Disease States I

Question 1

multi-system inflammatory disease of unknown etiology causing interstitial lung disease

Answer 1

sarcoidosis

MC lung, lymph node, eyes, skin

Question 2

sarcoidosis causes which specific forms of pulmonary disease

Answer 2

pulmonary fibrosis

hilar lymphadenopathy

Question 3

sarcoidosis pathophysiology

Answer 3

exaggerated immune response

develop non-caseating granulomatous disease

Question 4

sarcoidosis epidemiology

Answer 4

MC in AA, women

AA disease tend to be more severe and unremitting

Question 5

sarcoidosis clinical presentation

Answer 5

DOE, cough, chest pain

+/- fever, arthralgia, anorexia

Question 6

systemic clinical manifestations of sarcoidosis

Answer 6

pulmonary
cutaneous
ocular
endocrine

Question 7

pulmonary manifestations of sarcoidosis

Answer 7

hilar lymphadenopathy
interstitial lung dz
pulmonary HTN

Question 8

cutaneous manifestations of sarcoidosis

Answer 8

erythema nodosum
skin plaques
panniculitis
violet rash on cheeks, nose

Question 9

ocular manifestations of sarcoidosis

Answer 9

uveitis (can cause blindness)

Question 10

endocrine manifestations of sarcoidosis

Answer 10

hypercalcemia

Question 11

erythema nodosum

Answer 11

skin manifestation of sarcoidosis

large red indurated nodule on extremities

Question 12

diagnostic study used for sarcoidosis

Answer 12

CXR (shows the granules)

HRCT can be used to identify active alveoli’s or fibrosis

Question 13

lab eval of sarcoidosis

Answer 13

LFT’s
dihydroxy vitamin D levels
ACE levels

Question 14

sarcoidosis dx is confirmed by

Answer 14

BIOPSY of lung or lymph tissue

shows non caveating granulomas w/o fungus or TB

Question 15

sarcoidosis stage I

Answer 15

hilar or mediastinal lymphadenopathy only

45-65% of pts @ diagnosis

Question 16

stage II sarcoidosis

Answer 16

lymphadenopathy and parenchymal disease

infiltrates

Question 17

stage III sarcoidosis

Answer 17

parenchymal disease (infiltrates only)

Question 18

sarcoidosis treatment

Answer 18

given to pts with pulmonary disease - oral corticosteroids over 6 months

NSAIDS for symptomatic relief

Question 19

sarcoidosis prognosis

Answer 19

2/3 remit w/in 10 yrs

important prognostic indicator is staging of dz on CXR

Question 20

etiologies of restrictive lung disease

Answer 20

Pleural (trapped lung, empyema)
Alveolar (edema, hemorrhage 
Interstitial (pulmonary fibrosis) 
Neuromuscular (myasthenia gravis, ALS)
Thoracic cage abnormalities (obesity)

Question 21

restrictive lung disease results when

Answer 21

poorly compliant chest wall

muscles expand chest wall too weak to create normal neg pressure

pulmonary tissue is poorly expandable

alveoli have poor ability to exchange O2

ventilation

Question 22

test used to diagnose lung disease

Answer 22

PFT’s

decreased total lung capacity

Question 23

restrictive lung disease PFT

Answer 23

Low lung volumes but normal FEV1/FVC ratio

Question 24

restrictive lung disease and diffusion capacity PFT

Answer 24

DECREASED DLCO = interstitial lung disease

NORMAL DLCO - neuromuscular, thoracic cage, pleural etiology)

Question 25

interstitial lung disease

Answer 25

diffuse inflammation of the lung causing scaring and thickening of tissue between alveoli and capillaries RESTRICTIVE + DECREASED diffusion

Question 26

patho of interstitial lung disease

Answer 26

injury to lungs (aspiration, smoke, dust) that doesn't heal properly patchy replacement of normal tissue with scar tissue and fibroblasts

Question 27

end result of ILD

Answer 27

pulmonary fibrosis due to chronic inflammation

Question 28

etiologies of ILD

Answer 28

long term exposure to toxins and pollutants connective tissue diseases medications and radiation

Question 29

ILD presentation

Answer 29

varied dry cough > 6 months DOE progressing to DOR

Question 30

diagnosis of ILD -- suspect then order

Answer 30

history (insidious onset, chronic symptoms) PE (systemic signs of pulmonary dz - clubbing) pulmonary function testing (restrictive and DLCO decreased) + lab testing, imaging, lavage/bx

Question 31

lab testing ILD

Answer 31

arterial blood gas (hypoxemia) testing for specific etiology

Question 32

imaging ILD

Answer 32

HRCT STUDY OF CHOICE shows fibrosis

Question 33

bronco-alveolar lavage

Answer 33

lund tissue biopsy suggests severity, confirms diagnosis

Question 34

management of ILD

Answer 34

treat underlying dz, pulmonology steroids/immunomodulators prompt tx of infection oxygen

Question 35

pneumoconioses

Answer 35

collection of interstitial lung diseases caused by occupational exposure to inorganic mineral dust MC type is asbestosis

Question 36

when to consider pneumoconiosis

Answer 36

history, exam, and diagnosis of ILD with occupational exposure risk

Question 37

imaging and pneumoconiosis

Answer 37

involvement of upper lobes of lungs ** except asbestosis

Question 38

Black lung

Answer 38

coal workers lung due to coal/dust exposure upper lobes show coal macule --> fibrosis

Question 39

silicosis

Answer 39

upper lob opacity, EGGSHELL clarifications of lymphnodes ex. stonemason/sandblasting