Non-Infectious Inflammatory Diseases

Question 1

What is Sarcoidosis?

Answer 1

A multisystem granulomatous disease of unknown etiology

Question 2

Who does sarcoidosis affect?

Answer 2

(young and middle aged adults)
No gender difference
African american and caucasians
Have had past exposure to insectisides, agric. employment, and microbial bioaerosols

Question 3

What is the clinical presentation of sarcoidosis?

Answer 3

Most commonly: Lung involvement
Uveo-parotid fever = Heerford’s syndrome

Erythema nodosum
Polyarthralgia
Bilateral Hilar lymphadenopathy
=Lofgren’s syndrome

Question 4

How can diseases similar to Sarcoidosis be ruled out? Tests?

Answer 4

History
-symptoms
-occ exposure
PE: adenopathy, skin lesions, 
PFTs
Labs: Ca level, liver Ez, creatinine
ECG
Opthalmologic eval 
TB skin test

Question 5

WHat is seen on the Pulmonary Function test in Sarcoidosis?

Answer 5

Restrictive: Normal shape with smaller volumes
Dec Total Lung Capacity
Dec Vital Capacity 
Dec Rreserve Volume
Dec Diffusion Capacity (CO)

Question 6

What is the appearance of the stages of development of Sarcoidosis on CXR?

Answer 6

Stage 1: Hilum
St 2: consolidation(haziness)
St 3: no lymphadenopathy only infiltrates
St 4: Extensive fibrotic Change in lung

Question 7

What is the appearance of Sarcoidosis on Chest CT?

Answer 7

Granulomas

Question 8

What are the diagnositic procedures used for Sarcoidosis?

Answer 8

Bronchoscopy
BAL(broncho-alveolar lavage):
Endo/transbronchial biopsies

Question 9

What is the treatment of Sarcoidosis?

Answer 9

Systemic Corticosteroids in systemic involvement
Methotrexate
Azathioprene
Hydroxichloroquine

Question 10

What are the connective tissue diseases that can effect the lungs?

Answer 10

RA
Scleroderma
SLE
Sjogren Synd
Dermatomyositis and polymyositis

Question 11

What is the presentation of Rheumatoid lung diasease?

Answer 11

Non-productive cough 
Dyspnea on exertion
Clubbing 
-fine crackles 
-pleural rub

May precede joint disease by years

Question 12

What medications are used for Rheumatoid lung diasease?

Answer 12

Methotrexate
Etanercept
Infliximab

Question 13

What is the most common cause of death in Scleroderma?

Answer 13

Pulmonary fibrosis

Question 14

What are the different presentations of scleroderma?

Answer 14

Diffuse scleroderma
Interstitial Lung disease

Limited form(CREST Syndrome)
Pulmonary Htn
Dec DLCO

Question 15

What is included in CREST syndrome?

Answer 15

Calcinosis
Raynaud's 
Esophageal Dysmotility
Sclerodactyly
Telangectasia

Question 16

What is seen in Pulmonary involvement of SLE?

Answer 16

Serositis
Acute and Chronic Lupus Pneumonitis
Alveolar Hemmorhage
Diaphregmatic Dysfunction
Increased risk for DVT/PE

Question 17

What is the Presentaion of Sjogren’s syndrome in the lung?

Answer 17

Airway compromise

Bronchiectasis and bronchiolitis

Question 18

How can you tell if an airway is dilated on CT?

Answer 18

The airway is wider than the BV that runs with it.

Question 19

What is the presentation of Pulmonary Vasculitis?

Answer 19

Wegener’s granulomatosis
Churg Strauss synd
Diffuse Alveolar hemmorhage
Goodpasture’s synd

Question 20

How is wegener’s granulomatosis differentiated from TB?

Answer 20

Serology

Question 21

What is seen in CXR of Goodpasture’s syndrome?

Answer 21

Bleeding from Alveoli

Need to do bronchoscopy

Question 22

What is the Triad seen in Churg Strause Syndrome?

Answer 22

Asthma, hypereosinophelia, necrotizing vasculitis

Question 23

What is seen on Spirometry in Churg-Strauss Synd?

Answer 23

Similar to asthma