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Foundations-Pulmonary > Interstitial lung dz > Flashcards

Interstitial lung dz Flashcards

1
Q

Respiratory distress syndrome cause

A

Deficiency of surfactant production in immature lung

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2
Q

Who does RDS affect?

A

Preterm infants <37 weeks

80% =born before 28 weeks gestation

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3
Q

RDS signs and sx’s

A

Sign of respiratory distress

  • Tachypnea
  • Nasal flaring
  • Cyanosis
  • Expiratory grunting
  • Chest retractions
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4
Q

RDS treatment

A
  1. Oxygen
  2. CPAP
  3. Surfactant administration
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5
Q

CXR findings in RDS

A
  1. Low lung volume-hypoexpansion
  2. Reticulogranular “ground glass” appearance
  3. Air bronchograms
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6
Q

What can you give a women to help prevent RDS?

A

Antenatal steroids

Given to all women 23-34 wks gestation @ risk of preterm deliver in next 7 days

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7
Q

Signs and sx’s of mycobacterium avian complex (MAC)

A

Like TB but less severe:

  1. Cough
  2. Dyspnea
  3. Chest discomfort
    * Fever and wt. loss less common
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8
Q

What are the two major clinical presentation of MAC

A
  1. Those with underlying lung disease: White, middle-aged or elderly man, alcoholic and/or smoker with COPD
  2. Those without underlying lung disease: nonsmoking women >50 y.o. who have interstitial pattern on CXR
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9
Q

MAC diagnosis

A
  1. Pulmonary sx’s
  2. Nodular or opacities on CXR
  3. Exclusion of other Dx
  4. Positive cultures from two separate sputum samples
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10
Q

Indication for MAC treatment with abx?

A
  1. Fibrocavitary dz

2. +/- nodular bronchiectasis

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11
Q

MAC abx treatment

A

Azithromycin + Rifampin + Ethambutol

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12
Q

How long do you continue MAC abx treatment for?

A

Until sputum cultures are consecutively negative for @ least 12 months!

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13
Q

Clinical presentation of interstitial lung dz

A

Progressive dyspnea on exertion and nonproductive cough

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14
Q

Physical Exam of interstitial lung dz

A
  1. Crackles
  2. Inspiratory squeaks (high pitched rhonchi)
  3. Cor pulmonale
  4. Cyanosis
  5. Digital clubbing
  6. Extrapulmonary manifestations
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15
Q

CXR findings in ILD

A
  1. “Ground glass” appearance
  2. Reticular “netlike” opacities
  3. Honeycombing (small cystic spaces)
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16
Q

What CXR findings is a poor prognosis of ILD?

A

Honeycombing

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17
Q

Imaging used for ILD

A

High resolution Chest CT

18
Q

Are most ILD restrictive or obstructive? What would you expect to see on PFTs?

A

Restrictive
Decreased TLC
Decreased FVC
Normal FEV1/FVC ratio (or increased)

19
Q

What is a common and sometimes only findings in ILD in the early stage?

A

Reduced diffusing capacity of lung for carbon monoxide (DLCO)

20
Q

What would you expect to see on an ABG in ILD?

A
  1. Hypoxemia
  2. Respiratory alkalosis
  3. Maybe normal
21
Q

What is the gold standard for a definitive diagnosis for ILD?

A

Lung biopsy

22
Q

Indications for a lung biopsy

A
  1. Atypical or progressive sx’s
  2. Age <50 y.o,
  3. Fever, wt. loss, hemoptysis
  4. ILD sx’s with normal or atypical CXR
23
Q

Complications of ILD

A
  1. Pulmonary HTN–>Cor Pulmonale–>Right heart failure
  2. Pneumothorax
  3. Increased CA risk
  4. Progressive respiratory insufficiency
24
Q

Asbestosis signs and sx’s

A
  1. Dyspnea
  2. Reduced exercise tolerance
  3. Dry cough
25
Q

Asbestosis CXR findings

A

Opacities in lower lungs
Thickened pleura
Pleural plaques

26
Q

What population does Sarcoidosis affect 10x more?

A

African Americans

27
Q

Sarcoidosis physical exam findings

A
  1. Systemic complaints- fever, anorexia, arthralgia
  2. Pulmonary- DOE, cough, CP
  3. Extrapulmonary- Arthritis, CN palsies, visual disturbances, erythema nodosum
28
Q

CXR findings in sarcoidosis

A

Bilateral symmetric hilar adenopathy

Right paratracheal mediastinal adenopathy

29
Q

Lab findings in sarcoidosis

A
  1. Increased ACE
  2. Increase ESR
  3. Increased serum protein
  4. ACE
30
Q

sarcoidosis management

A
  1. Consult pulmonologist
  2. Symptomatic Tx- NSAIDs
  3. Corticosteroids (Prednisone) for severe dz
31
Q

Granulomatosis with Polyangiitis etiology

A

Immune mediated systemic vasculitis

32
Q

What is characteristic of Granulomatosis with Polyangiitis

A

Necrotizing granulomas of upper and lower respiratory tracts

33
Q

What is the main organ Granulomatosis with Polyangiitis effects?

A

Kidneys- Glomerulonephritis

34
Q

What are the most common signs of Granulomatosis with Polyangiitis

A

Upper airway sx’s:

  • Oral/Nasal ulcers
  • Sinus pain
  • Rhinorrhea
  • Purulent/bloody nasal discharge
35
Q

Pulmonary function in Granulomatosis with Polyangiitis

A

Restrictive AND obstructive patterns

Decreased DLCO

36
Q

CT findings in Wegener’s Granulomatosis

A
  1. Feeding vessels-Blood vessels leading to nodules and cavities
  2. “Vasculitis” sign-Irregular and stellate-shaped peripheral pulmonary arteries
37
Q

Lab findings in Granulomatosis with Polyangiitis

A

Nonspecific:

  1. Increased ESR
  2. Leukocytosis
  3. Thrombocytosis
  4. Normocytic anemia
  5. Increased BUN/Cr
  6. Pos. ANCA (antibodies)
38
Q

Granulomatosis with Polyangiitis management

A

Consult Rheumatologist

  • Immunosuppressant: Methotrexate or cyclophosphamide
  • Glucocorticoid
39
Q

What is the most common of the 7 idiopathic interstitial pneumonias?

A

Idiopathic Pulmonary Fibrosis

40
Q

What is a risk factor for Idiopathic Pulmonary Fibrosis

A

Curent or former smoker= 70% of patients

41
Q

What is the most common sign of IPF?

A

Exertional dyspnea

42
Q

CXR findings in IPF

A

Bilateral diffuse reticular or reticulonodular infiltrates

Foundations-Pulmonary (9 decks)

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