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Initial ddx exertional dyspnea
- Pulmonary (PNA, ILD)
- CV (CHF, ischemia, constrictive pericarditis)
- Anemia
- Thyroid disease
- Pregnancy
Posted 11/15/16 09:07:21 AM by Matthew Cummings
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Asbestos-related lung disease
- Crucial to ask extent of exposure -- was PPE worn? was asbestos being broken down? most exposure is typically safe (including if wearing appropriate PPE)
- Asbestosis (ILD--up to 30% w/ significant asbestos exposure have abnormal HRCT)
- Pleural disease (plaques)
- Malignancies (SCLC and NSCLC, mesothelioma)
Posted 11/15/16 09:11:30 AM by Matthew Cummings
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Stridor in adults
- Anaphylaxis
- Thyroid disease
- Trauma (including post-op--langyeal edema/damage)
- Malignancy/laryngeal polyps
- Granulomas/strictures (MPA, GPA, sarcoid)
- Epiglottitis (waning Hib immunity?)
Posted 11/15/16 09:15:30 AM by Matthew Cummings
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Interstitial Lung Disease Overview
- Clinically: MUST consider ILD and obtain HRCT in ANY patient w/ unexplained SOB/crackles (oftentimes r/o contribution of CHF concomitantly)
- Known cause/association
- Systemic disease
- Vasculitis (MPA, GPA, Churg-Strauss, etc -- ANCAs/MPO/PR3)
- Connective tissue disease (RA, SS, Sjogrens, Dermato/polymyositis--good H&P--skin, joints, muscle, hands, serologies--can oftentimes see ILD w/ +serologies PRIOR to joint/muscle involvement)
- Sarcoidosis
- Exposures:
- Medication/drug-related (Amiodarone, MTX, Other chemo)
- Chest radiation
- Occupational (pneumoconiosis--silica, asbestos)
- Environmental (HP--insp. squeak, mosaic attenuation on CT, +granulomas on bx)
- Smoking-related (IPF, idiopathic DIP, idiopathic RB-ILD, PLCH)
- Genetic (Hermansky-Pudlak)
- Unknown cause
- Idiopathic interstitial PNAs
- Specific pathology
Posted 11/15/16 09:30:31 AM by Matthew Cummings
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RA-associated ILD
- Never forget atlanto-axial subluxation risk -- cervical Xrays PRIOR to OR/intubation
- Often related to chronic inflammation, immunosuppression or direct toxicity from DMARDs/biologics.
- Parenchymal disease (ILD)
- Pleural disease (pleural thickening and effusions)
- Airway and PVD (vasculitis, laryngeal polyp, and pulmonary hypertension)
- Emerging association between +RF titers and subclinical ILD (even in absence of joint involvement)
Posted 11/15/16 09:40:27 AM by Matthew Cummings
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For further reading...
Posted 11/15/16 09:45:33 AM by Matthew Cummings
Created by Christopher Kelly
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