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Spr2015_Week6 > Pulmonary Manifestations of systemic disease > Flashcards

Pulmonary Manifestations of systemic disease Flashcards

1
Q

DDX pneumonic

A 
V = vascular
I = infection
N = neoplasm
D = drugs
I = inflamm/idiopathic/iatrogenic
C= congenital 
A = autoimmune
T = trauma
E = endocrine/metabolic
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2
Q

Anatomic differential for lungs

A

1) airway
2) alveoli
3) interstitium
4) vascular
5) pleura
6) chest wall
7) extrathoracic

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3
Q

Case 1
62 y/o male dx with ALS difficulty writing and buttoning
presents with dyspnea on exertion and more lethargic with confusion

numerous recent pneumonias
weak cough worse with drinking

A

a

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4
Q

Define ALS
what is it a disease of?

symptoms

A

progressive neurodegenerative disease

muscle weakness with upper and lower motor neurons dysfunction

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5
Q

patients with ALS may develop ___

A

dysphagia due to uncoord pharyngeal muscle movement –> aspiration of fluids and food

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6
Q

pulm manifestations of ALS

A

1) chronic aspiration due to uncoord pharyngeal muscle movement (bulbar dysfunction)
2) recurrent pneumonia
3) resp muscle weakness

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7
Q

effects of resp muscle weakness in ALS

A

1) inadeq ventilation to move CO2
2) nocturnal hypoventilation
3) weak cough risk of aspiration

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8
Q

steps to diagnose pulm disease

A

1) CXR
2) PFT
3) ABG

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9
Q

what will CXR show for ALS

A

1) right middle lobe infiltrate from chronic aspiration
filling defect next to soft tissue –> obscure right heart border

2) low lung volumes from chest wall weakness

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10
Q

what will PFTs show for ALS (6 things)

A

RESTRICTIVE

1) decr FEV1, FVC but normal ratio
2) decr TLC
3) decr FVC in supine
4) decr MIP and MEP
5) decr max voluntary ventilation (measure volume after max expiration/inspriation for 12s)
6) normal DLCO initially but can then lead to atelectasis and shunt from prolonged hypoventilation

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11
Q

if you see decr FEV1, FVC but normal ratio

decr TLC
decr FVC in supine
decr MIP and MEP

what could patient have?

A

ALS

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12
Q

P-V curve for ALS

A

shifted down due to chest wall weakness and restrictive disease

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13
Q

what will ABG show for ALS

A

elev PCO2 or hypercarbia

pH 7.35
pCO2 55 mmHg
pO2 68 mmHg
HCO3 32 mmHg

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14
Q

How do you treat pulm effects of ALS

A

1) noninvasive Positive pressure ventilation with biPAP
2) aspiration precaution
3) cough assistance

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15
Q

CASE 2
what does she have?

32 y/o woman Hx of RA
chest pain, SOB, DOE
SOB worse with supine

Dull to percussion on left chest
bilateral knee, ankle, wrist pain and MCP swelling

A

rheumatoid effusion

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16
Q

Describe RA

A

autoimmune disease

symmetric inflamm arthritis

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17
Q

exam of RA

A

synovitis with tender, swollen, boggy joint

in symmetric small and large joints (wrist/shoulder)

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18
Q

Labs for RA

A

Positive RF and anti-citrullinated peptide

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19
Q

how do you treat RA

A

1) NSAIDS

2) DMARDS

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20
Q

Pulm manifestations of RA

A

1) pleural disease
2) upper/smaller airway obstruction (bronchiolitis/bronchiectasis)

3) ILD (UIP>NSIP)

4) pneumonia
5) pulm HTN
6) vasculitis
7) pulm infection

21
Q

CXR of RA

A

can show pleural effusion

22
Q

PFTs of RA

A

Restrictive pattern with pleural effusion

decr DLCO b/c 1.5L in pleural space displacing lung

shunt and V/Q mismatch from lung collapse

23
Q

pleural fluid containing
high glucose and low pH

ddx?

A

infection but also RA

24
Q

if culture and cytology negative this means?

A

no malignancy or infection

25
Q

ddx of pleural fluid

A

1) rheumatoid effusion
2) empyema (infected pleural space)

3) TB effusion
4) malignant effusion
5) drug tox

26
Q

CTD with pulm manifestations

A

1) SLE
2) RA
3) scleroderma
4) DM/PM
5) mixed CTD
6) Ankylosing spondylitis

27
Q

CASE 3
what does she have?

36 y/o 1-2 week of swelling in hand and face
hemoptysis
decr urinary frequency

lab shows acute renal failure
urine shows protein, RBC, WBC, granular casts

A

Goodpasture’s

diffuse alveolar hemorrhage
rapidly progressive glomerulonephritis

28
Q

airway DDx for hemoptysis

A

1) bronchitis
2) bronchiectasisi
3) cancer
4) aspirated foreign body
5) alveolar hemorrhage syndrome (capillary inflammation, alveolar damage
6) pneumonia/abscess

29
Q

evaluation of patient what would you order

36 y/o 1-2 week of swelling in hand and face
hemoptysis
decr urinary frequency

lab shows acute renal failure
urine shows protein, RBC, WBC, granular casts

A

1) CXR

2) bronchoscopy with bronchoalveolar lavage to find blood in alveoli

30
Q

what would CXR show

36 y/o 1-2 week of swelling in hand and face
hemoptysis
decr urinary frequency

lab shows acute renal failure
urine shows protein, RBC, WBC, granular casts

A

patchy alveolar infiltrates with blood

alveolar hemorrhage

31
Q

what would PFT show

36 y/o 1-2 week of swelling in hand and face
hemoptysis
decr urinary frequency

lab shows acute renal failure
urine shows protein, RBC, WBC, granular casts

A

restrictive disease with incr DLCO

all blood filling alveoli
ineffective Hb binds CO

32
Q

pulm manifestation of goodpastures

A

diffuse alveolar hemorrhage

progessive glomerulonephritis

antibodies against glomerular basement membrane

33
Q

CASE 4
what does he have?

27 y/o hx of cramps and pain and diarrhea

fever and fatigue
productive cough with yellow green sputum
SOB
numerous pneumonia hx

no asthma, no smoker
scattered wheezes

A

IBD

bronchiectasis

34
Q

pulm manifestation of IBD

A

Obstructive
1) tracheobronchitis

2) subglottic stenosis = fixed obstruction
3) bronchiectasis
4) bronchiolitis

Restrictive
5) PE

6) ILD usu ILD
8) infection

35
Q

CXR with bronchiectasis

A

decr lung volumes

1) tram tracking = walls of bronchus dilated and thicken

36
Q

if you see bronchiole walls surrounded by something on CXR what is it?

A

air bronchogram

37
Q

CT with bronchiectasisi

A

dilation of airway –> as go distally, tapered size until terminal bronchiole/alveoli

38
Q

CASE 5
what does he have?

32 y/o black hx of sickle cell
runny nose, sore throat
incr SOB with yellowing of eyes
severe Chest pain, fever, cough

A

acute chest syndrome

39
Q

pulm manifestation of sickle cell

A

1) infection
2) embolism due to sickle cell occlude vessel –> bone marrow infarct and fat emboli

3) infarct from in-situ thrombosis
4) hypoventilation from rib and sternal infarcts
5) pulm edema from XS hydration
6) pulm HTN
7) chronic lung disease and scarring

40
Q

describe acute chest syndrome manifestation

A

new pulm infiltrate

chest pain

fever

cough, wheeze, tachypnea

41
Q

Acute chest syndrome

CXR

A

1) bilateral diffuse alveolar and interstitial infiltrates

2) reticular appearance

42
Q

Treatment of acute chest syndrome

A

1) antibiotics for PNA
2) O2 supplementation
3) transfusion

43
Q

why give O2 supplementation for acute chest syndrome

A

1) patient’s cells are sickling and lysing so not providing adequate O2 delivery
2) if transfuse healthy RBC, dilute sickled RBC so no flow problems

44
Q

CASE 6
what cause hemoptysis

42 y/o HIV+
hemoptysis x10 days
fever, chills, dyspnea

smokes cigarette, IVDU
unknown CD4

A

Kaposi’s sarcoma in his airway causing alveolar hemorrhage

45
Q

pulm complications of HIV

infectious

A

even if CD4 well controlled
1) bacterial pneumonia

2) TB
3) PCP
4) fungal/viral pneumonia

46
Q

pulm complications of HIV

noninfectious

A

1) Kaposi’s sarcoma = prolif of endothelium
2) non-Hodgkins’ lymphoma
3) Lung cancer
4) emphysema
5) ILD: lymphocytic interstitial PNA, NSIP
6) pulm HTN
7) effusions = TB, lymphoma

47
Q

evaluation of HIV patient with hemoptysis and pulm problems

A

1) CXR and CT
2) Cultures for infection
3) bronchoscopy due to alveolar hemorrhage

48
Q

what would CXR show for alveolar hemorrhage

A

bilateral alveolar filling

and/or bilat pneumonia

49
Q

what are skin findings of Kaposi’s sarcoma

A

purport that can be on skin and line bronchi

affecting endothelium of airway

Spr2015_Week6 (9 decks)

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