8 Lungs Part 3

Question 0

Interstitial Lung Dz PE

Answer 0

Crackles, may have pulmonary HTN

PFT shows restrictive ventilatory pattern

Question 1

Clinical features of interstitial lung dz

Answer 1

Insidious/progressive dyspnea, persistent non productive cough
MAY have hemoptysis, musculoskeletal pain, weakness, fatigue, fever, photsensitivity

Question 2

Hypersensitivity pneumonitis

Answer 2

Extrinsic allergic alveolitis. After inhalation of dusts, chemicals in sensitized patient–>granulomatous inflammation. 4-6hrs after exposure.

Question 3

Hx questions for pt with HSN pneumonitis

Answer 3

Bird fancier, move to new home/school, hx of recurrent pneumonia, water damage, hot tub, other people with sxs, better on vacay?

Question 4

Ssxs acute hsn pneumonitis

Answer 4

Acute onset, fever, chills, dry cough, chest tightness, malaise, look sick, tachypnea, crackles, dyspnea. NO wheezes.
Resolves in 12 hrs

Question 5

Ssxs subacute hsn pneumonitis

Answer 5

Gradual onset, cough, dyspnea, fatigue, anorexia, weight loss, I’ll appearance, tachypnea, crackles

Question 6

Ssxs Chronic hsn pneumonitis

Answer 6

Insidious onset, cough, progressive dyspnea, fatigue, weight loss, exercise intolerance, crackles, clubbing, inspiratory SQUWAK

Question 7

Eosinophilic pulmonary disorders

Answer 7

Allergic response w accumulation of eosinophils in lung interstitium. Get TRAVEL HX
Rxn to filaria, drugs, parasites, fungi, inhaled toxins

Question 8

Idiopathic interstitial pneumonias

Answer 8

Unknown but common in smokers. Present similarly, suspect on hx, lead to restrictive lung changes, seen on CXR

Question 9

Drug induced ILD

Answer 9

Antis, chemo, anti arrhythmics, statins, coke, heroin, anticoagulants

Question 10

Pneumoconiosis

Answer 10

Inhalation of inorganic/mineral dusts.
Asbestosis (mining, milling, manufacture)
Silicosis (mining, pottery, sand blasting, brick making)
Anthracosis (black lung)
Berylliosis (fluorescent light bulbs, ceramics, chemical plants, electronics, aerospace)
Miscellaneous (talc, iron, tin oxide, cadmium, aluminum, cotton)

Question 11

Occupational asthma

Answer 11

SOB, chest tightness, wheezing, cough, (sneezing, d/c)

Detected using a peak flow meter at work

Question 12

Irritant gas inhalation

Answer 12

Severe burning of eyes, nose, trachea, bronchi w cough, hemoptysis, wheezing
Due to: industrial accidents, chloramine, cyanide, CO, methane, chlorine, hydrogen sulfide

Question 13

Air pollution related illness

Answer 13

Nitrogen/sulfur oxides, ozone, CO, lead, VOC, CFCs

*exacerbation in asthmatics, COPD

Question 14

Wegener’s granulomatosis

Answer 14

Pulmonary vasculitides. Autoimmune–affects lung, nose, kidneys

Question 15

Churg-Strauss syndrome

Answer 15

Pulmonary vasculitides. Allergic granulomatosis and angiitis. Allergic rhinitis, asthma, alveolar hemorrhage

Question 16

Goodpasture’s syndrome

Answer 16

Pulmonary hemorrhage with severe, progressive glomerulonephritis. Connective tissue disorder

Question 17

Rheumatoid Lung dz

Answer 17

Autoimmune dz of joints, skin, lands, kidney.

Pleuritic chest pain, pleural effusion

Question 18

Lupus

Answer 18

Connective tissue disorder. Dz of blood, heart, joints, skin, lungs, liver, kidneys.
Pleuritic chest pain, cough, dyspnea, URIs, dec lung volume, hemoptysis

Question 19

Sarcoidosis

Answer 19

non caseating granulomas leads to more inflammation. Inflammatory response to environmental exposures.
Ssxs: fever, weight loss, jt pain, SOB, cough; erythema nodosum, conjunctivitis, brain/nerves/heart/lover/endocrine

Question 20

Sarcoidosis DDX

Answer 20

TB, aspergillosis, histoplasmosis, RA, lymphomas, wegner’s granulomatosis, hsn pneumonitis

Question 21

Solid lesion on CXR DDX

Answer 21

Cancer, benign tumor, granulomas/TB, histoplasmosis, coccidiomycosis

Question 22

Lung tumor causes

Answer 22

Smoking, second hand smoke, asbestos exposure, Radon, polycyclic aromatic hydrocarbons, beryllium, nickel

Question 23

If a lung tumor metastasizes..

Answer 23

Liver: RUQ pain, GI symptoms
Brain: behavioral chnages, confusion, aphasia, seizures, paresis, coma
Bone: bone pain, Pathologic fractures

Chem panel *High serum calcium

Question 24

Lung tumor PE

Answer 24

Local wheezing, dec breath sounds, dullness to percussion, enlargement of axillary and supraclavicular nodes, hepatomegaly

Question 25

Adult Resp Distress Syndrome

Answer 25

Sudden. Resp failure from inflamed alveoli.

Risk–infection, pneumonia, drug overdose, head injury, aspiration pneumonia, shock, burns

Question 26

ARDS PE

Answer 26

Dyspnea, tachypnea, cyanosis, moist skin, scattered crackles, agitation

Question 27

ARDS dx

Answer 27

Fluid in alveolar spaces of both lungs. Abnormal arterial blood has analysis.
Treat via mechanical ventilation

Question 28

Atelectasis

Answer 28

Collapse/closure of alveoli.  
Obstructive dt blockage (mucus, foreign body, mass, aneurysm, CF)
Non obstructive (pleural effusion, pneumothorax, compression, surfactant dysfunction, sarcoidosis)

Question 29

Atelectasis PE

Answer 29

Low BP, high temp, tachycardia, dull to percussion, trachea/heart may deviate

Question 30

Pulmonary embolism etiology

Answer 30

Septic material, malignancy, CHF, abnormal clotting, birth control predisposes

Question 31

Pulmonary embolism Ssxs

Answer 31

Sudden onset SOB, pleuritic pain, cough, hemoptysis, anxiety/restlessness

Question 32

Pulmonary effusion DDX

Answer 32

Acute MI, tension, pneumothorax,eri cardinal tamponade, pleurisy, bacterial pneumonia

Question 33

Pulmonary hypertension PE

Answer 33

Wide split S2 S3, tricuspid murmur, jugular venous distension, hepatomegaly, peripheral edema
If untreated..cor pulmonale

Question 34

Central cyanosis

Answer 34

Dt hypoxemia caused by acute or chronic cardio/pull dz, COPD, R to L cardiac shunt

Question 35

Peripheral cyanosis

Answer 35

Dt stagnant circulation through peripheral vasculature: emotional tension, decreased cardiac output, atherosclerosis

Question 36

Sleep apnea

Answer 36

Contributing factors: obesity, alcohol, sedatives, smoking, endocrine disorders, family hx, menopause, spinal deformities