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2 Pulm: Pleura, ILD

Step Up to Medicine, Chap 2: Diseases of Pleura and ILD

Which type of effusion: pathophys either from elevated capillary pressure in pleura (CHF) or decreased plasma oncotic pressure (hypoalbuminemia) Transudative effusions (protein poor)
Which type of effusion: pathophys from increased permeability of pleural surfaces or decreased lymphatic flow from pleural surface from damage to pleural membranes or vasculature Exudative effusions (protein rich)
Which tests should be performed if exudative effusion is suspected? Differential cell ct, glucose, pH, amylase, triglycerides, micro, and cytology
Protein and LDH parameters for exudative effusions? Pleural protein/serum protein >0.5. Pleural LDH/serum LDH >0.6. LDH >2/3 the upper limit of normal serum LDH.
MCC of pleural effusion? CHF (transudative; elevated capillary pressure)
Most reliable test for detecting pleural effusions? CT
What testing to do on pleural effusion fluid? 4 Cs: chemistry (glucose, protein), cytology, cell ct (CBC w/differential), and culture
What does the pleural tap indicate?: elevated amylase esophageal rupture (ouch!), pancreatitis, malignancy
What does the pleural tap indicate?: frankly purulent fluid empyema (pus in pleural space)
What does the pleural tap indicate?: bloody effusion malignancy
What does the pleural tap indicate?: exudative with predominant lymphocytes TB
What does the pleural tap indicate?: pH <7.2 parapneumonic effusion or empyema
Glucose level <60 can be used to rule out which cause of pleural effusion? Rheumatoid arthritis. Can also be low with TB, esophageal rupture, malignancy, and lupus
Noninfected pleural effusion secondary to bacterial pneumonia? Parapneumonic effusion
Complicated parapneumonic effusion that becomes infected. Empyema
Which procedures (3) should be followed by CXR to make sure no traumatic pneumothoraces occurred? Transthoracic needle aspiration, throacentesis, and central line placement
Mediastinal shift is in which direction in relation to the spontaneous pneumothorax? Shift is TOWARD the side of the pneumothorax
Mediastinal shift is in which direction in relation to the tension pneumothorax? Shift is AWAY from the side of the pneumothorax (pressure collapses ipsilateral lung)
Management for suspected tension pneumothorax? Do NOT obtain a CXR. Immediately decompress the pleural space via large-bore needle or chest tube!
Causes of tension pneumothorax? Mechanical ventilation, CPR, trauma
Hypotension, distended neck vv, shift of trachea away from midline on CXR. Tension pneumothorax
A history of which medications might suggest interstitial lung disease? Chemo, gold, amiodarone, penicillamine, and nitrofurantoin. Also bleomycin, phenytoin.
Which nail finding is associated with idiopathic pulmonary fibrosis? Digital clubbing (if pt has this, get CXR); typically caused by chronic hypoxia
FEV1/FVC ratio in ILD? Obstructive or restrictive? Ratio is increased (both are low, but FVC is lower). Restrictive.
What diagnostic testing is typically required in pts with ILD? Tissue biopsy
Systemic granulomatous disease characterized by non-caseating granulomas. Typically seen in AA women <40yo. Anterior uveitis is common. Sarcoidosis
MCC death in sarcoidosis? Cardiac disease (uncommon though)
How do serum ACE levels help support diagnosis of sarcoidosis? Elevated in abt 50% of pts. Note it is also elevated in other diseases.
Stage I sarcoidosis? Bilateral lymphadenopathy
Stage II sarcoidosis? Lymphadenopathy and ILD
Stage III sarcoidosis? ILD ONLY
Langerhans cells proliferation (abnormal); assoc'd with cigarette smoking; honeycomb appearance on chest radiograph and cystic lesions on CT scan; possible spontaneous pneumothorax, lytic bone lesions, and diabetes insipidus Histiocytosis X
Necrotizing granulomatous vasculitis; c-ANCA. Diagnosis? Gold std test for dx? Tx? Dx: Wegener's granulomatosis Test: Tissue biopsy Tx: immunosuppressants and glucocorticoids
Granulomatous vasculitis in pts with asthma? Churg-Strauss; assoc'd with p-ANCA adn eosinophilia inblood Tx: systemic glucocorticoids
Increased risk of which malignancies in asbestosis? Bronchogenic carcinoma and malignant mesothelioma
Which disease associated with mining, stone cutting, and glass manufacturing is linked with increased risk of TB? Silicosis
Hallmark serum finding in hypersensitivity pneumonitis (extrinsic allergic alveolitis)? Presence of serum IgG and IgA to the inhaled antigen
Autoimmune disease caused by IgG antibodies directed against glomerular and alveolar basement membranes (type II hypersensitivity reaction) Goodpasture's syndrome
Tx for Goodpasture's? Plasmapheresis, cyclophosphamide, and corticosteroids
Rare condition caused by accumulation of surfactant-like protein and phospholipids in the alveoli Pulmonary alveolar proteinois
What is the chest radiograph appearance in pulmonary alveolar proteinosis? Ground glass appearance with bilateral alveolar infiltrates that resemble a bat shape
Why should steroids not be given to treat pulmonary alveolar proteinosis? B/c they are already at increased risk of infection. Instead use lung lavage or GCSF (new tx).
Created by: sarah3148