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pulmonary > interstitial/restrictive lung disease > Flashcards

interstitial/restrictive lung disease Flashcards

1
Q

asbestosis causes

A

asbestosis exposure at high levels

average latency is greater than 20 years

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2
Q

clinical features of asbestosis exposure

A

insidious exertional SOB, worsening of dyspnea, cough: usually paroxysmal and dry with late stage mucoid sputum

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3
Q

physical exam for asbestosis

A

dry/fine end expiratory crackles (rales/crepitation), clubbing, edema and JVD

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4
Q

diagnostic studies for asbestosis

A

CXR/CT: small irregular opacities in lower lungs; pleural plaques; costophrenic angle blunting; thickening pleural, honeycombing

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5
Q

asbestosis lateral hallmark

A

calcified hemidiaphragmatic plaques

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6
Q

asbestosis treatment

A 
smoking cessation
bronchodilators 
proper nutrition
exercise
home oxygen therapy
removal of further exposure
ID respiratory infection promptly
annual flu and pneumonia vaccine
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7
Q

asbestosis and risk and prognosis

A

DEATH FROM RESPIRATIRY FAILURE COR PULMONALE
increased risk of
mesothelioma, lung cancer or TB.
Survival is 4-6 years after diagnosis of mesothelioma

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8
Q

cause of coal workers pneumonoconiosis

A

coal dust deposits in the peribronchial tissue

but extent of exposure depends on rank of coal (fibrogenic vs bitominous)

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9
Q

divisions of coal workers pneumonoconiosis

A

simple and PMF

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10
Q

coal workers pneumonoconiosis physical exam

A

inspiratory crackles, clubbing and cyanosis

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11
Q

diagnostic study for coal workers pneumonoconiosis

A

CXR:
simple: small round nodules (<10mm) in upper lobes

PMF: confluence developing large opacities

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12
Q

treatment for coal workers pneumonoconiosis

A 
bronchodilators
avoidance of exposure
supplemental oxygen 
smoking cessation 
TB surveillance 
antibiotics for infections
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13
Q

key points for coal workers pneumonoconiosis

A

predisposition to develop COPD

chronic bronchitis 10 years after exposure

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14
Q

significant info for asbestosis

A

pleural fibrosis

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15
Q

idiopathic interstitial pneumonias causes

A

etiology unknown

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16
Q

idiopathic interstitial pneumonia history, signs and symptoms

A

hx: duration, speed and presence of:
fever: highly sensitive pneumonia
hemoptysis: diffuse alveolar bleeding (goodpastures)
pleuritic chest pain: inflammatory

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17
Q

idiopathic interstitial pneumonia physical exam

A

auscultation in basilar area
“wet” quality - alveolar filling
“dry” (velcro) quality- no alveolar fills

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18
Q

diagnostic studies for idiopathic interstitial pneumonias

A

ABG’s: normal or respiratory alkalosis
PFT’s: restricted pattern
CXR/CT: reticulonodular, ground glass, nodular, honeycombing

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19
Q

key points to idiopathic interstitial pneumonias

A

progression is common & insidious

refer to pulmonologist

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20
Q

significant info for sarcoidosis

A

african-american women and scandinavian descent

age: 20-45

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21
Q

sarcoidosis causes

A

multisystem disease

must has 2 organ system affected for diagnosis

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22
Q

signs and symptoms on sarcoidosis

A

fever, malaise, fatigue, night sweats, weight loss, cough

23
Q

physical exam of sarcoidosis

A

erythema nodosum, lupus pernio, kerititis, sicca, uveitis

lofgren’s: erythema nodosum & hilar adenopathy

24
Q

diagnostic study for sarcoidosis

A

PATHOLOGIC HALLMARK:
noncaseated granuloma
CXR: hilar adenopathy
CT: hilar & mediastinal adenopathy with nodular infiltrates

25
Q

sarcoidosis labs

A

Serum ACE Levels: ↑, BUT not specific
LFT’s: ↑ Alk Phos = liver obstruction
Bilirubin: ↑ = advanced liver disease

26
Q

treatment for sarcoidosis

A

relieve symptoms
prevent significant organ function impairment
depends on symptomatology

27
Q

key points to sarcoidosis

A

early disease: reverible
chronic disease: irreversible
end stage: cysts with connective tissue
refer to pulmonology

28
Q

significant info silica silicosis

A

african americans 2-7 times higher risk

29
Q

causes of silica silicosis

A

crystaline silica or silicon dioxide

30
Q

occupations for risk of silica silicosis

A

stone cutting, Mining, Glass & Cement manufacturing, Quarrying (Granite), Sandblasting, Foundry

31
Q

3 clinical presentations of silica silicosis

A

acute
chronic
accelerated

32
Q

diagnostic studies for silica silicosis

A

peribronchial location of silicotic nodules

impaired gas exchange in early stages

33
Q

treatment for silica silicosis

A

smoking cessation

influenza and pneumococcal vaccinations for all types of silicosis

34
Q

key points for silica silicosis

A

crystalline silica causes lung cancer

35
Q

significant info for acute silicosis

A

AKA: acute silicoproteinosis
rare: found in patients with extremely high crystalline silica
can occur in weeks of months after exposure

36
Q

acute silicosis causes

A

heavy exposure: tunneling through areas of high quartz content, sandblasting in confined spaces, manufacturing abrasive soaps

37
Q

signs and symptoms of acute silicosis

A

RAPID ONSET

cough, dyspnea, wieght loss, fatigue

38
Q

physical exam for acute silicosis

A

crackles

rapid development of cyanosis, cor pulmonale, respiratory failure

39
Q

diagnosis studies for acute silicosis

A

ABGs: respiratory impairment
CXR: bilateral diffuse ground glass opacities: perihilar or basilar
CT: numerous bilateral centilobular nodular opacities, focal ground glass opacties

40
Q

acute silicosis treatment

A

avoidance of exposure
supplemental oxygen
bronchodilators
antibiotics for infections

41
Q

key point for acute silicosis

A

prognosis very poor survival typically <4 yrs

42
Q

significant info for chronic silicosis

A

subdivided into simple and progressive massive fibrosis

43
Q

chronic silicosis causes

A

10 years after exposure to low levels of silica

44
Q

clinical features for simple chronic silicosis

A

asymptomatic or chronic cough, exertional dyspnea, wheezes, fine/coarse crackles at the end of inspiration, rhonchi

45
Q

clinical features of PMF chronic silicosis

A

severe cough, exertional dyspnea, decreased breath sounds

no crackles, signs of respiratory failure and cor pulmonale

46
Q

diagnostic studies for simple chronic silicosis

A

PPD for latent TB (DDX)
PFT’s
complete cardiopulmonary exercise test
CXR: innumerable small round opacities (<10 mm) in upper lung fields

47
Q

diagnostic studies for PMF chronic silicosis

A

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

48
Q

treatment for chronic silicosis

A

avoidance of exposure
supplemental oxygen
bronchodilators
antibiotics for infections

49
Q

significant info for accelerated silicosis

A

differentiated from chronic

ONLY by its MORE RAPID DEVELOPMENT

50
Q

causes of accelerated silicosis

A

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)

51
Q

treatment for accelerated silicosis

A

avoidance of exposure
supplemental oxygen
bronchodilators
antibiotics for infection

52
Q

key points for accelerated silicosis

A

course: progressive respiratory failure & cor pulmonale

53
Q

clinical features of accelerated silicosis

A

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

54
Q

diagnostic studies for accelerated silicosis

A

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

pulmonary (6 decks)

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