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Allergy and Immunology > First Aid, Chapter 7 Hypersensitivity Disorders, Hypersensitivity Pneumonitis > Flashcards

First Aid, Chapter 7 Hypersensitivity Disorders, Hypersensitivity Pneumonitis Flashcards

1
Q

What are the Immunologic Lung Disease broad categories? What diseases fit within each category?

A

TH1
CD8: HP and COPD
CD4: granulomatous - TB, sarcoid, and berylliosis

TH2
Asthma, ABPA, pulmonary eosinophilia, HIV, and Graves’ disease

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2
Q

What are the 3 types of HP?

A

Acute, Subacute, Chronic

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3
Q

What are the features of acute HP with regard to symptoms, onset, recovery, and CT findings?

A
  • Explosive respiratory symptoms
  • Takes 4–6 hours
  • Nonproductive cough
  • Fever present
  • Recovery spontaneous
  • On HRCT: Normal or fleeting ground glass opacities seen
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4
Q

What are the features of subacute HP with regard to symptoms, onset, recovery, and CT findings?

A
  • Progressive
  • Slow onset
  • Productive cough
  • No systemic symptoms
  • HRCT: Diffuse micronodules, air trapping, mild fibrosis
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5
Q

What are the features of chronic HP with regard to symptoms, onset, recovery, and CT findings?

A
  • No explosive symptoms
  • No fever
  • Fibrotic lung
  • Anorexia
  • Weight loss
  • Permanent damage likely
  • HRCT: Ground-glass opacities, emphysema, honeycombing, and parenchymal micronodules
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6
Q

What is the antigen in Farmer’s lung? What is the source?

A

Antigen: Faenia rectivirgula or Micropolyspora faeni

Source: moldy hay and compost

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7
Q

What is the source of the HP antigen Thermoactinomyces vulgaris?

A

Bagassosis (moldy sugar cane)

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8
Q

What is the antigen in ventilation pneumonitis (humidifier/AC induced)?

A

Thermoactinomyces sacchari, Naegleria gruberi, or Acanthamoeba

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9
Q

What is the antigen in humidifier’s lung (cool mist humidifier)?

A

Bacillus cereus or Klebsiella oxytoca

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10
Q

What is the antigen in hot tub lung?

A

Mycobacterium avium intracellulare (MAI)

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11
Q

What is the antigen in malt worker’s lung (malt, tobacco, and soy)?

A

Aspergillus species

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12
Q

What is the antigen in cheese worker’s lung (moldy cheese?

A

Penicillium casei or P. roqueforti

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13
Q

What is the antigen in machine operator’s lung?

A

Pseudomonas, Acinetobacter, or Mycobacter

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14
Q

What is the antigen in bird fancier’s lung? What group has a good prognosis?

A

Avian proteins or Aspergillus species, kids have a good prognosis.

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15
Q

What is the antigen in detergent worker’s lung?

A

Bacillus Subtilis

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16
Q

What is the antigen in Woodworker’s lung?

A

Alternaria species

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17
Q

What is the antigen in winegrower’s lung?

A

Stachybotrys

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18
Q

What is the antigen in Air-conditioner lung?

A

Aureobasidium

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19
Q

What is the antigen in summer-type lung (Japan)?

A

Trichosporum cutaneum

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20
Q

What is the antigen in El NIno lung?

A

Pezizia

21
Q

What is the antigen in Saxophonist’s lung?

A

Candida albicans

22
Q

What is the antigen in basement shower lung?

A

Epicoccum nigricans

23
Q

What is the antigen in wheat weevil lung?

A

Sitophilus

24
Q

What is the antigen in paint finisher’s lung?

A

Toluene or toluene diisocyanate (TDI)

25
Q

What is the antigen in chemical worker’s lung?

A

Diphenylmethane diisocyanate (MDI)

26
Q

What is the antigen in epoxy resin worker’s lung?

A

Phthalic acid

27
Q

What is the antigen in plastic worker’s lung?

A

Trimellitic anhydride

28
Q

What are the diagnostic criteria for HP?

A

-HP symptoms
-Evidence of exposure (history and +IgG)
+ Radiograph of chest or high-resolution computed tomography (HRCT, reticular, nodular, or ground-glass opacities)
-Bronchoalveolar lavage (BAL) lymphocytosis > 20% (low CD4:CD8 ratio

29
Q

What are the BAL findings in HP?

A 
↑CD8 (CD4:CD8 20%  
↑ neutrophils  
↑ eosinophils  
>1% of WBCs in BAL are mast cells  
↑ IgG, IgA, IgM  
↑ hyaluronic acid
30
Q

What are the lung biopsy findings in HP?

A

Noncaseating granulomas Mononuclear cell infiltrates of alveolar walls (lymphocytes, plasma cells) Foamy histiocytes in alveoli Giant cells
peribronchiolar fibrosis

31
Q

What are the PFT findings in HP?

A

↓FEV1 after 4–6 hr of exposure
↓FVC after 4–6 hr of exposure
↓DLCO after 4–6 hr of exposure

32
Q

What are the lab differences in asymptomatic vs. symptomatic HP?

A

Asymptomatic
CD4>CD8
Normal CD8 numbers
Normal IgM

Symptomatic
CD8>CD4
Low CD8
High IgM

33
Q

What are drugs that can cause HP?

A

Mnemonic: A Boy Came From a Good Home to Make Nice Purple Sweets Amiodarone
Beta Blockers Chlorambucil, clozapine, cyclosporine
Fluoxetine
Gold
Heroin, HMG Co-A reductase inhibitors Methotrexate,
minocycline
Nitrofurantoin
Procarbazine
Sulfasalazine

34
Q

What is Organic dust toxic syndrome (ODTS, pulmonary mycotoxicosis)

A

Noninfectious, febrile illness that occurs in workers after exposure to dust contaminated by bacterial and/or fungal spores (from inhalation of toxinproducing fungi-contaminated aerosols [i.e., grain, hay]) 30 to 50 times more common than HP; young patients; usually contracted in the summer months; complete recovery.

35
Q

What is fire-eater’s lung?

A

Choking, coughing, respiratory symptoms from aspiration of the flammable petrochemicals used during the fire-eating demonstration. Fever and pleuritic chest pain also seen

36
Q

What is humidifier fever?

A

Toxic alveolitis, recirculated water with endotoxin, chest tightness occurs 4–8 hours after exposure; resolves in hours

37
Q

What is silo unloaders disease?

A

Acute exposure to NO2, leading to asphyxia (i.e., a farmer entering a silo)

38
Q

What is byssinosis?

A

Dust inhalation of cotton, flax, and hemp; bronchoconstriction first day of exposure; tends to improve as the week goes on

39
Q

In what percent of histiocytosis patients does pneumothorax occur?

A

10%

40
Q

What cell is predominant in usual interstitial pneumonia (UIP)? What physical exam finding is typical?

A

Clubbing present and neutrophil predominant

41
Q

What is occasional interstitial lung disease (ILD)?

A

Secondary to flock or nylon; lifeguarding at the pool, with endotoxin as the culprit

42
Q

What is the most common type of HP?

A

Farmer’s lung

43
Q

What is more common than farmer’s lung in farmers? How can you distinguish the two?

A

ODTS Organic dust toxic syndrome (nonimmunologic) up to 50 times more common. Farmer’s lung occurs after prolonged exposure, whereas ODTS occurs after a single highdose exposure.

44
Q

What is the most common pathogen seen in contamination of water and ventilation systems?

A

MAI

45
Q

Is smoking pathologic in HP? Why?

A

No, it is protective due to decreased antibody response to antigen in the lung.

46
Q

What is the particle size of agents in HP?

A

Must be

47
Q

What is the timing of the cells that are involved in HP?

A

Eosinophils and PMNs after a few hours, lymphocytes infiltrate after a few days and macrophages over months

48
Q

What is the treatment of HP?

A

Avoidance of offending agent. Glucocorticoids in severe or persistent symptoms accelerate recovery. Use daily for 1–2 weeks and taper over next 2–4 week

Allergy and Immunology (68 decks)

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