Interstitial lung dz

Question 1

Respiratory distress syndrome cause

Answer 1

Deficiency of surfactant production in immature lung

Question 2

Who does RDS affect?

Answer 2

Preterm infants <37 weeks

80% =born before 28 weeks gestation

Question 3

RDS signs and sx’s

Answer 3

Sign of respiratory distress

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

Question 4

RDS treatment

Answer 4

1. Oxygen
2. CPAP
3. Surfactant administration

Question 5

CXR findings in RDS

Answer 5

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

Question 6

What can you give a women to help prevent RDS?

Answer 6

Antenatal steroids

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

Question 7

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

Answer 7

Like TB but less severe:

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

Question 8

What are the two major clinical presentation of MAC

Answer 8

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

Question 9

MAC diagnosis

Answer 9

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

Question 10

Indication for MAC treatment with abx?

Answer 10

1. Fibrocavitary dz

2. +/- nodular bronchiectasis

Question 11

MAC abx treatment

Answer 11

Azithromycin + Rifampin + Ethambutol

Question 12

How long do you continue MAC abx treatment for?

Answer 12

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

Question 13

Clinical presentation of interstitial lung dz

Answer 13

Progressive dyspnea on exertion and nonproductive cough

Question 14

Physical Exam of interstitial lung dz

Answer 14

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

Question 15

CXR findings in ILD

Answer 15

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

Question 16

What CXR findings is a poor prognosis of ILD?

Answer 16

Honeycombing

Question 17

Imaging used for ILD

Answer 17

High resolution Chest CT

Question 18

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

Answer 18

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

Question 19

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

Answer 19

Reduced diffusing capacity of lung for carbon monoxide (DLCO)

Question 20

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

Answer 20

1. Hypoxemia
2. Respiratory alkalosis
3. Maybe normal

Question 21

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

Answer 21

Lung biopsy

Question 22

Indications for a lung biopsy

Answer 22

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

Question 23

Complications of ILD

Answer 23

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

Question 24

Asbestosis signs and sx’s

Answer 24

1. Dyspnea
2. Reduced exercise tolerance
3. Dry cough

Question 25

Asbestosis CXR findings

Answer 25

Opacities in lower lungs Thickened pleura Pleural plaques

Question 26

What population does Sarcoidosis affect 10x more?

Answer 26

African Americans

Question 27

Sarcoidosis physical exam findings

Answer 27

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

Question 28

CXR findings in sarcoidosis

Answer 28

Bilateral symmetric hilar adenopathy | Right paratracheal mediastinal adenopathy

Question 29

Lab findings in sarcoidosis

Answer 29

1. Increased ACE 2. Increase ESR 3. Increased serum protein 4. ACE

Question 30

sarcoidosis management

Answer 30

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

Question 31

Granulomatosis with Polyangiitis etiology

Answer 31

Immune mediated systemic vasculitis

Question 32

What is characteristic of Granulomatosis with Polyangiitis

Answer 32

Necrotizing granulomas of upper and lower respiratory tracts

Question 33

What is the main organ Granulomatosis with Polyangiitis effects?

Answer 33

Kidneys- Glomerulonephritis

Question 34

What are the most common signs of Granulomatosis with Polyangiitis

Answer 34

Upper airway sx's: - Oral/Nasal ulcers - Sinus pain - Rhinorrhea - Purulent/bloody nasal discharge

Question 35

Pulmonary function in Granulomatosis with Polyangiitis

Answer 35

Restrictive AND obstructive patterns | Decreased DLCO

Question 36

CT findings in Wegener's Granulomatosis

Answer 36

1. Feeding vessels-Blood vessels leading to nodules and cavities 2. "Vasculitis" sign-Irregular and stellate-shaped peripheral pulmonary arteries

Question 37

Lab findings in Granulomatosis with Polyangiitis

Answer 37

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

Question 38

Granulomatosis with Polyangiitis management

Answer 38

Consult Rheumatologist - Immunosuppressant: Methotrexate or cyclophosphamide - Glucocorticoid

Question 39

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

Answer 39

Idiopathic Pulmonary Fibrosis

Question 40

What is a risk factor for Idiopathic Pulmonary Fibrosis

Answer 40

Curent or former smoker= 70% of patients

Question 41

What is the most common sign of IPF?

Answer 41

Exertional dyspnea

Question 42

CXR findings in IPF

Answer 42

Bilateral diffuse reticular or reticulonodular infiltrates