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Resp DRX > 02b: Sarcoidosis, HP, et al > Flashcards

02b: Sarcoidosis, HP, et al Flashcards

1
Q

Sarcoidosis pathology is characterized by (X) involving multiple organs systems, but most commonly:

A

X = granuloma

Lungs, lymph nodes, eyes, skin

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2
Q

T/F: Less than 20% of cases of Sarcoidosis resolve spontaneously.

A

False - over 80% (most)

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3
Q

Which diseases may appear similar to sarcoidosis and should be ruled out?

A

TB and certain malignancies

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4
Q

T/F: Over 90% of patients with sarcoid will have pulm involvement.

A

True

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5
Q

Stage 0 Sarcoidosis: what would you expect to find on CXR?

A

Normal (no abnormality)

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6
Q

Stage I Sarcoidosis: what would you expect to find on CXR?

A

Bilateral hilar lymph adenopathy (symmetrical)

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7
Q

Stage II Sarcoidosis: what would you expect to find on CXR?

A

Hilar lymph adenopathy and lung parenchymal involvement

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8
Q

Stage III Sarcoidosis: what would you expect to find on CXR?

A

Lung parenchymal involvement (no more hilar lymph node enlargement)

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9
Q

Stage IV Sarcoidosis: what would you expect to find on CXR?

A

Lung fibrosis

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10
Q

List the differential diagnosis of all interstitial lung diseases.

A

Acronym: SHITFACEDMD

  1. Sarcoid
  2. Hemorrhagic
  3. Idiopathic Interstitial Pneumonia (UIP, DIP, COP, RB-ILD)
  4. TB
  5. Failure (heart)
  6. Asbestos/amyloid
  7. CVD (collagen)
  8. Eosinophilic lung diseases (granulomas)
  9. Drugs
  10. Malignancy
  11. Dirt (inhaled; organic/inorganic)
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11
Q

When diagnosing sarcoid, it’s mandatory to rule out (X) cause of granulomatous response. What would you order to rule this out?

A

X = infectous

Cultures/special stains for infectious agents

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12
Q

Unless clinical presentation and CXR are highly indicative of sarcoid, (X) is the procedure of choice used to make diagnosis.

A

X = transbronchial biopsy

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13
Q

Sarcoidosis: DLCO is (increased/decreased/unchanged) and TLC will be (increased/decreased/unchanged).

A

Decreased;

Decreased with progressive disease BUT sarcoid has obstructive component that may preserve TLC (air trapping)

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14
Q

Beryllium exposure/poisoning will mimic pathogenesis of which disease?

A

Sarcoidosis

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15
Q

List some occupations that run the risk of Beryllium exposure.

A
  1. Aerospace
  2. Ceramic manufacturing
  3. Electronics
  4. Lab and dental work
  5. Mineral extraction
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16
Q

(X)% of patients with sarcoid present with pulmonary symtpoms.

A

X = 30-50% (though pulm involvement seen in over 90%)

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17
Q

Lofgren syndrome involves (X) symptoms and can be highly indicative of (Y) disease.

A 
X = acute febrile illness with erythema nodosum on legs
Y = Sarcoid (ESP if CXR shows bilateral hilar adenopathy)
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18
Q

Treatment of sarcoidosis typically involves (X) therapy.

A

X = immunosuppressive (steroids)

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19
Q

T/F: Sarcoidosis is always treated with drugs.

A

False - unless highly symptomatic or involves critical organ (eyes, heart, brain), wait few months to monitor progression/resolution

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20
Q

Sarcoidosis: assessing severity of disease involves the use of which tests?

A
  1. Serum ACE
  2. Ca and liver function tests
  3. EKG
  4. Eye exam
  5. PFTs
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21
Q

HP (Hypersensitivity Pneumonitis) is a(n) (acute/subacute/chronic) condition. Give the two most common examples of this disease.

A

Could be any;

Farmer’s lung and Bird fancier’s lung

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22
Q

Which lung sounds would you expect to hear in acute HP?

A

Diffuse crackles (rarely any wheezing)

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23
Q

Acute HP biopsy would show which pathology?

A

Poorly formed, non-caseating granulomas (interstitial) in peribronchial distribution

24
Q

Your patient has acute HP. After doing a biopsy, you know you’re likely to find very prominent (X) cells.

A

X = giant

25
Q

T/F: PFTs won’t be altered in acute HP.

A

True (will be in subacute and chronic HP)

26
Q

Subacute HP biopsy would show which pathology?

A
  1. Well-formed non-caseating granulomas (interstitial)
  2. Bronchiolitis (maybe with pneumonia)
  3. Interstitial fibrosis
27
Q

In subacute and chronic HP, which drug treatment may be required?

A

Glucocorticoids (Prednisone)

28
Q

T/F: Sarcoid presenting with Lofgrens Syndrome is more than 95% likely to undergo spontaneous remission.

A

True

29
Q

T/F: Long term oral corticosteroid therapy for sarcoid has no/minimal effect on natural history of pulmonary disease.

A

True (groups similar at 24 months)

30
Q

T/F: Both HP and Sarcoid will present with crackles in lung sounds.

A

False - only HP

31
Q

T/F: HP, but not Sarcoid, will present with clubbing of finger nails.

A

True

32
Q

Bronchoalveloar lavage (BAL) CD4/CD8 can distinguish HP from (X) disease. Which has higher ratio?

A

X = Sarcoidosis

Sarcoid (over 3.5); HP less (under 1)

33
Q

Serology for HP detects:

A

Precipitins (Ab) for offending antigen (ex: pigeons)

34
Q

(X) is pulmonary disease caused by inhalation of (Y), the most abundant mineral on earth.

A 
X = silicosis
Y = (crystalline) silicon dioxide (silica)
35
Q

(Crystalline/amorphous) silica is the form that causes pulm disease. What is the cause of its toxicity?

A

Crystalline;

Generates free radicals and injures alveolar macrophages (inflammation and fibrosis)

36
Q

Occupational exposure, especially involving processing of rock, is the major risk factor leading to (X) disease. List examples of these occupations.

A

X = silicosis;

“Dusty trades”:
Mining, Construction, Sandblasting, Stone cutting, Tunneling, Ceramics/glass making, Furnace workers

37
Q

How soon after exposure do silicosis symptoms appear?

A

Few weeks to few years

38
Q

CXR of patient reveals diffuse interstitial markings that are nodular in nature. He denies smoking history and worked as sandblaster for 3 years. What’s on the top of your differential? Will you expect to hear normal lung sounds?

A

Silicosis;

No, probably crackles

39
Q

T/F: Acute Silicosis has rapid, progressive deterioration involving cor pulmonale/resp failure and death 4-5 years after symptom onset.

A

True

40
Q

T/F: Silicosis features diffuse micronodular markings on CXR with lower lobe predominance.

A

False - upper lobe

41
Q

List some diseases associated with silicosis.

A
  1. Lung cancer
  2. TB (mycobac infection)
  3. COPD/chronic bronchitis
  4. RA and sceroderma
42
Q

T/F: Biopsy usually not needed to diagnose silicosis.

A

True - get adequate history of exposure, CXR, mycobac tests (to exclude TB)

43
Q

Progressive Massive Fibrosis (PMF) results from combination/coalescence of (X) to form large opacities. CXR shows eggshell calcification pattern, characteristic of which disease?

A

X = silicotic nodules

Silicosis

44
Q

Eggshell calcification of hilar lymph nodes suggestive of (X). What would you expect the PFTs to look like?

A

X = Progressive Massive Fibrosis (PMF) in chronic silicosis

SUPER abnormal (decreased compliance, FEV1, FEV1/FVC ratio, and DLCO)

45
Q

Asbestosis is characterized by (slow/fast) progressive pulmonary fibrosis. Which occupations/exposures increase risk of disease?

A

Slow;

Shipbuilding, Insulation, Renovation/demolition of buildings, secondary exposure (ex: soiled clothes)

46
Q

Pathogenesis of asbestosis: inhaled fibers deposit at (X) sites in lung, where they affect (Y).

A

X = resp bronchioles and alveolar duct bifurcations

Y = alveolar macrophages (injured), inducing inflammation and producing free radicals

47
Q

T/F: Unlike silicosis, asbestosis patients present sooner with symptoms after exposure (within a year).

A

False! Most asbestosis patients asymptomatic for 20-30 years after initial exposure

48
Q

Earliest symptom of asbestosis is (X). This (progresses/resolves) if exposure to asbestos is removed.

A

X = dyspnea (progressive) on exertion

Progresses (even if exposure removed)

49
Q

T/F: Patients with asbestosis will have normal FEV1/FVC ratio.

A

True (no obstruction

50
Q

(X) is the only known risk factor for malignant mesothelioma.

A

X = Asbestos exposure

51
Q

A “shaggy heart border” on CXR with basilar interstitial disease. Patient’s husband worked in old building renovations. What’s on the top of your differential?

A

Asbestosis (secondary exposure, likely via husband’s clothes)

52
Q

CXR with pleural plaques. What’s on the top of your differential?

A

Asbestos exposure (NOT necessarily asbestosis/disease state)

53
Q

Histopathological diagnosis of asbestosis requires presence of (X) in association with interstitial pulmonary fibrosis.

A

X = asbestos bodies (asbestos fibers uncoated/coated by iron and protein)

54
Q

T/F: Detection of asbestos bodies is enough to diagnose asbestosis.

A

False - need DEFINITE evidence for pulmonary fibrosis

55
Q

Asbestos exposure increases risk of pulmonary malignancy by (X) fold. Smoking cigarettes by (Y) fold. Together, by (Z) fold.

A 
X = 6
Y = 11
Z = 59

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