Interstitial Lung Disease II Flashcards
50yo F, dyspnea, cough, bibasilar fine crackles, clubbing, CXR basilar opacities, calcified pleural plaques
asbestosis
calcified pleural plaques
asbestosis
BOOP
on CXR - looks like pneumonia
won’t get better with antibiotic
kaplans syndrome
rheumatoid arthritis and pneumoconiosis
22yo M Hx asthma, mild intermittent, albuterol 1x/week, runs 2 miles/day
PFT reveal?
greater than 20% decline in FEV1 on methacholine challenge test
restrictive lung disease
reduced FEV1 and FVC
with elevated FEV1/FVC ration
25yo severe asthma, cold on day of exacerbation, chemical fume inhalation, unable to breathe
RR 44
diaphoretic, suprasternal retractions, bialteral wheezes, , given albuterol and IV corticosteroids
next step - inhaled corticosteroids
65yo M, CXR rounded opacities upper lung zones, egg shell calcifications, increasing SOB last 2 years, accesory mm respiration, fine crackles end expiration
silicosis
- risk fx for TB
- so do a PPD skin test
65yo M, mine worker, increasing SOB, sleeps on sofa, right side HF, 2+ pretibial edema, diffuse qheezing
coal workers pneumoconiosis
pulmonary HTN > cor pulmonale
anti-GBM
goodpastures
non-caseating granulomas
sarcoidosis
fibrous plaques, pleural fibrosis
asbestosis
chronic mucopurulent infections causing dilation of resp bronchioles
bronchiectasis
coalescence of particle containing macules that form discrete areas of interstitial fibrosis causing distention of resp bronchioles, forming focal areas of emphysema
coal workers pneumoconiosis
35yo coal miner rheumatoid arthritis
-calcified pulmonary nodules on CXR
dx - kaplans syndrome
silicosis
egg shell calcifications
miliary TB
spots all over CXR
47yo roofer, increased SOB, 30py tobacco, roofing industry worker, CXR irregular shadows lower lung zones, thickened pleural plaques under diaphragms
asbestosis
decreased DLCO
decreased total lung capacity
asbestosis
golden brown, fisuform rods with translucent center consisting of particulat fibers coated with iron containing proteinaceous material
ferruginous bodies**
ferruginous bodies
asbestosis
65yo M increasing SOB, weight loss last 3 months, positive JVD, distant heart sounds, pulsus paradoxus, diminshed breath sounds base of lung on left
right side pleural effusion and pericardial effusion
works on shipyard
thoracentesis reveals?
pleural fluid analysis with malignant mesothelioma
asbestosis
berrylium
nuclear exposure
like sarcoidosis
transudate vs. exudate
exudate if:
-pleural protein/serum protein > 0.5
- pleural fluid LDH/serum LDH > 0.6
- pleural fluid LDH more than 2/3 normal upper limit for serum
35yo M, dyspnea, anorexia, night sweat, weight loss, nuclear technician, decreased breath sounds b/l, CXR bilateral fibrosis with hilar adenopathy, normal ACE and Ca levels, positive for mumps and trichophyton
beryllium exposure
BAL for beryllium lymphocyte proliferation test
heerfordts syndrome
variant of sarcoidosis
parotitis, uveitis, mild fever, facial nerve paralysis
25yo M, upholstery industry, polyurethane exposure, wheezing episodes at work
spirometry shows?
wheezing - FEF25-75 decreased- obstructive pattern
dx - TDI lung disease - polyurethane business
CXR with dextrocardia
not surprised to find?
no children
- kartagener syndrome
- primary ciliary dyskinesia
25yo male, dry cough, malaise, fevers, wheezing, weight loss, eosinophilia, LgE elevations, charcot leyden drystals, multiple nodules on CXR
treat with?
eosinophilia pneumonia?
- parasite
- tx diethylcarbamazine
wuchereria bancrofti
wuchereria bancrofti
elephantitis
-parasitic infection
14yo F, blood eosinophilia, fever, pulmonary infiltrates, episodic, abdomen pain, N/V, X-ray acute GI obstruction
diagnosis?
loefflers syndrome
parasite life cycle
- strongyloides
- lung phase an GI phase of life cycle
churg strauss
asthma like sx
progressive dx
diarrhea, abdominal pain
loefflers syndrome
intermittent disease
- parasites in GI and lungs
- strongyloides
38yo F, tx for breast ca mastectomy, low grade fever, night sweats, dyspnea, increased sputum, occasional cough
suspect?
chronic remodeling of lung tissue resulting in pulmonary fibrosis
radiation treatment effect on lungs
30yo rancher, fever, chills, cough, progressive SOB, wheezing increased over past 4 hours, diffuse infiltrates on CXR
learn more about ranch duties, surmise his problem is result of?
allergy to thermophylic actinomycetes
farmers lung
farmers lung
thermophylic actinomycetes
50yo M, sinusitis, allergies, persistent asthma, beta agonists, steroids, cromolyin, resp difficulty, pain legs, arms, hands, erythematous maculopapules, abdominal pain with rebound, decreased urination
right side infiltrates, elevated eosinos, p-ANCA elevated, IgE elevated, BUN/Cr elevated
diagnosis
-churg strauss syndrome
looked like wegeners - but no hematuria
pANCA
churg strauss
25yo hodgkins, chemotherapy, fever 3 days, dry cough and hemoptysis with pleuritic chest pain
BAL - suggest aspergillosis
most appropriate therapy - amphotericin B
-antifungal
amphotericin B
antifungal
27yo ranchhand, resp distress, cleaning at farm, CXR all white, see air bronchograms
diagnosis
-silo fillers disease
nitrogen dioxide
silo-fillers disease
can be fatal
