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Clinical Medicine II > Pulm: ILD > Flashcards

Pulm: ILD Flashcards

1
Q

What is the most common cause of ILD?

A

idiopathic

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2
Q

This class of pulmonary disorders cause progressive scarring of lung tissue

A

ILD

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3
Q

This disease is a process of fibrosis and aberrant healing response. It is NOT infectius

A

ILD

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4
Q

A patient presents with the following:

Progressive DOE

Persistent non-productive cough

A

ILD

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5
Q

What two signs/sxs are uncommon in ILD?

A

wheezing, CP

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6
Q

What is the duration of sxs for the following ILDs?

Acute idiopathic interstitial pneumonia

eosinophilic pneumonitis

hypersensitivity pneumonitis

Cryptogenic organizing pneumonia

A

Acute (days/weeks)

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7
Q

What is the duration of sxs for the following ILDs?

Sarcoidosis

Alveolar hemorrhage

Cryptogenic organizing pneumonia

Connective tissue disease

A

Subacute (weeks/months)

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8
Q

What is the duration of sxs for the following ILDs?

IPF

Sarcoidosis

Pulmonary langerhans cell histiocytosis

Chronic hypersensitivity pneeumonitis

A

Chronic (months-years)

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9
Q

Digital clubbing is a sign usually associated with _______

A

advanced disease

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10
Q

Erythema nodosum can be seen in what type of ILD?

A

sarcoidosis

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11
Q

Grottron’s papules can be seen in what type of ILD?

A

dermatomyositis

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12
Q

What lung sound is usually heard with ILD and where?

A

crackles at lung bases

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13
Q

What specialties should be involved in diagnosing ILD?

A

pulmonology

radiology

pathology

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14
Q

What imaging and diagnostic test are used to diagnose ILD?

A

HRCT

Tissue biopsy

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15
Q

What three signs present on CXR indicate ILD?

A

ground glass

reticular opacity

honeycombing

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16
Q

Honeycombing indicates a _______ prognosis

A

poor prognosis

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17
Q

What is the most common finding on CXR in ILD?

A

reticular opacity

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18
Q

On HRCT, you notice the distribution of disease in the upper zones of the lungs. This indicates what etiology?

A

inhalation related diseases (except asbestosis)

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19
Q

On HRCT, you notice the distribution of disease among the lower zones, this indicates…

A

IPF, connective tissue dz, asbestosis

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20
Q

What serologic studies can be ordered to rule out subclinical autoimmune disease?

A

ANA, RF ,CCP

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21
Q

What serologic studies would be useful for pulmonary hemorrhage or suspicious systemic symptoms/vasculitis?

A

ANCA

antiphospholipid Abs

Antistreptococcal Abs

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22
Q

Describe the results of PFTs in ILD (TLC, FEV-1, FVC)

A

Decreased TLC

Decreased FEV-1 and FVC

FEV-1/FVC ratio normal/increased

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23
Q

What PFT is sometimes the only finding of early ILD?

A

Decreased DLCO

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24
Q

What results can be expected on ABG with ILD?

A

hypoxemia

Respiratory alkalosis

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25
Q

What is the gold standard for dx of ILD?

A

lung biopsy

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26
Q

What is the contraindication to lung biopsy?

A

honeycombing

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27
Q

What are the three types of lung biopsy?

A

Transbronchial

Surgical biopsy

EBUS-TBNA

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28
Q

For what suspected condition should EBUS-TBNA be performed?

A

sarcoidosis

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29
Q

Transbronchial biopsy is helpful to biopsy what locations?

A

central

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30
Q

Which condition has the following characteristics?

MC ILD
Age > 50
Male
TOBB use

A

Idiopathic pulmonary fibrosis

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31
Q

A patient has the following S/S… What are these concerning for?

Inspiratory velcro crackles
digital clubbing
gradual onset of DOE
non-productive cough

A

Idiopathic pulmonary fibrosis

32
Q

What test offers a good baseline for IPF?

A

6 minute walk test

33
Q

You receive the following results after running diagnostic tests… what condition should you be concerned for?

CXR:

  • peripheral reticular opacities
  • honeycombing

HRCT:

  • bibasilar reticulonodular opacity
  • traction bronchiectasis
  • honeycombing

PFTs:
-restrictive pattern

34
Q

IPF has what pattern on HRCT?

35
Q

What condition should be treated (even if asymptomatic) in patients with IPF?

36
Q

What two pharmacologic interventions can help manage IPF? Are they curative?

A

Nintedanib

Pirfenidone

not curative

37
Q

what condition presents with the following characteristics?

multisystem inflammatory dz

non-caseating granulomas

secretes ACE

Mostly african american

female predominance

A

Sarcoidosis

38
Q

What type of ILD can present with the following extrapulmonary findings?

erythema nodosum
lupus pernio
granulomatous uveitis
arthralgias

A

Sarcoidosis

39
Q

A patient presents with:

DOE
CP
Cough
Hemoptysis
Systemic complaints
fever
anorexia
A

Sarcoidosis

40
Q

The following diagnostic study results indicate…

PFTs: restrictive, can be obstructive

CXR: Hilar adenopathy

Labs:
elevated serum ACE
elevated calcium
hypercalciuria

Biopsy: EBUS-TBLB

A

Sarcoidosis

41
Q

Stage 1 Sarcoidosis CXR:

A

hilar adenopathy

42
Q

Stage 2 Sarcoidosis CXR:

A

hilar adenopathy + diffuse infiltrates

43
Q

Stage 3 Sarcoidosis CXR:

A

diffuse parenchymal infiltrates

44
Q

Stage 4 Sarcoidosis CXR:

A

pulmonary fibrosis

45
Q

What is the treatment for stage 2+ sarcoidosis?

A

high dose CS

immunosuppressants if relapsing/multisystem

Lung transplant in stage 4

46
Q

Silicosis
Coal worker’s
asbestosis

These are types of…

A

pneumoconiosis

47
Q

Which pneumoconiosis has the following characteristics:

  • inhalation of quartz
  • occupational risk, esp. mining
  • smoking increases risk
48
Q

What can be seen on HRCT in acute silicosis?

A

crazy paving pattern

49
Q

What diagnostics should be ordered to assess silicosis and coal worker’s pneumonconiosis

A

CXR, HRCT

PFTs

50
Q

A miner presents with:

CXR:

  • eggshell calcifications
  • angel’s wing appearance
  • pleural abnormalities

PFTs showing restrictive pattern

A

silicosis and coal worker’s pneumonconiosis

51
Q

What signs/sxs are common physical exam with silicosis and coal worker’s pneumonconiosis?

A

tachypnea
prolonged expiration
rhonchi, wheezing, rales

52
Q

What two sxs indicate advanced silicosis/coal worker’s pneumonconiosis?

A

cyanosis

cor pulmonale

53
Q

What is an important question to ask on hx for asbestosis?

A

occupational hx

54
Q

A patient presents with:

digital clubbing
dry cough
end-inspiratory rales

insidious onset of:
dyspnea
reduced exercise tolerance
nonspecific chest discomfort

A

Asbestosis

55
Q

You receive the following results from diagnostic studies:

CXR:

  • opacity in lower lungs
  • calcified pleural plaques

PFTs: restrictive pattern

A

Asbestosis

56
Q

Where are calcified pleural plaques typically found on CXR in asbestosis?

A

diaphragmatic/parietal pleura of 6-9th ribs

57
Q

Will immunotherapeutic drugs or CS be effective tx for asbestosis?

58
Q

What will greatly increase the already high risk for CA . with asbestosis?

A

smoking (6x)

59
Q

This condition is defined as:

inflammatory syndrome of lungs caused by repetitive inhalation of antigens

A

Hypersensitivity pneumonitis

60
Q

Is hypersensitivity pneumonitis reversible?

61
Q

What are three classifications of exposures that can cause hypersensitivity pneumonitis?

A

bacteria, fungi, mold

proteins/chemicals

Environmental exposures

62
Q

Acute, subacute or chronic hypersensitivity pneumonitis?

flu-like syndrome w/in hours of exposure

63
Q

Acute, subacute or chronic hypersensitivity pneumonitis?

insidious onset
productive cough
dyspnea
fatigue

occurring over period of weeks

64
Q

Acute, subacute or chronic hypersensitivity pneumonitis?

progressive dyspnea, cough, fatigue, malaise

65
Q

On physical exam, a patient with the following findings should be concerning for…

diffuse, fine bibasilar crackles
fever
teachypnea
muscle wasting
clubbing
weight loss
A

Hypersensitivity pneumonitis

66
Q

A patient presents with the following results from imaging…

interstitial inflammation

honeycombing

centrilobular fibrosis

peribronchiolar fibrosis

A

Hypersensitivity pneumonitis

67
Q

What is the best course of tx for hypersensitivity pneumonitis?

A

avoidance +/- CS

68
Q

What ILD has the following characteristics?

Necrotizing granuloma

systemic vasculitis of small-medium vessels

common in northern european descent

men = women

69
Q

A patient presents with the following signs and symptoms:

  • recurrent respirator infx
  • nonspecific sxs: fever, weight loss, night sweats, low appetite

Pulm:
-Infiltrates, cough, hemoptysis, dyspnea, stridor

Renal: failure, erythrocyte casts

Skin: palpable purpura, ulcers

HEENT: saddle nose deformity

70
Q

Tissue biopsy shows vasculitis, granulomatous inflammation…

71
Q

CXR shows: nodules +/- cavitation

CT Chest:
-stellate shaped peripheral pulmonary arteries (vasculitis sign)

  • feeding vessels leading to nodules
  • Diffuse hemorrhage
72
Q

What labs should be ordered for evaluating GPA? (5)

A 
ESR/CRP
CBC
CMP
UA
C-ANCA
73
Q

The prognosis of GPA is improved with…

A

cyclophosphamide

74
Q

What are the two main categories of treatment-related ILD?

A

drug induced

radiation induced

75
Q

What connective tissue disorders are associated with ILD? (5)

A 
RA
SLE
Poly/dermatomyositis
Sjogrens
Scleroderma
76
Q

The following conditions are associated with…

respiratory bronchiolitis ILD

desquamative interstitial pneumonitis

pulmonary langerhans cell histiocytosis

A

Smoking related ILD

77
Q

What is a major complication of ILD?

A

cor pulmonale/CVD

Clinical Medicine II (31 decks)

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