Restrictive Pulm Diseases Flashcards
Etiology of interstitial lung disease?
Infectious, drug related, occupational
In order for pulmonary fibrosis to be considered “idiopathic,” you must be sure to what? Give examples if possible
Rule out other common causes such as drugs, environmental, or occupational exposures
EX) Medications (methotrexate, amiodarone, nitrofurantoin, rituximab, bleomycin, cyclophosphamide), viral infections, genetics, radiation treatment, GERD, environmental pollutants (silica, hard metal dusts, bacteria, animal proteins, gases, fumes)
What type of patients typically present with idiopathic pulmonary fibrosis?
M > F
60-70+ years old, rare in <50 years old
Smokers
Workers that have exposure to stone, metal, wood, and organic dusts
What kind of physical exam symptoms would you see with idiopathic pulmonary fibrosis?
Gradual onset of dyspnea on exertion with nonproductive cough over several months.
Raynauds and their jobs can also be strong clues.
60 year old male who is a current smoker presents with a 10 month history of respiratory symptoms including dyspnea on exertion, thoracic pain, and dry cough, which were preceded by pulmonary infection. You order a CXR which shows looks “lacey,” a CT showing “honeycombing,” and a spirometry which showed decreased lung volume with a normal FEV1/FVC ratio. What would you diagnose?
Idiopathic pulmonary fibrosis
Group these agents/occupations where they normally affect the lungs (1 or 2).
Coal dust (coal miners)
Beryllium (dental, computer, aerospace, fluorescent lights)
Talc (ceramics, plastics, rubber, paint, cosmetics)
Silica (mining, quarrying, drilling, sandblasting)
Hard metal/cobalt (diamond polishing, cobalt mining)
Asbestos (asbestos mining, insulation, brakes, construction)
- Upper lobe | 2. Lower lobe
- Coal dust, beryllium, talc, silica
2. Hard metal/cobalt, asbestos
What type of malignancy is asbestosis normally associated with?
Mesothelioma
True or False
For asbestosis, the latency period between exposure and symptoms is inversely proportional to the intensity of asbestos exposure?
True
True or False
Cough, sputum production, and wheezing are commonly seen in asbestosis
False
It normally is unusual, if present it tends to be a consequence of cigarette smoking rather than asbestos-induced lung disease
What is cor pulmonale?
Right ventricular enlargement secondary to a lung disorder that causes pulmonary artery hypertension
Describe what you see and what you would diagnose
Description: Hazy, “ground glass” appearance, “shaggy heart” sign
Diagnosis: Asbestosis
What are the treatments for asbestosis?
No specific treatments, just focus on preventive and supportive measures
What are the states where most coal is mined?
Probably won’t matter but it might be good to know for a clinical vignette
Eastern Pennsylvania Western Maryland West Virginia Virginia Kentucky
What are common CXR findings for coal worker’s lungs?
Nodular opacities at upper lung fields
What infectious disease has an increased risk for patients with silicosis?
Tuberculosis
Patients with silicosis are at about a 30-fold increased risk of pulmonary TB
