Hypersensitivity Pneumonitis

Question 1

diagnostic hallmark of HP

Answer 1

IgG precipitating antibody on double gel diffusion plate

Question 2

Headcheese sign can be seen it what stage of HP

Answer 2

Subacute

Headcheese
GGO, air trapping, mosaic perfusion

Question 3

PFT of HP

Answer 3

restrictive

lung volume decreased
DLCO decreased

can be normal, obstructive and mixed

Question 4

CD4 /cD8 in HP is

Answer 4

low

(normal is 1.8)

Question 5

classic triad of subacute HP

Answer 5

interstitial lymphocytic-histiocytic CELL INFILTRATE

Bronchiolitis obliterans

non necrotizing granulomas

Question 6

added to sugarcane to eliminate growth of organism responsible for Bagassosis

Answer 6

propionic acid

Question 7

most important factor in HP prognosis

Answer 7

presence of fibrosis

Question 8

in HP, compare lobes affected in HRCT findings in acute, subacute, chronic

Answer 8

acute: lower lobes
subacute and chronic:mid and upper

Question 9

it is a th2 mediated hypersensitivity lung dx that affects Asthmatics and CF patients

Answer 9

Allergic Bronchopulmonary Aspergillosis

Question 10

Minimum criteria of ABPA

Answer 10

worsening lung function
positive skin prick test

Total serum IgE >1000 ng/ml (416 IU/ml)
Increased Asp specific IgE and IgG antiBODIES

new pulmonary infiltrates

Question 11

additional criteria in ABPA

Answer 11

central bronchiectasis
Mucus plugs (aspergillus containing)

blood eosinophilia >400
(not in steroids)

precipitating antibodies

Question 12

High attenuation impaction is pathognomonic of

Answer 12

ABPA

Question 13

In px with cystic fibrosis, aspergillosis has 4 classifications:

Answer 13

Class 1: non disease
2: serologic
3: sensitized
4: bronchitis

Question 14

in ABPA, most common radio fx

Answer 14

large
homogenous shadow in one
upper lobe

no change in volume

Question 15

fine parallel lines radiating from hila which can be seen in ABPA

Answer 15

tram line shadows

(inflammation of airway walls)

Question 16

useful marker for disease activity of ABPA

Answer 16

IgE levels

Question 17

management of ABPA

Answer 17

Prednisone
Itraconazole

Question 18

Stages of ABPA

Answer 18

Stage 1 (acute)
Stage 2 remission - decline of Ige by 35%
Stage 3 Exacerbation - 2 fold inc in IgE
Stage 4 Corticosteroid dependednt
Stage 5 Fibrotic (severe upper lobe fibrosis), honeycombing

Question 19

diagnosis of eosinophilia with hyphae is consistent with

Answer 19

ABPA

Question 20

Male recently resume smoking may suffer from

Answer 20

acute eosinophilic pneumonia

Question 21

in acute eos pneumonitis, main pathologic findings are

Answer 21

acute and organizing DAD

marked infiltration of eosinophil

ABSENT granulomata

Question 22

in acute lung eos, peripheral blood eosinophilia is typically ________

Answer 22

absent
peripheral BLOOD eos

Question 23

steroid duration in acute eos pna

Answer 23

8 weeks

Question 24

middle aged female
non smoker
with Asthma

Answer 24

Chronic Eos pneumonia

Question 25

diagnostic of CEP

Answer 25

negative image of pulmonary edema

Question 26

lung biopsy fx of CEP

Answer 26

multinucleated GIANT cells

organizing pneumonia

eosinophilic abscesses

intraluminal fibrosis

Question 27

duration of steroid therapy in Cep

Answer 27

19 months
tapered 6 months

Question 28

differentiate AEP vs CEP

Answer 28