111414 interstitial lung dis

Question 1

synonyms for interstitial lung dis

Answer 1

infiltrative lung dis
diffuse parenchymal lung dis
restrictive lung dis

Question 2

pathogenesis of interstitial lung dis

Answer 2

alveolitis (damage to pneumocytes and endothelial cells)

leads to leukocytes releasing cytokines which mediate and stimulate interstitial fibrosis

interstitial fibrosis decreases lung compliance and elasticity.

Question 3

findings for interstitial lung dis

Answer 3

dry cough, dyspnea
late inspiratory crackles, bibasilar (velcro crackles)
cor pulmonale
CXR-bilateral reticulonodular infiltrates (reticular meaning thin walled cysts-honeycomb)

Question 4

interestitial lung dis-ex of ones that are of unknown cause

Answer 4

sarcoidosis

idiopathic pulmonary fibrosis

Question 5

pneumoconioses

Answer 5

non neoplastic lung diseases in response to inhalation of mineral dusts in the workplace

coal dust, silica, asbestos, beryllium

Question 6

for pneumoconioses, under what size must particles be to reach alveoli and by phagocytosed by alveolar macrophages?

Answer 6

0.5 micrometers

Question 7

are pneumoconioses reversible or irreversible?

Answer 7

irreversible

Question 8

coal workers’ pneumoconiosis develops from what

Answer 8

anthracotic pigment-coal mines, urban centers, tobacco smoke

Question 9

forms of coal workers’ pneumoconiosis

Answer 9

pulmonary anthracosis (mildest)
simple CWP
complicated CWP (progressive massive fibrosis)--most severe

Question 10

simple coal workers’ pneumoconiosis pathology

Answer 10

fibrous opacities under 1 cm
upper lobes and upper portions of lower lobes
coal dust deposits adjacent to respiratory bronchioles

Question 11

complicated coal workers’ penumoconiosis pathology

Answer 11

fibrous opacities greater than 1 cm
with or w/o central necrosis
can join and form massive fibrosis–black lung disease
complication–cor pulmonale
Caplan syndrome-CWP with rheumatoid nodules in lung
no increased incidence of TB or cancer

Question 12

silicosis–causes?

Answer 12

most common occupational disease worldwide

crystalline silicon dioxide (quartz)–foundries/metal casting, sandblasting, silica mines

Question 13

pathology of silicosis

Answer 13

nodular opacities with CONCENTRIC LAYERS OF COLLAGEN

POLARIZABLE QUARTZ particles

egg shell calcification in hilar lymph nodes

complications- cor pulmonale, associated with Caplan syndrome

increased risk for TB and cancer

Question 14

causes for asbestos related interstitial lung dis

Answer 14

insulation around pipes in old naval ships
roofing material used over 20 yrs ago
plumbing
demolition of old buildings
construction work

Question 15

pathology of asbestos related disease

Answer 15

ferruginous bodies (macrophages phagocytose asbestos fibers and coat them with ferritin)

benign pleural plaques
diffuse interstitial fibrosis
bronchogenic carcinoma
mesothelioma (fibrosis in the lung, fibrosis in the pleura, cancer in the lung, cancer in the pleura)

complications: cor pulmonale, Caplan syndrome

Question 16

causes of berylliosis

Answer 16

beryllium-nuclear and airspace industry

Question 17

pathology of berylliosis

Answer 17

GRANULOMATOUS INFLAMMATION (TB and sarcoidosis are also on the differential)

complications-cor pulmonale and lung cancer

Question 18

sarcoidosis-what causes it?

Answer 18

unknown

Question 19

sarcoidosis is more common in what population?

Answer 19

African American
female
70% are under 40 years
non-smokers

Question 20

pathogenesis of sarcoidosis

Answer 20

unknown antigen causes interaction with CD4 T cells and cytokine release, recruitment of histiocytes, non-necrotizing granuloma formation

it’s a diagnosis of exclusion

Question 21

sarcoidosis affects what very commonly?

Answer 21

lung

lymph nodes

Question 22

sarcoidosis can affect what other organs?

Answer 22

skin
eye (uveitis)
liver
other-salivary and lacrimal glands

Question 23

findings for sarcoidosis

Answer 23

increased ACE levels (marker of dis activity and response to steroids)

hypercalcemia

polyclonal gammopathy

cutaneous anergy

CXR-BILATERAL HILAR ADENOPATHY, RETICULONODULAR SHADOWS IN LUNGS

interstitial granulomas in “lymphatic” distribution pattern

Question 24

cause of hypersensitivity pneumonitis

Answer 24

inhaled antigen (known or unknown) producing granulomatous interstitial pneumonitis (extrinsic allergic alveolitis)

farmers’ lung-moldy hay, thermophilic actinomyces
silo fillers’ disease (plant material)
byssinosis (cotton, linen, hemp)

type III hypersensitivity rxn, but chronic exposure results in granuloma formation (type IV hypersensitivity response)

Question 25

pathology of hypersensitivity pneumonitis

Answer 25

interstitial and alveolar infiltrates of inflammatory cells, peri bronchiolar accentuation, ill-defined granulomas (not well circumscribed)

Question 26

usual interstitial pneumonia

Answer 26

by and large equates to idiopathic interstitial fibrosis

Question 27

pathology of idtiopathic pulm fibrosis

Answer 27

repeated injury to lung causes interstitial fibrosis.

as time progresses, interestitial fibrosis can result in irregular dilatation of adjacent airways, leading to honeycomb lung (end stage interstitial fibrosis)

Question 28

collagen vascular disease

Answer 28

SLE–unexplained pleural effusion in a young woman likely to be SLE
RA
systemic sclerosis (scleroderma)