S2 Ch 2 Pulm 2-3

Front 1

266. Malignant mesothelioma cause?

Back 1

a. Most cases are secondary to asbestos exposure.

Front 2

267. Symptoms/signs of malignant mesothelioma?

Back 2

a. Dyspnea, weight loss, and cough are common findings
b. Bloody effusion is common.

Front 3

268. Malignant mesothelioma prognosis?

Back 3

a. Dismal (few month’s survival).

Front 4

269. Note: not all mesotheliomas or malignant. Benign mesotheliomas have an excellent prognosis (and are unrelated to asbestos exposure).

Back 4

269. Note: not all mesotheliomas or malignant. Benign mesotheliomas have an excellent prognosis (and are unrelated to asbestos exposure).

Front 5

270. Pathophysiology of Interstitial Lung Disease (ILD)?

Back 5

a. ILD is defined as an inflammatory process involving the alveolar walls (resulting in widespread fibroelastic fibrosis and collagen deposition) that can lead to irreversible fibrosis, distortion of lung architecture, and impaired gas-exchange.
b. The prognosis is very variable and depends on the diagnosis
c. Pts w/environmental or occupational lung disease, esp those w/asbestosis, are frequently involved in lawsuits against their employers.

Front 6

271. 6 Classifications of Interstitial lung disease?

Back 6

1. Environmental Lung disease (4)
2. ILD associated w/granulomas (4)
3. Alveolar filling disease (3)
4. Hypersensitivity lung disease (2)
5. Drug-induced
6. Miscellaneous

Front 7

272. 4 environmental interstitial lung diseases?

Back 7

1. Coal worker’s pneumoconiosis
2. Silicosis
3. Asbestosis
4. Berylliosis

Front 8

273. 4 Interstitial lung diseases associated with granulomas?

Back 8

1. Sarcoidosis-other organs in addition to the long are involved
2. Histiocytosis X
3. Wegener's granulomatosis
4. Churg-Strauss syndrome

Front 9

274. 3 alveolar filling interstitial lung diseases?

Back 9

1. Goodpasture's syndrome
2. Idiopathic pulmonary hemosideroses
3. Alveolar proteinosis

Front 10

275. 2 hypersensitivity interstitial lung diseases?

Back 10

1. Hypersensitivity pneumonitis
2. Eosinophilic pneumonitis

Front 11

276. Drug-induced interstitial lung diseases?

Back 11

1. Amiodarone
2. Nitrofurantoin (Macrobid)
3. Bleomycin
4. Phenytoin
5. Illicit drugs
6. Penicillamine

Front 12

277. 5 Miscellaneous interstitial lung diseases?

Back 12

1. Capitalize
2. Bronchiectasis Obliterans Organizing Pneumonia (BOOP)
3. ILD associated with connective tissue disorders: rheumatoid arthritis, scleroderma, SLE, mixed connective tissue disease
4. Adult Respiratory Distress Syndrome (ARDS)

Front 13

278. Symptoms of interstitial lung disease?

Back 13

a. Dyspnea (at 1st with exertion; later at rest)
b. Cough (nonproductive)
c. Fatigue
d. Other symptoms may be present 2° to another condition (such as connective tissue disorder)

Front 14

279. Signs of interstitial lung disease on physical exam?

Back 14

a. Rales at the bases are common
b. Digital clubbing is common (especially with Idiopathic Pulmonary Fibrosis)
c. Signs of pulmonary HTN and scientists is an advanced disease

Front 15

280. What should you ask about it ILD is suspected?

Back 15

a. Medication history
b. Previous jobs

Front 16

281. Note: over 100 causes of ILD have been identified in general, the clinical findings and imaging study results are nonspecific and do not point to a definitive diagnosis. Often one is confronted with the question of whether to obtain a tissue biopsy.

Back 16

281. Note: over 100 causes of ILD have been identified in general, the clinical findings and imaging study results are nonspecific and do not point to a definitive diagnosis. Often one is confronted with the question of whether to obtain a tissue biopsy.

Front 17

282. 7 diagnostic modalities for interstitial lung disease?

Back 17

1. CXR
2. High-resolution CT scan
3. PFTs
4. Oxygen desaturation during exercise
5. Bronchoalveolar lavage
6. Tissue biopsy
7. Urinalysis

Front 18

283. Utility of CXR for interstitial lung disease?

Back 18

a. Findings are usually nonspecific
b. Typical diffuse changes are noted (particular, reticulonodular, ground glass, honeycombing)

Front 19

284. What imaging modality shows the extent of fibrosis better than any other?

Back 19

a. High-resolution CT scan

Front 20

285. What is demonstrated with PFTs for interstitial lung disease?

Back 20

a. A Restrictive pattern is noted: FEV1/FVC ratio is increased.
b. All lung volumes are low
c. Both FEV1 and FVC are low, but the latter more so.
d. Low diffusing capacity (DLCO)

Front 21

286. Utility of bronchoalveolar lavage for interstitial lung disease (fluid for culture and cytology)?

Back 21

a. Use is controversial because results are quite variable

Front 22

287. Utility of tissue biopsy for interstitial lung disease?

Back 22

a. This is often required in patients with ILD
b. This can be done via fiber-optic bronchoscopy with transbronchial biopsy (a limited amount of tissue can be obtained, which limits its utility), open lung biopsy, or video-assisted thoracoscopic lung biopsy

Front 23

288. Value of urinalysis for interstitial lung disease?

Back 23

a. Useful if there are signs of glomerular injury for Goodpasture's syndrome and Wegener's granulomatosis.

Front 24

289. What does honeycombing lung refer to?

Back 24

a. A scarred shrunken lung and is an end-stage finding with poor prognosis.
b. Air spaces are dilated and there are fibrous scars in the interstitium.
c. Can arise from many types of ILD.