Interstitial Lung Disease CIS I

Question 1

75yo M abnormal CXR, 60py tobacco, myalgias in shoulder and neck, fatigue, sinus infection, hemoptysis, weight loss, T 99F, crackles b/l, b/l lung nodules - cavitated, WBC 10,000

Answer 1

most likely diagnosis

-wegners granulomatosis

Question 2

wegners granulomatosis

Answer 2

sinusitis
lung
kidney

Question 3

DDx for cavitary lung lesions

Answer 3

CAVITY

c - carcinoma
a - autoimmune - wegners
v - vascular
i - infection 9 TB, fungal, bacterial
t - trauma
y - young - congenital lesions

Question 4

61yo M increasing SOB last year, hacking non-prod cough, a-fib, HTN, rheumatoid arthritis, velcro-like crackles, split S2, pitting lower extremity edema, clubbing

FVC 50%, FEV1 50%, FEV1/FVC 98%

Answer 4

appropriate next step in management

-stop amiodarone and methotrexate

Question 5

amiodarine and methotrexate

Answer 5

can cause restrictive lung disease

Question 6

methacholine challenge

Answer 6

for asthma

Question 7

amiodarone lung

Answer 7

2-4 months at doses greater than 400mg/day

lipid laden foamy alveolar macrophages

organizing pneumonia - 25% of cases - mimics infectious pneumonia

ARDS - post-surgical

diffuse alveolar damage

solitary lung mass

Question 8

50yo M increasing SOB with exercise, no fever, hemoptysis, weight loss, dry cough, no smoking, lungs crackle, clubbing, diffuse linear opacities, restrictive PFT, decreased diffusion capacity

Answer 8

most likely diagnosis

-idiopathic pulmonary fibrosis

Question 9

27yo F SOB reently, exercise tolerance dwindled, occasional dry cough, no smoking, O2 90% after exercise, bilateral hilar lymph nodes, restrictive PFT

Answer 9

next appropriate step
-obtain transbronchial lymph node biopsy

diagnostic for sarcoidosis**

Question 10

61yo F 3 day history of SOB, non-prod cough, fever, hemoptysis 3mL maroon, hx of SLE, cerebritis, lupus nephritis

T 100.4
CXR diffuse b/l infiltrates

Answer 10

PFT increased DLCO - most likely diagnosis

diffuse alveolar hemorrhage

Question 11

causes of increased DLCO

Answer 11

diffuse alveolar hemorrhage

polycythemia

Question 12

30yo M syncope, no fever, nonsustained V-tach, positive skin test for anergy, bilateral hilar adenopathy, elevated serum calcium, echo wall abnormality

bx of myocardium

Answer 12

upon receiving biopsy results you will

-begin tx for disorder associated with noncaseating granulomas

Question 13

noncaseating granulomas

Answer 13

sarcoidosis

Question 14

22yo F severe dyspnea on exertion, over last 6 months, O2 desat with exercise, enlarge pulmonary vasculature, V/Q normal, right heart strain, DLCO and PFT normal

Answer 14

next test to order for Dx?

right heart cath
-assess cause of pulmonary HTN

Question 15

30yo M 15py tobacco, URI tx with azithromycin 3 weeks ago, 3 days ago SOB, cough hemoptysis, lips cyanotic, 2 + edema, BUN 60, Cr 4, microscopic hematuria

Answer 15

most help confirm dx

C-ANCA

wegners

Question 16

C-ANCA

Answer 16

wegners

Question 17

anti-GM BM antibodies

Answer 17

goodpastures

Question 18

kveim test

Answer 18

sarcoidosis

Question 19

alpha1 antitrypsin

Answer 19

early emphysema

Question 20

goodpastures vs. wegners

Answer 20

history of URI - possible sinus involvement

Question 21

37yo AA M raised red lesions on anterior both legs, SOB, dry cough, no fever, never smoked, dry rales b/l, irregular heart rhythm, AV block, hilar adenopathy, noncaseating granulomas, PFT restrictive, elevated Ca and ACE

Answer 21

erythema nodosum

-sarcoidosis

Tx plan - high dose systemic corticosteroids

treat a patient that is symptomatic**

Question 22

hilar adenopathy without symptoms

Answer 22

sarcoidosis

-tx watchful waiting

Question 23

75yo M severe dyspnea 1 year, 100py tobacco, stone engraver, expiratory crackles b/l, clubbing, eggshell calcifications of hilar lymph nodes

Answer 23

most likely dx

-silicosis

Question 24

eggshell calcifications

Answer 24

silicosis

Question 25

asbestosis CXR

Answer 25

pleural plaques

Question 26

TB CXR

Answer 26

hilar adenopathy

upper lung fields

Question 27

50yo F acute dyspnea, dry cough, SOB, malaise, fever, pH 7.3, diffuse alveolar infiltrates - suggest ARDS, CT b/l ground glass with little honeycombing, septal thickening and subpleural distribution of opacities

lung bx - diffuse alveolar damage

ventilation, steroids, antibiotics, death

Answer 27

acidosis - respiratory

ground glass - alveolar filling - more treatable

most likely dx
-acute interstitial pneumonia

Question 28

38yo M, albuterol, salmeterol, ipratropium, steroid inhaler, steroid taper for aspergillus elevated IgE, hack and cough, purulent blood tinged sputum, cough for years, 60yr tobacco, four teacups of sputum/day, dyspnea over years, crackles and rhonchi

Answer 28

CXR findings in this disease?

mucus filled dilated bronchi with parallel linear opacities

bronchiectasis

allergic pulmonary aspergillosis - can lead to bronchiectasis

Question 29

bronchiectasis with aspergillus

Answer 29

allergic pulmonary aspergillosis

Question 30

49yo M CXR pre-op workup, small nodules left lung field laterally, high res CT, pleural based opacities, pleural plaques, restrictive PFT, decreased DLCO

Answer 30

most important to know
-occupational history

sounds like asbestosis

brake lines, house work, insulation, mining, ship building

Question 31

37yo M - 2-3 weeks dyspnea, hemoptysis, sinusitis, epistaxis

UA RBC and WBC

CXR - bilateral nodular infiltrates - one is cavitary

Answer 31

positive for C-ANCA likely

wegners

Question 32

tuberculosis

Answer 32

fever, chills, night sweats, malaise, weight loss, lymphadenopathy, cavitary lung lesions - upper lobes

Question 33

goodpasture

Answer 33

renal and lung involvement

Question 34

elevated ACE

Answer 34

sarcoidosis

-nonspecific

Question 35

29yo M chronic cough and sputum production, 3 courses of antibiotics per year, recurrent chronic sinusitis and otitis media, grain storage facility, CT thick/dilated peripheral airways in lower lobes

Answer 35

evaluation should include

• sweat chloride - CF
• serum Ig levels
• nasal mucosal Bx - with electron microscopy (for kartageners)
• serum protein electrophoresis

Dx - cystic fibrosis

Question 36

27yo F cough, fever, night sweats, weight loss, marked eosinos, non-cavitating lung lesions, CXR nonsegmental alveolar infiltrates

Tx with albuterol and oral corticosteroids - infiltrates resolve in 2 days - becomes asymptomatic

returns 3 weeks with diarrhea and same symptoms

Answer 36

churg strauss syndrome

vasculitis with initial asthma symptoms

also get GI sx, possible heart disease