Pulmonary Manifestation of Systemic Disease

Question 1

Differential Dx mneumonic

Answer 1

• VINDICATE
• Vascular
• Infection
• Neoplasm
• Drugs
• Inflammatory/idiopathic/iatrogenic
• Congenital
• Autoimmune
• Trauma
• Endocrine/metabolic

Question 2

Pulmonary anatomic differential includes:

Answer 2

•Airways •Alveoli •Interstitium •Vascular •Pleura •Chest wall •Extrathoracic

Question 3

ALS + pulmonary manifestations

Answer 3

• progessibve neurogenerative disease –> weakness
• •Chronic aspiration due to uncoordinated pharyngeal muscle movement (“bulbar dysfunction”)
• •Recurrent pneumonia
• •Respiratory muscle weakness
  
  • –Inadequate ventilation
  • –Nocturnal hypoventilation
  • –Weak cough

Question 4

Dx of pulmonary disease associated w/ALS

Answer 4

• CXR: right middle lobe infiltrates from chronic aspiration + low lung volumes
• PFTs:
  
  • Restrictive pattern: airflow symmetrically reduced; reduced TLC
  • •Reduced maximal inspiratory pressure (MIP) and reduced maximal expiratory pressure (MEP)
  • •Reduced maximum voluntary ventilation (MVV)
  • •Generally normal DLCO initially; prolonged hypoventilation results in atelectasis and shunt.

Question 5

Neuromuscular diseases (acute, relapsing, chronic)

Answer 5

• Acute: Guillain-Barre (GBS)
• Relapsing: Multiple sclerosis (MS), myasthenia gravis (MG)
• Chronic, progressive: ALS

Question 6

Neuromuscular diseases anatomical locations

Answer 6

• Spinal cord: MS, infarct, trauma, tetanus, transverse myelitis, tumors
• Motor nerves –ALS, polio, GBS, Phrenic nerve injury
• NM junction –Botulism, MG, Lambert Eaton, organophosphates
• Muscles –HypoK, hypophos, muscular dystrophy, polymyositis, thyroid disease

Question 7

RA + pulmonary manifestation

Answer 7

• RA = systemic autoimmune disease w/symmetric inflammatory arthritis
• •Pleuritis
• •Pleural Effusion
• •Airway obstructions
• •Interstitial Lung Disease (UIP > NSIP)
• •Pulmonary Hypertension
• •Drug reactions (esp methotrexate, sulfasalazine)
• •Pulmonary infections due to immunosuppression

Question 8

Connective tissue disease w/pulmonary manifestation

Answer 8

• SLE
• RA
• •Systemic sclerosis (scleroderma)
• •Sjogren’s disease (autoimmune destruction of exocrine glands)
• •Dermatomyositis/polymyositis
• •Mixed connective tissue disease
• •Ankylosing spondylitis

Question 9

Systemic diseases that lead to diffuse alveolar hemorrhange + renal disease

Answer 9

• Granulomatosis with polyangiitis (formerly Wegener’s)
• Microscopic polyangiitis
• Churg-Strauss Syndrome
• Goodpasture’s Syndrome (Anti-GBM disease)
• Systemic Lupus Erythematosus
• Systemic Sclerosis (Scleroderma)
• Henoch-Schonlein Purpura
• Cryoglobulinemia

Question 10

Pulmonary manifestations of IBD

Answer 10

• •Tracheobronchitis
• •Bronchiectasis ==> obstructive
• •Bronchiolitis ==> obstrutive
• •Pleural Effusion ==> restrictive
• •Interstitial Lung Disease ==> restrictive
• •Pulmonary embolism
• •Drug complications
• •Infections

Question 11

Common types of Obstructive disease

Answer 11

–Tracheobronchitis

–Bronchiectasis

–Bronchiolitis

Question 12

Common Types of Restrictive Disease

Answer 12

–Pleural Effusion

–Interstitial Lung Disease

Question 13

Pulmonary Manifestation of Sickle Cell Disease

Answer 13

• •Infection
• •Embolic phenomena due to bone marrow infarction and fat emboli
• •Infarction caused by in-situ thrombosis
• •Hypoventilation due to rib and sternal infarctions
• •Pulmonary Edema due to excessive hydration
• •Pulmonary hypertension
• •Chronic lung disease

Question 14

Pulmonary complications in HIV (infectious)

Answer 14

• Bacterial pneumonia
• Tuberculosis
• Pneumocystis jirovecii (PCP)
• Fungal pneumonia
• Viral pneumonia

Question 15

Pulmonary complications in HIV (noninfectious)

Answer 15

• Kaposi’s sarcoma
• Non-Hodgkin’s lymphoma
• Lung cancer
• Emphysema
• ILD
• Pulmonary HTN
• Effusions –Parapneumonic –TB –Malignant; esp lymphoma