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27 Cards in this Set
- Front
- Back
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old person w/ shortness of breath (ex 74 yo)
what are the ddx? |
- CHF, MI
- COPD, PE, PNA, asthma, bronchitis, TB, malignancy - anxiety |
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hx: SH
- smoking (ex. 25 yr) -> what can we rule in? |
- COPD, emphysema
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PE:
- S3 and +1 peripheral edema --> what can we rule in? |
- CHF
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CXR:
what would be some findings that would make you consider pulm edema and pleural effusion? |
- extensive pleural changes
- blunted costophrenic angles - shaggy heart border w/ septal thickening |
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CT scan:
what would be a finding that would make you consider asbestosis? |
- dense fibrocalcific plaques of the parietal pleura
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pneumoconiosis:
types |
- asbestosis
- coal worker lung - silicosis - berylliosis (not too common b/c a/w people working in Manhattan project or light industry in 50s) |
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asbestosis:
- occurs as - 2 forms |
1. naturally occurs as fibers
2. sperpentine (curved) - safe - straight (amphibole) - dangerous b/c distributes to lungs |
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asbestosis:
dangerous when? cumulative exposure? |
1. airborne; not generally a problem w/ houses until remodeling
2. breathing in asbestos once isnt harmful, but repeat exposure over long periods of time increases risk of developing ds |
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the effects of asbestosis depends on
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composition and size of fiber
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related diseases of asbestosis
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non-cancer: pleural plaques
cancer: lung ca, malignant mesothelioma |
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pleural plaques
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- just calcified plaques, no dec diffusion capacity
- 2 layers of membrane lining the chest wall, not cancerous |
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screening of asbestosis for people w/ exposure
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- ship & boat building/repair (fire retardant)
- mining - construction workers - plumbing - brake line assembly - navy |
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if pt has occupational history, what do you do annually?
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- resp questionnaire
- physical exam - PFTs |
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if pt has occupation history, what do you do:
1. 3-5 yrs 2. 1-2 yrs 3. every year |
1. if <10 years since exposure
2. if >10 years since exposure 3. if over 20 yrs of exposure |
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due to inhaling over many years, asbestosis is?
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- chronic and progressive
- takes a long time to develop (5-20 yrs) - consider this in someone who is progressively getting SOB |
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what causes less O2 exchange in asbestosis?
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- inflammation from fibers that cause fibrosis
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how is the dx of asbestosis made
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- hx of exposure
- latent period from 1st exposure (10-15 yrs) - interstitial fibrosis - r/o other causes |
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clinical presentation of asbestosis
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- dyspnea (insidious/prog)
- cough (nonprod/mucoid) - evidence of R heart failure - tachypnea - clubbing - cyanosis (late) - bibasilar crackles - tachycardia |
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CXR of asbestosis
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- pleural plaques
- starts at lower lung fields - ground glass appearance - shaggy heart - bilat basilar reticuo-nodular infiltrates |
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CT of asbestosis
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- pleural plaques
- honeycombing - mixed pleural densities |
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PFTs of asbestosis
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- restrictive pattern (low TLC; low DLCO)
- obstruction is usually due to smoking - mixed obstructive-restrictive pattern - hypoxia on ABG |
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you rarely do biospy w/ asbestosis, but in what cases would it be indicated?
what would you see? |
- if questionable history
- or atypical latent period 2. asbestos bodies in the lung |
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ddx of asbestosis
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- IPF (onset at 66)
- lipid PNA - sarcoidosis (usually mid-lungs rather than lower lungs) - silicosis (but in upper lobe( - TB (but in upper lobe) - berylliosis (mistaken for sarcoid due to hilar lymphadenopathy) - CHF (perihilar & mid-lung zone infiltrates - occupational asthma - lung ca - hypersens pneumonitis (variable & diffuse xray) |
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tx of asbestosis
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- stop smoking
- O2 if hypoxic - pulm rehab (doesnt change mortality but improves QOL) - no drug therapy ** - menage co-morbid COPD b/c improve functional status |
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synergy between asbestos and what?
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cigarette smoking
- asbestos inc risk of lung ca (takes 10-20 yrs) |
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cigarettes + asbestos =
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59x risk of lung ca (number not important but cigs + asbestos = VERY HIGH RISK OF LUNG CA)
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mesothelioma
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- ca of pleura (lining of lung and chest cavity)
- in about 2/3 of time it can occur in abd cavity - takes 30-50 yrs to develop - rapidly fatal: 75% dead 1 year s/p dx - *smoking doesn't affect risk of mesothelioma (purely asbestosis) |
