Dyspnea and Cough (Tyler) DSA + Johnson Dyspnea Flashcards
What is a cinical finding in chronic cough indicative of asthma?
episodic wheezing
What are alarm sx of cough?
fever
productive cough
progressive dyspnea
persistent wheezing
What are the most common sx of wegener’s
upper respiratory in 90% of pts
lower respiratory in 60%
renal involvement in 75%
What complication are wegener’s pts at high risk for?
venous thrombotic events
What lab tests are positive in wegener’s
>90% of ppl have positive c-ANCA/antiproteinase-3
10-25% have p-ANCA
What is the tx plan for Wegener’s?
induction of remission: prednisone + cyclophosphamide or rituximab w/ steroids
maintaining remission: azithioprine or methotrexate or rituximab
What is rituximab?
risks?
b-cell depleting Ab approved for tx of wegeners and microscopic polyangitis
both this and cyclophosphamide incr risk of infection
WHich drug used for treating wegeners should not be used in pts with kidney disfunction?
methotrexate
Prophylaxis for what infection should be done w/ cyclophosphamid tx?
pneumocystis jirovecii
What systems are mainly affected in churg-strauss?
small and medium vessels
skin and lung most common
can be heart, GI and peripheral nerves also
What are the clinical findings in Churg-Strauss?
marked peripheral eosinophilia
chest XR = transient opacities to pulmonary nodules
What is the treatment plan for Churg-Strauss?
corticosteroid taper over 3-6 mos and cyclophosphamide until complete remission
replace cyclophosphamide w/ methotrexate or azathioprine for maintenance
What are the 2 most frequently affected organs in sarcoidosis?
lung
liver
(followed by eyes, bone, skin, hear, and parotid gland)
What are 3 dangerous complications of myocardial sarcoidosis?
restrictive cardiomyopathy
cardiac dysrhythmias
conduction disturbances
What CBC measurement is elevated in sarcoidosis?
sed rate
What is the significance of elevated ACE levels in sarcoidosis?
commonly elevated, but neither sensitive nor specific enough to be of diagnostic value
What are the radiograph stages of sarcoidosis?
I: hilar adenopathy alone
II: hilar adenopathy w/ parenchymal involvement
III: parenchymal involvement alone
IV: advanced fibrotic changes principally in upper lobes
What is the general Tx of sarcoidosis?
corticosteriods
methotrexate, azathioprine, cyclosporine, or anti-TNF therapy with infliximab (used in steroid-intolerant pts or steroid-refractory dz)
What is usually the most common sx of IPF?
progressive dyspnea
What are the 2 FDA approved drugs for the use of IPF?
pirfenidone: antifibrotic w/out known MOA; tid and monitor LFTs
nintedanib: tyrosine kinase inh taken bid; diarrhea is major side efect
What are the ACC/AHA stages of HF
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%
What are the NYHA functional classifications of HF?
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
What defines systolic HF?
EF < 40%, decr vent emptying so decr SV
S3 gallop
sx associated w/ hypoperfusion
What characterizes diastolic HF?
normal EF
stiff ventricles, resistance to vent filling
SOB, DOE, pulmonary edema
What characterizes high output HF?
EF reduced, but high CO
hyperthyroidism, pregnancy, anemia, beriberi, paget’s dz
What characterizes low output HF?
seen in ischemic heart dz, HTN
dilated cardiomyopathy, valvular and pericardial dz
What common drugs should be avoided in HF?
NSAIDS
inh COX 1 and 2 –> inh prostaglandin syn –> renal vasoconstriction –> makes fluid overload worse
How do DIP and RB-ILD differ on CT?
DIP: peripheral or diffuse ground-glass opacities, reticular markings, sometimes small cysts
RB-ILD: bronchial wall thickening, centrilobular nodules, patchy ground-glass opacities
In what lobes does IPF predominate?
lower lobes
(rarely upper)
What does IPF look like on CT?
subpleural ground glass opacities + reticular patterns
(rare to see ground glass w/out reticular - usually leads to alt dx)
predominant to lower lobes
