Chronic Interstitial Lung Dz Flashcards
1
Q
CXR
A
- small lungs
* fine lines to peripher (don’t branch like vessels)
2
Q
What causes x ray lines?
A
Inflamed septal area (connective tissue)
Thickening it
Rule out Heart Failure/Renal failure
3
Q
Diffuse Parenchymal Lung Disease
Known causes
A
- drugs
- inhaled particles (hypersensitivity pneumonitis)
- immune complexes
- associated w/ collegen vascular dz (immune complexes)
4
Q
DPLD classification
A
- known cause
- idopathic
- Granulomatous DPLD (sarcoidosis = mostly AA)
- other (rare) = LAM, HX, etc.
5
Q
DPLD
Etiology
A
*occupational/inhalant
(Inorganic, organic (HyperPneum), fumes)
- Drugs
- radiation
- infectious (TB, P carinii)
- Pulm edema, uremia
- Collegen vascular dz
6
Q
DPLD
Unknown etiology
A
*Idiopathic Interstitial
HUGE LIST
*sarcoidosis
7
Q
Pathogenesis
A
- injury to alveolar epithelial cells
- inflammation at MEMBRANE-LEVEL
- scarring/structural (honeycombing)
- repair = pro-inflammatory /pro-fibrotic cytokines from inflammatory/epithelial/fibroblast cells
8
Q
BAL
Neutrophilic inflammatory profile?
A
UIP/IPF
Inorganic dust
9
Q
BAL
Lymphatic inflammatory?
A
Sarcoidosis
Hypersens Pneumonitis
10
Q
BAL
CD4/CD8 ratio
A
High : sarcoidosis
Low:HSP/HIV
11
Q
Elasticity Measurement
A
Restrictive - stiffer lung, takes more work, so person accepts lower max inspiration
12
Q
Spirometry
Restrictive
A
All volumes reduce
13
Q
Spirometry
Obstructive
A
RV up (trapped air) Encroaches on other volumes
14
Q
W/ exercise
A
O2 fine at rest, terrible with exercise, membrane too thick
Exercise Desaturation
15
Q
V/Q
A
Low V because alveoli not elastic
CO2 up
16
Q
- Dyspnea
- Dry cough
CXR =
- infiltrates
- restriction
- resting desaturation
- exercise desaturation
DOWN D L CO2 (CO2 diffusion)
*RULE OUTpulmonary HTN
Dx
A
DPLD
17
Q
Areas of DX
A
Clinical
- History
- PE
- Lab
- PFTs
Radiology
- CXR
- HRCT
Pathology
- FOB w/ BAL/TBB
- Surgical lung biopsy
18
Q
Ground glass opacities
A
Inflammation, water in lung
19
Q
AA?
A
Sarcoid
20
Q
Fever/HIV?
A
Pneumocystis
21
Q
DX questions
A
- Specific Dx?
- Active dz?
- Need biopsy?
- Therapy?
22
Q
PE
A
- crackles
- clubbing
- lesions, eye, lymphadenopathy, cardio, hepatosplenomegaly, MSK
- Labs
- images
- PFTs
23
Q
Sarcoid in
A
Upper lobes
24
Q
IPF in
A
Lower lobes
25
lympadenopathy + infiltrate
Sarcoid
Silicosis
Infxn (TB, Histoplasm)
Malignacy
26
HRCT
* early detection
* ground glass opacities
* determine biopsy site
* progression/assessment
27
PFTs
* restrictive
* small airway dz
* reduced DLCO2
* hypoxemia at rest
* exercise desaturation
28
Infiltrates + Pleural dz
* infxn (TB, Fungal)
* Malignancy
* Collogen vascular dz : SLE, RA
* Drug Hypersensitivity
* Cardio dz
* Asbestos-related Dz
29
PE
Watch for
* small lung volumes
* inspiratory crackles
* position dependent crackles
* Evidence for pulmonary HTN
* clubbing
* extrapulmonary signs (skin, cardio, etc.)
30
Idiopathic Pulmonary Fibrosis (IPF)
Also called
Cryptogenic Fibrosing Alveolitis (IPF)
Must distinguish from NSIP (nonspecific interstitial pneumonia)
31
Tobacco Smoker's dz
* Respiratory Bronchiolitis Interstitial Lung Dz (RB-ILD)
- from small airway to big
*Desquamative Interstitial Pnuemonia (DIP) = macrophage cells crowd airways
32
Cryptogenic Organizing Pneumonia (formerly BOOP)
Pneumonia like shadows on CXR (not normal infiltrate)
33
* progressive dyspnea
* clubbing
* old
* progressive cough, non-productive
* mid-late inspiratory crackle
* restrictive
* DOWN DLCO
* WIDE P(A-a)DO2
* exercise desaturaton
IPF
34
IPF
Tx
Transplant
1/2 dead in 5 years (more deadly than lung cancer)
35
IPF
Biopsy?
Yes, MUST HAVE
Fibroblastic foci
36
* younger 40
* no association cig smoking
* dyspnea, cough, fatiuge
* weight loss
* basilar crackles
* less clubbing
Nonspecific Intersitial Pneumonitis NSIP
37
Classic NSIP
CXR
Histology
CXR = ground glass opacities
Histology = uniform, no fibroblastic foci
38
NSIP
Tx
Steroids
39
* SOB
* PFT = mixed obstructive/ restrictive
* DLCO down
* Pigmented intraluminal macrophages in 1st and 2nd order respiratory bronchioles
* smoker
Respiratory Bronchiolitis-Associated Lung Dz RB-ILD
Linked to DIP (more severe)
40
RB-ILD
Tx
Steroids
| Smoking cessation
41
*male
*smoker
*clubbing
*40s
*insidious onset dyspnea + dry cough
*
Desquamative Interstitial Pneumonitis (DIP)
42
DIP
Tx
Steroids
Smoking cessation
*complete recovery possible
43
* young/middle age
* CXR: BILATERAL HILAR LYMPHANDOPATHY
* Pulmonary infiltration
* low fever
* skin lesions: ERYTHEMA NODOSUM/LUPUS PERNIO/MACUOPAPULAR RASH
* EYE: anterior uveitis, conjuctivitis
* non-caseating granulomas = liver, spleen, eyes, salivary ,
* CARDIO : arrhythmias
* LABS: UP ACE / Ca2+ /eosinophils
* dry cough
* dyspnea
* fatigue malaise weight loss
* AA
*NO clubbing
*NO lung noise
*
Sarcoidosis
44
Sarcoidosis
Biopsy
Non-caseating epithelioid cell granuloma
NEW WAY = ultrasound to find lymph node, then fine needle aspirate node
Rule out TB w/ culture
45
Sarcoidosis
Tx
STEROIDS
Methotrexate
Skin: *Hydroxychloroquine
46
Sarcoidosis
Path
*CD4+ T cells - antigens/self-antigens
HIV can eliminate!
* central immune activation, peripheral immune depression
* Granulomas (-->fibrosis) = eyes, lungs, liver
47
Sarciodosis
Sequalae
Large, calcified lymph nodes
48
Sarcoidosis
Prognosis
Self-limited course
Relentless, fibrosis of lungs/eye etc.
49
Asymptomatic w/ Bilat Hilar lymph nodes?
Biopsy
50
Sarcoidosis
Cause
Unknown
Some think microbacterial antigen
51
CXR
Huge potato like bilat hilar lymph nodes
Diffuse nodules
Sarcoidosis Stage 1
Get biopsy
52
CXR
Infiltrates more in upper lobes
Hilar lymph can push trachea
Sarcoidosis stage 2
53
If horrible chest x ray but patient looks well
Sarcoidosi
54
HRCT
Nodularity
(Edges subplural, along airways, in lung)
Beading pattern
Sarcoidosis
55
Sarcoidosis
Dx approach
* BIOPSY
* Extent/severity of organ involvment
* stable? Active? (NO TEST, must check function tests)
* Therapy will help?
56
* 4-8 hours after exposure
* fever, malaise
* cough, dyspnea
* s/s 12-48 hours
* farmer's lung (mold in hay)
* Bird fancier's lung
Hypersensitivity Pneumonitis
| Extrinsic Allergic Alveolitis
57
Bird fancier's lung
Antigens from
Feathers + droppings
| More complex than farmers
58
Hypersensitivity Pneumonitis
Path
Inflammation in small airways
59
Asbestos exposure leads to
Pleural thickening = mesothelioma
Pleural plaques
Shaggy ??? In bottom of lungs
60
Hot tub lung
Hypersensitivity Pneumonitis
61
Accumulation of dust in lung
| Asbestos, etc.
Pneumoconiosis
62
Asbestos in
Elevator break pads
Auto break pads
Pipes in building
63
Asbestos + cig smoker
Highest possible risk
64
Sarcoid
PFT
Restriction
| Low DLCO
65
Common work exposures
* asbestos, shipyard work
* Silica, mining, quarrying, sandblasting
* Solvents, degreasers
* Two-part glue, paint, urethane
66
Questions about work experience
* # hours worked
* employment duration
* "mist in air?"
67
Labs
Up ACE?
Sarcoidosis
68
CXR
* Honeycombing
* more in bases
* NO ground glass really (no inflammation)
UIP
