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foundations pulm exam > ILD > Flashcards

ILD Flashcards

1
Q

______ primarily due to deficiency of surfactant in immature lungs

A

Respiratory distress syndrome (RDS)

*common in preterm infants

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2
Q

the more _____ the infant is, the more likely to suffer RDS

A

preterm

32 weeks more likely to have RDS than 36 weeks

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3
Q

what is the physical exam of RDS?

A

presents within minutes-hours after birth
worsens over 1st 48 hrs of life
tachypnea
nasal flaring
expiratory grunting
intercostal, subxiphoid, subcostal retractions
cyanosis
urine output in 1st 24-48 hr is low due to increased vasopressin
peripheral edema

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4
Q

what is the first line of treatment for baby with RDS?

A

CPAP

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5
Q

what are common CXR findings with RDS?

A

low lung volume

classic reticulograndular ground glass appearance with air bronchograms

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6
Q

what labs may you see with RDS?

A

ABG - hypoxemia

hyponatremia due to water retention

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7
Q

what other diseases must you distinguish RDS from?

A 
transient tachypnea of the newborn (more mature infant)
bacterial PNA
pneumothorax
cyanotic congenital heart disease
ILD
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8
Q

how to prevent RDS?

A 
prevent preterm birth
antenatal steroids (given to all women 23-34 weeks gestation at risk of preterm delivery in next 7 days)
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9
Q

how to manage RDS?

A

nasal CPAP
OR
intubation + surfactant therapy + mechanical ventilation

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10
Q

if CPAP not working in baby, what do you do next?

A

intubate baby and administer surfactant therapy

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11
Q

non-TB mycobacteria infections (NTM) can cause what 4 clinical syndromes?

A 
pulmonary disease (MAC and mycobacterium kansaii)
superficial lymphadenitis (MAC)
disseminated disease (MAC)
skin and soft tissue infection (mycobacterium marinum and mycobacterium ulcerans)
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12
Q

unlike TB, NTM are not due to ______?

A

human-to-human or animal-to-human transmission

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13
Q

what are S&S of MAC?

A

looks like TB but less severe
fatigue, malaise, weakness
cough
dyspnea, chest discomfort

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14
Q

what is the clinical presentation in those with underlying lung disease and MAC?

A

primarily white, middle-aged, or elderly men, often alcoholics and/or smokers with underlying COPD

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15
Q

what is the clinical presentation in those without underlying lung disease and MAC?

A

nonsmoking women over age 50 who have interstitial pattern on CXR

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16
Q

what diagnostic test distinguishes MAC vs TB?

A

positive skin test

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17
Q

what antibiotics recommended for MAC?

A

azithromycin + rifampin + ethambutol

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18
Q

how long is antibiotic treatment for MAC usually?

A

15-18 months

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19
Q

what are etiologies to ILD?

A

sarcoidosis
exposures (asbestos, coal dust, aluminum)
drugs (macrobid, amiodarone)
idiopathic

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20
Q

what is the common S&S for ILD?

A

progressive DOE and nonproductive (dry) cough

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21
Q

what are physical exam findings for ILD?

A

crackles

inspiratory squeaks

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22
Q

what are CXR findings for ILD?

A 
abnormal CXR
ground-glass apperance
hazy opacity
reticular "netlike" MOST COMMON
honeycombing
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23
Q

what PFTs will you note with ILDs?

A

decreased TLC
decreased FEV1 and FVC
normal FEV1/FVC ratio or increased

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24
Q

what are PFTs of an obstructive disease (i.e. asthma)?

A

TLC increased
FVC normal
FEV1/FVC ratio decreased

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25
Q

what is the bronchodilator challenge?

A

for obstructive diseases
give pt bronchodilator (beta agonist inhaled)
if FEV1 improves over 12%, obstruction may be reversible or partially reverisble

26
Q

what may be the only PFT finding in early ILD?

A

reduced diffusing capacity of lung for carbon monoxide (DLCO)

27
Q

what is the gold standard for diagnosing ILD?

A

lung biopsy

28
Q

what are the indications for lung biopsy?

A

atypical or progressive symptoms
age < 50 y/o
fever, weight loss, hemoptysis
ILD symptoms with normal or atypical CXR

29
Q

what are the types of lung biopsies?

A

fiberoptic bronchoscopy with transbronchial lung biopsy
thoracoscopy
open lung biopsy

30
Q

what are complications of ILD?

A

PH leading to cor pulmonale
pneumothorax
elevated cancer risk
progressive respiratory insufficiency

31
Q

you determine ILD, but no clinical recovery or specific systemic disease yet? what are your next steps and what are steps after those?

A

bronchoalveolar lavage or transbronchial lung biopsy (TLB)
THEN if no specific dx
HRCT, if still nothing THEN
lung biopsy

32
Q

define pneumoconiosis

A

any disease of the respiratory tract due to inhalation of dust particles (asbestotis, silicosis)

33
Q

list facts about pneumoconiosis

A

asbestotis presents after 10-15 years of exposure
age of dx at 40-75 y/o
construction is high risk occupation
asbestos linked to lung cancer and malignant mesothelioma

34
Q

what is almost always associate with asbestos exposure?

A

mesothelioma

35
Q

what is the physical exam findings for asbestosis?

A

no specific S&S
insidious onset - dyspnea, reduced exercise tolerance
digital clubbing (30-40% pts)

36
Q

what are CXR findings for asbestosis?

A

opacities in lower lungs and pleural plaques

37
Q

what is needed to diagnose asbestosis usually?

A

consistent H&P, symptoms, and CXR

38
Q

what are the PFT findings of asbestosis?

A

decreased TLC

FEV1/FVC ratio normal

39
Q

most important preventative measures against asbestosis?

A

smoking cessation
avoid exposure
protective mask

40
Q

list facts on sarcoidosis

A 
multisystem inflammatory disease with unknown etiology
noncaseating granulomas in lungs
prevalence in African Americans
20-40 y/o
female predominance
asymptomatic to multi-system disease
41
Q

what are physical exam findings for sarcoidosis?

A

fever, anorexia, arthralgias (MOST COMMON 3)
DOE and dry cough
arthritis, cranial nerve palsies, visual disturbances, and erythema nodusum

42
Q

classify the different stages on CXR for sarcoidosis (stage 0-4)

A

stage 0: normal
stage 1: hilar adenopathy
stage 2: hilar adenopathy + diffuse infiltrates
stage 3: only diffuse parenchymal infiltrates
stage 4: pulmonary fibrosis

43
Q

what are the PFTs for sarcoidosis?

A

decreased DLCO
decreased TLC
decreased FEV1
FEV1/FVC ratio normal

44
Q

what are lab findings with sarcoidosis?

A

hypercalcemia
increased ESR
increased serum protein
increased serum ACE

45
Q

how to diagnose sarcoidosis?

A

fiberoptic bronchoscopy with transbronchial biopsy

46
Q

how to manage sarcoidosis?

A

consult pulmonologist
NSAIDS
corticosteroids - MAINSTAY for severe disease
monitor CXR and ACE level

47
Q

list facts on granulomatosis with polyangiitis (aka Wegener’s granulomatosis)

A 
immune-mediated, systemic vasulitis
necrotizing granulomas of upper/lower respiratory tracts
renal involvement/glomerulonephritis
multiple organ system involvement
40-50 y/o (men or women)
can result in ESRD
48
Q

what are common upper airway symptoms associated with Wegener’s granulomatosis?

A

rhinorrhea, purulent/bloody nasal discharge

oral/nasal ulcers, sinus pain

49
Q

what are PFT findings in Wegener’s granulomatosis?

A

restrictive/obstructive pattern
decreased DLCO
decreased lung volume if diffuse interstitial involvement present

50
Q

what does CXR look like with Wegener’s granulomatosis?

A

opacities

nodules which may cavitate

51
Q

what does CT look like with Wegener’s granulomatosis?

A

irregular and stellate-shaped peripheral pulmonary arteries (vascultitis sign)

52
Q

what are lab findings with Wegener’s granulomatosis?

A

increased ESR (greater than 100)
leukocytosis, thrombocytosis, normocytic anemia
increased BUN/Cr
+ ANCA

53
Q

how to diagnose Wegener’s granulomatosis?

A

difficult to distinguish

compatible clinical presentation and histopathology

54
Q

how to manage Wegener’s granulomatosis?

A

consult rheumatologist

treat with immunosuppressant (methotreaxate or cyclophosphamide) and glucocorticoid

55
Q

lists facts about idiopathic pulmonary fibrosis

A

most common of the 7 idiopathic interstitial PNAs
inflammation and fibrosis of lung parenchyma
diagnosis made efter excluding other causes of ILD
70% are current/former smokers
slight male predominance
insidious onset

56
Q

what is most common symptom of IPF?

A

DOE

57
Q

what are physical exam findings with IPF?

A

inspiratory crackles

digital clubbing

58
Q

what are CXR findings with IPF?

A

bilateral diffuse reticular or reticulonodular infiltrates, periphery and bases

59
Q

what diagnostic tool to meet criteria for dx of IPF?

A

lung biopsy (thoracoscopy or open)

60
Q

what are PFT findings for IPF?

A

decreased TLC

normal FEV1/FVC ratio

61
Q

how to manage IPF?

A

consult pulmonologist

evaluated for lung transplant (most common indication = IPF)

foundations pulm exam (10 decks)

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