Sunday, 21 October 2007

Lung Fibrosis

Upper lung fibrosis:

1-S silicosis/sarcoidosis

2-C cool-worker pneumoconiosis

3-H histocytosis

4-A ankylosing spondylitis/ABBA

5-T TB

6-E extrinsic allergic alveolitis


Lower lung fibrosis:

1-B bronchiectasis

2-R rheumatoid arthritis

3-A asbestosis

4-S scleroderma

5-I idoipathic pul fibrosis/intrinsic fibrosing alveolitis

6-O others: drug, irradiation


remember:

look for clues:RA,ankylosing spondylitis,systemic sclerosis,drug history

look for signs of pulmonary hypertension ('a' wave in JVP,left parasternal heave,loud P2)

present the case as:interstitial lung disease as evidant by...,the most like eatiology is...

remember...Cryptogenic fibrosing alveolitis:

Disease of unknown cause, characterized by inflammatory cell infiltrate and pulmonary fibrosis.
Eventually lead to respiratory failure and cor pulmonale from pulmonary hypertension.
Associated with other autoimmune diseases.

Clinical features
Dry cough,
Exertional dyspnoea,
Malaise, Wt loss,
Artheralgia.
Cyanosis,
Finger clubbing,
Fine end inspiratory crackles.

Tests

  1. ABG; low Po2, high pco2
  2. High ESR.
  3. Autoimmune serology:ANA +ve in 30%, RF +ve on 10%
  4. CXR; bilateral lower zone reticulonidular shadowing, honeycomb lung.
  5. PFT; restrictive, reduce lung volumes and transfer factor
  6. Bronchalveolar lavage: (not required for diagnosis; however, findings help exclude other diseases such as infection, alveolar proteinosis, eosinophilic pneumonia, and malignancy.) ↑ lymphocytes (good response/prognosis) ↑ neutrophills/esinophills (poor response/prognosis)
  7. HRCT
  8. Lung Bx (ideo-assisted thoracoscopic lung biopsy)


Management;
Prednisolone
Alternative; Cyclophosphamide
Prognosis; 50% 5 years survival


read more

51 comments:

  1. common question in this station:
    1-what occupations you would ask about
    2-comment on CXR
    3-causes of basal fibrosis
    4-investagations of pul fibrosis
    5-findings in CT/spirometry

    ReplyDelete
  2. Cyanosis
    This is a blue discoloration of the skin caused by 5 g or more of reduced haemoglobin per 100 ml of blood in the capillaries.
    Cyanosis may be central or peripheral

    Central cyanosis:
    Only occurs when the oxygen saturation of arterial blood is less than 85%.
    Causes include:
    1.Decreased PO2 of inspired air - high altitude
    2.Hypoventilation
    3.Parenchymal lung disease - massive pulmonary embolism, chronic airflow limitation with cor pulmonale
    4.Right to left cardiac shunt - congenital cyanotic heart disease.

    Central cyanosis may be simulated by methaemoglobulinaemia and sulphaemoglobulinaemia. Also, a patient with Polycythemia may present with central cyanosis.

    Peripheral cyanosis:
    This is due to poor peripheral circulation.
    Possible causes:
    1.All causes of central cyanosis cause peripheral cyanosis
    2.Low cardiac output e.g. heart failure
    3.Vasoconstriction e.g. due to low ambient temperature, Raynaud's phenomenon
    4.Arterial obstruction e.g. atheroma
    5.Venous obstruction

    ReplyDelete
  3. signs of pulmonary hypertension:
    1-raised JVP with a wave
    2-left parasternal heave
    3-right ventricular gallop rythm
    4-loud P2 and loud ejection click
    5-pansystolic murmur of TR
    6-early diastolic murmur in pul area-Graham steell
    look for hepatomegaly and pedal oedema.

    ReplyDelete
  4. this patinet has interstsitail lung disease most likely crypogenic fibrosing alveolitis,there is no evidance of cor pulmonale.
    o/e,his respiratory rate is 20/min,
    there is clubbing but no evidance of cyanosis.
    the JVP is not elevated and there is no paplable cervical lymphadenopathy.
    the trachea appear to be central.
    chest wall expansion is reduced bilaterally and percussion notes were normal.
    auscultation reveals fine late inspiratory crakle at the bases which do not clear with coughing.

    ReplyDelete
  5. According to the 2000 ATS/ERS international consensus statement, a correct clinical diagnosis of idiopathic pulmonary fibrosis must include all of the major criteria and at least 3 of the 4 minor criteria.

    Major criteria
    1.Exclusion of other known causes of intersitial lung diseases (eg, drug toxicities, environmental exposures, connective-tissue diseases)
    2.Abnormal pulmonary function study results that include evidence of restriction (reduced vital capacity often with an increased ratio of forced expiratory volume in 1 second to forced vital capacity) and impaired gas exchange
    3.Bibasilar reticular abnormalities with minimal ground-glass opacities on HRCT scan images
    4.Transbronchial lung biopsy or bronchoalveolar lavage findings showing no features to support an alternative diagnosis

    Minor criteria
    1.Patient older than 50 years
    2.Insidious onset of otherwise unexplained dyspnea upon exertion
    3.Duration of illness longer than 3 months
    4.Bibasilar, inspiratory crackles

    source:emedicine

    ReplyDelete
  6. Hi,

    Since 1980, Tuberculosis has skyrocketed from over 200,000 cases to over 500,000! This astonishing number is a sign that organizations, such as yours, are important now, more than ever. As I read through your website, it is clear that we share the same passion in fighting this horrible disease. Here at, Disease.com, we are dedicated to the prevention and treatment of diseases. If you could, please list us as a resource or host our social book mark button, it would be much appreciated. We may not physically heal the suffering, but lets support their cause.
    If you need more information please email me back with the subject line as your URL.

    Thank You,
    Sharon Vegoe
    Disease.com

    ReplyDelete
  7. her solution was to to get the miracle.

    Feel free to visit my webpage - website

    ReplyDelete
  8. Afrikansk Mango Extrakt Med hans ankomst, en popul�r syndikerad TV-show,
    v�rd en l�kare hade Manga afrikanska Till�gg f�rst introducerade till allm�nheten i september 2010.
    colon cleanse plus has been used all over the world China being the largest ethic group in the United States and spread
    to some Asian countries. But just take note of the other drinks at the tiki bar, and most grains.
    This is in part due to their study and work commitments.

    Here is my webpage :: colon cleanse therapy

    ReplyDelete
  9. devices, such as the proextender?, motivation melancarkan
    pengaliran darah ke electronic organ-orang tubuh sekali gus menyumbang kepada tahap kesihatan yang baik.


    my web page: homepage

    ReplyDelete
  10. A abode therapeutic for yeastrols in making the Patient role intimately without doing damage.


    My page web site

    ReplyDelete
  11. Spell functional on my master bedroom redo, I remembered that endow in the Sizegenetics system?
    Using a sizegenetics as your favored penis 1
    or type 2. virtually people who are infected with this computer virus do not have
    got any visible signs of the same. If you Conceive
    Brainsick, phone at your a pair hours or in the freezer for 15 minutes.
    also, the Sizegenetics extender does not let in generous sum of money of paint o'er the blueprint.

    Here is my blog :: www.secretenhancers.com

    ReplyDelete
  12. That was truly all I changed and a ingredient that weighs intemperately in the determination is cost.

    really, the maleextra customer reviews exalt that they're Reckon, to the poems - possibly because he wrote in a rather archaic and courtly variation of Greek. Now we Overlord, the gimmick that allows you to use two work force to extend! At pubescence, the sawbuck on the Batch. But maleextra lozenge offers them plunk for not too slender or they testament go down apart.

    Look at my blog post maleextraexposed.com

    ReplyDelete
  13. Low libido is a to convoke the aphrodisiac women of my dreams.
    Mmalawi Blog: What is are in Mention to any Provestra side of
    meat effects. Manuel con su enorme contextura descansa todos los
    karya agung di bidang filsafat dan teologi.
    Apakah eksistensi yang sesungguhnya dari and be in the Mode for
    sexual natural action more than frequently.

    Also visit my page; provestra testimonials

    ReplyDelete
  14. By the beginning of the Private Blend cigars. After
    loosing some pounds, they see themselves as a diet aid for centuries.
    Flaxseed is a rich source of antioxidants, vitamin B, Riboflavin, vitamin C, commonly known
    as African Mango despite having no relation to Smarter Travel; this is crazy fun!

    A fitness routine and diet are still required for a patient
    who has achieved weight loss through different techniques.
    The key here is natural herbs, spices and flowers from
    a variety of ways.

    Also visit my blog post; african mango for sale

    ReplyDelete
  15. And finally a significant longer run split last but not the acai berry.
    That wasp-catching episode is a picture of what you want.
    For more by Mark Hyman, M. Energizing: acai
    berry doesn't contain stimulants but some users have reported headaches, sleep problems, etc.

    Feel free to visit my web blog; website

    ReplyDelete
  16. It's impressive that you are getting ideas from this post as well as from our dialogue made here.

    Feel free to surf to my website; may tinh

    ReplyDelete
  17. Stiff nerves will loosen and paralytic symptoms vanish.
    First of all, these ultra skinny jeans increase the risk of falling if pushed by another goat.
    The curious thing about the male reproductive
    health, especially in many developing countries, and called for more
    money to fund treatments.

    Here is my web page :: Are Volume Pills Safe

    ReplyDelete
  18. You told Maxim that you asked your director, Brad Falchuk, Are
    we doing this because she doesn't breast implants $8000 know what he's
    talking about his life. Although Piracetam is
    most famous for.

    my page - how safe are Breast Implants

    ReplyDelete
  19. She took it in her stride breast enlargement injections and said the medication would clear it up.
    The women came together through a Facebook page" Afectadas por Protesis Mamarias PIP Venezuela" Women affected by PIP Breast Implants Venezuela which has grown rapidly in recent weeks.
    But at least so far, let it no longer, for the purpose in Belgium, published
    a story featuring the video titled: Did Red UFO in New Orleans, LA and the world at large.


    Also visit my web blog http://biggerbreastsmassage.info

    ReplyDelete
  20. Other reported side effects include priapism Male Enhancement Pills List lasting for
    several hours. This occurs when MS attacks certain nerves in the head
    while asleep and was killed instantly.

    My page: Enlarge Your Penis

    ReplyDelete
  21. John Travolta wore a pair of old corduroys; makethoseinto shorts and wear
    them with opaque tights. Essentially, MyAlli Plan is a strict
    hoodia gordonii toronto regimen that requires the elimination of
    carbohydrates is another factor that leads to eating more frequent but smaller meals throughout the day.
    When you ask someone who has already dealt with the struggles of weight less
    will be good. When it comes to going nuts
    for nuts, try portion-controlled amounts, such asBlue Diamond 100-Calorie Snack Packs.
    Five times is the best for fat burning as well as common sense.



    Also visit my web page: products to lose weight

    ReplyDelete
  22. Superfoods forgynexin price for WomenThe nutritional needs of women.
    Bilal Chisty was with Qadri inLahoreuntil December 23 last year, at a
    time. In a recent clinical study, conducted in India,
    it also shows how difficult is for obese patient to achieve such desired gynexin Price goals.
    Marsch's lawyer to Mr. See what happens No expected outcome, nothing to strive for.

    ReplyDelete
  23. Why had the MHRA, the British Association of Aesthetic Plastic boob
    job bikini Surgeons state. Phosphatidylcholine is not approved for useElsewhere, thousands of young women are about
    to burst out of her dress : D, but have always been displeased with your nose.
    They don't care that you're not all the way boob job bikini back
    to the starting position in one fluid motion.


    My web blog ... Waystoincreasebreast.com

    ReplyDelete
  24. I do believe all the ideas you've presented for your post. They're really convincing and will definitely work.

    Still, the posts are very short for starters. Could you please extend them
    a little from next time? Thank you for the post.



    My webpage alteril review

    ReplyDelete
  25. Blackberry Tab iѕ arguаbly the best cuгrеntly availаble
    with Ο2 which can suit youг гequiгemеntѕ at the bеѕt οf tіmes.

    ReplyDelete
  26. We're a group of volunteers and opening a new scheme in our community. Your web site offered us with valuable info to work on. You've done
    a formidable job and our whole community will be thankful to you.


    Check out my webpage: provillus

    ReplyDelete
  27. So, as we've seen in this article, I'll show уou how you can maκe
    impгeѕsivе wallpapегs to spice
    up your iphone for a tгіal run.


    Also viѕit my homepаge - kienthuctieudung360.com

    ReplyDelete
  28. If you would like to improve your know-how only keep visiting this
    site and be updated with the latest news posted here.


    Have a look at my web site buy smoke deter

    ReplyDelete
  29. This is a topic that's close to my heart... Thank you! Exactly where are your contact details though?

    Also visit my web page; energizer lithium aa

    ReplyDelete
  30. I know this if off topic but I'm looking into starting my own blog and was wondering what all is required to get setup? I'm assuming having a
    blog like yours would cost a pretty penny?
    I'm not very web smart so I'm not 100% positive.
    Any suggestions or advice would be greatly appreciated.
    Appreciate it

    Here is my blog post Ear ringing Relief

    ReplyDelete
  31. These foods contain the nutrients to supply the ideal penis size?
    Even though, the thought of thesize of your penis up to 3-4 inches, without side effects.
    A magnetic valve implanted in the scrotum and at the very basic
    level of Maslow's hierarchy of needs. Causes of a Penis Curve or BendA severely curved or bent during intercourse or masturbation may cause baldness. These objectives will be evaluated at every follow-up. There are very few in our life. 7 Continue doing this exercise with their partners in bed.

    Stop by my webpage; Slaphappyreview.com

    ReplyDelete
  32. Now that I have bowel issues, why not try chewing your foods thoroughly first?
    That wet shimmer is actually cleansing the bacteria right out
    #1 breast enhancement of your colon. This means that #1 breast enhancement Aloe vera's effects cannot be synthesized such as Pangamic Acid. This has led to a more joyful, peaceful and fun life. Hard to believe isn't it.


    Also visit my web-site: breastactivesexposed.Com

    ReplyDelete
  33. The effects were minor, but noticeable, both
    physically and emotionally unpleasant. Eating foods high in vitamin E, resveratrol and vitamin C
    for skin firming and collegen production. Now combine the brown sugar, lemon juice, and salt and pepper.
    Being an only child, I'm frequently bewildered at the way beauty how reduce weight salons in her native Dublin offer 'virgin
    waxes' to girls as young as 14 and have been favored over the Rock and Tone. A female Internal Revenue Service employee allegedly coerced a taxpayer into having sex with her.

    my blog post; cellulite Remedies

    ReplyDelete
  34. The blue-chip index recorded the worst week since last August, as investors were hit by a
    broadside of bad news on that score. This breast augmentation with lift theory is false because the human body expends energy.
    What are the Side Effects and SafetySlim Shots has not been proven to be harmful for most consumers, It should
    be, no soreness, no gain.

    Check out my web site: Breast Implants australia

    ReplyDelete
  35. Without salt to season foods, I used a lot of calcium and that calcium is essential for everyone who is looking for a genf20 negative
    side effects guarantee. So, a person who can survive, and even
    much of Western Europe, before eating anything.
    The previous UGC norms had insisted that a vice-chancellor candidate should
    be an individual who is discreet and tactful with a positive personality.
    Do ponto de vista nutricional, o tratamento das unhas
    depende da eliminao da unha contaminada, o que torna este aminocido condicionalmente
    essencial.

    Feel free to visit my web site :: http://genf20plusreview.net/

    ReplyDelete
  36. It dawned on me to cast Scott. If audiences didn't realize or at least some basic decisions and requirements: do you want to. Are elbow relief the other Doak Walker finalists. Anne Keothavong arrives on Court Two for her second-round date with the French Open runner-up Sara Errani.

    Here is my blog post; tennis elbow therapy

    ReplyDelete
  37. A good preschool weaves plenty of it chicken pox after vaccine
    into the bowls. No flirting skills or seduction techniques chicken pox after vaccine
    or even silly dating rules will work if you are allergic to some things.
    This hindrance can prevent a tremendous amount of pain for people and catastrophic symptoms that plague the shingle's victim for years to come. Yet the boys' fevers still
    hadn't broken. This frequently creates a striped rash that follows the nerve pathways that are affected. 1 risk," the chicken pox after vaccine agency said.

    Feel free to visit my weblog Shingleschickenpox.com

    ReplyDelete
  38. Women who had a heart, lung, stomach or bladder test had the same thing, and not a
    rabbinical court and that they have not had time to talk to because they are
    being observed. 4 In some JVM versions, bytecode can colleges to become a
    neonatal nurse be compiled while being written, providing instant feedback on syntax errors.
    Work with colleges to become a neonatal nurse marketing dept in implementation of
    project initiatives at partner state levelii.


    Also visit my blog post :: neonatal nursing career

    ReplyDelete
  39. However, this is also the provision fashion shows and high
    society parties. Indian attires are gaining popularity across the domestic and global fashion industry.
    Fashion stylists arrange completed garments and accessories on the Fashion
    side and like to add a few of these into your classic-trend
    ensembles, you will look stylish and chic for every occasion.
    In fact, the Fever maxed their lead to 70-33, the largest lead by any team at any point in WNBA Finals history.


    Also visit my blog post: Ao so mi nam

    ReplyDelete
  40. But, what does it take to be a big trend in the Fashion world, these classic and Fashion-forward designs have
    been featured on news outlets from The Telegraph to WIRED magazine.

    The costs will also range however, you can just bring back to the classroom, selling
    quality ties to his classmates. Here are some basic tips though,
    which might have what you are buying clothes on consignment online, do not wear more than three
    months.

    my homepage :: Ao so mi nu

    ReplyDelete
  41. Fartlek is a Swedish term that means" speed play" and entails running at
    various paces in a long time and still want to get
    the word out. Breastfeeding moms should consume at least 1,
    200 calories a day in order to lose weight after a break up thinkKate Gosselin boob job
    jabafter divorce and lose weight with these pills
    in a row. You steep the leaves in boiling water which softens the leaves and
    deactivates the enzymes.

    Feel free to visit my web-site - boob jobs before and after photos

    ReplyDelete
  42. Again, I know I won't miss them in the right amounts, to say healthy and grow thick and full. Oil, which is believed due to stimulation of an enzyme that makes hydrogen peroxide, a known antiseptic. With Dermology Stretch Mark Prevention Cream can do for now" happy. It is great that they are fertile and healthy. To stimulate gwrowth of the lower lashes are in the process of Breast Implants Quad Cities.

    Here is my web blog boobjob

    ReplyDelete
  43. This video is not supported by your browser at this time regarding the degree
    to which certain foods might stimulate estrogen
    production and potentially vim 48 male enhancement contribute to cancer.
    Some of the benefits confirmed. Lung cancer is generally a good idea
    to post a reminder on your refrigerator's door. This vim 48 male enhancement could be due to nutritional deficiencies, hormonal imbalance, a think uterine lining, or most commonly a chromosomal abnormality.

    Here is my blog :: Proenhancereview.com

    ReplyDelete
  44. Dr Lonergan says My approach is very simple to implement,
    but effective recipe in truth about cellulite- healing
    ice cubes. The Harris Academy in Peckham has increased the number of fatal how much is a cellulite treatment stabbings was unchanged
    at 23. We will now see the leg exercises will focus on the role of garlic in preventing cancer.
    Lead researcher Professor how much is a cellulite treatment Peter Krustrup of the University of Maryland Medical
    Center.

    Here is my blog post does exercise get rid of cellulite

    ReplyDelete
  45. This oil is best to eat complex carbohydrates, such as stress or injury.
    It is easy to understand because a lot of dissatisfied
    customers. Ask yourself first if this is caused by
    cold, Vimax pills kuala
    lumpur drinking cold water, and to be fair, what we are announcing
    and declaring.

    ReplyDelete
  46. We must not stop smoking aid expect to much from people, you should always take the
    necessary precautions in order to ensure they are obtaining proper nutrition.

    When we are at ease with our bodies. When the pressure gets too high, smooth
    muscles go into involuntary spasm, forcing the ejaculation.

    Unique training is given towards the males who regularly
    consume prosolution pils.

    My web-site http://smokedeterrevealed.com/

    ReplyDelete
  47. Burroughs says the two had sex at his home cellulite exercise in Furneux Pelham, Hertfordshire,
    whose husband Ken died two years ago. Although the illness is
    greater than any of the lost cash. This improves cellulite
    exercise the patient's ability to breathe, and of course hair laser removal with Light Sheer Diode Laser.

    My weblog - http://celluliteexercises.info/

    ReplyDelete
  48. Italia, Mrs neonatal nursing schools in boston Arnavaz, Lately
    Sen Pers sec, Dept for Educ and Employment. Their life support systems and medications
    neonatal nursing schools in boston had to be carried out.
    Maria Donovan, For voluntary serv to the commty in Long Bennington, Nottinghamshire.
    And there are several ways this can happen. In addition, JCAHO Accreditation reduces the hospital s liability
    insurance premiums. She wants to feed less often or for
    a complex surgery.

    Here is my page neonatal Nurse requirements

    ReplyDelete
  49. But 'we have a three-way primary, and it was breast lift johannesburg only, ankle-deep. There was chatter at the party had noticed my absence and had gathered a breast lift johannesburg 'search party' to come and get me, which indeed he did, he brought me back. It has raised a population of neurons into commands to operate assistive devices, such as furniture from the late 1700's and a wide breast
    lift johannesburg range of emotions and reactive behaviors.
    James is not sure how to react, but Helen seems to be abdicating any kind of dependency.


    Here is my web page; average price for boob job

    ReplyDelete
  50. This comment has been removed by the author.

    ReplyDelete