Pulmonary Review

Sarcoidosis

Systemic disease of unknown etiology in about 90% of patients by granulomas + inflammation of the lung

30-40 year old african american women

high risk age and population for Sarcoidosis

NON-caseating granulomas

hallmark sign of Sarcoidosis

Erythema nodosum

Bilateral hilar lymphadenopathy

lupus pernio

3 factors that indicate sarcodoidosis

lupus pernio

hard, often purplish lesion of skin on nose, ears, lips, cheek and forehead indicative of sarcoidosis

ACE

lab test that is indicative of sarcoidosis

Oral corticosteroids

1st line medication for sarcoidosis

Methotrexate, Azathioprine

2nd line medication for sarcoidosis (if intolerant of oral corticosteroids)

Bronchiectasis

permanent dilation and destruct of larger bronchi from chronic infect and inflammation

CF

most common cause of Bronchiestasis

THICK of foul-smell, purulent sputum

Pleuritic chest pain

Dyspnea and wheezing

Clubbing

signs and symptoms of Bronchiectasis

“tram tracks” or ring like markings

Dilated and thickened bronchi that indicate Bronchiestasis on a radiograph

High-resolution CT

dx study of choice for Bronchiectasis

Pseudomonas aeruginosa, S pneumo and S Aureus

bacteria seen in Bronchiectasis

Empiric oral antibiotic x 10-14 days

general treatment for Bronchiectasis

Methotrexate

immunomodulator that can cause a medication caused injury of the lungs

Medication induced lung injury

Pulmonary complications because of medication inculding allergic reactions, idiosyncratic reactions, overdose, or side effects.

radiation pneumonitis

Acute Radiation lung injury

steroids

medication given for Acute Radiation lung injury

breast cancer, lung, or lymphoma

types of cancer involved with radiation lung injuries

prev XRT, chemo, withdrawal of steroids

causes of radiation lung injuries

Radiation lung injury

A pneumonitis caused by the therapeutic use of ionizing radiation to treat malignancies

Berylliosis

occupational pulmonary disease caused by machining and handling of beryllium products and alloys (electronics) or aerospace

alloys (electronics), aerospace

occupations/exposures involved in Berylliosis

Acute Berylliosis

toxic, ulcerative trachea-bronchitis and chem pneumonitis following intense and severe exposure to beryllium

Chronic berylliosis

systemic dz resemble sarcoidosis and is more common, fibrotic disease

Occupational Asthma

Common cause adult-onset asthma

Industrial Bronchitis

bronchitis in coal miners and others exposed to cotton, flax, or hemp dust – “COPD-like”

Byssinosis

Asthma-like, in textile worker from inhale cotton dust

Avoidance of further exposure to the offending agents

bronchodilators

treatment recommendation of Occupational Asthma

Chest tightness, cough, dyspnea worse on Monday after 1st day back at work; subside later in the week

signs of Byssinosis (occupational asthma)

Spirometry

Bronchial provocation

testing for occupational asthma

chronic bronchitis

occurs if repeated exposure to a trigger causing occupational asthma

Pneumoconiosis

Chronic fibrotic lung dz cause by inhale inorganic dusts

Coal Worker’s

Silicosis

Asbestosis

Pneumoconiosis examples

Coal Worker’s Pneumoconiosis

caused by Ingesting inhaled coal dust by alveolar macs → form coal macules (2-5 mm diameter)

diffuse small opacities in the upper lung

chest radiograph sign of coal worker’s pneumoconiosis

normal or restrictive d/t fibrosis

Pneumoconiosis PFT

Calcification of periphery of hilar lymph nodes (eggshell calcification) in upper lungs

indicative sign of silcosis

TB

disease that is tested for in silicosis patients

Asbestosis

Nodular fibrosis in expose to asbestos fiber ~10-20 yrs

old buildings, insulation, shipyard, construction

occupations at risk for asbestosis

honeycombing in the lung base

seen on an X-ray indicative of asbestosis

fibrosis or coexist pleural plaques

seen an a CT indicative of asbestosis

mesothelioma and branchiogenic carcinoma

diseases that as high risk for asbestosis patients

Pneumocystis jirovecci

PNA in HIV, AIDS or immunosuppressed patients

dyspnea on exertion, nonproductive cough, fever

classic triad of Pneumocystis jirovecci PNA

diffuse bilateral intersitial infiltrates

seen on a CXR indicative of Pneumocystis jirovecci PNA

beta-D-glucan, increased LDH

labs indicative of Pneumocystis jirovecci

Bactrim

medication given after dx and prophylacticly for Pneumocystis jirovecci PNA

Hypersensitivity pneumonitis

Inflammation of lung that is nonatopic, non-asthmatic inflammatory pulmonary disease – TYPE 3 (reversible if early dx)

Hypersensitivity pneumonitis

Also called extrinsic allergic alveolitis d/t dust, mold, foreign obj

Avoid more exposure

Oral corticosteroids (Prednisone) if prolonged

treatment for Hypersensitivity pneumonitis

PNA, Severe Sepsis

most common causes of ARDS

Acute respiratory distress syndrome

New, bilateral radiographic pulm opacities not explained by PE, atelectasis, or nodules.

Acute respiratory distress syndrome

Resp distress, progressive resp failure within 7 days of known clinical insult

Marked hypoxemia that is refractory to supplemental oxygen (O2 tx doesn’t help)

indicative sign of acute respiratory distress syndrome

Air bronchograms

air filled bronchi from alveoli filled with fluid seen in ARDS

Treat the underlying cause, manage O2 and fluid, PEEP, prone position

treatment for ARDS

damage to alveoli, fill up with wbc, fluid, thick membrane, o2 cant move/ exchange as well, hypoxia

ARDS patho

PEEP

treatment needed by ALL ARDS patients

PEEP

treatment for ARDS that keeps alveoli open, prevent cycles of recruitment /derecruitment (collapse)

Confused, head bob, breathe slow

signs indicative of Acute Respiratory Failure

PO2 < 60 mm Hg OR PCO2 > 50 mm Hg

ABG levels indicative of acute respiratory failure

Croup (laryngo-tracheo-bronchitis)

acute inflame of upper & lower resp tracts from a virus

raspy barking cough w/ inspiratory stridor

hallmark symptom of CROUP

Steeple Sign (narrowing of subglottic area)

CXR sign of croup

RT-PCR or viral culture

diagnostic testing for croup

support care or steroids

basic treatment for Croup

racemic epinephrine and/or dexamethasone

severe croup treatment

parainfluenza virus

top cause of Croup

babies that are premature; low birth weight; young (>6mnth)

high risk for RSV

Low-grade fever

Apnea (stop breathing)

Hyperinflated lungs

signs of RSV

bronchiolitis

disease associated with/caused by RSV

Hydration, humidification, antivirals

treatment for RSV

Ribavirin

antiviral given for RSV

Pertussis

Whooping cough

Pertussis

Highly infectious bacterial disease mostly in kids (esp under 2) and adolescents that spreads via droplet

Catarrhal stage

1st stage of Pertussis - insidious onset w/ lacrimation, sneeze coryza, anorexia and malaise. Hacking night cough, URI → most contagious stage

Paroxysmal stage

2nd stage of Pertussis - rapid “whooping” coughs w/ deep, high-pitched inspiration

Convalescent stage

4wks after onset of pertussis w/ decreased freq and severity of paroxysms of cough (resolution/taper stage)

PCR (preferred)

Nasopharyngeal cuture

testing for pertussis

Macrolide (Erythromycin, Azithromycin, Clarithromyci)

antibiotics given for pertussis

Interstitial Lung Disease

disease of lung Parenchyma – air spaces…affects bronchioles and alveolar area ONLY

Interstitial Lung Disease

also Diffuse Interstitial Pneumonias/ “Parenchymal disease”

injury to alveolar epithelial cells or the capillary endothelial cells

general cause of interstitial lung disease that leads to fibrosis

Progressive dyspnea,

crackles

Inflammation & swelling

signs and symptoms of interstitial lung disease

Age 55-60,

slight male predominance

Usual interstitial pneumonia (UIP) common age group

Insidious dry cough and progressive dyspnea over months to years

Clubbing

signs and symptoms of usual interstitial PNA

decrease diffusion, ground glass and honeycombing

diagnostic symptoms of usual interstitial PNA

Age 40-45

heavy smokers

high risk population for Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD)

minimal honeycombing, more ground glass and upper lobe emphysema

diagnostic signs of respiatory bronchiolitis-associated interstitial lung disease

any age

Possible preceding respiratory illness

risk population for acute interstitial PNA (AIP)

Abrupt dyspnea → sudden respiratory failure

symptom of acute interstitial PNA (AIP)

Age 45-55,

slight female predominance

high risk population of non-specific interstitial PNA

Typical age 50-60, but wide age variance

More bronchiole affect

high risk population for Cryptogenic organizing pneumonia (COP)

Insidious dry cough and progressive dyspnea over months (not years)

signs of nonspecific interstitial PNA

Preceding flu-like illness followed by dyspnea, cough, fatigue, fever, weight-loss

signs and symptoms indicationing Cryptogenic organizing pneumonia (COP)

corticosteroids

given for COP, may be have lifelong tx

Obstructive Sleep Apnea

Multi episode part/complete upper airway close in sleep → stop/min breathing > 10 sec → arousals and hyperpnea.