Interstitial lung dz Flashcards
Respiratory distress syndrome cause
Deficiency of surfactant production in immature lung
Who does RDS affect?
Preterm infants <37 weeks
80% =born before 28 weeks gestation
RDS signs and sx’s
Sign of respiratory distress
- Tachypnea
- Nasal flaring
- Cyanosis
- Expiratory grunting
- Chest retractions
RDS treatment
- Oxygen
- CPAP
- Surfactant administration
CXR findings in RDS
- Low lung volume-hypoexpansion
- Reticulogranular “ground glass” appearance
- Air bronchograms
What can you give a women to help prevent RDS?
Antenatal steroids
Given to all women 23-34 wks gestation @ risk of preterm deliver in next 7 days
Signs and sx’s of mycobacterium avian complex (MAC)
Like TB but less severe:
- Cough
- Dyspnea
- Chest discomfort
* Fever and wt. loss less common
What are the two major clinical presentation of MAC
- Those with underlying lung disease: White, middle-aged or elderly man, alcoholic and/or smoker with COPD
- Those without underlying lung disease: nonsmoking women >50 y.o. who have interstitial pattern on CXR
MAC diagnosis
- Pulmonary sx’s
- Nodular or opacities on CXR
- Exclusion of other Dx
- Positive cultures from two separate sputum samples
Indication for MAC treatment with abx?
- Fibrocavitary dz
2. +/- nodular bronchiectasis
MAC abx treatment
Azithromycin + Rifampin + Ethambutol
How long do you continue MAC abx treatment for?
Until sputum cultures are consecutively negative for @ least 12 months!
Clinical presentation of interstitial lung dz
Progressive dyspnea on exertion and nonproductive cough
Physical Exam of interstitial lung dz
- Crackles
- Inspiratory squeaks (high pitched rhonchi)
- Cor pulmonale
- Cyanosis
- Digital clubbing
- Extrapulmonary manifestations
CXR findings in ILD
- “Ground glass” appearance
- Reticular “netlike” opacities
- Honeycombing (small cystic spaces)
What CXR findings is a poor prognosis of ILD?
Honeycombing
Imaging used for ILD
High resolution Chest CT
Are most ILD restrictive or obstructive? What would you expect to see on PFTs?
Restrictive
Decreased TLC
Decreased FVC
Normal FEV1/FVC ratio (or increased)
What is a common and sometimes only findings in ILD in the early stage?
Reduced diffusing capacity of lung for carbon monoxide (DLCO)
What would you expect to see on an ABG in ILD?
- Hypoxemia
- Respiratory alkalosis
- Maybe normal
What is the gold standard for a definitive diagnosis for ILD?
Lung biopsy
Indications for a lung biopsy
- Atypical or progressive sx’s
- Age <50 y.o,
- Fever, wt. loss, hemoptysis
- ILD sx’s with normal or atypical CXR
Complications of ILD
- Pulmonary HTN–>Cor Pulmonale–>Right heart failure
- Pneumothorax
- Increased CA risk
- Progressive respiratory insufficiency
Asbestosis signs and sx’s
- Dyspnea
- Reduced exercise tolerance
- Dry cough
Asbestosis CXR findings
Opacities in lower lungs
Thickened pleura
Pleural plaques
What population does Sarcoidosis affect 10x more?
African Americans
Sarcoidosis physical exam findings
- Systemic complaints- fever, anorexia, arthralgia
- Pulmonary- DOE, cough, CP
- Extrapulmonary- Arthritis, CN palsies, visual disturbances, erythema nodosum
CXR findings in sarcoidosis
Bilateral symmetric hilar adenopathy
Right paratracheal mediastinal adenopathy
Lab findings in sarcoidosis
- Increased ACE
- Increase ESR
- Increased serum protein
- ACE
sarcoidosis management
- Consult pulmonologist
- Symptomatic Tx- NSAIDs
- Corticosteroids (Prednisone) for severe dz
Granulomatosis with Polyangiitis etiology
Immune mediated systemic vasculitis
What is characteristic of Granulomatosis with Polyangiitis
Necrotizing granulomas of upper and lower respiratory tracts
What is the main organ Granulomatosis with Polyangiitis effects?
Kidneys- Glomerulonephritis
What are the most common signs of Granulomatosis with Polyangiitis
Upper airway sx’s:
- Oral/Nasal ulcers
- Sinus pain
- Rhinorrhea
- Purulent/bloody nasal discharge
Pulmonary function in Granulomatosis with Polyangiitis
Restrictive AND obstructive patterns
Decreased DLCO
CT findings in Wegener’s Granulomatosis
- Feeding vessels-Blood vessels leading to nodules and cavities
- “Vasculitis” sign-Irregular and stellate-shaped peripheral pulmonary arteries
Lab findings in Granulomatosis with Polyangiitis
Nonspecific:
- Increased ESR
- Leukocytosis
- Thrombocytosis
- Normocytic anemia
- Increased BUN/Cr
- Pos. ANCA (antibodies)
Granulomatosis with Polyangiitis management
Consult Rheumatologist
- Immunosuppressant: Methotrexate or cyclophosphamide
- Glucocorticoid
What is the most common of the 7 idiopathic interstitial pneumonias?
Idiopathic Pulmonary Fibrosis
What is a risk factor for Idiopathic Pulmonary Fibrosis
Curent or former smoker= 70% of patients
What is the most common sign of IPF?
Exertional dyspnea
CXR findings in IPF
Bilateral diffuse reticular or reticulonodular infiltrates
