Diffuse Lung Disease

Question 1

What is diffuse lung disease?

Answer 1

Collection of lung conditions featuring

• Dyspnoea
• Cough
• CR showing diffuse lung involvement

Question 2

What anatomical structures does diffuse lung disease involve?

Answer 2

Either/both

• Alveoli
• Interstitium

Question 3

What is the cough usually like in diffuse lung disease?

Answer 3

Dry

Rarely produce sputum

Question 4

What are examples of diseases occurring in the airways?

Answer 4

Asthma

COPD

Question 5

What can collect in the alveoli, causing disease?

Answer 5

Pus
Blood
Fluid

Question 6

What are examples of diseases occurring in the vessels of the lungs?

Answer 6

Pulmonary embolism

Pulmonary hypertension

Question 7

What happens in the alveolar compartment in diffuse lung diseases?

Answer 7

Inflammatory cells
Fibrin
Pulmonary oedema

Question 8

What happens in the interstitial compartment in diffuse lung diseases?

Answer 8

Chronic inflammatory cells
Collagen deposition
Fibrosis

Question 9

What happens ink the vascular compartment in diffuse lung diseases?

Answer 9

Capillary inflammation

Leak

Question 10

What are the symptoms of airways diseases?

Answer 10

Wheeze
Cough
Sputum
Dyspnoea

Question 11

What are the symptoms of diffuse lung diseases?

Answer 11

Cough
Dyspnoea
Wheeze unusual

Question 12

What are the symptoms of pulmonary vascular diseases?

Answer 12

Dyspnoea
Pleuritic chest pain
Haemoptysis

Question 13

What makes up the interstitium?

Answer 13

Alveolar lining cell
Epithelial basement membrane
Connective tissue
- Passing and fixed cell populations
- Fluid
Endothelial basement membrane
Endothelial lining cell

Question 14

What influences the presentation of diffuse lung diseases?

Answer 14

Amount of inflammation

Speed at which inflammation occurs

Question 15

What kinds of processes cause an acute diffuse lung pattern?

Answer 15

Water - from altered Starling forces in pulmonary oedema
Inflammation
- Toxic fumes
- Drug toxicity
- Infection
Blood - diffuse leakage from inflamed vessels in vasculitis

Question 16

What are the symptoms of acute diffuse lung diseases?

Answer 16

Stiff lungs > increased work of breathing
Tachypnoea
Cough
Severe dyspnoea
Hypoxia due to severe V/Q mismatch

Question 17

What kinds of processes cause a subacute or chronic diffuse lung pattern?

Answer 17

Many interstitial disease

Present over months-years

Question 18

What are the relevant points in the history that help narrow down the cause of dyspnoea and cough?

Answer 18

Onset
Time course
Intensity
Aggravating and relieving factors
Occupational history
Medication history
Associated features
- Weight loss
- Chest pain
- Fever
- Joint symptoms
- Rashes

Question 19

What are the relevant points in the examination that help narrow down the cause of dyspnoea and cough?

Answer 19

Crackles
Clubbing
Signs of connective tissue disease
Signs of pulmonary hypertension
Oxygen saturation
- At rest
- Whilst patient walks until they become breathless

Question 20

What are the investigations that can be conducted to narrow down the cause of dyspnoea and cough?

Answer 20

Respiratory function tests
High resolution CT of chest
Blood tests
- Systemic illness
- Connective tissue diseasse
Echocardiogram
- Left ventricular dysfunction
- Pulmonary hypertension
Lung biopsy
- Not required in all cases

Question 21

What is a restrictive pattern on spirometry?

Answer 21

Reduced vital capacity

Normal/high FEV1:FVC ratio

Question 22

What shows impaired gas exchange on a respiratory function test?

Answer 22

Reduced CO diffusion capacity

Question 23

How is alveolar opacity on CXR described?

Answer 23

Fluffy
Cotton wool-like
Cloud-like

Question 24

What are the four basic interstitial lung patterns on chest x-ray?

Answer 24

Linear = septal lines (Kerley lines)
Reticular = mesh-like appearance, lines in all directions
Nodular = discrete opacities
Reticulonodular = combination of reticular and nodular