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Y1 - Respiratory > ILD > Flashcards

ILD Flashcards

1
Q

What are the main ILDs?

A

Idiopathic pulmonary fibrosis
Sarcoidosis
Extrinsic allergic alveoli’s (hypersensitivity pneumonitis)

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2
Q

What are ILDs?

A

Diseases affecting the interstitium

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3
Q

What pattern do ILDs have on spirometry?

A

Restrictive

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4
Q

What is the pathology of early stage ILD?

A

Alveolitis - injury and inflammatory cell infiltration that interferes with gas transfer

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5
Q

What is the pathology of late stage ILD?

A

Fibrosis, leading to hypoxia and cardiac failure

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6
Q

What is diagnosis based on?

A

Clinical failures and biopsy confirmation

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7
Q

What are the two methods for biopsy, and what are the pros and cons?

A

Transbronchial

Thorascopic - more invasive but more reliable

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8
Q

Which is the most common ILD?

A

Idiopathic pulmonary fibrosis

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9
Q

What is idiopathic pulmonary fibrosis?

A

Progressive interstitial fibrosis of unknown cause

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10
Q

What are the pathological changes in idiopathic pulmonary fibrosis?

A

Basal and sub-pleural fibrosis

Terminal lung structure replaced by dilated spaces surrounded by fibrosis

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11
Q

What are the symptoms of idiopathic pulmonary fibrosis?

A

Progressive breathlessness over years

Dry cough

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12
Q

What are the signs of idiopathic pulmonary fibrosis?

A

Finger clubbing

Bilateral fine inspiratory crackles

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13
Q

What investigations are done for idiopathic pulmonary fibrosis - and what is seen?

A

Spirometry - restrictive
Low gas transfer
CXR - bilateral infiltrates
CT - shadowing, worse at bases and periphery, traction bronchiectasis, honeycombing

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14
Q

When is a biopsy done for idiopathic pulmonary fibrosis?

A

Only if unsure after CT

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15
Q

What is the treatment for idiopathic pulmonary fibrosis?

A

Oxygen if hypoxic

Lung transplant

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16
Q

What is the prognosis and median survival after diagnosis for idiopathic pulmonary fibrosis?

A

Bad - 4 years

17
Q

What is sarcoidosis?

A

Multi-system granulomatous disorder of unknown cause

18
Q

What type of hypersensitivity is sarcoidosis?

A

Type 4

19
Q

What is the presentation of acute sarcoidosis?

A 
Erythema nodosum
Bilateral hilar lymphadenopathy
Arthritis
Uveitis, parotitis
Fever
20
Q

What is the presentation of chronic sarcoidosis?

A 
Lung infiltrates
Skin infiltrates
Peripheral lymphadenopathy
Hypercalcaemia
Other organ involvement
21
Q

What investigations are done for sarcoidosis?

A 
CXR
CT
Biopsy
Spirometry
Bloods (increased calcium)
22
Q

What is seen on biopsy in sarcoidosis?

A

Non-caveating granulomas

23
Q

What is the treatment for sarcoidosis?

A

Steroids

24
Q

What is hypersensitivity pneumonitis?

A

Inflammatory condition of the small airways and interstitium with occasional granulomas caused by a trigger

25
Q

What type of hypersensitivity is hypersensitivity pneumonitis?

A

Type 3 - immune complex mediated

26
Q

What are the causes of hypersensitivity pneumonitis, and who are affected by each?

A

Thermophilic bacteria - farmers, malt workers, mushroom workers
Avian proteins - bird owners
Fungi
Drugs - sulphasalazine

27
Q

What are the symptoms of acute hypersensitivity pneumonitis?

A

Cough
Breathlessness
Fever
Myalgia

28
Q

When do symptoms of acute hypersensitivity pneumonitis come on?

A

Hours after exposure

29
Q

What are the signs of acute hypersensitivity pneumonitis?

A

Fever
Crackles
Hypoxia
No wheeze

30
Q

What is seen on CXR in acute hypersensitivity pneumonitis?

A

Widespread pulmonary infiltrates

31
Q

What is the treatment for acute hypersensitivity pneumonitis?

A

Oxygen
Steroids
Antigen avoidance

32
Q

What are the symptoms of chronic hypersensitivity pneumonitis?

A

Breathlessness

Cough

33
Q

When do the symptoms of chronic hypersensitivity pneumonitis come on?

A

Over years

34
Q

What are the signs of chronic hypersensitivity pneumonitis?

A

Crackles

35
Q

What is seen on CXR in chronic hypersensitivity pneumonitis?

A

Pulmonary fibrosis, mostly upper zones

36
Q

How is diagnosis made in chronic hypersensitivity pneumonitis?

A

History of exposure
Precipitins (IgG)
Lung biopsy if unsure

37
Q

What is the treatment for chronic hypersensitivity pneumonitis?

A

Remove antigen exposure

Oral steroids if breathless or low gas transfer

Y1 - Respiratory (12 decks)

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