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]
What is the standard pharmacological treatment for influenza?
neurominidase inhibitors
We need to know Oseltamivir
[2/11/21 SM173]
Who recieves influenza treatment?
anyone hospitalized
severe sxs
those at high risk of complications
[2/11/21 SM173]
RSV is common in _______
RSV is common in kids < 1
[2/11/21 SM173]
RSV causes _____
RSV causes bronchiolitis and wheezing
[2/11/21 SM173]
Adenovirus has {#?} serotypes
Adenovirus has >40 serotypes
[2/11/21 SM173]
Adenovirus can cause ________
Adenovirus can cause keratoconjunctivitis
[2/11/21 SM173]
Adenovirus is associated with ______
Adenovirus is associated with crowded living quarters (military barracks)
An key component in assessing occupational lung disease is __________
An key component in assessing occupational lung disease is a detailed history
Can not be stressed enough. Need detailed exposure/occupational history going back as long as a patient can remember. Often long latency period between exposure and disease onset
[2/11/21 SM170]
_____ is an independent risk factor for mycobacterium Tuberculosis and lung cancer
Silicosis is an independent risk factor for mycobacterium Tuberculosis and lung cancer
[2/11/21 SM170]
What is the biggest pro and the biggest con of viral cultures?
Pro: Specific
Con: VERY slow
therefore not practical for clinical use
[2/12/21 SM176]
____ is the live attenuated TB vaccine from Mbovis culture.
Bacilli Calmetter-Guerin (BCG) vaccine is the live attenuated TB vaccine from Mbovis culture.
[2/12/21 SM176]
Bacilli Calmetter-Guerin (BCG) vaccine is the {vaccine type?} TB vaccine from Mbovis culture.
Bacilli Calmetter-Guerin (BCG) vaccine is the live attenuated TB vaccine from Mbovis culture.
[2/12/21 SM176]
BCG vaccine sensitvity may be a concern for {patient populations?}
BCG vaccine sensitvity may be a concern for patients with:
immune suppression
low number of peripheral blood mononuclear cells
impaired T-cell function
[2/12/21 SM176]
PPD skin test {is/is not?} able to distinguish latent from active TB disease
PPD skin test is not able to distinguish latent from active TB disease
[2/12/21 SM176]
Interferon gamma release assay {is/is not} able to distinguish latent from active TB disease
Interferon gamma release assay is not able to distinguish latent from active TB disease
[2/12/21 SM176]
Strep pneumoniae is a lancet-shaped gram (+) diplocci that causes:
dense lobar consolidation
may see bacteremia
pleural effusions
meningitis
(Two different vaccines available)
[2/12/21 SM175]
Haemophilus influenzae is small gram (-) diploccoci that can cause:
epiglottis
Meningitis in kids – now much less common with widespread Hib vaccination
[2/12/21 SM175]
