Hypersensitivity Pneumonitis

Question 1

What is the alternative name of Hypersensitivity Pneumonitis

Answer 1

Extrinsic allergic alveolitis

Question 2

What is the inflammatory pattern of Hypersensitivity pneumonitis?TH1 or TH2?

Answer 2

TH1

Question 3

What Hypersensitivity Pneumonitis may be seen in sugarcane plantation workers?

Answer 3

Bagassosis

Question 4

What antigen is involved in cheese washer’s lung?

Answer 4

Penicillium casei; Aspergillus clavatus

Question 5

What antigen is common to all of the following: Malt worker’s lung, Tobacco grower’s lung, and Potato riddler’s lung?

Answer 5

Aspergillus species

Question 6

HRCT findings in subacute HP

Answer 6

Ground glass airspace opacities are characteristic as is the presence of centrilobular nodules

Question 7

HRCT findings of chronic HP

Answer 7

Reticular changes and traction bronchiectasis

Question 8

Bronchoalveolar lavage finding in HP

Answer 8

BAL lymphocytosis is characteristic of HP

Question 9

Lung biopsy findings in HP

Answer 9

Presence of noncaseating granulomas in the vicinity of small airways. Granulomas are loose and poorly defined in nature as compared to sarcoidosis. Within the aveolar spaces and interstitium- mixed cellular infiltrate with a lymphocytic predominance.

Question 10

Mainstay of treatment of HP

Answer 10

Antigen avoidance

Question 11

Glucocorticoid therapy in subacute to chronic HP

Answer 11

Prednisone therapy 0.5 to 1 mg/kg of body weight not to exceed 60 mg/day or alternative glucocorticoid equivalent x 1-2 weeks followed by a taper of 2-6 weeks

Question 12

Syndrome characterized by fevers, acute respiratory failure that often requires mechanical ventilation, diffuse pulmonary infiltrates and pulmonary eosinophilia in a previously healthy individual.

Answer 12

Acute Eosinophilic Pneumonia

Question 13

Diagnostic Criteria of Acute Eosinophilic Pneumonia

Answer 13

Acute febrile illness with respiratory manifestations of <1 month in duration
Hypoxemic respiratory failure
Diffuse pulmonary infiltrates on chest x ray
BAL> 25% eosinophilia
Absence of parasitic, fungal, or other infection
Absence of drugs to cause pulmonary eosinophilia
Quick clinical response to corticosteroids
Failure to relapse after discontinuation of corticosteroids

Question 14

Patients present with subacute illness over weeks to months with cough, low-grade fevers, progressive dyspnea, weight loss, wheezing, malaise, night sweats. CXR: migratory bilateral peripheral or pleural-based opacities

Answer 14

Chronic Eosinophilic Pneumonia

Question 15

Primary features include asthma, peripheral eosinophilia, neuropathy, pulmonary infiltrates, paranasal sinus abnormality, presence of eosnophilic vasculitis

Answer 15

Eosinophilic Granulomatosis with Polyangiitis (EGPA)

Question 16

Which nerve is the most commonly involved in mononeuritis multiplex in EGPA?

Answer 16

Peroneal

Question 17

Primary target organ of EGPA?

Answer 17

Heart. Patients may have acute pericarditis, constrictive pericarditis, myocardial infarction, other ECG changes.

Question 18

This refers to transient pulmonary infiltrates with eosinophilia that occurs in response to passage of helminthic larvae through the lungs most commonly Ascaris.

Answer 18

Loffler Syndrome