Pulmonary Manifestations of Systemic Disease

Question 1

What is does the differential diagnosis pneumonic VINDICATE stand for?

Answer 1

• Vascular
• Infection
• Neoplasm
• Drugs
• Inflammatory/idiopathic/iatragenic
• Congenital
• Autoimmune
• Trauma
• Endocrine/Metabolic

Question 2

What are patients with Amyotrophic lateral sclerosis (ALS/Lou Gerrig’s Disease) at high risk for as it relates to pulmonary disease?

*Hint*: This card applies to all patients with neuromuscular weakness

Answer 2

• ALS is a neurologic disorder that can often lead to dysphagia
  
  • Chronic aspiration
  • Recurrent pneumonia
  • Respiratory muscle weakness
    
    • Inadequate ventilation
    • Nocturnal hypoventilation
    • Weak Cough

Question 3

What are patients with a rheumatologic condition, like rheumatoid arthritis, at risk for as it relates to pulmonary disease?

Answer 3

• Pleural Effusion/Pleuritis
• Pneumothorax
• Airway obstruction
• Interstitial Lung Disease (ILD)
• Organizing pneumonia
• Pulm HTN
• Vasculitis
• Drug rxn (especially methotrexate)

Question 4

What test would you order for someone with hemoptysis?

Answer 4

• Chest X-ray
• Bronchoscopy w/ bronchoalveolar lavage to identify if blood is in the alveoli
  
  • See attached
    
    • Notice how 3 is darker than 1, this is indicative of an active alveolar bleed
    • If the fluid got more clear instead of darker it would be indicative of an upper airway bleed not alveolar

Question 5

Question: Your patient has an alveolar hemorrhage will his DLCO be elevated, normal, or decreased?

Answer 5

DLCO will be elevated

• This is b/c the hemorrahged blood in the alveoli will still bind the CO even though there is obviously an issue with diffusion
  
  • Essentially it would be a false elevation

Question 6

What are the pulmonary manifestations of someone with Inflammatory bowel disease (IBD)?

Answer 6

• Bronchitis
• Bronchiectasis
• Bronchiolitis
• Pleural Effusion
• ILD
• Pulmonary Embolism
• Drug Complications

Question 7

What are the pulmonary complications of immunocompromised patients? (e.g. patients with HIV)

Answer 7

• Infectious
  
  • Bacterial/Fungal/Viral Pneumonia
  • TB
• Noninfectious
  
  • Kaposi’s sarcoma
  • Lung Cancer
  • Emphysema
  • ILD
  • Pulm HTN
  • Effusions