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72 Cards in this Set
- Front
- Back
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What is the cause of Sarcoidosis?
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idiopathic,
but might be infectious or noninfectious environmental agent |
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What is hallmark of sarcoidosis?
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noncaseating granulomas but they can occur in other things (beryllium, fungi,Crohns, malignancy)
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What are the most commonly infected organs with sarcoid?
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LUNGS
lymph nodes,liver, skin, eyes (uveitis, lupus pernio, salmon colored plaques) also nerves, kidney, heart |
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What kind of pulmonary disease does sarcoid cause?
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diffuse interstitial pulm disease
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What disease causes an initial influx of alot of tcells? rare in untreated hiv pts
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sarcoidosis (harrisons)
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What does sarcoid need to be diagnosed?
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granulomas
systemic disease, consistency and cause unknown, But needs to be systemic, a sx of skin would be sarcoid reaction, not sarcoidosis |
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What stage of sarcoid is most likely to see dyspnea?
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3
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What are the stages of sarcoid?
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1- bilateral hilar adenopathy
2- bilateral hilar adenopathy w. diffuse parenchymal infiltrate 3-parencyhmal infiltrate 4- irreversible fibrosis |
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Describe treatment for sarcoidosis.
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Stage 1- none needed unless erythema nodosum etc
Stage 2 & 3- steroids. use steroids in presymptomatic pts because dyspnea indicates irreversible disease |
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What is SACE used to monitor?
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Serum angiotensin converting enzyme-> sarcoidosis
if it is high,more tx needed also look at CXR for sarcoid |
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What is interstitial lung disease?
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inflammation that causes increase in collagen production, causing fibrosis
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What do PFT's indicate in pt with interstitial lung disease?
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stiff noncompliant lungs, all volumes reduced
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Whats important in defining interstitial lung disease and whats the gold standard for dx?
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history is very important (H & P and lab date)
gold standard = lung bx |
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What is hte most common diagnosis in people with interstitial lung disease?
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idiopathic fibrosing interstitial pneumonia
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Hallmark:Presence of serum IgG & IgA precipitating antibodies to the inhaled antigen
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Extrinsis Allergic Alveolitis (Hypersensitivity Pneumonitis)
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What are fibrosing pneumoconiosis?
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silica and asbestos
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What pneumoconiosis predisposes you to TB?
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silicosis
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Describe silicosis
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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) |
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What are the three disease associated with asbestos?
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Asbestosis
Lung Cancer Mesothelioma |
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What is the most common type of asbestos?
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chrysotile
other two are (crocidolite and amosite) |
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What is a serious cancer of the pleura?
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mesothelioma
(usually die within 12-15 mos of dx) |
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What is Hammen Rich syndrome
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Acute interstitial pneumonitis
-indistinguisable from ARDS -50% report previous viral disease |
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What are the four anatomic lung volumes measured in PFTs?
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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 |
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What are the four capacites measured with PFT?
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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 |
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Which lung measurement is an indirect measurement via helium or nitro washout?
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Functional Residual Capacity (amt of air left in lungs after normal tidal volume exhalation)
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What is FVC?
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Forced vital capacity- forced amout of air expired as rapidly and forcefully as possible
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What is FEV1?
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max amt of air expired in one second
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What does obstructive disease do to the FEV1 and FVC?
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decreased FEV1/FVC ratio
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What is the best indicator for alveolar ventilation?
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paCO2
Increase: hypoventilate decrease: hyPERventilate compensate for acidosis |
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Is bronchiectasis an obstructive or restrictive disease?
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obstructive
(along with asthma COPD emphysema bronchiolitis) |
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Is pulmonary fibrosis a restrictive or obstructive disease?
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restrictive (along with phrenic nerve injury, diaphragm dysfunction, neuromuscular disease, pleural disease, large pleural effusion)
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What is DLCO?
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extent to which oxygen from the the air sacs of the lungs to the blood
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What does the DLCO depend on?
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membrane and the hemoglobin concentration
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What would decrease the DLCO?
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pulmonary htn, PE, restrictive lung disease
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What would increase DLCO?
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alveolar hemorrhage, asthma, acute CHF
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What are normal values for FEV and FVC?
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4 and 5
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What is the sign of primary infection of tuberculosis?
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tubercles
(in lymph nodes ?) |
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Which disease/organism likes high O2 concentration?
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tuberculosis
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How many exposed TB patients get infected?
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30%
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What disease starts in the alveoli and moves to regional lymph nodes?
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TB
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How long does it take for TB to make a pt seroconvert?
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6 weeks
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Describe primary TB
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usually self limited, seems like a cold, Bacillemia occurs in primary stage where it sets up for reactivation
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What is the chest xray like in Primary TB?
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Infiltrates in middle or lower lung zones
Ipsilateral adenopathy Ghon's complex (MIG) |
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Where can TB survive?
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Renal cortex
Epiphyses of long bones Apical and posterior upper lobes of lungs meninges vertebrae |
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Most common extrapulmonary site for TB?
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lymphatic system
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T or F; you have a positive CXR in latent tb
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false
-positive PPD -neg cxr -no sx |
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How can you get secondary TB?
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reactivation of old lesion (most common) OR
reinfection with new inhaled droplet |
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What is miliary TB?
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massive dissemination of TB into theblood stream
usually with HIV pts |
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What are the sx of secondary tb?
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pulmonary- productive cough (common), pleuritic chest pain, dyspnea, hemopytsis
systemic- low grade fever (common), anorexia, wt loss, tired |
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What is the most useful test for active tb?
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Cxr pa and lat
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Describe the infiltrates of TB in active and secondary
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active- middle and lower with or w/o ipsilateral adenopathy
secondary- upper with scarring possible |
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Who would get a false negative PPD?
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people with poor immune responses
(you get positive when your immune system mounts a strong enough response) |
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Who is positive for a PPD with a 5mm response?
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those with poor immune systems, those who you know that were recently exposed, those with positive cxr
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Who is positive in 10 mm induration?
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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 |
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What is the Quantiferon Gold test?
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Blood test for TB
more specific than PPD (less likely to yield false positives) |
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What is the treatment for active tb?
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4 drug regimen:
rifampin ethambutol pyrazinamide INH |
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when do pts with active tb usually have neg sputum?
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2 mos
on 4 drug regimen (INH, ethambutol, pyrazinamide and rifampin) |
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How do we treat patients with TB and HIV?
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same 4 drug regimen but can replace rifabutin for rifampin
and add b6 or pyridoxine to prevent neuropathy |
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How do we treat pts with extrapulmonary tb?
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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 |
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What is the drug of choice for latent tb therapy?
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INH
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What is used for TB if there is rifampin resistance?
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INH and ethambutol for 18 mos
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Who needs DOT?
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Directly observed therapy
TB patients! random reminder:pyrzinamide increases uric acid levels |
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What is the vaccine for TB pts?
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BCG
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What is the cause of bronchiectasis?
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no single cause
50% caused by CF could be neoplasm, TB, aspiration etc |
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What is bronchiectasis?
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dilation of medium/large bronchi. chronic inflammation and destruction. fibrosis
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Some tx for bronchiectasis?
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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 |
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What is the most common form of lung ca?
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bronchogenic ca (95%)
most originiate from the mucosal cells from the lower respiratory tract |
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What is the most common type of lung ca?
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adenocarcinoma (NSCLC)
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What accounts for 25-35% of all bbronchogenic lung cas?
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squamous cell ca
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This type of ca metastasizes early and spreads to lymph nodes. also amenable to early detection
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squamous cell ca
detectable because usually in central bronchi near septum |
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most aggressive type of lung ca
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small cell carcinoma (oat cell)
central in origin |
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What may present with horners syndrome? and what is horners?
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SCLC
anhidrosis, miosis, ipsilateral ptosis |
