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RESP II Exam 2 > Interstitial Lung Disease DSA II > Flashcards

Interstitial Lung Disease DSA II Flashcards

1
Q

churg strauss syndrome

A

systemic necrotizing vasculitis
-upper and lower resp tracts

preceded by allergic disorders

peripheral and lung eosinophilia

IgE increase

rashes

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2
Q

CXR for churg strauss

A

bilateral patchy, fleeting infiltrates

diffuse nodular infiltrates

diffuse reticulonodular infiltrates

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3
Q

biopsy for churg strauss

A

granulomatous angiitis or vasculitis

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4
Q

Tx for churg strauss

A

corticosteroids

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5
Q

chronic eosinophilic pneumonia

A

pulmonary interstitium and alveolar spaces are infiltrated by eosinos and to lesser extent macrophages

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6
Q

clinical for chronic eosinophilic pneomonia

A

over weeks to months
-fever, weight loss, dyspnea, productive cough

pulmonary infiltrates with peripheral distribution

increased eosinophils in peripheral smear

BAL with increased eosinophils

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7
Q

Tx of chronic eosinophilic pneumonia

A

dramatic response to corticosteroids within days to weeks

therapy - prolonged for months - prevent recurrence

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8
Q

pulmonary alveolar proteinosis

A

primary path process affects alveolar spaces

filled with proteinacious phospholipid material
-components of surfactant

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9
Q

clinical for pulmonary alveolar proteinosis

A

dyspnea, cough, bilateral alveolar infiltrates

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10
Q

high res CT for pulmonary alveolar proteinosis

A

crazy paving pattern

thickened interlobular septa accompanied by groundglass alveolar filling

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11
Q

nocardia

A

superimposed resp infection

with pulmonary alveolar proteinosis

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12
Q

Tx for pulmonary alveolar proteinosis

A

whole lung lavage

good prognosis

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13
Q

whole lung lavage

A

gold standard treatment for pulmonary alveolar proteinosis

-saline into lungs with percussion to dislodge material in lungs

fluid then removed

repeated until no more material is recovered (when fluid is clear)

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14
Q

hypersensitivity pneumonitis

A

hyperimmune respiratory syndrome caused by inhalation of wide variety of allergic antigens that are usually rganic

bacteria, fungi, protozoa, animal proteins, reactive chemicals

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15
Q

Tx for hypersensitivity pneumonitis

A

avoid exposure

corticosteroids speed resolution

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16
Q

intermittent pulmonary and systemic symptoms, progressive interstitial CXR changes, non-resolving pneumonia

A

suspect hypersensitivity pneumonitis

agriculture, cattle farming, bird keeping, contaminated home ventilation, hot tubs

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17
Q

abrupt onset of cough, dyspnea, fever, chest pain, following heavy exposure to offending antigen, Sx 4-6 hours after exposure

subsides 24 hours after removal from exposure

A

acute hypersensitivity pneumonitis

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18
Q

gradula development of symptoms and less severe intensity

A

subacute hypersensitivity pneumonitis

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19
Q

insidious progressive dyspnea, cough, weight loss, fatigue, pulmonary fibrosis and resp failure

A

chronic hypersensitivity pneumonitis

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20
Q

thermophilic actinomycetes

A

moldy hay, grain, silage - farming - dairy cattle

hypersensitivity pneumonitis

also from ventilation - water-related contamination
-humidifier, hot tub, air conditioner

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21
Q

mycobacterium avium intracellular complex

A

hypersensitivity pneumonitis

from ventilation and water-related contamination

22
Q

CXR for hypersensitivity pneumonitis

A

acute disease
-diffuse reticulonodular infiltrates

chronic disease
-diffuse interstitial fibrosis

23
Q

high res CT for hypersensitivity pneumonitis

A

ground glass opacities early

chronic - with traction bronchiectasis, honeycombing, and fibrosis

24
Q

PFT for hypersensitivity pneumonitis

A

restrictive, small lung volume, decreased diffusion capacity

25
Q

sarcoidosis

A

systemic granulomatous disease
-non-caseating granuloma

can effect any organ

unknown etiology

age 40-60yo
-peak 20-40yo

3.5x higher than african americans

more in women

26
Q

sarcoidosis

A

pulmonary not necessary for Dx

abnormal CXR with mediastinal and hilar adenopathy

may lead to chronic disease
-pulmonary fibrosis

27
Q

lofgrens syndrome

A

acute manifestation of sarcoidosis

  • erthyema nodosum
  • arthritis
  • bilateral hilar lymphadenopathy

favorable prognosis

28
Q

fatigue, night sweats, fever, weight loss, cough, dyspnea, wheeze, rash, macules, hyper/hypopigmentation, erythema nodosum, dry eyes, pain, redness, blurry vision, arrhythmia, palpitations, syncope, HAs, numbness, epigastric pain, RUQ pain, jaundice, swelling and joint stiff, muscle pain, nasal congestion, sinus pressure

A

sarcoidosis

29
Q

rales, exp whezing, infiltration of old scars/tattoos, macolopapular lesions, erythema nodosum uveitis, iritis, scleral plaque, irregular cardiac rhythm, CN II, VII, VIII neuropathies, hepatomegaly, arthritis, palpable adenopathy

A

sarcoidosis

30
Q

lupus pernio

A

affect nose, cheeks, ears in sarcoidosis

31
Q

yellow nodules in eyes

A

can be bx to make dx of sarcoidosis

32
Q

calcium in sarcoidosis

A

disorder of vit D

nephrolithiasis, nephrocalcinosis, hypercalcuria

33
Q

Dx of sarcoidosis

A

clinical, radiographic, histologic evidence of noncaseating granuloma in one or more organs

bronchoscopy with transbronchial lung bx

also elevated ACE - but this is nonspecific

34
Q

pathognomonic for sarcoidosis

A

lofgrens syndrome

35
Q

staging of sarcoidosis

A

CXR

0 normal
1 bilateral hilar adenoapthy
2 bilateral hilar adenopathy and parenchymal infiltrates
3 parenchymal infiltrates without lymphadenopathy
4 advanced parenchymal disease with fibrosis

36
Q

PFT for sarcoidosis

A

restrictive ventilatory defect

  • concurrent obstruction
  • decrased DLCO
37
Q

other testing for sarcoidosis

A 
opthalmology exam
EKG
CVC
CMP
serum ACE level
Bx of involved organ
38
Q

Tx of sarcoidosis

A

only for symptomatic patient**

prednisone - daily for 3 months
-monitor with FVC

taper off if improvement

39
Q

sarcoidosis prognosis

A

spontaneous remission in 50% of patients at 3 years

lofgrens - best prognosis

2/3 remission after 10 years

1/3 with unrelenting disease

less than 5% die

40
Q

silicosis

A

fibrotic lung disease cased by inhalation of crystalline silica in form of quartz

41
Q

risk for silicosis

A 
mining
tunneling
excavating
quarrying
stonework
foundries
sandblasting
ceramics
42
Q

chronic silicosis

A

most common

20 or more years after exposure

silicotic nodule
-whorled hyalinized collagen fibers with peripheral zone of dust laden macrophages

asymptomatic - or complain of dyspnea and productive cough

43
Q

accelerated silicosis

A

nodules after 3-10 years after exposure

-progressive clinical course

44
Q

acute silicosis

A

6 months to 2 years after exposure

dyspnea, cough, weight loss, resp failure and death

alveolar filling process

45
Q

progressive massive fibrosis

A

with silicosis

lesions are at least 1 cm in diameter and often larger

upper lobes

resp failure, cor pulmonale, weight loss, death

46
Q

diseases associated with silicosis

A 
TB
COPD
chronic bronchitis
collagen vascular disease
rheumatoid arthritis
scleroderma
lung cancer
47
Q

CXR for silicosis

A

symmetric nodular pattern involving upper lobes

hilar lymphadenopathy with eggshell calcification is strongly suggestive

progressive massive fibrosis - coalescence of nodules with larger mass lesions

acute silicosis displays air space and interstitial pattern on x-ray

48
Q

PFT for silicosis

A

normal early in chronic silicosis

later mixed pattern obstructive and restrictive

49
Q

Dx of silicosis

A

x-ray changes and history of exposure

50
Q

Tx of silicosis

A

irreversible
avoid further exposure
TB test
smoking cessation

consider lung transplant

RESP II Exam 2 (23 decks)

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