Respiratory Flashcards
Differentials for Interstitial Lung Disease
IREST VIDRO
Idiopathic Pulmonary Fibrosis
Rheumatological Diseases
(RA, SLE, Polymyositis, Dermatomyositis, Sjogren’s, MCTD, Ankylosing Spondylitis, Psoriasis)
Eosinophilic Lung Disease
(Aspergillosis + Medications [nitrofurantoin, sulfasalazine])
Sarcoidosis
Tuberculosis
Vasculitis
Inhaled Agents
(Extrinsic Allergic Alveolitis, Asbestosis, Silicosis, Beryliosis)
Drugs
(Amiodarone, Nitrofurantoin, Bleomycin, MTX, Gold)
Radiation Fibrosis
Other: Tuberous Sclerosis, NFT
Causes of Clubbing
3 Respiratory: - Suppurative Lung Disease (CF + Bronchiectasis) - Interstitial Lung Disease - Lung Cancer 3 Cardiac: - Cyanotic Heart Disease - Infective Endocarditis - Myxoma 3 Other: - Thyroid (Graves) - GI / IBD / Hepatopulmonary - Idiopathic
Management of IPF
Non-Pharmacological
- smoking cessation
- oxygen therapy
- ordine
Pharmacological
- anti-fibrotic agents (nintendanib + pirfinedone)
Transplant (single or double lung)
Investigations in IPF
Bloods - FBC, inflammatory markers (ESR + CRP), Immunoglobulins, ANA, ENA, ANCA, antiGBM, CK, myositis panel, RF, anti-CCP, serum ACE, Precipitins
ABG
CXR - bibasal reticular markings, destruction of parenchyma (honeycombing), bilateral hilar lymphadenopathy, pleural plaques (asbestosis)
Pulmonary Function Tests - FVC/FEV1 ratio (restrictive), FEV1, FVC, TLC, DLCO (reduced = impaired gas exchange)
HRCT
- UIP pattern (subpleural and basal predominance of reticulation, honeycombing with traction bronchiectasis)
- NSIP pattern (reticulation, ground glass changes with traction bronchiectasis - better prognosis)
Bronchoscopy - lavage + biopsy
Causes of Apical Lung Fibrosis
BREASTS CLAP Berylliosis Radiation Extrinsic Allergic Alveolitis (Hypersensitivity Pneumonitis) ABPA - Allergic Bronchopulmonary Aspergillosis Sarcoidosis TB Silicosis
Coal worker’s pneumoconiosis
Langerhans’ Histiocytosis
Ank Spondy
Psoriasis
