Chronic Obstructive/Infiltrative Lung Diseases Flashcards by Stewart Stinton

Name some non-lung disorders caused by cystic fibrosis in adults

Aspermia

Pancreatic exocrine insufficiency

Chronic sinusitis

Nasal polyps

Bone disease

Hepatobiliary disease

How well did you know this?

Not at all

Perfectly

Describe how the GOLD assessment tool guides treatment in COPD

Based on exacerbation history per year

2 or more moderate exacerbation OR any hospitalization = LAMA (tiotropium) + LABA (salmeterol, formoterol)

0-1 moderate exacerbations WITHOUT hospitalization = Bronchodilator (just tiotropium) OR LAMA + LABA
Determination made based on breathlessness questionnaire

ALL COPD patient get albuterol for PRN

How well did you know this?

Not at all

Perfectly

Physical signs in asbestosis

Fine-end expiratory rales

Digital clubbing

Cor pulmonale (late disease)

How well did you know this?

Not at all

Perfectly

Increased levels of ACE would be seen in these four chronic diffuse infiltrative lung diseases

Beryliosis

Asbestosis

Silicosis

Sarcoidosis

(ACE increased in BASS)

How well did you know this?

Not at all

Perfectly

Apart from antibiotics/antivirals, what three things are used to treat an exacerbation of COPD?

Supplemental oxygen 88-92%

SABA (albuterol/levalbuterol) with or without ipratropium

Systemic steroids for up to two weeks

How well did you know this?

Not at all

Perfectly

This chronic diffuse infiltrative lung disease is associated with increased collagen in the extra-cellular matrix

Idiopathic pulmonary fibrosis

How well did you know this?

Not at all

Perfectly

This chronic diffuse infiltrative lung disease is associated with the bite of the wolf

Sarcoidosis

How well did you know this?

Not at all

Perfectly

This chronic diffuse infiltrative lung disease will show bilateral hilar lymphadenopathy on chest x-ray

Sarcoidosis

How well did you know this?

Not at all

Perfectly

Which pneumoconiosis can be most acute and show symptoms within 4-8 hours of exposure?

Hypersensitivity pneumonitis (includes farmer’s lung)

How well did you know this?

Not at all

Perfectly

Most common cause of bullous lung disease

Smoking

How well did you know this?

Not at all

Perfectly

Patients with this pneumoconiosis would have pleural plaques on their chest x-ray

Asbestosis

How well did you know this?

Not at all

Perfectly

How is a cystic fibrosis newborn screening confirmed?

Sweat chloride test

How well did you know this?

Not at all

Perfectly

Which chronic diffuse infiltrative lung disease shows bilateral reticular or reticularnodal infiltrates on chest x-ray

Malignant diffuse infiltrative lung disease

(Pulmonary lymphangitic carcinomatosis)

How well did you know this?

Not at all

Perfectly

Name three cancer medications that cause chronic diffuse infiltrative lung diseases

Bleomycin

Cyclophosphamide

Methotrexate

How well did you know this?

Not at all

Perfectly

Which antibiotics are best for treatment of COPD exacerbations?

Macrolides (azithromycin)

Ciprofloxacin (fluroquinolone)

2nd/3rd gen cephalosporins

How well did you know this?

Not at all

Perfectly

How to diagnose chronic diffuse infiltrative lung disease caused by illicit drugs?

Biopsy is needed to confirm

How well did you know this?

Not at all

Perfectly

This chronic diffuse infiltrative lung disease is three times more common in blacks

Sarcoidosis

How well did you know this?

Not at all

Perfectly

Average age for bronchiectasis

60+

How well did you know this?

Not at all

Perfectly

How long after initiation of amiodarone could a chronic diffuse infiltrative lung disease show up?

Two months to two years

How well did you know this?

Not at all

Perfectly

This obstructive lung condition is triggered by infection and impaired drainage (usually cystic fibrosis)

Bronchiectasis

How well did you know this?

Not at all

Perfectly

Which pneumoconiosis is least likely to lead to fibrosis?

Hypersensitivity pneumonitis (includes farmer’s lung)

How well did you know this?

Not at all

Perfectly

How many COPD cases are due to smoking?

80-90%

How well did you know this?

Not at all

Perfectly

Which pneumoconiosis is associated with egg-shells on chest x-ray?

Silicosis

How well did you know this?

Not at all

Perfectly

Describe process of bullous lung disease

Alveoli distend and leak air

Big bullae forms

Bullae presses on functional lung tissue like a mass would

How well did you know this?

Not at all

Perfectly

Physical exam sign for bronchiectasis

Inspiratory rales

Which two obstructive lung diseases might show bullae on CT?

Bullous lung disease Alpha-1 antitrypsin deficiency

How many years of exposure are needed before there is a risk of developing coal worker's pneumoconiosis?

10+ years

True or false. Corticosteroids are useful in treatment of nitrofurantoin induced infiltrative lung disease

False. Symptoms resolve within four days of stopping med

History is important in diagnosing chronic diffuse infiltrative lung diseases because they are commonly caused by these two things

Occupation/exposures Drugs (medications and illicit)

What is the average age of sarcoidosis onset?

50+

Name two non-cancer medications that cause diffuse infiltrative lung disease

Nitrofurantoin (Macrobid) Amiodarone

Name the illicit drugs that can cause chronic diffuse infiltrative lung disease

Amphetamines or narcotics with TALC

Is a CT scan necessary for COPD diagnosis?

No, mostly used if there are complications like pneumonia or pneumothorax

When should antivirals be used in treatment of COPD exacerbation?

If influenza or covid are causing exacerbation. Must be used EARLY to be effective.

Name the three structural changes in bronchi in chronic bronchitis

Inflammation Metaplasia Gland enlargement

In farmer's lung, which bacteria causes a hypersensitivity reaction?

Actinomyces - found in hay mold

Are chronic diffuse infiltrative lung diseases more obstructive, restrictive, or a mix of both?

Restrictive

In anti-GBM antibody lung disease (Goodpasture's) which other organ may be affected?

Kidneys

How is beryliosis diagnosed?

BeLPT blood draw (berylium levels in blood)

Three treatments for cystic fibrosis

Manage infections (chronic azithromycin) Inhaled DNase (mucolytic) Inhaled hypertonic saline (draw H2O into airway)

COPD most common symptoms

Shortness of breath Chronic cough

Which four vaccinations are helpful supportive treatment in COPD patients?

Influenza Pneumococcal COVID RSV

True or false. Supplemental oxygen use as needed improves survival rates in COPD.

False. Long-term oxygen only improves survival rate if used 24/7

Best imaging type for bronchiolitis obliterans

High res CT

This pneumoconiosis may develop into PMF (progressive massive fibrosis)

Coal worker's pneumoconiosis PMF = black lung

Name three genetic obstructive lung diseases

Alpha-1 antitrypsin deficiency Cystic fibrosis Primary Ciliary Dyskinesia

Which pneumoconiosis shows up 20 to 30 years after initial exposure?

Absestosis

Treatment for anti-GBM antibody lung disease (Goodpasture's)

Plasmapheresis (take plasma out and remove antibodies)

Which lung disorder is known as "super emphysema"

Bullous lung disease

What is the goal level for SaO2 maintenance in COPD?

>90%

This chronic diffuse infiltrative lung disease is associated with clubbing of digits and will show honeycombing on high resolution CT scans

Idiopathic pulmonary fibrosis

What test is needed for diagnosis of primary ciliary dyskinesia?

Biopsy - to look at cilia

In newborns with cystic fibrosis, you might see this unique sign

Meconium ileus

Explain the staging of COPD diagnosis/classification

In all stages FEV1/FVC ration <0.7 Stages based on FEV1 % Stage 1: 80-100% Stage 2: 50-80% Stage 3: 30-50% Stage 4: 0-30%

Which obstructive lung condition is described as "pan-acinar"?

Alpha-1 antitrypsin deficiency Pan-acinar = affects all terminal airways

Half of patients with this obstructive lung disease have their organs on the wrong side (situs inversus)

Primary ciliary dyskinesia

This chronic diffuse infiltrative lung disease mimics pneumonia but the patient does not improve with antibiotics

BOOP Bronchiolitis obliterans organizing pneumonia

When should antibiotics be considered in the treatment of a COPD exacerbation?

If increased dyspnea/sputum/purulence or any of the following risk factors: - Age 65+ - FEV1 <50% - On continuous supplemental O2 - CHF/CAD

How long must a patient have had a productive cough in order to classify as chronic bronchitis?

At least 3 months for two years in a row

Explain alveolar changes in emphysema

Walls of parenchyma (functional unit of alveoli) break down (due to things like smoking). Alveoli turns into one big chamber, rather than lots of small rooms. Air circulates inside alveoli but can't get out.

Two diagnostic methods for alpha-1 antitrypsin deficiency

CT = basilar bullae (bubbles at lung base) Serum AAT levels (also genetic testing)

This pneumoconiosis is associated with at least five years exposure to sandblasting, stone work or foundry work

Silicosis

What would you expect to see on spirometry in COPD?

Reduced FEV1/FVC ratio (obstructive) Increased residual volume Increased total lung capacity

Which chronic diffuse infiltrative lung disease, of known etiology, has the symptoms that progress most quickly?

Malignant diffuse infiltrative lung disease (Pulmonary lymphangitic carcinomatosis)

At what O2 levels should supplemental oxygen be ordered in COPD patients?

PaO2 <55 SaO2 <88%

Which condition shows tram-track signs and ring shadows

Bronchiectasis

What is the most common chronic diffuse infiltrative lung disease?

Idiopathic pulmonary fibrosis

Between what ages is COPD most common?

40-79

Most common symptom in anti-GBM antibody lung disease (Goodpasture's)

Gross hematuria (also some hemoptysis)

True or false. Patients with bronchiolitis obliterans will have relief with bronchodilators.

False. Can't dilate scar tissue

Cystic fibrosis patients have a genetic defect that leads to this ...

Chloride channels don't work Leads to dry sputum Mucus plugs airways Causes secondary bacterial infections, persistent inflammation, bronchiectasis

What would be seen on chest x-ray for a patient with bronchiectasis?

Thickened bronchial walls - tram-track sign Ring shadows

Definition of chronic obstructive pulmonary disease

Lung condition characterized by chronic dyspnea, cough, and exacerbations

Which occupation is beryliosis associated with?

Metal/electronics manufacturing

This pneumoconiosis shows hilar lymph node calcification and central nodular opacities on CT

Silicosis

This obstructive lung disease may be seen in patients with a history of chronic respiratory infections, such as RSV, as a child

Bronchiolitis obliterans

In alpha-1 antitrypsin deficiency what other organ (apart from lungs) might show damage?

Liver (hepatitis, cirrohsis, hepatocellular carcinoma)

Average age of onset for alpha-1 antitrypsin deficiency symtpoms

45-50 35-40 in smokers

Best diagnostic test for anti-GBM antibody lung disease (Goodpasture's)

Serology - need to find anti-GBM antibodies in the blood

Why do patients with COPD get recurrent lower respiratory tract infections?

Metaplasia of cells lining airway = loss of cilia = less expulsion of bacteria/viruses = more infections

Why do patients with COPD have chronic coughs?

Lack of cilia due to metaplasia makes it harder for them to expel mucus, especially in chronic bronchitis

What might you see on chest x-ray in COPD?

Hyperinflation of lungs, flat diaphragm

Primary ciliary dyskinesia symptoms

Otitis media Daily productive cough since birth

Treatment for sarcoidosis

Glucocorticoids

The biggest thing you can do do help COPD patients (will help the most) is ...

Smoking cessation

Chronic Obstructive/Infiltrative Lung Diseases Flashcards

(85 cards)