Week 3 Flashcards
What are 2 common PFT abnormalities in interstitial lung disease?
- Restrictive Defect
- Reduced DLCO
[2/8/21 SM167]
What is the imaging test of choice in suspected ILD?
High-resolution CT (HRCT)
The increased resolution and thin slices allow for identification of specific radiographic patterns that can be diagnostic of specific diseases in patients with lung fibrosis. A chest x-ray is almost never sufficient.
[2/8/21 SM167]
What are characteristic findings of sarcoidosis?
Younger patient
upper-lobe nodules and/fibrosis + hilar adenopathy
path with tightly formed granulomas
Responsive to steroids
[2/8/21 SM167]
What are characteristic findings of hypersensitivity pneumonitis?
Due to inhalation of organic antigens
Upper lobe predom
a lot of lymphocytes on bronchoalveolar lavage
loose granulomas on biopsy
Tx: removal from offending antigen +/- steroids
[2/8/21 SM167]
What are the clinical presenting signs/symptoms of ILD?
dyspnea
fine Velcro crackles on pulm eval
[2/8/21 SM167]
What is the prognosis of IPF compared to other ILDs?
Notably worse (mean survival 3.5 years)
[2/9/21 SM168]
What are 2 pharmacotherapy options for IPF?
Pirfenidone and nintedanib
Slow decline in FVC but don’t improve mortality, GI side effects
[2/9/21 SM168]
What is the UIP Pattern on HRCT?
Subpleural, basilar predominant fibrosis, reticulation, and honeycombing
A classic UIP pattern + a consistent history = IPF w/o need for further testing
[2/9/21 SM168]
What is the only group of Pulmonary Hypertension with a curative therapy?
Group IV (chronic thromboembolic pulmonary hypertension)
diagnose with a V/Q scan
curative therapy is a pulmonary thromboendarterectomy
[2/9/21 SM171]
Where is the lesion for Group 1 Pulmonary Hypertension?
Group 1 PAH: Small arterioles
[2/9/21 SM171]
Where is the lesion for Group 2 Pulmonary Hypertension?
Group 2 PVH: Pulmonary veins
[2/9/21 SM171]
Where is the lesion for Group 3 Pulmonary Hypertension?
Group 3 (Lung Disease): Pulmonary capillary bed
[2/9/21 SM171]
Where is the lesion for Group 4 Pulmonary Hyper Tension?
Group 4 CTEPH: Larger pulmonary arteries
[2/9/21 SM171]
What is Light’s Criteria in the setting of pleural effusion?
Pleural fluid total protein/serum total protein (TPef/TPserum) > 0.5
Pleural fluid LDH/serum LDH (LDHef/LDHserum) > 0.6
Pleural fluid LDH (LDHef) > 2/3 Upper Normal Value
If any of these=exudative, if not transudative
“Know these” -Dr. W
[2/10/21 SM169]
Differential Diagnosis for Transudative Effusion?
- CHF
- cirrhosis
- nephrotic syndrome
- other volume overload states (end stage renal disease with missed dialysis)
[2/10/21 SM169]
Differential Diagnosis for lymphocyte predominant Exudative Effusion?
- Malignancy
- TB
- connective tissue disease
[2/10/21 SM169]
What is the algorithm for Pulmonary Embolism diagnosis?
Low pre-test prob (Wells 4 or less) –> d-dimer. If low you are done. If high –> CTPA
High pre-test prob (Wells >4) –> CTPA
[2/10/21 SM172]
What is standard treatment for Pulmonary Embolism?
Most patients: Heparin-based anticoagulation (unfractionated heparin infusion or low-molecular-weight heparin subQ injections)
Massive PE (PE + Shock): Systemic fibrinolytic therapy
[2/10/21 SM172]
Who recieves influenza treatment?
anyone hospitalized
severe sxs
those at high risk of complications
[2/11/21 SM173]
