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Chronic Interstitial Lung Dz Flashcards

1
Q

CXR

A
  • small lungs

* fine lines to peripher (don’t branch like vessels)

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2
Q

What causes x ray lines?

A

Inflamed septal area (connective tissue)

Thickening it

Rule out Heart Failure/Renal failure

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3
Q

Diffuse Parenchymal Lung Disease

Known causes

A
  • drugs
  • inhaled particles (hypersensitivity pneumonitis)
  • immune complexes
  • associated w/ collegen vascular dz (immune complexes)
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4
Q

DPLD classification

A
  • known cause
  • idopathic
  • Granulomatous DPLD (sarcoidosis = mostly AA)
  • other (rare) = LAM, HX, etc.
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5
Q

DPLD

Etiology

A

*occupational/inhalant
(Inorganic, organic (HyperPneum), fumes)

  • Drugs
  • radiation
  • infectious (TB, P carinii)
  • Pulm edema, uremia
  • Collegen vascular dz
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6
Q

DPLD

Unknown etiology

A

*Idiopathic Interstitial
HUGE LIST

*sarcoidosis

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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
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8
Q

BAL

Neutrophilic inflammatory profile?

A

UIP/IPF

Inorganic dust

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9
Q

BAL

Lymphatic inflammatory?

A

Sarcoidosis

Hypersens Pneumonitis

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10
Q

BAL

CD4/CD8 ratio

A

High : sarcoidosis

Low:HSP/HIV

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11
Q

Elasticity Measurement

A

Restrictive - stiffer lung, takes more work, so person accepts lower max inspiration

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12
Q

Spirometry

Restrictive

A

All volumes reduce

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13
Q

Spirometry

Obstructive

A 
RV up (trapped air)
Encroaches on other volumes
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14
Q

W/ exercise

A

O2 fine at rest, terrible with exercise, membrane too thick

Exercise Desaturation

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15
Q

V/Q

A

Low V because alveoli not elastic

CO2 up

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16
Q
  • Dyspnea
  • Dry cough

CXR =

  • infiltrates
  • restriction
  • resting desaturation
  • exercise desaturation

DOWN D L CO2 (CO2 diffusion)

*RULE OUTpulmonary HTN

Dx

A

DPLD

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17
Q

Areas of DX

A

Clinical

  • History
  • PE
  • Lab
  • PFTs

Radiology

  • CXR
  • HRCT

Pathology

  • FOB w/ BAL/TBB
  • Surgical lung biopsy
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18
Q

Ground glass opacities

A

Inflammation, water in lung

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19
Q

AA?

A

Sarcoid

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20
Q

Fever/HIV?

A

Pneumocystis

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21
Q

DX questions

A
  • Specific Dx?
  • Active dz?
  • Need biopsy?
  • Therapy?
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22
Q

PE

A
  • crackles
  • clubbing
  • lesions, eye, lymphadenopathy, cardio, hepatosplenomegaly, MSK
  • Labs
  • images
  • PFTs
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23
Q

Sarcoid in

A

Upper lobes

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24
Q

IPF in

A

Lower lobes

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25
Q

lympadenopathy + infiltrate

A

Sarcoid
Silicosis
Infxn (TB, Histoplasm)
Malignacy

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26
Q

HRCT

A
  • early detection
  • ground glass opacities
  • determine biopsy site
  • progression/assessment
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27
Q

PFTs

A
  • restrictive
  • small airway dz
  • reduced DLCO2
  • hypoxemia at rest
  • exercise desaturation
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28
Q

Infiltrates + Pleural dz

A
  • infxn (TB, Fungal)
  • Malignancy
  • Collogen vascular dz : SLE, RA
  • Drug Hypersensitivity
  • Cardio dz
  • Asbestos-related Dz
29
Q

PE

Watch for

A
  • small lung volumes
  • inspiratory crackles
  • position dependent crackles
  • Evidence for pulmonary HTN
  • clubbing
  • extrapulmonary signs (skin, cardio, etc.)
30
Q

Idiopathic Pulmonary Fibrosis (IPF)

Also called

A

Cryptogenic Fibrosing Alveolitis (IPF)

Must distinguish from NSIP (nonspecific interstitial pneumonia)

31
Q

Tobacco Smoker’s dz

A
  • Respiratory Bronchiolitis Interstitial Lung Dz (RB-ILD)
  • from small airway to big

*Desquamative Interstitial Pnuemonia (DIP) = macrophage cells crowd airways

32
Q

Cryptogenic Organizing Pneumonia (formerly BOOP)

A

Pneumonia like shadows on CXR (not normal infiltrate)

33
Q
  • progressive dyspnea
  • clubbing
  • old
  • progressive cough, non-productive
  • mid-late inspiratory crackle
  • restrictive
  • DOWN DLCO
  • WIDE P(A-a)DO2
  • exercise desaturaton
34
Q

IPF

Tx

A

Transplant

1/2 dead in 5 years (more deadly than lung cancer)

35
Q

IPF

Biopsy?

A

Yes, MUST HAVE

Fibroblastic foci

36
Q
  • younger 40
  • no association cig smoking
  • dyspnea, cough, fatiuge
  • weight loss
  • basilar crackles
  • less clubbing
A

Nonspecific Intersitial Pneumonitis NSIP

37
Q

Classic NSIP

CXR
Histology

A

CXR = ground glass opacities

Histology = uniform, no fibroblastic foci

38
Q

NSIP

Tx

39
Q
  • SOB
  • PFT = mixed obstructive/ restrictive
  • DLCO down
  • Pigmented intraluminal macrophages in 1st and 2nd order respiratory bronchioles
  • smoker
A

Respiratory Bronchiolitis-Associated Lung Dz RB-ILD

Linked to DIP (more severe)

40
Q

RB-ILD

Tx

A

Steroids

Smoking cessation

41
Q

*male
*smoker
*clubbing
*40s
*insidious onset dyspnea + dry cough
*

A

Desquamative Interstitial Pneumonitis (DIP)

42
Q

DIP

Tx

A

Steroids
Smoking cessation
*complete recovery possible

43
Q
  • 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
*

A

Sarcoidosis

44
Q

Sarcoidosis

Biopsy

A

Non-caseating epithelioid cell granuloma

NEW WAY = ultrasound to find lymph node, then fine needle aspirate node

Rule out TB w/ culture

45
Q

Sarcoidosis

Tx

A

STEROIDS
Methotrexate

Skin: *Hydroxychloroquine

46
Q

Sarcoidosis

Path

A

*CD4+ T cells - antigens/self-antigens
HIV can eliminate!

  • central immune activation, peripheral immune depression
  • Granulomas (–>fibrosis) = eyes, lungs, liver
47
Q

Sarciodosis

Sequalae

A

Large, calcified lymph nodes

48
Q

Sarcoidosis

Prognosis

A

Self-limited course

Relentless, fibrosis of lungs/eye etc.

49
Q

Asymptomatic w/ Bilat Hilar lymph nodes?

50
Q

Sarcoidosis

Cause

A

Unknown

Some think microbacterial antigen

51
Q

CXR

Huge potato like bilat hilar lymph nodes

Diffuse nodules

A

Sarcoidosis Stage 1

Get biopsy

52
Q

CXR

Infiltrates more in upper lobes

Hilar lymph can push trachea

A

Sarcoidosis stage 2

53
Q

If horrible chest x ray but patient looks well

A

Sarcoidosi

54
Q

HRCT

Nodularity
(Edges subplural, along airways, in lung)

Beading pattern

A

Sarcoidosis

55
Q

Sarcoidosis

Dx approach

A
  • BIOPSY
  • Extent/severity of organ involvment
  • stable? Active? (NO TEST, must check function tests)
  • Therapy will help?
56
Q
  • 4-8 hours after exposure
  • fever, malaise
  • cough, dyspnea
  • s/s 12-48 hours
  • farmer’s lung (mold in hay)
  • Bird fancier’s lung
A

Hypersensitivity Pneumonitis

Extrinsic Allergic Alveolitis

57
Q

Bird fancier’s lung

Antigens from

A

Feathers + droppings

More complex than farmers

58
Q

Hypersensitivity Pneumonitis

Path

A

Inflammation in small airways

59
Q

Asbestos exposure leads to

A

Pleural thickening = mesothelioma

Pleural plaques

Shaggy ??? In bottom of lungs

60
Q

Hot tub lung

A

Hypersensitivity Pneumonitis

61
Q

Accumulation of dust in lung

Asbestos, etc.

A

Pneumoconiosis

62
Q

Asbestos in

A

Elevator break pads
Auto break pads
Pipes in building

63
Q

Asbestos + cig smoker

A

Highest possible risk

64
Q

Sarcoid

PFT

A

Restriction

Low DLCO

65
Q

Common work exposures

A
  • asbestos, shipyard work
  • Silica, mining, quarrying, sandblasting
  • Solvents, degreasers
  • Two-part glue, paint, urethane
66
Q

Questions about work experience

A
  • # hours worked
  • employment duration
  • “mist in air?”
67
Q

Labs

Up ACE?

A

Sarcoidosis

68
Q

CXR

  • Honeycombing
  • more in bases
  • NO ground glass really (no inflammation)

Pulmonology (12 decks)

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