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RESP > 9. Interstitial Lung Disease > Flashcards

9. Interstitial Lung Disease Flashcards

1
Q

What is interstitial lung disease?

A

A group of diseases the result in disruption of the acinus due to scarring
Alveoli are gradually replaced by fibrotic tissue, and lose the ability to transfer oxygen into the blood

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2
Q

What are the causes of interstitial lung disease?

A 
Idiopathic
Associated with collagen vascular diseases
Drug/treatment related
Occupational/environmental exposure
Post infection
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3
Q

What are the causes of interstitial lung disease in the upper zones?

A 
CHHARTS
Coalworkers
Hypersensitivity
Histiocytosis
ankylating spondylitis
Radiation
TB
Silicosis
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4
Q

What are the causes of interstitial lung disease in the lower zones?

A 
RAIDS
Rheumatoid Arthritis
Asbestosis
IPF
Drugs
Scleroderma
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5
Q

What general ILD symptoms can be picked up when taking a history?

A

Gradual dyspnoea for 6-12 months

Dry cough

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6
Q

What age group and gender has the highest rate of IPF?

A

men >60

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7
Q

What age group and gender has the highest rate of sarcoid and connective tissue disease related ILD?

A

women 20-40

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8
Q

What type of ILD goes away when the patient stops smoking?

A

Respiratory bronchiolitis

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9
Q

What signs can be seen in the hands in ILD?

A 
Clubbing (IPF, asbestosis)
Sclerodactaly (scleroderma)
Splinter haemorrhages (RA, SLE)
Raynaud's (scleroderma, SLE)
Gottron papules (dermatomyositis)
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10
Q

What signs can be seen on the head and neck in ILD?

A

Butterfly rash (SLE)
Parotid swelling, facial palsy and iritis (sarcoid)
Telangiectasia (scleroderma)
Central cyanosis

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11
Q

What signs can be found in the chest in ILD?

A 
Rapid shallow breathing
Tracheal deviation
Decreased chest diameter and expansion
Tactile fremitus normal or increased
Percussion is normal or dull
Bilateral fine end inspiratory creps ('velcro crackles')
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12
Q

What other signs might be seen in ILD?

A

Erythema nodosum on legs (sarcoidosis)
Myopathy and small joint arthritis (mixed connective tissue disease)
Marks of radiation therapy

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13
Q

What investigations should be done if ILD is suspected?

A 
High res CT thorax
CXR
PFTs
Bloods
Functional assessment
Bronchoscopy and lung biopsy
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14
Q

What can be seen on a HRCT in ILD?

A

Coarse reticular opacities
‘Ground glass’ infiltrates
Honeycomb cysts
Traction bronchiectasis (airways are pulled open)

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15
Q

How are infiltrates on a CT differentiated from fluid?

A

CT is taken with the patient in different positions: if the opacity moves then it is fluid

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16
Q

How is ILD diagnosed from a CXR?

A

Patchy or nodular infiltrates that start peripherally

No other signs of congestive cardiac failure

17
Q

What will PFTs show in ILD?

A

Restrictive pattern on spirometry (decreased FEV1 and FVC)
Reduced diffusion lung capacity
Reduced total lung capacity

18
Q

What are the causes of an obstructive defect in ILD?

A

Have both COPD and ILD

Sarcoidosis

19
Q

What bloods can be done in ILD?

A

FBC, U&E, liver and bone profiles

Connective tissue disease antibodies

20
Q

What are the functional assessments used in ILD?

A

ABG

6 minute walk test

21
Q

What drugs are given as anti-fibrotics in IPF?

A

Pirfenidone

Nintedanib

22
Q

What management is given for patients with IPF?

A

Oxygen therapy
Lung rehab
Lung transplant if under 65

23
Q

What can commonly be picked up on CXR in sarcoidosis?

A

Bihilar lymphadenopathy

24
Q

What method is used to sample hilar lymph nodes in sarcoidosis?

A

EBUS-TBNA

25
Q

What is the combination of bihilar lymphadenopathy and erythema nodosum known as?

A

Lofgren’s syndrome

26
Q

What can be found in the blood in sarcoidosis?

A

Increased Ca and ACE

27
Q

What other symptoms can be found in sarcoidosis?

A

Uveitis
Keratoconjunctivits
Rash
hepatic granulomas

28
Q

What type of drug does sarcoid respond well to?

A

Steroids eg. prednisone

29
Q

What type of hypersensitivity is referred to in hypersensitivity ILD?

A

Type 3: 6-8 hours after exposure

Progresses to type 4 which causes pulmonary fibrosis

30
Q

What can be seen in the blood in hypersensitivity ILD?

A

Serum precipitins to antigen

IgE

31
Q

What are the symptoms of hypersensitivity ILD?

A

Dry cough, fever, chills, basal creps

32
Q

What are the pulmonary manifestations of RA?

A

Fibrotic lung disease
Pulmonary nodules
Pleuritis
Pleural effusion

33
Q

Is the pleural effusion in RA exudative or transudative?

A

Exudative

34
Q

How long after treatment does radiation ILD present?

A

6 months

35
Q

What drugs can cause ILD?

A 
Bleomycin, busulphan
Methotrexate
Nitrofuratoin
Amiodarone
Prolonged high dose O2

RESP (17 decks)

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