20) ILD and Pleural Diseases

Question 1

What is the interstitial space?

Answer 1

Potential space between alveolar cells and capillary basement membrane, only apparent in disease states

Question 2

What can the interstitial space contain?

Answer 2

Fibrous tissue
Cells
Fluid

Question 3

What is the function of the interstitium?

Answer 3

Supports lung
Allows collagen formation (repair and remodelling)
Releases cytokines

Question 4

What structures can interstitial lung disease affect?

Answer 4

Alveoli, bronchioles, endothelium, mesenchymal and macrophage cells

Question 5

How does fibrous tissue in interstitium affect lung function?

Answer 5

Less compliant lungs, decreased ventilation
Reduced diffusion - longer pathway
Reduced perfusion - capillary destruction

Question 6

What does development of fibrous tissue in interstitium lead to?

Answer 6

Type 1 and then type 2 resp failure

Question 7

What are some general symptoms of ILD?

Answer 7

Chronic shortness of breath, chronic cough, reduced exercise intolerance

Question 8

What are some general signs of examination in ILD?

Answer 8

Cyanosis
Tachycardia
Tachypnoea
RHF
Clubbing

Question 9

Give some examples of occupational ILD:

Answer 9

Asbestosis, coal worker pneumoconiosis, silicosis

Question 10

Give some examples treatments causing treatment related ILD:

Answer 10

Radiation 
Methotrexate (Ra, sarcoid, chemo)
Nitrofuratoin (UTI)
Amiodarone (arrhythmias)
Bleomycin (lymphoma)

Question 11

Give some examples of connective tissue disease causing ILD:

Answer 11

Rheumatoid arthritis
Lupus
Scleroderma

Question 12

Give some examples of immunological ILD:

Answer 12

Sarcoidosis

Hypersensitivity pneumonitis

Question 13

Give the main example of idiopathic ILD:

Answer 13

Idiopathic pulmonary fibrosis

Question 14

What is idiopathic pulmonary fibrosis?

Answer 14

Progressive inflammatory condition of lungs with tissue destruction and fibrosis

Question 15

When do those with IPF usually present and how are they diagnosed?

Answer 15

60-80 years

By CT

Question 16

How does IPF present on CXR?

Answer 16

Small lungs with micronodular shadowing in lower lobes

Question 17

What causes asbestosis and what does this lead to?

Answer 17

Inhalation of fibres

Leads to asbestos plaques and pleural thickening

Question 18

How does asbestosis present on CXR?

Answer 18

Plaques, fibrosis, mesothelioma

Question 19

How does sarcoidosis present? (include biopsy)

Answer 19

Cough, rash, non-caseating granuloma

Question 20

How is sarcoidosis treated?

Answer 20

None, steroids, methotrexate

Question 21

How does sarcoidosis present on CXR?

Answer 21

Miliary and nodular shadowing, diffuse fibrosis

Question 22

What is hypersensitivity pneumonitis?

Answer 22

Allergic reaction in walls of alveoli and bronchioles

Question 23

What is acute hypersensitivity pneumonitis called and how does is present on CXR?

Answer 23

Farmer’s lung

Micro-nodular infiltrate, dense at hila

Question 24

What is chronic hypersensitivity pneumonitis called and how does is present on CXR?

Answer 24

Bird fancier’s lung

Normal, progressing to fibrosis

Question 25

What are the functions of pleura?

Answer 25

Allows movement of lung and chest wall Coupling of lung and chest wall Pleural fluid circulation

Question 26

What is the parietal pleura's innervation?

Answer 26

Intercostal and phrenic nerve

Question 27

Describe pleurisy:

Answer 27

Sever, sharp pain Worse on inspiration or coughing Pleural rub can be heard (creaking noise)

Question 28

What is the normal pleural fluid turnover?

Answer 28

15ml per day

Question 29

How is pleural fluid produced and absorbed?

Answer 29

Produced by capillary filtration at parietal pleura and absorbed by lymphatic drainage

Question 30

What can cause pleural fluid volume to rise?

Answer 30

Rise in intravascular pressure (heart failure) Fall in plasma oncotic pressure Increase in permeability of capillary Obstruction to lymph flow

Question 31

What is fluid in pleural space called?

Answer 31

Pleural effusion

Question 32

What is blood in pleural space called? | What can cause this?

Answer 32

Haemothorax | Trauma

Question 33

What is pus in pleural space called? | What can cause this?

Answer 33

Empyema | Inflammation

Question 34

What is lymph (chyle) in pleural space called?

Answer 34

Chylothorax

Question 35

How can pleural fluid be obtained?

Answer 35

Thoracocentesis

Question 36

What is looked at in pleural fluid?

Answer 36

Appearance, cell count, protein, LDH, pH, glucose

Question 37

What causes a transudate?

Answer 37

Heart failure Cirrhosis Hypoalbuminaemia

Question 38

What causes an exudate?

Answer 38

``` Infection (TB) Malignancy Pulmonary embolism RA Ascites ```

Question 39

What is pleural fibrosis?

Answer 39

Unabsorbed pleural effusion, reduces lung volume

Question 40

What pleural tumours are there?

Answer 40

Lung or breast metastases | Mesothelioma

Question 41

What can cause a primary pneumothorax?

Answer 41

Smoking Tall Iatrogenic - procedures e.g. central lines

Question 42

What causes a secondary pneumothorax?

Answer 42

Underlying disease e.g. COPD

Question 43

What are the symptoms of a pneumothorax?

Answer 43

``` Chest pain (pleuritic) Dyspnoea ```

Question 44

How is a pneumothorax treated?

Answer 44

None if small Aspiration/chest drain Chemical pleurodesis

Question 45

What is chemical pleurodesis?

Answer 45

Glue visceral and parietal peritoneum together using inflammation, so there is no space for fluid or air

Question 46

What are the symptoms of a tension pneumothorax?

Answer 46

Tachycardia, hypotension, hypoxemia, hyper-resonance

Question 47

What is the treatment for a tension pneumothorax?

Answer 47

Intercostal chest drain, 2nd ICS, MCL

Question 48

What congenital chest wall deformities are there?

Answer 48

Pectus excavatum (sternum) - timmy Scoliosis Kyphosis

Question 49

What acquired chest wall deformities are there?

Answer 49

Trauma - broken ribs, flail segment

Question 50

What muscle disease can cause restrictive respiratory failure?

Answer 50

Muscular dystrophy Motor neurone disease Polio