Pediatrics Flashcards
1
Q
Nieman Pick enzyme deficiency?
A
sphingomyelinase
2
Q
Nieman Pick H&P
A
cherry red macula
protruding abdomen
Lymphadenopathy
hepatosplenomegaly
3
Q
Tay Sachs enzyme deficiency
A
hexoaminidase
4
Q
Tay Sachs H&P
A
hyperacusis
mental retardation
seizures
cherry red macula
5
Q
Gaucher’s disease enzyme deficiency
A
glucocerebrosidase
6
Q
Gaucher’s H&P
A
hepatosplenomegaly
anemia
leukopenia
thrombocytopenia
7
Q
Krabbes Disease enzyme deficiency
A
galactocebrosidase
8
Q
Krabbes Disease H&P
A
hyperacusis, irritability, seizures
9
Q
What is transient neonatal pustular melanosis and TX?
A
superficial pustules overlying hyperpigmented macules, spont resolves.
TX: tell parents to leave it alone
10
Q
What is neonatal acne and what is the treatment
A
hormone stimulation of sebaceous glands occuring in 20% of infants 2-3wks of life
TX: resolves spontaneously, severe cases can be treated with benzoyl peroxide or topical retinoids
11
Q
What is milia?
A
accumulation of sweat beneath sweat glands blocked by keratin, occurs in 1st week of life. Associated with increased temperature.
TX: possibly cool child
12
Q
Mongolian Spot
A
bluish discoloration of butt and base of spine, benign
TX: document to prevent confusion with child abuse
13
Q
Cutis marmorata
A
spider webbing/paleish marbling of neonates skin
tx: none, self resolving
14
Q
Erythema toxicum
A
2-3mm yellow pustules with red base (look like white heads)
Arise first 24-72 hours, filled with eosinophils
tx: none, resolves by 3 weeks
15
Q
Macular stains (stork bites)
A
permanent vascular malformations usually near nape of neck, upper eyelids, and middle of forehead
tx: none, but persist forever
16
Q
Childhood immunization schedule
A
birth/1month = HEP B
2 months = Hep B, RV, DTAP, Hib, PCV, IPV
4 months = RV, DTAP, Hib, PCV, IPV
6 months = RV, DTAP, Hib, PCV, IPV, FLU
12 months = DTAP, HiB, PCV, IPV, FLU, MMR, Varicella
17
Q
How many Hep B doses?
A
3 doses
18
Q
How many MCV doses
A
2 doses
19
Q
How many Hep A doses
A
2 doses
20
Q
How many MMR doses?
A
2 doses
21
Q
How many IPV doses
A
4 doses
22
Q
How many PCV doses
A
4 doses
23
Q
How many HiB doses
A
4 doses
24
Q
How many DTAP doses
A
5 doses, and 4 years a TDap Booster
25
How many Rota Doses
3 doses
26
signs of diabetic ketoacidosis
```
dehydraton (thrist, polydipsia, dry skin, dry mouth)
polyuria
nausea/vomiting
abdominal pain
altered mental status
```
27
Labs in diabetic ketoacidosis
increased glucose
elevated anion gap metabolic acidosis
ketones in urine and serum
hyperkalemia, hyponatremia
28
management of acute coronary syndrome
1st) get a submaximal (or maximal of patient can tolerate it) stress test
2) if stress is negative; patient discharged on aspirin, beta blocker, statin, ACEi
3) if stress test is positive; get coronary angiogram
4) if angiogram shows 1 or 2 vessel disease --> percutaneous coronary intervention is done
5) if angiogram shows 3+vessel disease --> cardiac bypass surgery
29
diagnostic modality for AAA in a symptomatic obese patient
CT with contrast
30
labs on autoimmune hepatitis:
anti-nuclear antibodies (anti-ANA), anti-smooth muscle antibodies (anti-ASMA), hypergammaglobulinemia
associated with other immune disorders
31
treatment for autoimmune hepatitis
low dose corticosteroids (prednisone)
32
dacryostenosis H&P/treatment
blocked tear duct, usually unilateral and painless
excessive tearing and mucoid material secretion
treated with nasolacrimal massage until 1 year old
nasal duct probing done after age 1 year
33
criteria for metabolic syndrome
BMI >30 (OBESITY) + 2 of the following:
fasting triglyceride level >150
HDL 130/85
fasting glucose >100
34
Atherosclerosis H&P:
asymptomatic for most of disease progression
later sequelae include; Angina, claudication, progressive hypertension, retinal changes, extra heart sounds, MI, stroke, renal damage
35
For stable angina
refer patient for cardiac stress test; if equivocal, refer patient for nuclear stress testing or exercise stress test with echocardiography; if these are positive possible angiography or PET scan
36
athersclerosis treatment
primarily minimize risk factors (tobacco use, HTN, hyperglycemia, hypercholesterolemia)
Diet low in fats and cholesterol and high in antioxidants is helpful in preventing disease.
37
When do you screen for hyperlipidemia?
Men >35 yrs
| women > 45 yrs
38
hyperlipidemia H&P:
```
usually asymptomatic
severe disease presents with:
1) xanthomas (lipids on tendons)
2) xanthalesmas (lipid deposits on medial eye)
3) cholesterol emboli in retina
```
39
hyperlipidemia TX:
1st line: tobacco cessation, exercise, dietary restrictions,
2nd line: cholesterol lowering agents (statins, niacin, fibric acids and bile acid sequestrants)
40
Goal LDL in humans
<100 in pts with CAD/PVD/AAA/carotid disease
41
Angina Pectoris H&P:
temporary myocardial ischemia causes substernal chest pain that may radiate to left shoulder, arm, jaw, or back, will usually occur during exertion
42
Angina Pectoris treatment
Primary: sublingual nitroglycerin and cessation of intense activity
Secondary: stress testing; followed by nuclear studies (nuclear stress test), and angiography if stress test is negative/positive
43
1st degree heart block
asymptomatic
PR interval > 0.2sec
No treatment
44
2nd Degree heart block MOBITZ I
caused by intranodal or his bundle conduction defect or drug side effects
asymptomatic
progressive PR lengthening until a QRS is skipped
tx: adjust medication doses; if there is symptomatic brady cardia you put in a pacemaker
45
2rd degree heart block MOBITZ II
Infranodal conduction problem (His, Purkinje)
usually asymptomatic
randomly skipped QRS without changes in PR interval
TX: ventricular pacemaker; because it can progress to 3rd degree heart block
46
3rd degree heart block
absence of conduction between atria and ventricles
syncope, dizziness, hypotension
no relationship between P waves and QRS
TX: ventricular pacemaker, avoid meds that affect AV conduction
47
What is PVST
tachy cardia (HR>100bpm) arising in atria or AV junction; usually in young patients with healthy hearts
48
H&P for PVST
sudden tachycardia, possible chest pain, shortness of breath, palpitations, syncope
P waves hidden in T waves, 150-250 BPM, normal QRS
49
TX for PVST
carotid massage, valsalva maneuver, IV adenosine
If hemodynamically unstable cardioversion or calcium channel blocker
sometimes catheter ablation of accessory conduction pathways is used for long term control
50
what is MAT (MFAT?)
tachycardia due to several ectopic foci in the atria that discharge automatic impulses, usually asymptomatic
51
What do you see on ECG for MFAT?
variable morphology of P waves (at least 3), and HR >100
52
What is the treatment of MFAT?
calcium channel blockers or beta blockers acutely
| catheter ablation or surgery to eliminate abnormal pacemakers
53
define bradycardia
HR < 60 BPM
frequently asymptomatic, possible weakness, syncope
TX: pacemaker if severe, stop precipitating medications
54
risk factors for Atrial fibrillation
pulmonary disease, CAD, HTN, anemia, valvular disease, pericarditis, hyperthyroidism, rheumatic heart disease, sepsis, alcohol use
55
Afib H&P:
SOB, chest pain, palpitations, irregularly irregular pulse
56
ECG findings in Afib
no discernible P waves, irregular QRS rate
57
TX for Afib
anticoagulaton and rate control!
rate control with CA-channel blockers, beta blockers, digoxin.
Cardioversion if caught within 48hrs; or if after 48 hours but echo shows no thrombus.
If more than 48 hours or thrombus present; anticoagulate for 3-4 weeks and then cardiovert afterwards.
AV nodal ablation can be considered for recurrent cases.
58
Aflutter risk factors
CAD, CHF, COPD, valvular disease, pericarditis
59
Aflutter H&P:
asymptomatic, or palpitations, syncope
60
Aflutter ECG changes:
regular tachycardia >150BPM with a sawtooth pattern of P waves
61
Aflutter TX:
rate control with Ca-channel blockers, beta blockers
| electrical/chemical cardioversion
62
PVC causes
```
common, frequently benign; can also be caused by:
hypoxia
abnormal serum electrolyte levels
hyperthyroidism
caffeine use
```
63
PVC H&P:
usually asymptomatic; possible palpitations, syncope
64
ECG in PVC
early and wide QRS without preceding P wave, followed by brief pause in conduction
65
PVC treatment
none in healthy patients, beta blockers in patients with CAD to prevent sudden death
66
Vtach H&P
series of 3+ PVCs with heart rate of 160-240 BPM,
| possibly asymptomatic if brief, but can cause palpitations, syncope, hypotension
67
Vtach ECG
series of regular, wide QRS complexes independent of P waves.
68
Vtach treatment
electrical cardioversion followed by antiarrhythmic medications, may need internal defibrillator
69
Vfib H&P
lack of ordered ventricular contraction leads to loss of cardiac output; presents with syncope, hypotension, pulselessness
70
Vfib ECG findings
totallly erratic tracing, no P waves or QRS
71
Ffib treatment
CPR, immediate electric or chemical cardoversion
72
what causes systolic heart dysfunction
decreased contractility, increased preload, increased afterload, HR abnormalities, high output conditions
73
what causes diastolic heart dysfunction
decreased ventricular compliance with decreased ventricular filling, increased diastolic pressure decreased CO
74
CHF risk factors
CAD, HTN, valvular disease, cardiomyopathy, COPD, drug toxicity, alcohol use
75
systolic heart failure treatment
loop diuretics, ACE-I or ARBs, beta blockers, spironolactone, add digoxin to increase contractility for symptomatic relief
76
diastolic heart failure treatment
calcium channel blocker, ARB or ACE-I, beta blockers, aldosterone antagonists
77
aortic stenosis symptoms
chest pain, DOE, SYNCOPE
78
aortic stenosis murmur
crescendo-decrescendo systolic murmur radiating from right upper sternal border to carotids
79
aortic stenosis treatment
valve replacement
80
mitral regurgitation symptoms
palpitations, DOE, orthopnea, paroxysmal nocturnal dyspnea
81
mitral regurg murmur
harsh blowing holosystolic murmur radiating fro apex to axilla, widely split S2, midsystolic click
82
mitral regurg treatment
vasodilators, prophylactic antibiotics, prophylactic anticoagulation
83
aortic regurgitation symptoms
chest pain, orthopnea, DOE
84
aortic regurg murmur
bounding pulses
widened pulse pressure
diastolic decrescendo murmur at right second intercostal space
late diastolic rumble
capillary pulsations in nail beds when pressure is applied
85
aortic regurg treatment
ACEI, CCB, valve replacement
86
mitral stenosis symptoms
DOE, orthopnea, PND, peripheral edema, hepatomegaly
87
mitral regurg murmur
opening snap after S2, diastolic rumble, loud S1
88
mitral regurg treatment
diuretics, antiarry for Afib secondary to atrial enlargement
89
hypertrophic cardiomyopathy causes
congential (autosomal dominant)
90
hypertrophic cardiomyopathy symptoms
syncope, dyspnea, palpitations, chest pain, symptoms worsen with exertion
91
hypertrophic cardiomyopathy exam findings
S4 sound, systolic murmur
92
hypertrophic cardiomyopathy Xray findings
Boot-shaped heart on CXR
93
hypertrophic cardiomyopathy treatment
beta blockers, CCB, pacemaker, partial septal excision
94
Dilated cardiomyopathy causes
idiopathic, alcohol use, beri beri, coxsackievirus B, cocaine use, doxorubicin, HIV, pregnancy, hemochromatosis, chagas disease, ischemic heart disease
95
Dilated cardiomyopathy symptoms
similar to CHF
96
Dilated cardiomyopathy exam findings
S3, systolic and diastolic murmurs
97
Dilated cardiomyopathy Xray findings
balloon-like heart on CXR
98
Dilated cardiomyopathy treatment
stop alcohol or cocaine use, diuretics, ACEI, beta blockers, anticoagulation
99
Restrictive cardiomyopathy causes
sarcoid, amyloid
100
Restrictive cardiomyopathy symptoms
similar to CHF with right sided symptoms worse
101
Restrictive cardiomyopathy exam findings
ascites, JVD
102
What is becks triad?
hypotension, distended neck veins, distant heart sounds = cardiac tamponade
103
Acute pericarditis causes
acute inflammation of pericardium along with pericardial effusion
caused by viral infection, tuberculosis, SLE, uremia, neoplasm, drug toxicity, post-MI inflammation, radiation, recent heart surgery
104
acute pericarditis H&P
pleuritic chest pain, dyspnea, cough, chest pain decreased by leaning forward, fever, friction rub, pulsus paradoxus
105
acute pericarditis ECG findings
global ST segment elevations, pr depression
106
acute pericarditis treatment
NSAIDS for pain
colchicine to prevent recurrence
pericardiocentesis for large effusions
107
chronic constrictive pericarditis H&P
diffuse thickening of pericardium with possible calcifications due to radiation or heart surgery
heart failure symptoms: JVD, DOE, afib common, increasing JVD with inspiration
108
chronic constrictive pericarditis imaging
pericardial calcifications; echo/CT/MRI show pericardial thickening
109
chronic constrictive pericarditis treatment
NSAIDS, colchicine, steroids, surgical excision of pericardium
110
cardiac tamponade treatment
immediate pericardiocentesis
111
cardiac tamponade symptoms
dyspnea, tachypnea, JVD, pulsus paradoxus
112
myocarditis causes
coxsackie virus, parvovirus, HHV-6, adenovirus, echovirus, EBV, CMV, influenza
bacteria, rickettsiae, fungi, parasites
drug toxicity (cyclophosphamide, daunorubicin, doxorubicin), toxins
113
myocarditis H&P
```
recent history of URI
pleuritic chest pain
dyspnea
S3 or S4
friction rub
```
114
acute rheumatic fever H&P
migratory arthritis, hot and swollen joints, fever, subcutaneous nodules, sydenham chorea, erythema marginatum
115
acute rheumatic fever labs
increased ESR, CRP, and WBC + antistreptococcal antibodies
116
acute rheumatic fever treatments
NSAIDS, steroids for severe carditis, antibiotics (penicillin) for infection
117
JONES major criteria for RHD
```
joints = polyarthritis, hot/swollen joints
heart = carditis, valve damage
Nodules = subcutaneous/extensor surfaces
Erythema marginatum
Sydenham chorea
```
118
JONES minor criteria for RHD
```
previous rheumatic fever
ECG with PR prolongation
Arthralgias
CRP and ESR elevated
increased temperature
```
119
endocarditis H&P
fever, chills, night sweats, fatigue, arthralgias, possible new heart murmur
osler nodes = small, tender nodules on fingers and toes
Janeway lesions = peripheral petechaie
Roth spots = retinal hemorrhages
splinter hemorrhages under nails
120
endocarditis treatment
```
long term (4-6 wks) IV antibiotics; beta lactam plus aminoglycoside
antibiotic prophylaxis before surgical or dental work
```
121
hypertensive emergency (malignant hypertension)
BP > 180/120 with evidence of end organ damage:
| renal damage, pulmonary edema, aortic dissection, encephalopathy, papilledema
122
hypertensive emergency (malignant hypertension) treatment
hospitalization to rapidly reduce diastolic blood pressure to 100mm Hg with IV nitroprusside, labetalol, nicardipine or fenoldopam
then beta blockers and ACEI to gradually reduce mean diastolic pressure to 100 to 105 over 2 hours
diuretics for pulmonary edema
123
cardiogenic shock treatment
dobutamine, intraortic balloon pump, PTCA for MI
124
septic shock treatment
treat underlying infection, norepinephrine, IV fluids
125
hypovolemic shock treatment
IV fluids, transfusions, surgery to stop cause of volume loss, skin grafts for severe burns
126
anaphylactic shock treatment
maintain airway, epinephrine, bendaryl, IV fluids
127
neurogenic shock treatment
IV fluids, pressor agents, atropine for bradycardia
128
abdominal aortic aneurysm H&P
localized dilation of aorta inferior to the renal arteries
| lower back pain, pulsating abdominal mass, abdominal bruits, hypotension and severe pain with rupture
129
AAA screening
one time screening US for men age 65-75 with a history of smoking
130
AAA diagnosis
ultrasound followed by CT or MRI for more accurate information
131
AAA treatment
monitor with periodic US if 5.5cm
132
Aortic dissection H&P:
intimal tear causes formation of false lumen, Type A ascending aorta, type B descending aorta
acute "ripping" chest pain, syncope, decreased peripheral pulses, HTN may be present
133
aortic dissection radiology
widening of aorta and superior mediastinum on CXR
| CT w/ contrast, echo, MRI, or MRA good for definite diagnosis
134
aortic dissection treatment
nitropursside, beta blockers if unstable
| standford A need emergency surgery, stanford B can be medically managed
135
peripheral vascular disease H&P
occlusion of peripheral blood supply secondary to atherosclerosis
presents with: leg claudication that improves with rest, resting leg pain in severe disease, dry skin, skin ulcers, decreased air growth in affected area, male impotence
136
PVD labs
ABI <0.4 indicates severe disease
137
PVD radiology
US useful for locating stenosis, angiography will map narrowing in the arterial distribution
138
PVD treatment
exercise, foot examinations
asparin, pentoxifylline or cilostazol to help slow occlusion
percutaneous transluminal angioplasty indicated for medical management failure
amputation if necrosis/neurosensory loss/vascular death occurs to prevent gangrene
139
What is virchows triad?
blood stasis, hypercoagulability, endothelial damage
140
venous varicosities H&P
pain and fatigue that lessens with leg elevation; possible visible or palpable veins, increased local pigmentation, edema, or ulceration
141
venous varicosities treatment
exercise, compression hosiery, leg elevation
| surgical removal or injection sclerotherapy for cosmetic improvement or symptomatic varicosities
142
arteriovenous malformations H&P
abnormal communications between arteries and veins
| palpable, warm, pulsating masses, painful if mass compresses adjacent structures
143
AVM treatment
surgical removal or sclerosis if symptomatic or located in the bowel/brain
144
DVT H&P
deep leg pain, swelling, warmth
145
DVT labs
D-dimer will be elevated, more useful to rule out DVT if negative
146
DVT radiologic anaylsis test
compressive venous ultrasound and contrast venography
147
DVT treatment
leg elevation, LMW heparin, warfarin for long term management, IVC filters placed in patients with recurrent DVTs or anticoagulation contraindications
148
polyarteritis nodosa H&P
inflammation of small/medium arteries
ASSOCIATED WITH HEP B/C
presents as: fever, HTN, hematuria, anemia, neuropathy, weight loss, joint pain, palpable purpura, or ulcers on skin
149
polyarteritis nodosa Labs
```
increased WBC
decreased H&H
increased ESR
proteinuria
hematuria
```
150
polyarteritis nodosa treatment
corticosteroids, immunosuppressive agents
151
Temporal Arteritis (giant cell) H&P
subacute granulomatous inflammation of carotid and vertebral arteries
associated with polymyalgia rheumatica
new onset of headache, temporal region pain, jaw claudication, transient or permanent monocular blindness, myalgias, arthralgias, fever
152
Temporal Arteritis (giant cell) labs
increased ESR, temporal artery biopsy shows inflammation in media with lymphocytes, plasma cells or giant cells
153
Temporal Arteritis (giant cell) treatment
prednisone for 1-2months followed by taper; low dose ASA, vitamin D and calcium supplementation to reduce osteoporosis risk from chronic steroids
154
Takayasu Arteritis H&P
inflammation of aorta and its branches, asian heritage, usually women 10-40
malaise, vertigo, syncope, fever, decreased carotid and limb pulses
155
Takayasu Arteritis radiology
arteriography may detect abnormal vessels or stenoses; CT or MRI useful for detecting vessel wall abnormalities
156
Takayasu Arteritis treatment
corticosteroids, immunosuppressive agents, bypass grafting of obstructed vessels
157
Churg Strauss (allergic granulomatosis with angiitis) H&P
```
inflammation of small or medium arteries
ASTHMA SYMPTOMS (a kid usually), fatigue, malaise, mononeuropathy, erythematous or papular rash
```
158
Churg Strauss (allergic granulomatosis with angiitis) labs
increased eosinophils, increased ESR, p-ANCA positive, eosinophilic granulomas in lungs
159
Churg Strauss (allergic granulomatosis with angiitis) treatment
corticosteroids, immunosuppressive agents
160
Henoch-Schonlein purpura H&P
IgA immune complex mediated vasculitis, usually in children
| recurrent upper respiratory tract infections, abdominal pain, fever, hemorrhagic urticaria, ass w/ intussuception
161
Henoch-Schonlein purpura treatment
frequently self limited, steroids for severe G symptoms
162
Kawasaki disease treatment
high dose ASA, IVIG, frequently self limited
163
What is the normal A-a gradient?
5-15mm Hg
164
Increased A-a gradient indicates what diseases?
PE, pulmonary edema, right to left vascular shunts
165
signs of a peritonsillar abscess
difficulty opening mouth, asymetric tonsils, displacement of the uvula away from the abscess
166
tuberculosis treatment
isoniazid, rifampin, pyrazinamide, and ethambutol initially
followed by INH and rifampin for 6 months
vitamin B6 supplement
167
PPD test cutoffs
```
5mm = immunocompromised patients, close contact with TB infected patient, signs of TB on CXR
10mm = homeless patients, immigrants, IVDA users, chronically ill patients, health care workers, patients from jail
15mm = always positive if greater
```
168
ARDS H&P
acute dyspnea and pulmonary decompensation; cyanosis, tachypnea, wheezing, rales, rhonchi
caused by sepsis, trauma, pancreatitis, aspiration, near drowning, drug overdose, shock, lung infection
169
ARDS labs
ABG shows respiratory alkalosis, decreased O2, decreased CO2, wedge pressure <18mm Hg
170
ARDS radiology
bilateral pulmonary edema and infiltrates
171
ARDS treatment
ICU admission with mechanical ventilation
PEEP, increased insipratory times
treat underlying cause
172
status asthmaticus treatment
aggressive bronchodilator therapy, supplemental O2, possibly intubation
173
chronic bronchitis H&P
productive cough, recurrent respiratory infections, dyspnea, wheezing, rhonchi
history of productive cough for 3 months of the year >2 yrs
174
chronic bronchitis treatment
smoking cessation, antibiotics given for URI, bronchodilators during exacerbations
175
Emphysema H&P
dyspnea, possible productive cough, morning headache, barrel chested, pursed-lip breathing, prolonged expiratory duration, decreased heart sounds, decreased breath sounds, wheezing, rhonchi, accessory muscle use, JVD, exacerbations present with worsening of symptoms
176
emphysema radiology
CXR shows flat diaphragm, hyperinflated lungs, subpleural blebs and bullae, decreased vascular markings
177
emphysema treatment
smoking cessation, supplemental O2, inhaled corticosteroids and long acting beta 2 agonists
pneumococcal and influenza vaccines important
enzyme replacement in alpha 1 antitripsin, lung transplant in severe disease
178
bronchiectasis H&P
permanent dilation of bronchi
| persistent, productive cough, hemoptysis, frequent respiratory infections, copious sputum, wheezing, rales, hypoxemia
179
bronchiectasis treatment
hydration/sputum removal, chest PT, antibiotics when sputum increased, inhaled B2 agonists and corticosteroids may reduce symptoms; resection of severely diseased portion of lungs
180
squamous cell lung cancer paraneoplastic syndromes
hypercalcemia, dermatomyositis
181
adenocarcinoma of the lung paraneoplastic syndromes
DIC, thrombophlebitis, microangiopathic hemolytic anemia, dermatomyositis
182
small cell lung cancer paraneoplastic syndromes
cushings, SIADH, GH/ACTH secretion, eaton-lambert syndrome, dermatomyositis
183
large cell lung cancer paraneoplastic syndromes
gynecomastia, dermatomyositis
184
laryngeal cancer H&P
ass with tobacco and alcohol use
| hoarsness that worsens with times, dysphagia, ear pain, hemoptysis
185
laryngeal cancer treatment
partial or total laryngectomy used to remove lesions in larynx; radiation therapy can be used with surgery for extensive lesions
186
idiopathic pulmonary fibrosis H&P
progressive exercise intolerance, dyspnea, dry crackles, JVD, tachypnea, possible digital clubbing
187
idiopathic pulmonary fibrosis labs
PFTs show restrictive lung disease, decreased TLC, decreased compliance
bronchioalveolar lavage shows PMNs
lung biopsy shows extensive fibrosis and loss of parenchymal architecture
188
idiopathic pulmonary fibrosis imaging
reticulonodular pattern and "honeycomb lung"
| CT shows ground glass appearance
189
idiopathic pulmonary fibrosis treatment
corticosteroids + azathioprine or cyclophosphamide
| lung transplant usually indicated, most die before they receive a lung transplants
190
Sarcoidosis H&P
noncaseating granulomas, hilar adenopathy, pulmonary infiltrates
cough, malaise, weight loss, dyspnea, hypercalcemia, arthritis, chest pain, fever, erythema nodosum, lymphadenopathy, vision loss
191
Sarcoidosis labs
increased serum ACE, increased calcium hypercalcuria, increased ALP, decreased WBC, increased ESR, decreased DLCO
192
Sarcoidosis imaging
CXR shows bilateral hilar lymphadeopathy and ground grass pulmonary infiltrates
193
Sarcoidosis treatment
occasionally self resolving
corticosteroids in chronic cases
cytotoxic drugs if steroids fail
194
asbestosis
insulation/construction/demolition/building maintenance/car making
radiology: multinodular opacities, pleural effusions, pleural/parenchymal fibrosis
increased risk of malignant mesothelioma and lung cancer
195
silicosis
mining, pottery, sandblasting, granite cutting
radiology = small apical nodular opacities; hilar adenopathy
increased risk of TB infection, progressive fibrosis
196
coal worker disease
coal mining
restrictive lung pattern
radiology: small apical nodular opacities
progressive fibrosis
197
berylliosis
electronics, ceramics, die manufacturing
pulmonary edema, diffuse granuloma formation
radiology: diffuse infiltrates, hilar adenopathy
increased risk of lung cancer; may need steroids
198
goodpasture syndrome H&P
antiglomerular basement membrane antibodies, intra-alveolar hemorrhage and glomerulonephritis
hemoptysis, dyspnea, recent respiratory infection
199
goodpasture syndrome imaging
bilateral alveolar infiltration
200
goodpasture syndrome treatment
plasmapheresis and corticosteroids and immunosuppressive agents
201
granulomatosis with polyangitis (wegeners) H&P
hemoptysis, dyspnea, myalgias, chronic sinusitis, ulcertations of nasopharynx, fever, renal symptoms, CNS problems, opthalmologic and cardiac involvement
202
granulomatosis with polyangitis (wegeners) labs
noncaseating granulomas
| + c-ANCA
203
granulomatosis with polyangitis (wegeners) treatment
cytotoxic therapy (cyclophosphamide) and corticosteroids
