8 Lungs Part 3 Flashcards
Interstitial Lung Dz PE
Crackles, may have pulmonary HTN
PFT shows restrictive ventilatory pattern
Clinical features of interstitial lung dz
Insidious/progressive dyspnea, persistent non productive cough
MAY have hemoptysis, musculoskeletal pain, weakness, fatigue, fever, photsensitivity
Hypersensitivity pneumonitis
Extrinsic allergic alveolitis. After inhalation of dusts, chemicals in sensitized patient–>granulomatous inflammation. 4-6hrs after exposure.
Hx questions for pt with HSN pneumonitis
Bird fancier, move to new home/school, hx of recurrent pneumonia, water damage, hot tub, other people with sxs, better on vacay?
Ssxs acute hsn pneumonitis
Acute onset, fever, chills, dry cough, chest tightness, malaise, look sick, tachypnea, crackles, dyspnea. NO wheezes.
Resolves in 12 hrs
Ssxs subacute hsn pneumonitis
Gradual onset, cough, dyspnea, fatigue, anorexia, weight loss, I’ll appearance, tachypnea, crackles
Ssxs Chronic hsn pneumonitis
Insidious onset, cough, progressive dyspnea, fatigue, weight loss, exercise intolerance, crackles, clubbing, inspiratory SQUWAK
Eosinophilic pulmonary disorders
Allergic response w accumulation of eosinophils in lung interstitium. Get TRAVEL HX
Rxn to filaria, drugs, parasites, fungi, inhaled toxins
Idiopathic interstitial pneumonias
Unknown but common in smokers. Present similarly, suspect on hx, lead to restrictive lung changes, seen on CXR
Drug induced ILD
Antis, chemo, anti arrhythmics, statins, coke, heroin, anticoagulants
Pneumoconiosis
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)
Occupational asthma
SOB, chest tightness, wheezing, cough, (sneezing, d/c)
Detected using a peak flow meter at work
Irritant gas inhalation
Severe burning of eyes, nose, trachea, bronchi w cough, hemoptysis, wheezing
Due to: industrial accidents, chloramine, cyanide, CO, methane, chlorine, hydrogen sulfide
Air pollution related illness
Nitrogen/sulfur oxides, ozone, CO, lead, VOC, CFCs
*exacerbation in asthmatics, COPD
Wegener’s granulomatosis
Pulmonary vasculitides. Autoimmune–affects lung, nose, kidneys
Churg-Strauss syndrome
Pulmonary vasculitides. Allergic granulomatosis and angiitis. Allergic rhinitis, asthma, alveolar hemorrhage
Goodpasture’s syndrome
Pulmonary hemorrhage with severe, progressive glomerulonephritis. Connective tissue disorder
Rheumatoid Lung dz
Autoimmune dz of joints, skin, lands, kidney.
Pleuritic chest pain, pleural effusion
Lupus
Connective tissue disorder. Dz of blood, heart, joints, skin, lungs, liver, kidneys.
Pleuritic chest pain, cough, dyspnea, URIs, dec lung volume, hemoptysis
Sarcoidosis
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
Sarcoidosis DDX
TB, aspergillosis, histoplasmosis, RA, lymphomas, wegner’s granulomatosis, hsn pneumonitis
Solid lesion on CXR DDX
Cancer, benign tumor, granulomas/TB, histoplasmosis, coccidiomycosis
Lung tumor causes
Smoking, second hand smoke, asbestos exposure, Radon, polycyclic aromatic hydrocarbons, beryllium, nickel
If a lung tumor metastasizes..
Liver: RUQ pain, GI symptoms
Brain: behavioral chnages, confusion, aphasia, seizures, paresis, coma
Bone: bone pain, Pathologic fractures
Chem panel *High serum calcium
Lung tumor PE
Local wheezing, dec breath sounds, dullness to percussion, enlargement of axillary and supraclavicular nodes, hepatomegaly
Adult Resp Distress Syndrome
Sudden. Resp failure from inflamed alveoli.
Risk–infection, pneumonia, drug overdose, head injury, aspiration pneumonia, shock, burns
ARDS PE
Dyspnea, tachypnea, cyanosis, moist skin, scattered crackles, agitation
ARDS dx
Fluid in alveolar spaces of both lungs. Abnormal arterial blood has analysis.
Treat via mechanical ventilation
Atelectasis
Collapse/closure of alveoli. Obstructive dt blockage (mucus, foreign body, mass, aneurysm, CF) Non obstructive (pleural effusion, pneumothorax, compression, surfactant dysfunction, sarcoidosis)
Atelectasis PE
Low BP, high temp, tachycardia, dull to percussion, trachea/heart may deviate
Pulmonary embolism etiology
Septic material, malignancy, CHF, abnormal clotting, birth control predisposes
Pulmonary embolism Ssxs
Sudden onset SOB, pleuritic pain, cough, hemoptysis, anxiety/restlessness
Pulmonary effusion DDX
Acute MI, tension, pneumothorax,eri cardinal tamponade, pleurisy, bacterial pneumonia
Pulmonary hypertension PE
Wide split S2 S3, tricuspid murmur, jugular venous distension, hepatomegaly, peripheral edema
If untreated..cor pulmonale
Central cyanosis
Dt hypoxemia caused by acute or chronic cardio/pull dz, COPD, R to L cardiac shunt
Peripheral cyanosis
Dt stagnant circulation through peripheral vasculature: emotional tension, decreased cardiac output, atherosclerosis
Sleep apnea
Contributing factors: obesity, alcohol, sedatives, smoking, endocrine disorders, family hx, menopause, spinal deformities
