Pulm- DPLD and ILD Flashcards
Best way to diagnose DPLD or ILDs?
High resolution CT is the diagnostic tool of choice–it gives the best resolution
When should a diagnosis of DPLD and ILD be considered?
once infection, heart failure, and COPD has been ruled out
When should one use biopsy to diagnose?
Video assisted thorascopic lung biopsy should be used for patients with disparate findings on history, physical exam, imaging, and lab studies
What is the primary form of management for smoking-related diffuse parenchymal lung disease?
Smoking cessation!
How does hypersensitivity pneumonitis happen?
It occurs as a result of an immunologic response to repetitive inhalation of antigens
What are the most common antigens causing a hypersensitivity pneumonitis
thermophilic actinomycetes, fungi, bird droppings
When does acute hypersensitivity pneumonitis occur? How does it present?
It occurs within 48 hours of a high level exposure and will often be associated with fevers, flulike symptoms, cough, shortness of breath. symptoms usually wane within 48 hours after removal of exposure
What are the radiological findings of acute hypersensitivity pneumonitis?
bilateral hazy opacities, ground glass opacities, centrilobular micro nodules that are upper and mid lung predominant
How does subacute or chronic forms of a hypersensitivity pneumonitis occur
chronic low-level exposures to inhaled antigens
What is the treatment for hypersensitivity pneumonitis?
The treatment is to remove the offending agent, GCs are for those with more severe symptoms and for those with evidence of fibrosis
What are the 5 most common drugs that can cause a lung toxicity?
Amiodarone, Methotrexate, Nitrofurantoin, Busulfan, Blemoycin
How does radiation induced parenchymal lung disease present?
radiation pneumonitis usually occurs 6-12 weeks after exposure
GC can be use for moderate to severe disease, ,mild disease may not need them
What is the epidemiological presentation of IPF?
Older than 60
Gradual onset of dyspnea over several years with cough
Inspiratory crackles at the bases
Severe disease shows right sided heart failure or evidence of secondary pulmonary hypertension
What is the estimated survival for IPF?
3-5 years
Should you intubate someone with worsening respiratory failure due to IPF?
No. Guidelines recommend against mechanical ventilation because it is terminal
What is the only therapy for IPF
‘
Lung transplantation
What is the general pathology of Cryptogenic Organizing Pneumonia?
patchy process that involves proliferation of granulation tissue within alveolar ducts, alveolar spaces, and surrounding areas of chronic inflammation
What are common causes of COP?
Acute infections, autoimmune disorders like rheumatoid arthritis
What is the presentation of COP usually
They usually present over 6-8 weeks and mimic community acquired pneumonia
Symptoms are usually <3 months duration
Peripheral nodules or masses
How is diagnosis established?
Usually after a course of txt for infection doesn’t work, bronchoscope or surgical lung biopsy may be necessary
What is the prognosis of COP?
It is favorable with a good response to GCs
What is sarcoidosis?
It is a multi system granulomatous disease of unclear cause with a predilection for the lung. Pulmonary involvement occurs in >90% of patients
How is sarcoidosis usually determined?
It is usually discovered incidentally on chest imaging.
Describe the radiographic patterns of sarcoidosis and the relationship to prognosis
0-normal
I-hilar LAD, normal lung parenchyma; >90% will have spontaneous resolution w/o treatment
II-hilar LAD with abnormal lung parenchyma; approximately 20% rate of spontaneous improvement w/o treatment
III- No LAD, abnormal lung parenchyma, about 20% spontaneously resolve
IV-Parenchymal changes with fibrosis and architectural distortion
What is the main therapy for sarcoidosis?
GCs! Treatment is usually limited to those with evidence of clinical symptoms from organ dysfunction. It is usually a long steroid taper
Bc there is a high rate of spontaneous resolution most protocols favor a period of observation without therapy
Initiate GCs if there is physiologic impairment based on disease
What is lymphangioleiomyomatosis?
It is a rare disorder that causes cyst formation in the lungs, particularly in ppl with tuberous sclerosis
