old

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13
Q

Clinical findings of bronchiogenic carcinoma

A

majority are symptomatic at dx

depends on type and location of primary tumor, extent of spread, presence of distant mets

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14
Q

s/sx bronchiogenic carcinoma

A

anorexia, weigh loss, asthenia>55-90%

new cough, change in chronic cough 60%

dyspnea, hemoptysis, anoxeria

pain-non specific chest pain

local spread of disease

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15
Q

Mesothelioma essentials of dx

A

unilateral, nonpleuritic chest pain and dyspnea

distant hx of exposure to asbestos

pleural effusion or pleural thickening or both on CXR

malignant cells in pleural fluid/tissue biopsy

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16
Q

Where do mesotheliomas primary tumors lay?

A

arise from surface lining of pleura or peritoneum

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17
Q

Biggest risk factor for mesothelioma

a. mold
b. asbestos
c. CA
d. smoking

A

B. asbestos

inquire about exposure through work

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18
Q

s/sx of mesothelioma include

A

insidious onset of SOB, nonpleuritic chest pain, weight loss

dullness to percussion, diminished breath sounds, digital clubbing

onset to sx = 2-3 months

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19
Q

To determine primary diadnosis of pulm metas, one would use?

A

immunohistochemical staining on biopsy specimen

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20
Q

When bronchiogenic carcinoma has spread to liver what will you see?

a. jaundice
b. asthenia and weight loss
c. severe abd pain with jaundice
d. h/a, n/v

A

b. asthenia and weight loss

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21
Q

When bronchiogenic carcinoma has spread to brain what will you see?

A

H/A, N/V, seizures, dizzy, AMS

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22
Q

paraneoplastic syndrome

A

patterns of immune mediated or secretory effects of neoplasms (SIADH, hypercoagulability, peripheral neuropathy)

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23
Q

smoke inhalation 3 consequences

A

impaired tissue oxygenation

thermal injury to upper airway

thermal injury to lower airways and lung parenchyma

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24
Q

Impaired tissue oxygenation is caused from?

a. inhalation of super-heated gases
b. inhalation of toxic gases and products of combustions
c. inhalation of a hypoxemic gas mixture, carbon monoxide or cyanide
d. non of the above

A

c. INHALATION OF HYPOXEMIC GAS MIXTURE, CARBON MONOXIDE OR CYANIDE W/ ALTERATIONS IN V/Q MATCHING

immediate THREAT! Requires 100% O2

continue till Carboxyhemoglobin levels fall less than 10% and metabolic acidosis resolves

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25
Thermal injury to UPPER airway is caused from? a. inhalation of super-heated gases b. inhalation of toxic gases and products of combustions c. inhalation of a hypoxemic gas mixture, carbon monoxide or cyanide d. non of the above
a. INHALATION OF SUPER-HEATED GASES mucosal edema, upper airway obstruction, inability to clear oral secretions use high-HUMIDITY mask for O2, gentle suctioning, HOB 30, topical epi, helium-gas mixture monitor ABG
26
Thermal injury to LOWER airway and lung parenchyma caused from? a. inhalation of super-heated gases b. inhalation of toxic gases and products of combustions c. inhalation of a hypoxemic gas mixture, carbon monoxide or cyanide d. non of the above
b. INHALATION OF TOXIC GASES AND PRODUCTS OF COMBUSTIONS site of injury depends on solubility of gas 1st sign=bronchorrhea, bronchospasms+dyspnea, tachypnea, tachycardia>labored breathing, and cyanosis 1-2days=ARDS 2-3= sloughing airway mucosa, worsening hypoxeia 5-7=bacterial colonize and PNA
27
T or F: using routine corticosteroids can be beneficial for smoke inhalation
FALSE no benefit and can be harmful
28
Acute aspiration of gastric contents (Mendelson Syndrome)
Pulmonary response to aspiration depends on gastric contents aspirated more acidic=chemical pneumonitis
29
Gastric pH of less than___ can cause extensive desquamation of bronchial epithelium and ARDS a. 7.3 b. 5 c. 2.5 d. 8
C. less than 2.5
30
What are the sx of pulmonary aspiration syndrome?
abrupt onset of respiratory distress +cough, wheezing, fever, tachypnea Will hear CRACKLES at bases, hypoxemia immediately after aspiration patchy opacities on CXR
31
How to tx pulmonary aspiration syndrome?
supplemental O2, maintain airway, tx acute resp failure
32
What are some causes of chronic pulmonary aspiration syndrome?
cigarettes, ETOH/caffeine, theophylline> relax the lower esophageal sphincter>risk of GERD asthma, chronic cough, bronchiectasis, pulmonary fibrosis
33
What is Café Coronary:
acute obstruction of upper airway by food
34
What is hydrocarbon pneumonitis? a. r/t aspiration of food b. caused by arpiration of petroleum distillates c. caused by asthma medication d. caused by repeated aspiration of oily materials
b. caused by aspiration of ingested petroleum distillates gasoline, kerosene, furniture polish>vomit and aspirate
35
What is lipoid pneumonia? a. r/t aspiration of food b. caused by arpiration of petroleum distillates c. caused by asthma medication d. caused by repeated aspiration of oily materials
d. Chronic syndrome d/t repeated aspiration of oily materials minearl oil, cod liver oil, oily nose drops
36
Pneumoconiosis is chronic fibrotic lung disease caused by? a. inhalation of inorganic dust b. inhalation of steroids c. aspiration of gases d. aspiration of smoke
a. Inhalation of inorganic dusts may be asymptomatic w/ diffuse nodular opacities on CXR or severe life shortening disease
37
What is coal-workers pneumoconiosis? a. Exposure to asbestor fibers b. extensive or prolonges inhalation of free silica c. inhalation of coat dust d. presence of necrobiotic rheumatoid nodules
C. inhalation of coast dust CXR= diffuse small opacitites usually asymptomatic, may have effects on ventilatory function
38
What is Caplan Syndrome? a. Exposure to asbestor fibers b. extensive or prolonges inhalation of free silica c. inhalation of coat dust d. presence of necrobiotic rheumatoid nodules
d. rare condition characterized by presence of NECROBIOTIC RHEUMATOID NODULES in the periphery of the lungs with RA
39
What is Silicosis? a. Exposure to asbestor fibers b. extensive or prolonges inhalation of free silica c. inhalation of coat dust d. presence of necrobiotic rheumatoid nodules
b. Extensive or prolonged inhalation of free silica (silicon dioxide)> formation of small rounded opacities throughout lungs CXR: periphery of hilar lymph nodes "EGGSHELLS" usually asymptomatic
40
What is Asbestosis? a. Exposure to asbestor fibers b. extensive or prolonges inhalation of free silica c. inhalation of coat dust d. presence of necrobiotic rheumatoid nodules
A. Exposed to asbestos fibers over many years usually seek medical after 15 years d/t progressive dyspnea, inspiratory crackles, clubbing and cyanosis CXR: honeycomb changes in advanced cases CT is BEST option
41
T or F: Smoking in asbestos workers increases prevalence of pleural and parenchymal changes and incidence of lung carcinoma
TRUE can interfere w/ clearance of short asbestos fiber from lungs PFT:restrictive dysfunction and reduced diffusing capacity NO TX
42
What is hypersensitivity pneumonitis?
nonatopic, nonasthmatic inflammatory pulmonary disease Can be reversible if caught early Interstitial infiltrates of lymphocytes and plasma cells w/ noncaseating granulomas in the interstitium and air space
43
What is tx for hypersensitivity pneumonitis
avoid future exposure severe or protracted= prednisone
44
What is occupational asthma? a. asthma-like disorder in textile workers b. agents in workplace trigger asthma c. chronic bronchitis found in coal miners d. none of the above
b. Agents in workplace (dust, tobacco, pollen, enzymes, dyes, and various other agents) trigger asthma Tx: avoid trigger, bronchodilators
45
What is industrial bronchitis? a. asthma-like disorder in textile workers b. agents in workplace trigger asthma c. chronic bronchitis found in coal miners d. none of the above
C. chronic bronchitis found in coal miners and those exposed to cotton, flax, hemp dust
46
What is byssinosis? a. asthma-like disorder in textile workers b. agents in workplace trigger asthma c. chronic bronchitis found in coal miners d. none of the above
A. asthma-like disorder in textile workers caused by inhalation of cotton dust sx: chest tight, cough, dyspenea that is WORSE on Monday and subside throughout week
47
What causes Toxic lung injury?
inhalation of irritant gases silo-fillers disease: acute toxic high permeability pulmonary edema caused by inhalation of NITROGEN dioxide extensive exposure=FATAL Diacetyl: popcorn worker
48
What are pulmonary carcinogens
``` asbestos radon gas arsenic iron chromium nikcle coal tar fuems petroleum oil ispropyl oil mustard gas printing ink cigarette smoke ```
49
What causes pleural disease?
Asbestos or Talc Talc= pleural plaques asbestos: blunting of costophrenic angle on CXR
50
What are the 2 randomized controlled trials for pulmonary neopplasm?
PLCO | NLST
51
PLCO
prostate, lung, colorectal, and ovarian CA
52
NLST
National lung screening trial
53
Solitary pulmonary nodules are
D. 3cm most asymptomatic, and dx found on CXR
54
Risk factors for solitary pulmonary nodules
>30, smokers, prior malignancy
55
T or F: imaging can help estimate the probability of malignancy in solitary pulmonary nodules
TRUE size correlates w/ malignancy ill-defined margins or a lobular appearance suggest malignancy
56
DX of solitary pulmonary nodules are best with
high-resolution CT Can use PET scan, sputum cytology, VATS
57
Urticaria & angio edema are caused by? a. eosinophils b. neutrolphils c. mast cells d. lymphocytes
C. Mast cell degranulation in the skin commonly caused by virus , food allergy, drug allergy, serum sickness
58
Urticaria & angio edema first line treatment
2nd generation PO antihistamines Omalizumab 3rd line, effective for urticaria
59
T or F: Urticaria lesions classified by trigger
TRUE mast cell activation & degranulation infectious= strep, mycoplasmsa, HBV, H.pylori
60
s/sx urticaria
wheals w/ reflex erythema, pruritic & transient, resolve after hours
61
s/sx angioedema
rapid erythematous or skin-colored swelling associated w/ burning or pain
62
What cells are released during anaphylactic shock?
mast cells and basophils
63
Lab findings in anaphylactic shock
ST depression, BBB, arrhythmias hypoxemia hypercapnia acidosis CXR:hyperinflation
64
Tx for anaphylactic shock
EPI repear q 5-15 min antihistamines- Diphenhydramine 2nd line, ceririzine in kids Ranitidine may be added IVF, bronchodilator, corticosteroids, vasopressors, observation
65
T or F: abx most common drug reaction
TRUE amox, bactrim, ampicillin PCN and other beta-lactams= cross sensitivity (cephalo, carbacephems)
66
tx w/ radiocontract media dye
low-molarity agent with prednisone, benadryl, and possibly H2 blocker
67
Insulin reaction
IgE reactions are rare Resistance with IgG
68
s/sx associated with ASA and NSAIDS
urticaria, angioedema, rhinosinusitis, nasal polyps, asthma, anaphylactoid reactions
69
Highest prevalence of food allergies found in kids with? a. asthma b. atopic dermatitis c. latex allergy d. PCN allergy
B. Atopic dermatitis caused by mixed IgE and non-IgE occurs 2 hours after ingestion
70
Children who have had anaphylactic reactions to hymenoptera stings should have a?
Epi pen and wear medical bracelet hymenoptera= honeybees, yellow jackets, yellow and white hornets, wasp, fire ants
71
tx for insect reactions
cold compress antipruritics (antihistamines) topical corticosteroids remove stinger by flicking elevate PO NSAIDS
72
T or F: most cases of hemoptysis are self-limiting and resolves w/ tx of underlying condition
TRUE
73
bleedinsg occurs within the airways, lung parenchyma or capillary beds after? a. inflammation b. trauma c. erosion d. all of the above
D. ALL OF THE ABOVE
74
Central cyanosis corresponds to oxygen saturation of <=___-____ a. 50-60% b. 85-100% c. 25-50% d. 75-80%
D. 75-80%
75
Massive hemoptysis is considered expectorating >___cc per 24hr
200cc or 60cc over 2 hours
76
What hx would you want from a pt with hemoptysis?
epistaxis GI sx pain w/ eating ASA NSAIDS warfarin timing color consistency smoking drugs-inhaled
77
Class triad of PE include:
hemoptyosis dyspnea chest pain
78
Frequent or daily production of foul-smelling sputum may suggest?
Bronchiectasis tx: abx, aggressive pulmonary hygiene
79
Bleeding in excess of ___cc per day or hemoptysis that lasts longer than one week or is otherwise unexplained should prompt referral to a pulmonologist
30cc

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