interstitial/restrictive lung disease Flashcards
asbestosis causes
asbestosis exposure at high levels
average latency is greater than 20 years
clinical features of asbestosis exposure
insidious exertional SOB, worsening of dyspnea, cough: usually paroxysmal and dry with late stage mucoid sputum
physical exam for asbestosis
dry/fine end expiratory crackles (rales/crepitation), clubbing, edema and JVD
diagnostic studies for asbestosis
CXR/CT: small irregular opacities in lower lungs; pleural plaques; costophrenic angle blunting; thickening pleural, honeycombing
asbestosis lateral hallmark
calcified hemidiaphragmatic plaques
asbestosis treatment
smoking cessation bronchodilators proper nutrition exercise home oxygen therapy removal of further exposure ID respiratory infection promptly annual flu and pneumonia vaccine
asbestosis and risk and prognosis
DEATH FROM RESPIRATIRY FAILURE COR PULMONALE
increased risk of
mesothelioma, lung cancer or TB.
Survival is 4-6 years after diagnosis of mesothelioma
cause of coal workers pneumonoconiosis
coal dust deposits in the peribronchial tissue
but extent of exposure depends on rank of coal (fibrogenic vs bitominous)
divisions of coal workers pneumonoconiosis
simple and PMF
coal workers pneumonoconiosis physical exam
inspiratory crackles, clubbing and cyanosis
diagnostic study for coal workers pneumonoconiosis
CXR:
simple: small round nodules (<10mm) in upper lobes
PMF: confluence developing large opacities
treatment for coal workers pneumonoconiosis
bronchodilators avoidance of exposure supplemental oxygen smoking cessation TB surveillance antibiotics for infections
key points for coal workers pneumonoconiosis
predisposition to develop COPD
chronic bronchitis 10 years after exposure
significant info for asbestosis
pleural fibrosis
idiopathic interstitial pneumonias causes
etiology unknown
idiopathic interstitial pneumonia history, signs and symptoms
hx: duration, speed and presence of:
fever: highly sensitive pneumonia
hemoptysis: diffuse alveolar bleeding (goodpastures)
pleuritic chest pain: inflammatory
idiopathic interstitial pneumonia physical exam
auscultation in basilar area
“wet” quality - alveolar filling
“dry” (velcro) quality- no alveolar fills
diagnostic studies for idiopathic interstitial pneumonias
ABG’s: normal or respiratory alkalosis
PFT’s: restricted pattern
CXR/CT: reticulonodular, ground glass, nodular, honeycombing
key points to idiopathic interstitial pneumonias
progression is common & insidious
refer to pulmonologist
significant info for sarcoidosis
african-american women and scandinavian descent
age: 20-45
sarcoidosis causes
multisystem disease
must has 2 organ system affected for diagnosis
signs and symptoms on sarcoidosis
fever, malaise, fatigue, night sweats, weight loss, cough
physical exam of sarcoidosis
erythema nodosum, lupus pernio, kerititis, sicca, uveitis
lofgren’s: erythema nodosum & hilar adenopathy
diagnostic study for sarcoidosis
PATHOLOGIC HALLMARK:
noncaseated granuloma
CXR: hilar adenopathy
CT: hilar & mediastinal adenopathy with nodular infiltrates
sarcoidosis labs
Serum ACE Levels: ↑, BUT not specific
LFT’s: ↑ Alk Phos = liver obstruction
Bilirubin: ↑ = advanced liver disease
treatment for sarcoidosis
relieve symptoms
prevent significant organ function impairment
depends on symptomatology
key points to sarcoidosis
early disease: reverible
chronic disease: irreversible
end stage: cysts with connective tissue
refer to pulmonology
significant info silica silicosis
african americans 2-7 times higher risk
causes of silica silicosis
crystaline silica or silicon dioxide
occupations for risk of silica silicosis
stone cutting, Mining, Glass & Cement manufacturing, Quarrying (Granite), Sandblasting, Foundry
3 clinical presentations of silica silicosis
acute
chronic
accelerated
diagnostic studies for silica silicosis
peribronchial location of silicotic nodules
impaired gas exchange in early stages
treatment for silica silicosis
smoking cessation
influenza and pneumococcal vaccinations for all types of silicosis
key points for silica silicosis
crystalline silica causes lung cancer
significant info for acute silicosis
AKA: acute silicoproteinosis
rare: found in patients with extremely high crystalline silica
can occur in weeks of months after exposure
acute silicosis causes
heavy exposure: tunneling through areas of high quartz content, sandblasting in confined spaces, manufacturing abrasive soaps
signs and symptoms of acute silicosis
RAPID ONSET
cough, dyspnea, wieght loss, fatigue
physical exam for acute silicosis
crackles
rapid development of cyanosis, cor pulmonale, respiratory failure
diagnosis studies for acute silicosis
ABGs: respiratory impairment
CXR: bilateral diffuse ground glass opacities: perihilar or basilar
CT: numerous bilateral centilobular nodular opacities, focal ground glass opacties
acute silicosis treatment
avoidance of exposure
supplemental oxygen
bronchodilators
antibiotics for infections
key point for acute silicosis
prognosis very poor survival typically <4 yrs
significant info for chronic silicosis
subdivided into simple and progressive massive fibrosis
chronic silicosis causes
10 years after exposure to low levels of silica
clinical features for simple chronic silicosis
asymptomatic or chronic cough, exertional dyspnea, wheezes, fine/coarse crackles at the end of inspiration, rhonchi
clinical features of PMF chronic silicosis
severe cough, exertional dyspnea, decreased breath sounds
no crackles, signs of respiratory failure and cor pulmonale
diagnostic studies for simple chronic silicosis
PPD for latent TB (DDX)
PFT’s
complete cardiopulmonary exercise test
CXR: innumerable small round opacities (<10 mm) in upper lung fields
diagnostic studies for PMF chronic silicosis
PPD: for latent TB (DDX)
PFT’s
complete cardiopulmonary exercise test
PMF: small opacities that develop into larger opacities (>10 mm) in upper and middle fields
treatment for chronic silicosis
avoidance of exposure
supplemental oxygen
bronchodilators
antibiotics for infections
significant info for accelerated silicosis
differentiated from chronic
ONLY by its MORE RAPID DEVELOPMENT
causes of accelerated silicosis
high level exposure: rapid development with 10 years of exposure
greater risk for developing PMF and complications (TB, narcotizing aspergillosis, lung cancer, kidney dz, COPD, chronic bronchitis)
treatment for accelerated silicosis
avoidance of exposure
supplemental oxygen
bronchodilators
antibiotics for infection
key points for accelerated silicosis
course: progressive respiratory failure & cor pulmonale
clinical features of accelerated silicosis
same as chronic silicosis
SIMPLE: Asymptomatic or chronic cough, exertional dyspnea, wheezes, fine/coarse crackles @ end inspiration, rhonchi
PMF: Severe cough, exertional dyspnea, < BS, no crackles, signs of respiratory failure & cor pulmonale
diagnostic studies for accelerated silicosis
same as chronic silicosis
PPD: for latent TB (DDx) PFT’s Complete cardiopulmonary exercise test CXR: Simple: Innumerable, small round opacities (<10mm) in upper lung fields
PMF: Small opacities that develop into larger opacities (>10mm) in upper and middle fields Same as Chronic Silicosis
