Everything Courtney Could Be Better At

EKGs, Murmurs, Microbio, Antibiotics, RLDs

Interstitial lung diseases (ILDs)

Idiopathic pulmonary fibrosis

Sarcoidosis

Occupational lung dz - Pneumoconiosis

Rheum Autoimmune- RA, SLE

ILD Patho

Injury to alveolar epithelium and interstitium → Accumulation of immune cells → Chronic interstitial inflammation and fibroblast activation → Proliferative fibrosis

IPF

Age 50-65, Male

Insidious onset

Smoking history

Clubbing of the digits

CXR/CT - Peripheral, patchy reticular pattern and reduced lung volume, Honeycombing

Diagnosis of exclusion

Txt - Pulm rehab, O2, Transplant, Nintedanib, Pirfenidone

Sarcoidosis

Age 20-40, Female AA

Insidious onset

Smoking history

Absence of crackles

CMP eval hepatic and renal function

CXR - Bilateral hilar lymphadenopathy, Diffuse reticular/ground-glass opacity

CT - Central nodules, Granulomas in upper lung zones, Bilateral hilar lymphadenopathy

Diagnosis of exclusion

Txt - Not necessary, Systemic corticosteroids (1st line), Immunosuppressants (MTX), Antimalarial (Chloroquine), and TNF (Infliximab)

ILDs CP

SOB - Exertional or at rest

Cough - Typically dry, may have mucus production

Insidious onset/progression

ILD PE

Finale, late inspiratory crackles in basilar area

Late in disease - Cor pulmonale (split S2, P2, R S3 or S4, pansystolic murmur)

PFTs - Restrictive, decrease lung volume and DLco

Rheum Autoimmune ILD

Pulm sxs + Fever, weakness, fatigue, joint pain/swelling/stiffness

Labs - RF, ANA, ESR, CRP

Pneumoconiosis

Coal worker’s pneumoconiosis

Silicosis

Asbestosis

Pneumoconisis Patho

Prolonged exposure to small dust particles → Mucociliary elevator unable to clear → Immune response activate → Stimulates fibroblasts (fibrosis)

Pneumoconiosis PE

Bibasilar inspiratory crackles and clubbing

Cor pulmonale (Peripheral edema, JVD, Hepatomegaly)

Coal worker’s pneumoconiosis (Black lung)

Asxs - Incidental finding

Coal worker

CXR - Diffuse small, rounded opacities <1 cm, Upper lobes

PFTs - Normal

Silicosis

Asxs - Incidental finding

Construction - cutting, mining, or masonry

CXR - Innumerable small 1–3 mm rounded opacities, Upper lobes, Calcification of the peripheral hilar lymph nodes

PFTs - Combined obstructive and restrictive, Reduced DLco

Asbestosis

Formation of pleural plaques

High risk of mesothelioma and lung cancer

Progressive DOE

Construction, Railroads, Shipbuilding, Mechanic, Sheet metal

CXR - Linear reticular streaking, Peripheral lung bases, Bilateral opacities of ground-glass appearance, Honeycombing in the mid and lower lung fields

PFTs - Restrictive, Reduced DLco

Pneumoconiosis Txt

None

Avoid exposure

Vaccination

O2 w/ Hypoxia

Aggressive txt of COPD and infections