Dyspnea and Cough (Tyler) DSA + Johnson Dyspnea

Question 1

What is a cinical finding in chronic cough indicative of asthma?

Answer 1

episodic wheezing

Question 2

What are alarm sx of cough?

Answer 2

fever

productive cough

progressive dyspnea

persistent wheezing

Question 3

What are the most common sx of wegener’s

Answer 3

upper respiratory in 90% of pts

lower respiratory in 60%

renal involvement in 75%

Question 4

What complication are wegener’s pts at high risk for?

Answer 4

venous thrombotic events

Question 5

What lab tests are positive in wegener’s

Answer 5

>90% of ppl have positive c-ANCA/antiproteinase-3

10-25% have p-ANCA

Question 6

What is the tx plan for Wegener’s?

Answer 6

induction of remission: prednisone + cyclophosphamide or rituximab w/ steroids

maintaining remission: azithioprine or methotrexate or rituximab

Question 7

What is rituximab?

risks?

Answer 7

b-cell depleting Ab approved for tx of wegeners and microscopic polyangitis

both this and cyclophosphamide incr risk of infection

Question 8

WHich drug used for treating wegeners should not be used in pts with kidney disfunction?

Answer 8

methotrexate

Question 9

Prophylaxis for what infection should be done w/ cyclophosphamid tx?

Answer 9

pneumocystis jirovecii

Question 10

What systems are mainly affected in churg-strauss?

Answer 10

small and medium vessels

skin and lung most common

can be heart, GI and peripheral nerves also

Question 11

What are the clinical findings in Churg-Strauss?

Answer 11

marked peripheral eosinophilia

chest XR = transient opacities to pulmonary nodules

Question 12

What is the treatment plan for Churg-Strauss?

Answer 12

corticosteroid taper over 3-6 mos and cyclophosphamide until complete remission

replace cyclophosphamide w/ methotrexate or azathioprine for maintenance

Question 13

What are the 2 most frequently affected organs in sarcoidosis?

Answer 13

lung

liver

(followed by eyes, bone, skin, hear, and parotid gland)

Question 14

What are 3 dangerous complications of myocardial sarcoidosis?

Answer 14

restrictive cardiomyopathy

cardiac dysrhythmias

conduction disturbances

Question 15

What CBC measurement is elevated in sarcoidosis?

Answer 15

sed rate

Question 16

What is the significance of elevated ACE levels in sarcoidosis?

Answer 16

commonly elevated, but neither sensitive nor specific enough to be of diagnostic value

Question 17

What are the radiograph stages of sarcoidosis?

Answer 17

I: hilar adenopathy alone

II: hilar adenopathy w/ parenchymal involvement

III: parenchymal involvement alone

IV: advanced fibrotic changes principally in upper lobes

Question 18

What is the general Tx of sarcoidosis?

Answer 18

corticosteriods

methotrexate, azathioprine, cyclosporine, or anti-TNF therapy with infliximab (used in steroid-intolerant pts or steroid-refractory dz)

Question 19

What is usually the most common sx of IPF?

Answer 19

progressive dyspnea

Question 20

What are the 2 FDA approved drugs for the use of IPF?

Answer 20

pirfenidone: antifibrotic w/out known MOA; tid and monitor LFTs
nintedanib: tyrosine kinase inh taken bid; diarrhea is major side efect

Question 21

What are the ACC/AHA stages of HF

Answer 21

A: at risk for HF, no structural Dz, no sx

B: structural heart disease, no sx

C: Structural dz + sx

D: refractory HF, needs biventricular pacemaker, LVAD, transplant; 1 yr mortality 50-60%

Question 22

What are the NYHA functional classifications of HF?

Answer 22

1: no limitation of phys activity, asymptomatic
2: slight limitation of PE, exertional sx, no sx at rest
3: marked limitations, less than ordinary activity causes sx, no sx at rest
4: unable to do PE w/out sx; SYMPTOMATIC AT REST

Question 23

What defines systolic HF?

Answer 23

EF < 40%, decr vent emptying so decr SV

S3 gallop

sx associated w/ hypoperfusion

Question 24

What characterizes diastolic HF?

Answer 24

normal EF

stiff ventricles, resistance to vent filling

SOB, DOE, pulmonary edema

Question 25

What characterizes high output HF?

Answer 25

EF reduced, but high CO

hyperthyroidism, pregnancy, anemia, beriberi, paget’s dz

Question 26

What characterizes low output HF?

Answer 26

seen in ischemic heart dz, HTN

dilated cardiomyopathy, valvular and pericardial dz

Question 27

What common drugs should be avoided in HF?

Answer 27

NSAIDS

inh COX 1 and 2 –> inh prostaglandin syn –> renal vasoconstriction –> makes fluid overload worse

Question 28

How do DIP and RB-ILD differ on CT?

Answer 28

DIP: peripheral or diffuse ground-glass opacities, reticular markings, sometimes small cysts

RB-ILD: bronchial wall thickening, centrilobular nodules, patchy ground-glass opacities

Question 29

In what lobes does IPF predominate?

Answer 29

lower lobes

(rarely upper)

Question 30

What does IPF look like on CT?

Answer 30

subpleural ground glass opacities + reticular patterns

(rare to see ground glass w/out reticular - usually leads to alt dx)

predominant to lower lobes