Fibrotic lung disease

Question 1

What drug is known to cause lung fibrosis?

Answer 1

amiodarone

Question 2

Which cytotoxic agents can cause lung fibrosis?

Answer 2

busulphan, bleomycin

Question 3

What anti-rheumatoid drugs are associated with lung fibrosis?

Answer 3

methotrexate, sulfasalazine

Question 4

Which antibiotic is known to cause lung fibrosis?

Answer 4

nitrofurantoin

Question 5

What type of drugs derived from ergot can cause lung fibrosis?

Answer 5

dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

Question 6

What is idiopathic pulmonary fibrosis (IPF)?

Answer 6

IPF is a chronic lung condition characterised by progressive fibrosis of the interstitium of the lungs. The term IPF is reserved when no underlying cause exists.

Question 7

What age group is typically affected by IPF?

Answer 7

IPF is typically seen in patients aged 50-70 years and is twice as common in men.

Question 8

What are the key features of IPF?

Answer 8

Key features include progressive exertional dyspnoea, bibasal fine end-inspiratory crepitations on auscultation, dry cough, and clubbing.

Question 9

How is IPF diagnosed?

Answer 9

Diagnosis involves spirometry showing a restrictive picture, impaired gas exchange with reduced transfer factor, and imaging revealing bilateral interstitial shadowing.

Question 10

What imaging is preferred for diagnosing IPF?

Answer 10

High-resolution CT scanning is the investigation of choice for diagnosing IPF.

Question 11

What are the common serological findings in IPF?

Answer 11

ANA is positive in 30% of cases and rheumatoid factor is positive in 10%, but low titres do not necessarily indicate secondary fibrosis.

Question 12

What is the management for IPF?

Answer 12

Management includes pulmonary rehabilitation, potential use of pirfenidone, supplementary oxygen, and possibly lung transplant.

Question 13

What is the prognosis for patients with IPF?

Answer 13

The prognosis is poor, with an average life expectancy of around 3-4 years.

Question 14

Answer 14

Question 15

Answer 15

Idiopathic pumonary fibrosis

Question 16

Answer 16

Question 17

Answer 17

Question 18

What is lung fibrosis?

Answer 18

Lung fibrosis is a condition characterized by scarring and thickening of the lung tissue.

Question 19

Why is it important to differentiate between upper and lower zone fibrosis?

Answer 19

Differentiating between conditions causing predominantly upper or lower zone fibrosis is crucial for diagnosis.

Question 20

What are the common causes of lower zone fibrosis?

Answer 20

Common causes include idiopathic pulmonary fibrosis and drugs like amiodarone, bleomycin, and methotrexate.

Question 21

What conditions predominantly affect the upper zones?

Answer 21

Conditions include hypersensitivity pneumonitis, coal worker’s pneumoconiosis, silicosis, sarcoidosis, ankylosing spondylitis, histiocytosis, tuberculosis, and radiation-induced pulmonary fibrosis.

Question 22

What is the acronym for causes of upper zone fibrosis?

Answer 22

The acronym is CHARTS: C - Coal worker’s pneumoconiosis, H - Histiocytosis/hypersensitivity pneumonitis, A - Ankylosing spondylitis, R - Radiation, T - Tuberculosis, S - Silicosis/sarcoidosis.

Question 23

What is a notable feature of radiation-induced pulmonary fibrosis?

Answer 23

It may develop following radiotherapy for breast or lung cancer, typically seen between 6 and 12 months after treatment.