Unit 3-various lung diseases Flashcards
Sarcoidosis
systemic disease of unknown etiology
granulomatous inflammation of the lung
sx: skin, lung, eyes, peripheral nerves, liver, kidney, heart
onset- 30-40
sarcoidosis s/sx
insidious onset of malaise, fever, dyspnea
seek care d/t: erythema nodosum, lupus pernio, iritis, peripheral neuropathy, arthritis, cardiomyopathy
bilateral hilar and R paratracheal adenopathy on CXR
atypical interstitial lung disease
parotid gland enlargement, hepatosplenomegaly, lymphadenopathy
lab findings with sarcoidosis
leukopenia, elevated ESR, hypercalcemia, hypercalcemuria
angiotensin-converting enzyme (ACE) levels elevated
PFT: obstructive airflow
skin test anergy: present in 70%
dysrhythmia
diagnostic imaging stages
- blateral hilar adenopathy alone
- hilar adenopathy and parenchymal involvement
- parenchymal involvement alone by reticular infiltrates
- advanced fibrotic changes in upper lobe
Dx of sarcoidosis
requires histological demonstration of noncaseating granulomas in biopsy
*must exclude granulomatous disease
BAL>increase in lymphocytes and high CD4/CD8
**BIOPSY necessary w/ possibly alt dx
All pt with sarcoidosis require what kind of exam?
a. cardiac
b. gastrointestinal
c. pulmonary
d. opthalmogic
d. optho
tx for sarcoidosis
PO corticosteroids
long term therpay required
immunosuppressive medication (Methotrexate) used in those who cannot tolerage corticosteroids
20% have irreversible lung damage
Pulmonary metastes
spread of extrapulm malignant tumor through vascular of lymphatic channels
nodules on CXR
Most are INTRAPARENCHYMAL
Risk factors for pulm metastes
carcinoma of kidney, breast, rectum, colon, cervix, malignant melanoma , head and neck CA, lymphatic carcinomatosis
S/sx pulm metastes
uncommon, cough, hemoptysis, dyspnea, hypoxemia
Bronchiogenic carcinoma essentials of diagnosis
New cough, change in cough
dyspnea, hemoptysis, anorexia, weight loss
enlarging nodule or mass, persistent opacity, atelectasis, pleural effusion on cxr or CT
cytologic or histologic finding of lung CA in sputum, pleural fluid, or biopsy
Risk factors for bronchiogenic carcinoma
smoking, radon, asbestos, diesel exhaust, ionizing radiating, metals-arsenic/chromium/nickel/iron oxide
family hx of lung CA, (pulm fibrosis, COPD, sarcoidosis)
70 year old
Clinical findings of bronchiogenic carcinoma
majority are symptomatic at dx
depends on type and location of primary tumor, extent of spread, presence of distant mets
s/sx bronchiogenic carcinoma
anorexia, weigh loss, asthenia>55-90%
new cough, change in chronic cough 60%
dyspnea, hemoptysis, anoxeria
pain-non specific chest pain
local spread of disease
Mesothelioma essentials of dx
unilateral, nonpleuritic chest pain and dyspnea
distant hx of exposure to asbestos
pleural effusion or pleural thickening or both on CXR
malignant cells in pleural fluid/tissue biopsy
Where do mesotheliomas primary tumors lay?
arise from surface lining of pleura or peritoneum
Biggest risk factor for mesothelioma
a. mold
b. asbestos
c. CA
d. smoking
B. asbestos
inquire about exposure through work
s/sx of mesothelioma include
insidious onset of SOB, nonpleuritic chest pain, weight loss
dullness to percussion, diminished breath sounds, digital clubbing
onset to sx = 2-3 months
To determine primary diadnosis of pulm metas, one would use?
immunohistochemical staining on biopsy specimen
When bronchiogenic carcinoma has spread to liver what will you see?
a. jaundice
b. asthenia and weight loss
c. severe abd pain with jaundice
d. h/a, n/v
b. asthenia and weight loss
When bronchiogenic carcinoma has spread to brain what will you see?
H/A, N/V, seizures, dizzy, AMS
paraneoplastic syndrome
patterns of immune mediated or secretory effects of neoplasms (SIADH, hypercoagulability, peripheral neuropathy)
smoke inhalation 3 consequences
impaired tissue oxygenation
thermal injury to upper airway
thermal injury to lower airways and lung parenchyma
Impaired tissue oxygenation is caused from?
a. inhalation of super-heated gases
b. inhalation of toxic gases and products of combustions
c. inhalation of a hypoxemic gas mixture, carbon monoxide or cyanide
d. non of the above
c. INHALATION OF HYPOXEMIC GAS MIXTURE, CARBON MONOXIDE OR CYANIDE W/ ALTERATIONS IN V/Q MATCHING
immediate THREAT! Requires 100% O2
continue till Carboxyhemoglobin levels fall less than 10% and metabolic acidosis resolves
Thermal injury to UPPER airway is caused from?
a. inhalation of super-heated gases
b. inhalation of toxic gases and products of combustions
c. inhalation of a hypoxemic gas mixture, carbon monoxide or cyanide
d. non of the above
a. INHALATION OF SUPER-HEATED GASES
mucosal edema, upper airway obstruction, inability to clear oral secretions
use high-HUMIDITY mask for O2, gentle suctioning, HOB 30, topical epi,
helium-gas mixture
monitor ABG
Thermal injury to LOWER airway and lung parenchyma caused from?
a. inhalation of super-heated gases
b. inhalation of toxic gases and products of combustions
c. inhalation of a hypoxemic gas mixture, carbon monoxide or cyanide
d. non of the above
b. INHALATION OF TOXIC GASES AND PRODUCTS OF COMBUSTIONS
site of injury depends on solubility of gas
1st sign=bronchorrhea, bronchospasms+dyspnea, tachypnea, tachycardia>labored breathing, and cyanosis
1-2days=ARDS
2-3= sloughing airway mucosa, worsening hypoxeia
5-7=bacterial colonize and PNA
T or F: using routine corticosteroids can be beneficial for smoke inhalation
FALSE
no benefit and can be harmful
Acute aspiration of gastric contents (Mendelson Syndrome)
Pulmonary response to aspiration depends on gastric contents aspirated
more acidic=chemical pneumonitis
Gastric pH of less than___ can cause extensive desquamation of bronchial epithelium and ARDS
a. 7.3
b. 5
c. 2.5
d. 8
C. less than 2.5
What are the sx of pulmonary aspiration syndrome?
abrupt onset of respiratory distress +cough, wheezing, fever, tachypnea
Will hear CRACKLES at bases, hypoxemia immediately after aspiration
patchy opacities on CXR
How to tx pulmonary aspiration syndrome?
supplemental O2, maintain airway, tx acute resp failure
What are some causes of chronic pulmonary aspiration syndrome?
cigarettes, ETOH/caffeine, theophylline> relax the lower esophageal sphincter>risk of GERD
asthma, chronic cough, bronchiectasis, pulmonary fibrosis
What is Café Coronary:
acute obstruction of upper airway by food
What is hydrocarbon pneumonitis?
a. r/t aspiration of food
b. caused by arpiration of petroleum distillates
c. caused by asthma medication
d. caused by repeated aspiration of oily materials
b. caused by aspiration of ingested petroleum distillates
gasoline, kerosene, furniture polish>vomit and aspirate
What is lipoid pneumonia?
a. r/t aspiration of food
b. caused by arpiration of petroleum distillates
c. caused by asthma medication
d. caused by repeated aspiration of oily materials
d. Chronic syndrome d/t repeated aspiration of oily materials
minearl oil, cod liver oil, oily nose drops
Pneumoconiosis is chronic fibrotic lung disease caused by?
a. inhalation of inorganic dust
b. inhalation of steroids
c. aspiration of gases
d. aspiration of smoke
a. Inhalation of inorganic dusts
may be asymptomatic w/ diffuse nodular opacities on CXR or severe life shortening disease
What is coal-workers pneumoconiosis?
a. Exposure to asbestor fibers
b. extensive or prolonges inhalation of free silica
c. inhalation of coat dust
d. presence of necrobiotic rheumatoid nodules
C. inhalation of coast dust
CXR= diffuse small opacitites
usually asymptomatic, may have effects on ventilatory function
What is Caplan Syndrome?
a. Exposure to asbestor fibers
b. extensive or prolonges inhalation of free silica
c. inhalation of coat dust
d. presence of necrobiotic rheumatoid nodules
d. rare condition characterized by presence of NECROBIOTIC RHEUMATOID NODULES in the periphery of the lungs with RA
What is Silicosis?
a. Exposure to asbestor fibers
b. extensive or prolonges inhalation of free silica
c. inhalation of coat dust
d. presence of necrobiotic rheumatoid nodules
b. Extensive or prolonged inhalation of free silica
(silicon dioxide)> formation of small rounded opacities throughout lungs
CXR: periphery of hilar lymph nodes “EGGSHELLS”
usually asymptomatic
What is Asbestosis?
a. Exposure to asbestor fibers
b. extensive or prolonges inhalation of free silica
c. inhalation of coat dust
d. presence of necrobiotic rheumatoid nodules
A. Exposed to asbestos fibers over many years
usually seek medical after 15 years d/t progressive dyspnea, inspiratory crackles, clubbing and cyanosis
CXR: honeycomb changes in advanced cases
CT is BEST option
T or F: Smoking in asbestos workers increases prevalence of pleural and parenchymal changes and incidence of lung carcinoma
TRUE
can interfere w/ clearance of short asbestos fiber from lungs
PFT:restrictive dysfunction and reduced diffusing capacity
NO TX
What is hypersensitivity pneumonitis?
nonatopic, nonasthmatic inflammatory pulmonary disease
Can be reversible if caught early
Interstitial infiltrates of lymphocytes and plasma cells w/ noncaseating granulomas in the interstitium and air space
What is tx for hypersensitivity pneumonitis
avoid future exposure
severe or protracted= prednisone
What is occupational asthma?
a. asthma-like disorder in textile workers
b. agents in workplace trigger asthma
c. chronic bronchitis found in coal miners
d. none of the above
b. Agents in workplace (dust, tobacco, pollen, enzymes, dyes, and various other agents) trigger asthma
Tx: avoid trigger, bronchodilators
What is industrial bronchitis?
a. asthma-like disorder in textile workers
b. agents in workplace trigger asthma
c. chronic bronchitis found in coal miners
d. none of the above
C. chronic bronchitis found in coal miners and those exposed to cotton, flax, hemp dust
What is byssinosis?
a. asthma-like disorder in textile workers
b. agents in workplace trigger asthma
c. chronic bronchitis found in coal miners
d. none of the above
A. asthma-like disorder in textile workers caused by inhalation of cotton dust
sx: chest tight, cough, dyspenea that is WORSE on Monday and subside throughout week
What causes Toxic lung injury?
inhalation of irritant gases
silo-fillers disease: acute toxic high permeability pulmonary edema caused by inhalation of NITROGEN dioxide
extensive exposure=FATAL
Diacetyl: popcorn worker
What are pulmonary carcinogens
asbestos radon gas arsenic iron chromium nikcle coal tar fuems petroleum oil ispropyl oil mustard gas printing ink cigarette smoke
What causes pleural disease?
Asbestos or Talc
Talc= pleural plaques
asbestos: blunting of costophrenic angle on CXR
What are the 2 randomized controlled trials for pulmonary neopplasm?
PLCO
NLST
PLCO
prostate, lung, colorectal, and ovarian CA
NLST
National lung screening trial
Solitary pulmonary nodules are
D. 3cm
most asymptomatic, and dx found on CXR
Risk factors for solitary pulmonary nodules
> 30, smokers, prior malignancy
T or F: imaging can help estimate the probability of malignancy in solitary pulmonary nodules
TRUE
size correlates w/ malignancy
ill-defined margins or a lobular appearance suggest malignancy
DX of solitary pulmonary nodules are best with
high-resolution CT
Can use PET scan, sputum cytology, VATS
Urticaria & angio edema are caused by?
a. eosinophils
b. neutrolphils
c. mast cells
d. lymphocytes
C. Mast cell degranulation in the skin
commonly caused by virus , food allergy, drug allergy, serum sickness
Urticaria & angio edema first line treatment
2nd generation PO antihistamines
Omalizumab 3rd line, effective for urticaria
T or F: Urticaria lesions classified by trigger
TRUE
mast cell activation & degranulation
infectious= strep, mycoplasmsa, HBV, H.pylori
s/sx urticaria
wheals w/ reflex erythema, pruritic & transient, resolve after hours
s/sx angioedema
rapid erythematous or skin-colored swelling associated w/ burning or pain
What cells are released during anaphylactic shock?
mast cells and basophils
Lab findings in anaphylactic shock
ST depression, BBB, arrhythmias
hypoxemia
hypercapnia
acidosis
CXR:hyperinflation
Tx for anaphylactic shock
EPI repear q 5-15 min
antihistamines- Diphenhydramine 2nd line, ceririzine in kids
Ranitidine may be added
IVF, bronchodilator, corticosteroids, vasopressors, observation
T or F: abx most common drug reaction
TRUE amox, bactrim, ampicillin
PCN and other beta-lactams= cross sensitivity (cephalo, carbacephems)
tx w/ radiocontract media dye
low-molarity agent with prednisone, benadryl, and possibly H2 blocker
Insulin reaction
IgE reactions are rare
Resistance with IgG
s/sx associated with ASA and NSAIDS
urticaria, angioedema, rhinosinusitis, nasal polyps, asthma, anaphylactoid reactions
Highest prevalence of food allergies found in kids with?
a. asthma
b. atopic dermatitis
c. latex allergy
d. PCN allergy
B. Atopic dermatitis
caused by mixed IgE and non-IgE
occurs 2 hours after ingestion
Children who have had anaphylactic reactions to hymenoptera stings should have a?
Epi pen and wear medical bracelet
hymenoptera= honeybees, yellow jackets, yellow and white hornets, wasp, fire ants
tx for insect reactions
cold compress
antipruritics (antihistamines)
topical corticosteroids
remove stinger by flicking
elevate
PO NSAIDS
T or F: most cases of hemoptysis are self-limiting and resolves w/ tx of underlying condition
TRUE
bleedinsg occurs within the airways, lung parenchyma or capillary beds after?
a. inflammation
b. trauma
c. erosion
d. all of the above
D. ALL OF THE ABOVE
Central cyanosis corresponds to oxygen saturation of <=___-____
a. 50-60%
b. 85-100%
c. 25-50%
d. 75-80%
D. 75-80%
Massive hemoptysis is considered expectorating >___cc per 24hr
200cc
or 60cc over 2 hours
What hx would you want from a pt with hemoptysis?
epistaxis
GI sx
pain w/ eating
ASA
NSAIDS
warfarin
timing
color
consistency
smoking
drugs-inhaled
Class triad of PE include:
hemoptyosis
dyspnea
chest pain
Frequent or daily production of foul-smelling sputum may suggest?
Bronchiectasis
tx: abx, aggressive pulmonary hygiene
Bleeding in excess of ___cc per day or
hemoptysis that lasts longer than one week or is otherwise unexplained
should prompt referral to a pulmonologist
30cc
