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42 Cards in this Set

  • Front
  • Back
hypersensitivity pneumonitis
etiol
immune mediated granulomatous reaction to organic antigens
hypersensitivity pneumonitis
occupations/causes
moldy hay/actinomycetes/farmers lung
pet birds/bird fanciers
grain dust
isocyanates
AC systems
organic dusts that cause ILD
byssinosis
inhalation of cotton, flax or hemp dust
asbestosis exposure
bilat mid thoracic pleural plaques
malig mesothelioma (80% related to asbestos exposure)
asbestosis
path, what part of lung
TOB assoc?
parenchymal fibrosis, in BASES
with >10 yrs mod exposure, but latency may be 30 yrs
smoking/synergy
asbestosis assoc w what type of lung cancers
squamous and adeno
Silica
assoc w what occupations
most prevalent occ dx in world
mining, glassmaking, ceramics, sandblasting
Silica cxr
fibrocalcific, upper lobes
hilar eggshell calcification
increase susceptible to TB
get yearly PPDs
no tx but if worsening ck PPD
Silicaproteinosis
big nodules from overwhelming exposure
alveolar filling w eosinophilic material
present looking like pul edema
Coal Workers pneumoconiosis
upper lung nodules
simple CWP worsens w exposure
complicated CWP does not
Caplans syndrome
seropos RA assoc w massive CWP
see periph lung nodules
complicated CWP
progressive massive fibrosis w nodules >2 cm
TOB accelerates
Berylliosis what is it, where from
cell mediated immune response
>2 yr exposure to even sm amts beryllium
Beryllium cxr,
diagnose
tx
chronic interst pneum upperlob
+ hilar adenopathy--like sarcoid
lymphocyte transformation test
tx: steroids
Idiopathic Interstitial Pneumonias (ILPs)
name 2
Idiopathic Pulmonary Fibrosis
Cryptogenic Organizing Pneumonia
Idiopathic Pulmonary Fibrosis
etiol
path
prob autoimmune M=f 55 yo
leakiness of cap/alveolar wall
causes wall damage--hyalinizes the alveolar memb
IPF cxr
HRCT shows ground glass appearance
diagnosis of exclusion
IPF course
early inflamm,
late fibrotic--restrictive dx, pul htn cor pulmonale
progresses to death
IPF PE
presents w dyspnea cough diffuse infil on cxr
clubbing
no other s/s
no drugs/infection/chemicals
MUST R/O INFECTION/CANCER
IPF pfts
restrictive/intrathoracic pattern
IPF tx
steroids +/- cyclphosphamides or azathioprine
best test for improvment is meas lung fxn/pfts, A-a gradient
cryptogenic organizing pneumonia or COP or BOOP
etiol, path
unknown etiol
bronchiolitis and chronic alveolitis
prolif of granulocytes around airways
COP
onset, presentation
tx
insidious onset wks-2 mos
fever, cough malaise, myalgias

responds well to steroids
Sarcoidosis
what is it
path
usu cxr
multisystem
noncaseating granuloma
usu bilat hilar/mediastinal LN
Sarcoid
use of ACE
no use in diagnosis
but can use to follow dx
Sarcoid abnl labs
hypercalcemia hypercalciuria, hypergammaglobulinemia
Sarcoid diagnosis
of exclusion
+BAL inc lymphs helper/suppressor 4/1
culture, examine for orgs
bronch bx noncaseating granuloma
Sarcoid
what skin lesion shows good prognosis
e nodosum
Sarcoid tx
75% resolve w/o tx
rare progression to pul fibrosis or htn
severe:steroids, but not proven to induce remissions, but does help w sx.
also plaqenil, remicade, mtx, thalidomide
Eosinophilic Granuloma\
other names
langerhans cell granulomatosis
Histiocytosis X
Eosinophilic Granuloma
associations:
physical findings
pneumothorax, TOB
M>F
lytic bone lesions
diabetes insipidus (post pituitary involved)
Eosinophilic Granuloma
CXR
tx
"honey comb" appearance
upper lungs
STOP TOB
Hand-Schuller-christian syn
lytic bone lesions
diabetes insidus
exophthalmus
Eosinophilic Granuloma
Lymphangioleiomyomatosis
who gets it
genetic relat to which dx
premenopausal women
tuberous sclerosis
Lymphangioleiomyomatosis
path
immature sm musc proliferation in lymph, vasc and alveolar wall/peribronchial structures
get constrictions/cysts in these areas
Lymphangioleiomyomatosis
cxr
honeycombing diffusely thruout the lung
(upper lung only in eos granuloma)
may see PTX
Lymphangioleiomyomatosis
on effusion tap see
chylous effusion
Lymphangioleiomyomatosis
tx
stop all exogenous estrogens
lung transplant, but may recur in transplant
Rheumatoid arthritis/ILD
see this in 1/3 of RA pts
pleurisy MC
low glucose in pl fluid
necrobiotic nodules upper lung
SLE/ILD
pleuritis +/- effusion
diaphragm weakness
hemoptysis
Scleroderma/ILD
what 3 chgs do you see pulmonary here?
1. interstitial fibrosis
2. intimal proliferation (AFFECTS BOTH LUNG/PLEURA!)
3. Potential aspiration/achalasia
intimal prolif--pul htn out of proportion
prone to pneumonia
causes of pneumothorax
secondary: CF, eos granuloma(histiocytosis X=smoking males), LAM (premenopausal women)
ventilator related