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72 Cards in this Set

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What is the cause of Sarcoidosis?
idiopathic,
but might be infectious or noninfectious environmental agent
What is hallmark of sarcoidosis?
noncaseating granulomas but they can occur in other things (beryllium, fungi,Crohns, malignancy)
What are the most commonly infected organs with sarcoid?
LUNGS
lymph nodes,liver, skin, eyes
(uveitis, lupus pernio, salmon colored plaques)
also nerves, kidney, heart
What kind of pulmonary disease does sarcoid cause?
diffuse interstitial pulm disease
What disease causes an initial influx of alot of tcells? rare in untreated hiv pts
sarcoidosis (harrisons)
What does sarcoid need to be diagnosed?
granulomas
systemic disease, consistency
and cause unknown,
But needs to be systemic, a sx of skin would be sarcoid reaction, not sarcoidosis
What stage of sarcoid is most likely to see dyspnea?
3
What are the stages of sarcoid?
1- bilateral hilar adenopathy
2- bilateral hilar adenopathy w. diffuse parenchymal infiltrate
3-parencyhmal infiltrate
4- irreversible fibrosis
Describe treatment for sarcoidosis.
Stage 1- none needed unless erythema nodosum etc
Stage 2 & 3- steroids. use steroids in presymptomatic pts because dyspnea indicates irreversible disease
What is SACE used to monitor?
Serum angiotensin converting enzyme-> sarcoidosis

if it is high,more tx needed
also look at CXR for sarcoid
What is interstitial lung disease?
inflammation that causes increase in collagen production, causing fibrosis
What do PFT's indicate in pt with interstitial lung disease?
stiff noncompliant lungs, all volumes reduced
Whats important in defining interstitial lung disease and whats the gold standard for dx?
history is very important (H & P and lab date)
gold standard = lung bx
What is hte most common diagnosis in people with interstitial lung disease?
idiopathic fibrosing interstitial pneumonia
Hallmark:Presence of serum IgG & IgA precipitating antibodies to the inhaled antigen
Extrinsis Allergic Alveolitis (Hypersensitivity Pneumonitis)
What are fibrosing pneumoconiosis?
silica and asbestos
What pneumoconiosis predisposes you to TB?
silicosis
Describe silicosis
in quarrying, stone cutting, ceramics, glass cutting
-nodular lesions are most common and in upper lobes
-birefringent particles that can reach alveoli
-15-20yrs latent pd
tx=supportive (o2, bronchodilation etc)
What are the three disease associated with asbestos?
Asbestosis
Lung Cancer
Mesothelioma
What is the most common type of asbestos?
chrysotile

other two are (crocidolite and amosite)
What is a serious cancer of the pleura?
mesothelioma
(usually die within 12-15 mos of dx)
What is Hammen Rich syndrome
Acute interstitial pneumonitis
-indistinguisable from ARDS
-50% report previous viral disease
What are the four anatomic lung volumes measured in PFTs?
tidal volume-amt of air inhaled and exhaled with each breath (resting)
IRV-amt that can be inhaled after TV inhalation
ERV-amt that can be exhaled after TV inhalation
RV-amt of air left in lungs after forced exhalation
What are the four capacites measured with PFT?
TLC- maximum amt of air in lungs after max inspiration (TL= VC + RV)
VC- max amt of air that can be expired after max inspiratio
IC-max amt of air that can be insipired after normal exp
FRC-vol of air left in lungs after tidal vol expiration
Which lung measurement is an indirect measurement via helium or nitro washout?
Functional Residual Capacity (amt of air left in lungs after normal tidal volume exhalation)
What is FVC?
Forced vital capacity- forced amout of air expired as rapidly and forcefully as possible
What is FEV1?
max amt of air expired in one second
What does obstructive disease do to the FEV1 and FVC?
decreased FEV1/FVC ratio
What is the best indicator for alveolar ventilation?
paCO2

Increase: hypoventilate

decrease: hyPERventilate
compensate for acidosis
Is bronchiectasis an obstructive or restrictive disease?
obstructive
(along with asthma COPD emphysema bronchiolitis)
Is pulmonary fibrosis a restrictive or obstructive disease?
restrictive (along with phrenic nerve injury, diaphragm dysfunction, neuromuscular disease, pleural disease, large pleural effusion)
What is DLCO?
extent to which oxygen from the the air sacs of the lungs to the blood
What does the DLCO depend on?
membrane and the hemoglobin concentration
What would decrease the DLCO?
pulmonary htn, PE, restrictive lung disease
What would increase DLCO?
alveolar hemorrhage, asthma, acute CHF
What are normal values for FEV and FVC?
4 and 5
What is the sign of primary infection of tuberculosis?
tubercles
(in lymph nodes ?)
Which disease/organism likes high O2 concentration?
tuberculosis
How many exposed TB patients get infected?
30%
What disease starts in the alveoli and moves to regional lymph nodes?
TB
How long does it take for TB to make a pt seroconvert?
6 weeks
Describe primary TB
usually self limited, seems like a cold, Bacillemia occurs in primary stage where it sets up for reactivation
What is the chest xray like in Primary TB?
Infiltrates in middle or lower lung zones
Ipsilateral adenopathy
Ghon's complex
(MIG)
Where can TB survive?
Renal cortex
Epiphyses of long bones
Apical and posterior upper lobes of lungs
meninges
vertebrae
Most common extrapulmonary site for TB?
lymphatic system
T or F; you have a positive CXR in latent tb
false

-positive PPD
-neg cxr
-no sx
How can you get secondary TB?
reactivation of old lesion (most common) OR
reinfection with new inhaled droplet
What is miliary TB?
massive dissemination of TB into theblood stream
usually with HIV pts
What are the sx of secondary tb?
pulmonary- productive cough (common), pleuritic chest pain, dyspnea, hemopytsis
systemic- low grade fever (common), anorexia, wt loss, tired
What is the most useful test for active tb?
Cxr pa and lat
Describe the infiltrates of TB in active and secondary
active- middle and lower with or w/o ipsilateral adenopathy
secondary- upper with scarring possible
Who would get a false negative PPD?
people with poor immune responses
(you get positive when your immune system mounts a strong enough response)
Who is positive for a PPD with a 5mm response?
those with poor immune systems, those who you know that were recently exposed, those with positive cxr
Who is positive in 10 mm induration?
10 mm or more is positive in
Recent arrivals (less than 5 years) from high-prevalence countries
Injection drug users
Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
Mycobacteriology lab personnel
Persons with clinical conditions that place them at high risk
What is the Quantiferon Gold test?
Blood test for TB

more specific than PPD (less likely to yield false positives)
What is the treatment for active tb?
4 drug regimen:
rifampin
ethambutol
pyrazinamide
INH
when do pts with active tb usually have neg sputum?
2 mos

on 4 drug regimen
(INH, ethambutol, pyrazinamide and rifampin)
How do we treat patients with TB and HIV?
same 4 drug regimen but can replace rifabutin for rifampin
and add b6 or pyridoxine to prevent neuropathy
How do we treat pts with extrapulmonary tb?
6 mos of INH and rifampin usually works
except 12 mos for pts with miliary tb, children with tb meningitis, and bone and joint involvemtn
What is the drug of choice for latent tb therapy?
INH
What is used for TB if there is rifampin resistance?
INH and ethambutol for 18 mos
Who needs DOT?
Directly observed therapy

TB patients!

random reminder:pyrzinamide increases uric acid levels
What is the vaccine for TB pts?
BCG
What is the cause of bronchiectasis?
no single cause
50% caused by CF
could be neoplasm, TB, aspiration etc
What is bronchiectasis?
dilation of medium/large bronchi. chronic inflammation and destruction. fibrosis
Some tx for bronchiectasis?
Management and Treatment
Suppressive Rx with above antibiotics or inhaled aminoglycosides to reduce pseudomonas colonization
Inhaled antibiotics help CF patients
Surgery may be used for those with recurrent hemoptysis
What is the most common form of lung ca?
bronchogenic ca (95%)

most originiate from the mucosal cells from the lower respiratory tract
What is the most common type of lung ca?
adenocarcinoma (NSCLC)
What accounts for 25-35% of all bbronchogenic lung cas?
squamous cell ca
This type of ca metastasizes early and spreads to lymph nodes. also amenable to early detection
squamous cell ca

detectable because usually in central bronchi near septum
most aggressive type of lung ca
small cell carcinoma (oat cell)

central in origin
What may present with horners syndrome? and what is horners?
SCLC

anhidrosis, miosis, ipsilateral ptosis