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Respiratory > Non-Infectious Inflammatory Diseases > Flashcards

Non-Infectious Inflammatory Diseases Flashcards

1
Q

What is sarcoidosis?

A

a disease involving abnormal collections of inflammatory cells (granulomas) that can form as nodules in multiple organs

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2
Q

Who is usually affected with sarcoidosis? Which gender is more affected?

A

Young to middle aged black adults with no gender difference

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3
Q

What are the exposures that have been associated with sarcoidosis?

A
  • Insecticides
  • Agricultural employment
  • Microbial bioaerosols
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4
Q

What are the organs that are most often affected with sarcoidosis?

A

Involvement of the lymphatic and pulmonary system

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5
Q

What is characteristic about sarcoidosis in the black population, besides more prevalent?

A

usually more widespread.

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6
Q

What are the components Lofgren’s syndrome? (3) What is it?

A

Sarcoidosis characterized by:

  • Erythema nodosum
  • Polyarthralgia
  • Bilateral hilar LAD
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7
Q

What is Heerfordt’s syndrome?

A

a rare manifestation of sarcoidosis. The symptoms include inflammation of the eye (uveitis), swelling of the parotid gland, chronic fever, and in some cases, palsy of the facial nerves

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8
Q

What are the ssx of sarcoidosis?

A

Like TB, but can include progressive SOB

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9
Q

What are the PE findings with sarcoidosis?

A

Adenopathy

Skin lesions

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10
Q

What are the lab findings with sarcoidosis?

A

Hypercalcemia
Elevated LFTs
Increases creatinine

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11
Q

Why should an ECG be obtained with sarcoidosis?

A

Can lead to conduction abnormalities and arrhythmias

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12
Q

Why should an ophthalmologic exam be performed with sarcoidosis?

A

Can present with uveitis, uveoparotitis, and retinal inflammation, which may result in loss of visual acuity or blindness

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13
Q

Why should PFTs be obtained with Sarcoidosis?

A

Most predominant manifestation of sarcoidosis is fibrotic lung disease

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14
Q

Why should you get a TB test with sarcoidosis?

A

Since so similar ssx, need to r/o

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15
Q

What percent of patients with sarcoidosis have lung involvement?

A

90%

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16
Q

What percent of patients with sarcoidosis have constitutional symptoms?

A

30%

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17
Q

What percent of patients with sarcoidosis have palpable LAD?

A

30%

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18
Q

What percent of patients with sarcoidosis have ski involvement?

A

25%

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19
Q

What percent of patients with sarcoidosis have ECG changes?

A

5%

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20
Q

What is lupus pernio?

A

a chronic raised indurated (hardened) lesion of the skin, often purplish in color. It is seen on the nose, ears, cheeks, lips, and forehead. It is pathognomonic of sarcoidosis.

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21
Q

What, generally, is the treatment for sarcoidosis?

A

Steroids

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22
Q

What are the CBC findings of sarcoidosis?

A

Leukopenia

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23
Q

True or false: GI and/or renal involvement with sarcoidosis is common

A

False-both are rare

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24
Q

What are the PFTs like with sarcoidosis?

A

Restrictive findings

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25
Q

What happens to TLC, VC, RV and DLCO with sarcoidosis?

A

All decreased

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26
Q

Can you have obstructive lung findings of sarcoidosis?

A

True

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27
Q

What is stage 0 of the siltzbach radiographic classification for sarcoidosis?

A

Normal CXR

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28
Q

What is stage I of the siltzbach radiographic classification for sarcoidosis?

A

Hilar LAD

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29
Q

What is stage II of the siltzbach radiographic classification for sarcoidosis?

A

Hilar adenopathy

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30
Q

What is stage III of the siltzbach radiographic classification for sarcoidosis?

A

No adenopathy, abnormal lung parenchyma

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31
Q

What is stage IV of the siltzbach radiographic classification for sarcoidosis?

A

Fibrotic changes architectural

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32
Q

What are the CT findings of the lungs with sarcoidosis?

A

Nodular appearance

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33
Q

What comprises the granulomas of sarcoidosis?

A

Langerhans cells

Macrophages

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34
Q

What is the definitive test for sarcoidosis? What are the findings of this?

A

BAL–high percentage of lymphocytes (50%), low granulocyte count

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35
Q

What is the CD4/CD8 ratio with sarcoidosis? How sensitive/specific is this?

A

greater than 3.5

low sensitivity
High specificity

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36
Q

Why should you only biopsy one side of a lung?

A

May cause pneumothorax

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37
Q

True or false: every patient with sarcoidosis should get some sort of treatment

A

False

38
Q

What are the two tests that, when combined, get a high sensitivity/specificity for sarcoidosis?

A

Endobronchial plus transbronchial biopsies

39
Q

True or false: most of the time, sarcoidosis is a lifelong disease

A

False–usually resolves spontaneously

40
Q

When is the use of systemic steroids indicated for sarcoidosis?

A
  • symptomatic stage II
  • stage III
  • Any clinical findings present
41
Q

How long does it take for oral steroids to take effect on sarcoidosis?

A

3-24 months

42
Q

In whom is lung involvement with RA more common in: men or women?

A

Men

43
Q

What is the usual age of presentation for lung involvement with RA?

A

50-60 yo

44
Q

What percent of patients with RA develop ILD?

A

50%

45
Q

What are the ssx of ILD secondary to sarcoidosis?

A

Non-productive cough
DOE
Cubbing

46
Q

True or false: lung ssx with RA can precede the joint ssx of RA

A

True

47
Q

What are the lung exam findings with ILD secondary to RA?

A

Inspiratory fine crackles

Pleural friction rub

48
Q

What are the radiographic findings of RA in the lungs?

A

Cavitary lesions in the lungs

OR

Sponge like lesions

49
Q

What are the three major drugs to treat RA lung disease?

A
  • Methotrexate
  • Etanercept
  • Infliximab
50
Q

What happens with the glucose levels of the interstitial fluid with RA? Why?

A

Lower, since granulomas there are utilizing it

51
Q

How common is lung involvement with scleroderma?

A

75% or patients, and 30% with significant pulmonary ssx

52
Q

What is the most frequent cause of morbidity and mortality in scleroderma patients?

A

Lung involvement

53
Q

What are the ssx of lung involvement with scleroderma?

A

DOE

54
Q

What are the two forms of scleroderma involvement of the lungs?

A

Interstitial lung disease

CREST

55
Q

What are the PE lung findings with scleroderma?

A

Inspiratory crackles

56
Q

Is scleroderma lung involvement usually a restrictive or obstructive disease?

A

Restrictive with decreased DLCO

57
Q

What is the major sequelae of CREST syndrome?

A

pHTN

Decreased DLCO

58
Q

What are the components of CREST syndrome?

A 
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasia
59
Q

What are the usual CT findings with CREST syndrome?

A

Honeycombing fibrosis

60
Q

What percent of SLE pts will have lung involvement?

A

90%

61
Q

What is the most common presentation of SLE in the lungs?

A

Serositis

and pleural effusions

62
Q

What are the consequences of SLE in the lungs?

A
  • Pneumonitis
  • Alveolar hemorrhage
  • Diaphragmatic dysfunction
63
Q

What is the major vascular pathology that can happen with SLE, that affects the lungs?

A

DVT/PE

64
Q

What are the antibodies that are elevated in Sjogren’s syndrome?

A

anti-SSA/Ro or anti-SSB/La

65
Q

What is the most common lung involvement of Sjogren’s syndrome?

A

Bronchiectasis and bronchiolitis

66
Q

What type of lung pathology is usually found with Sjogren’s: restrictive or obstructive.Why?

A

Obstructive d/t bronchiolitis

67
Q

How do you determine if there is enlarged bronchioles on a CT?

A

Compare to the arteries

68
Q

What is the lung involvement with polymyositis/dermatomyositis?

A

Aspiration pneumonia secondary to diaphragmatic weakness.

69
Q

What percent of patients with polymyositis/dermatomyositis have lung involvement?

A

40%

70
Q

Interstitial fibrosis with polymyositis/dermatomyositis usually involves what part of the lungs?

A

Lung bases

71
Q

What is the strongest predictive factor for lung involvement with polymyositis/dermatomy?

A

The presence of autoantibodies to aminoacyl tRNA synthetase (anti-Jo1)

72
Q

What is Wegener’s granulomatosis?

A

Systemic disorder that involves both granulomatosis and polyangiitis. It is a form of vasculitis that affects small- and medium-size vessels in many organs. Damage to the lungs and kidneys can be fatal.

73
Q

What are the ssx of Wegener’s granulomatosis lung involvement?

A

Cough
Hemoptysis
Sinus symptoms

74
Q

What are the antibodies that are elevated with Wegener’s granulomatosis? How sensitive/specific is this?

A

Antineutrophil cytoplasmic antibody
cANCA

High sensitivity and specificity

75
Q

What are the urinalysis findings with Wegener’s granulomatosis? (3)

A

Proteinuria
Hematuria
Red cell casts

76
Q

What are the usual radiological findings with Wegener’s granulomatosis?

A

Cavitary lesions

77
Q

What is Goodpasture syndrome?

A

a rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure. It is thought to attack the alpha-3 subunit of type IV collagen, which has therefore been referred to as Goodpasture’s antigen

78
Q

What are the ssx of lung involvement with Goodpasture syndrome?

A

Alveolar hemorrhage

Hemoptysis

79
Q

What are the antibodies that are diagnostic for Goodpasture syndrome?

A

Anti-glomerular base membrane antibodies

80
Q

What are the bronchoscopy findings with Goodpasture syndrome?

A

Persistent bloody fluid that does not clear on serial samplings

81
Q

What are the radiological findings of Goodpasture syndrome?

A

Diffuse Alveolar hemorrhage

82
Q

What percent of patients with Goodpasture syndrome will not have hemoptysis?

A

1/3

83
Q

What is Churg-strauss syndrome?

A

an autoimmune condition that causes inflammation of small and medium-sized blood vessels (vasculitis) in persons with a history of airway allergic hypersensitivity (atopy)

84
Q

What is the prodrome phase of Churg-strauss syndrome?

A

Rhinitis
Sinusitis
Asthma

85
Q

What is the eosinophilic stage of Churg-strauss syndrome?

A

Peripheral eosinophilia
Eosinophilic pneumonia
Vasculitis

86
Q

What age does Churg-strauss syndrome usually present? In which gender is this more common in?

A

Between 4th and 5th decade

No gender difference

87
Q

What are the three phases of Churg-strauss syndrome?

A

Prodrome (asthma ssx)
Eosinophilic
Vasculitis

88
Q

What are the characteristics of Churg-strauss syndrome lung PFTs?

A

Reversible obstructive airway ssx

89
Q

What is the largest cause of mortality with Churg-strauss syndrome?

A

Cardiovascular compromise

90
Q

True or false: renal involvement with Churg-strauss syndrome is uncommon

A

True

91
Q

What are the CBC values that can be seen with Churg-strauss syndrome?

A

Eosinophilia
pANCA
Elevated IgE

92
Q

What are the radiographic findings with Churg-strauss syndrome?

A

Nonspecific infiltrates

Respiratory (34 decks)

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