17 - Interstitial/Acute lung injury cases

Question 1

What are 3 causes of lacrimal gland swelling?

Answer 1

1. infectious (bacterial, viral, TB, syphilis, mumps)
2. inflammatory (sarcoid, pseudotumor)
3. malignancy (solid tumor, leukemia)

Question 2

What is a major lung disorder that does NOT cause finger clubbing?

Answer 2

Emphysema/COPD

**if you see clubbing in COPD think lung cancer

Question 3

What are some causes of finger clubbing?

Answer 3

• lung disease (e.g. cystic fibrosis, lung cancer)
• heart disease (e.g. cardiac shunt, bacterial endocarditis)
• cirrhosis of the liver
• inflammatory bowel disease (e.g. Crohn’s)
• congenital clubbing

Question 4

Contrast obstructive and restrictive PFT results

Answer 4

• obstructive= cannot get air OUT but have plenty of it in your chest
  
  • FEV1/FVC ratio < 70%
• restricted= can get air out but you have LESS in your chest than normal
  
  • FEV1 and FVC reduced but ratio > 70%

Question 5

What is the mnemonic for causes of restrictive lung disease?

Answer 5

PAINT:

• Pleural
• Abdomen (diaphragm pushed up)
• Interstitial lung disease
• Neuromuscular
• Thoracic abnormality (kyphosis)

Question 6

What could cause an elevated residual volume?

Answer 6

Obstructive lung disease or neuromuscular weakness

Question 7

What does this chest xray show?

Answer 7

“Potato nodes” of sarcoid stage I

Question 8

What is the mnemonic for interstitial infiltrates?

Answer 8

SAFE PITCH (use when scratchy CXR)

• Sarcoid
• Asbestosis
• Fungal
• Eosinophil granuloma (langerhans cell histiocytosis)
• Pharmacia (drugs)
• Interstitial lung disease (pulm fibrosis most common)
• Tumor/TB
• Collagen vascular disease (SLE, rheumatoid arthritis)
• Hypersensitivity pneumonitis

Question 9

What does this image show?

Answer 9

Non-caseating granuloma consistent with sarcoidosis

Question 10

What does this chest xray show?

Answer 10

Sarcoid stage II (hilar adenopathy + scratchy infiltrate)

Question 11

What does this chest xray show?

Answer 11

Sarcoid stage III (more scratchy infiltrate, no nodes)

Question 12

What does this chest xray show?

Answer 12

Sarcoid stage IV (BAD fibrosis, may need transplant)

Question 13

What does this chest xray show?

Answer 13

“Fluffy” alveolar infiltrate

Question 14

What is the mnemonic for alveolar infiltrates?

Answer 14

PC PIE “pecan pie” (use when fluffy CXR)

• Pus
• Cells (blood, eosinophils, tumor)
• Protein
• Inflammatory
• Edema (cardiogenic/increased hydrostatic pressure or non-cardiogenic/increased permeability)

Question 15

What are the 4 types of respiratory failure?

Answer 15

• type I= hypoxemic (PaO2 < 60)
• type II= hypercapnic (PaCO2 > 45)
• type III= perioperative respiratory failure
• type IV= shock

Question 16

What are the berline definititions of mild, moderate, and severe ARDS?

Answer 16

Question 17

What does this chest xray show?

Answer 17

“Sail sign” of left lower lobe collapse

Question 18

What are the 3 main etiologies of atelectasis?

Answer 18

1. obstructive (mucus plug, mass)
2. non-obstructive (effusion/fluid, pnemothorax/air, ARDS)
3. post-operative (diaphragm takes several days to fully recover from anesthesia and surgery)

Question 19

Describe the progression of acute ventilatory failure

Answer 19

1. disease onset
2. alveolar hyperventilation
3. acute ventilatory failure

Question 20

What therapy can help a patient with atelectasis?

Answer 20

CPAP mask (positive pressure to open lungs)