Term
| What should be suspected in a pt with small cell lung CA and new onset AMS, seizures, and hallunications? |
|
Definition
| Paraneoplastic Limbic Encephalitis |
|
|
Term
| What will be seen in CSF of a pt with paraneoplastic limbic encephalitis? |
|
Definition
| Anti-Hu, Anti-Yo antibodies most common |
|
|
Term
| What is lesler treslat sign? |
|
Definition
| sudden eruption of multiple sebborheic keratosis 2/2 to malignancy |
|
|
Term
| What is a catamenial pneumothorax? |
|
Definition
| pneumothorax is caused by menstrual cycle in a pt with endometriosis. Endometrial tissue in these pts is in the pleural space, which fills with blood during menses |
|
|
Term
| What is the treatment for Primary spontaneous PTX with minimal symptoms and small size (2-3 cm from apex of chest wall to apex of lung)? |
|
Definition
observe or give supplemental O2
Repeat CXR in 4-6 hours to ensure no increase in size
Rate of resolution on RA 1.5%/day
A PTX resulting in 30% of chest filled with air would resolve in 20 days
Rate increases 4x if on supplemental O2 (2-4 L) |
|
|
Term
What is the treatment for Large/symptomatic primary spontaneous pneuomothorax?
(large is > 3cm) |
|
Definition
| Drainage (simple aspiration or chest tube) |
|
|
Term
What is the treatment for Secondary spontaneous pneumothorax of any size?
(secondary to lung disease eg cystic fibrosis. . . etc) |
|
Definition
|
|
Term
| What is the treatment for recurrent pneumothoracis? |
|
Definition
|
|
Term
| What is the recurrence rate for primary spontaneous pneuothorax? |
|
Definition
| 25-50% rate of recurrence in 1st 3 years |
|
|
Term
| What is Lofgren's syndrome? |
|
Definition
acute sarcoidosis, associated with
Bilateral hilar adenopathy, erythema nodosum, fever, and arthritis [usually of ankles |
|
|
Term
|
Definition
IL-5 is the interleukin
which stimulates bone marrow production, maturation, and release of eosinophils |
|
|
Term
| What is Loffler's syndrome? |
|
Definition
SIMPLE PULMONARY EOSINOPHILIA
(LOFFLER’S SYNDROME)
-Due to lung migration stage of ascaris, strongyloides,
And hookworm infections
-Transient, infiltrates and eosinophilia; minimal sxs
-Unlikely to recur as lung migration only occurs once
During a single infection |
|
|
Term
| Does Loffler's syndrome recurr? |
|
Definition
| No, usually happens once during a parasitic infection |
|
|
Term
| What is tropical pulmonary eosinophilia? |
|
Definition
this is a persistent disease
Caused by filarial infections such as wuchereria bancrofti and brugia malayi |
|
|
Term
| What do Charcot-leyden crystals suggest? |
|
Definition
| -Suggest eosinophilic inflammation |
|
|
Term
|
Definition
| Allergic bronchopulmonary aspergillosis (ABPA): allergic sensitization to aspergillus in bronchi |
|
|
Term
|
Definition
| with hard to control or steroid dependent asthma |
|
|
Term
| What is necessary to make the diagnosis of ABPA? |
|
Definition
|
|
Term
| What is the treatment for ABPA? |
|
Definition
-Treatment is steroids, +/- antifungals
-Steroids usually do NOT result in an
Invasive aspergillus infection such as
Chronic semi-invasive aspergillosis or
Angioinvasive pulmonary aspergillosis |
|
|
Term
| What is seen on ST in pts with ABPA? |
|
Definition
|
|
Term
| What is acute eosinophilic pneumonia? |
|
Definition
-Rapid onset of respiratory sxs, often to respiratory failure within 1 week
-Associated with initiation of cigarette smoking |
|
|
Term
| Is peripherial eosinophilia seen in pts with ACUTE eosinophilic pneumonia? |
|
Definition
|
|
Term
| How is acute eosinophilia diagnosed? |
|
Definition
| -Diagnosis is made by BAL eosinophilia (>25%) |
|
|
Term
| What is the treatment for acute eosinophilic pneumonia? |
|
Definition
| -Treatment is steroids, with rapid resolution and extremely rare relapses |
|
|
Term
| How does CHRONIC eosinophilic pneumonia present? |
|
Definition
| flu-like symptoms usually subacute/chronic presentation (weeks-months) |
|
|
Term
| Is peripheral eosinophilia seen with CHRONIC eosinophilic pneumonia? |
|
Definition
|
|
Term
| What is typically seen on CXR in pts with chronic eosinophilic pneumonia? |
|
Definition
-Classic radiographic pattern is upper lobe predominant, peripheral infiltrates (photographic
Negative of CHF) |
|
|
Term
| What is the rx for CHRONIC eosinophilic pneumonia? |
|
Definition
| -Good response to systemic steroids |
|
|
Term
| Will relapses occur once the steroids are tapered? |
|
Definition
| -Relapse is common however (unlike acute eos PNA) |
|
|
Term
| What is Churg-Strauss disease? |
|
Definition
| Necrotizing, eosinophilic vasculitis |
|
|
Term
| What are the stages of Chrug Strauss? |
|
Definition
-3 phases which occur in sequence over years:
1. prodrome (asthma and sinusitis),
2. eosinophilic
(significant peripheral eosinophilia present),
3. vasculitic
-Unlike many small vessel vasculidites, cardiac and GI involvement common, whereas renal
Involvement is uncommon |
|
|
Term
| What is the diagnostic criteria for Churg-Strauss? |
|
Definition
Diagnostic criteria (ACR): presence of 4 or more of…
1. Asthma
2. Eosinophilia of 10% or above
3. Mononeuropathy or polyneuropathy
4. Migratory or transient pulmonary infiltrates
5. Sinusitis
6. Biopsy containing blood vessel with eosinophils in extravascular space |
|
|
Term
| What is the treatment for Churg-Strauss? |
|
Definition
Treatment: Corticosteroids are mainstay; may use steroid-sparing agents (azathioprine, MTX,
Rituximab, omalizumab (anti-IgE), or mepolizumab (anti-IL-5) to minimize dose
-plasma exchange has no clear role |
|
|
Term
|
Definition
| Aspirin-exacerbated respiratory disease (AERD, AKA aspirin-sensitive asthma, samter’s triad) |
|
|
Term
|
Definition
| triad of sinusitis, nasal polyps, asthma with aspirin sensitivity |
|
|
Term
| What does ASA induced asthma usually result in? |
|
Definition
| -Results in refractory sinusitis, recurrent polyps, asthma; eosinophilia is common |
|
|
Term
| What is the treatment for AERD? |
|
Definition
-Rx: standard topical therapy for asthma, polyps, and sinusitis (topical steroids)
-Leukotriene receptor antagonists (monteleukast) are first-line oral Rx (NOT 5-lipoxygenase
Inhibitors such as zileuton, which is second-line)
-Avoiding all NSAIDs should be tried
-Aspirin desensitization: most effective therapy; use if 1. failed more conservative treatment, and
2. If ASA is necessary (coronary disease with drug-eluting stent) |
|
|
