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MODHIII - Unit 3 > Diffuse Parenchymal Lung Disease > Flashcards

Diffuse Parenchymal Lung Disease Flashcards

1
Q

What can effect the interstitium

A
  • edema
  • malignancy
  • infections
  • inflammation and fibrosis (INTERSTITIAL LUNG DISEASE)
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2
Q

Mechanism of interstitial lung disease

A
  1. lung injury: environment, autoimmune, unknown (can lead to 2 or 3)
  2. inflammation: this can lead to possible resolve or 3
  3. lung fibrosis
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3
Q

Causes of primary interstitial lung disease (ILD)

A
  • idiopathic interstitial pneumonias

- sarcoidosis

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4
Q

Causes of secondary ILD

A
  • drugs
  • exposures/occupations
  • radiation
  • aspiration
  • connective tissue disease related ILD (autoimmune)
  • smoking-related
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5
Q

Important aspect to diagnosing ILD

A
  • taking a good history
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6
Q

Types of diffuse parenchymal lung disease

A
  • smoking related
  • environmental exposure
  • granulomatous
  • autoimmune
  • idiopathic interstitial pneumonias
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7
Q

Signs of sarcoidosis

A
  • uveitis
  • erythema nodosum (bruises on shins)
  • noncaseating granulomas
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8
Q

Person to first diagnose someone with sarcoidosis & when

A

J. Hutchinson - 1878

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9
Q

Systems effected by sarcoidosis

A
  • multisystem disease: every system can be effected

- most common: lung (95%), eyes, lymph nodes, liver, skin

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10
Q

Who gets sarcoidosis

A
  • all ages, gender, races

- familial

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11
Q

Incidence/Prevalence of sarcoidosis

A
  • highest in african american women

- norther european african americans (sweden)

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12
Q

Clinical manifestations of sarcoidosis by country

A
  • US/Europe: respiratory disease

- Japanese: cardiac & eye disease

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13
Q

What defines sarcoidosis

A
  • granuloma with no identifiable bug
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14
Q

What is a granuloma

A
  • macrophages, epitheliod cells, multinucleated giant cells

- surrounded by CD4 T cells (Th1) w/ few CD8 and B cells

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15
Q

How do patients present w/ sarcoidosis

A
  • skin abnormality
  • fevers, night sweats, fatigue, weight loss
  • cough, shortness of breath
  • chest pain, palpitations, arrhythmia
  • NO symptoms at all**
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16
Q

Aspects needed to diagnose sarcoidosis

A
  • clinical symptoms
  • radiograph
  • biopsy w/ pathology
  • MUST RULE OUT ANY OTHER CAUSE: infections, cancer, foreign bodies, inhalations*
17
Q

Meaning behind staging of sarcoidosis

A
  • doesn’t mean you have a worse prognosis

- deals with how you will treat the patient

18
Q

Clinical course of sarcoidosis

A
  • spontaneous remission: 50-70%
  • wax and wane-chronic and persistent: 30-50%
  • progressive: 1-5%
19
Q

Treatment of sarcoidosis

A
  • lacking evidence
  • vital organ involvement such as eye, cardiac, neuro: corticosteroids
  • other immunosuppressants
20
Q

Clinical case of fibrosis

A
  • old age

- chronic

21
Q

Physical exam findings of fibrosis

A
  • low O2 when walking
  • VELCRO crackles w/ NO wheezing
  • mild clubbing
22
Q

Percentage of idiopathic pulmonary fibrosis (IPF) patients that have crackles

A

80%

23
Q

Percentage of IPF patients that have clubbing

A

50%

24
Q

Pulmonary function test results of IPF patients

A
  • low FVC, FEV, total lung capacity, diffusing capacity
25
Q

Type of lung disease in IPF

A
  • restrictive lung disease w/ severely reduced diffusing capacity
26
Q

Radiograph findings of IPF patient

A
  • reduced lung volume
  • honeycombing
  • lower lobe predominance
27
Q

Diagnosing idiopathic pulmonary fibrosis (IPF)

A
  • exclude other known causes of pulmonary fibrosis
  • abnormal pulmonary function tests
  • features of pulmonary fibrosis on CT scan
  • usual interstitial pneumonia an open lung biopsy
28
Q

Other causes of pulmonary fibrosis

A
  • medications: amiodarone, nitrofurantoin, cocaine/heroin, mineral oil, chemo, anti TNF
  • medical history: autoimmune disease
29
Q

Social history showing possible causes of IPF

A
  • smoking, occupation, hobbies, inhalations, drugs, mold exposure, pets (BIRDS ARE BAD), hot tubs (mycobateria)
30
Q

Mechanism of injury in IPF

A

insult to epithelium and basement membrane–aberrant wound healing or vascular injury–fibrotic foci (fibroblast proliferation, collagen deposition)–Fibrosis (circulating fibroblasts also contribute)
INFLAMMATION does NOT play a roel

31
Q

Does inflammation play a role in IPF

A

NO INFLAMMATION DOES NOT PLAY A ROLE

32
Q

Another name for idiopathic pulmonary fibrosis

A

usual interstitial pneumonia

33
Q

Median survival of patient w/ IPF

A

3-5 years

34
Q

Treatment for IPF

A
  • anti fibrotics: prifenidone, nintedanib
  • pulmonary rehab
  • oxygen
  • lung transplant
35
Q

Diffuse parenchymal lung disease types and treatments

A
  • smoking related: stop smoking
  • environmental exposure: remove exposure
  • granulomatous: steroids/immunosuppressants
  • idiopathic interstitial pneumonias: steroids/immuno/ANTIFIBROTIC
  • autoimmune/collagen vascular disease: steroids/immuno
36
Q

How is the type of interstitial lung disease determined

A
  • by the type, amount, location of cells

MODHIII - Unit 3 (20 decks)

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