ILD

Question 1

Common drugs

Answer 1

Amiodarone 
MTX
Bleomycin
Nitrofurantoin
Ritux
Aza
TNF blockers

Question 2

Associated CTD

Answer 2

RA
Scleroderma
PM/DM
Sarcoid

Question 3

Occupational exposure

Answer 3

Asbestos

Silicosis

Question 4

Clinical features ILD

age of onset

Answer 4

chronic dry cough, progressive SOBOE

usually >60
if a/w CTD, 20-40

Question 5

ILD - upper zones

Answer 5

Hypersensitivity pneumonitis
Sarcoidosis
AS
Silicosis
Coal worker's pneumoconiosis

Question 6

ILD - lower zones

Answer 6

IPF
CTD
Drug related
Asbestosis

Question 7

Strongest risk factor ILD

Answer 7

Smoking

Question 8

Genetic factor

Syndrome
Genes
Associated features

Answer 8

Telomeropathy syndrome (short telomeres)
High anticipation 

Genes - TERT, TERC, RTEL1, PARN

Premature ageing, Aplastic anaemia, opportunistic inf, cancers, pul fibrosis, OP etc

Question 9

IPF

CF
Imaging

Answer 9

Smokers, Fly hx, 60s
SOB + cough, progressive
clubbing

Subpleural reticular changes, basal predominance, traction bronchiectasis, honeycombing
Classic UIP pattern

Question 10

IPF Treatment

Answer 10

Fibrinolytics
has mortality benefit but AE ++, improves symptoms

Pirfenidone - TGF-B inhibitor. Photosensitivity rash, nausea

Nintedanib - TKI, increased bleeding and CVS risk. AE Diarrhoea

?NAC inf in TOLLIP mutation

DONT use immunosuppression

Question 11

NSIP CT

Answer 11

More ground glass opacity than UIP
No basal predominance
Spares subpleural regions

Dx of exclusion
Gold Standard - Surgical biopsy via VATS or thoracotomy is the gold standard

Question 12

Cryptogenic Organizing Pneumonia

Answer 12

Can be a/w organ transplant
Peribronchiolar opacities with ground glass changes, no honeycombing
Revers halo or Atoll sign = subpleural sparing
BAL - neuts, eosinophils, lymphocytes, nil bacteria

Question 13

Sarcoidosis

Answer 13

mediastinal/hilar lymphadenopathy

Question 14

Pulmonary Alveolar Proteinosis

Answer 14

• Accumulation of surfactant in alveoli and terminal airways
• Can be congenital or acquired

Anti GM-CSF
Milky fluid on BAL - Acid Schiff +ve
Mx - while lung lavage, immunomodulation

Question 15

Lymphangioleiomyomatosis (LAM)

Answer 15

abnormal proliferation of smooth muscle cells –> destruction of lung –> cysts
young, female, can be part of tuberous sclerosis complex
abdo tumours - angiomyolipomas

Mx - Sirolimus

Question 16

Granulomatous Lymphocytic ILD (GIILD)

Answer 16

A/w CVID - recurrent infections
can mimic sarcoid (Serum ACE and ANA)
BAL TRO other causes

Question 17

Langerhan cell histiocytosis

Answer 17

Langerhans cell buildup –> tumours/granulomas ?cancer
Spread to LN, skin, spleen, lung ,liver, BM
CT - cysts in lung (sparing costoprenic recess)

Question 18

Hypersensitivity Pneumonitis

Common forms

Answer 18

Hypersensitivity to inhaled particles –> immune medicated –> granulomatous

Common forms

1. Bird fancier’s lung
2. Hot tub lung - MAC

Mx - avoid exposure, steroids

Question 19

Bronchiolitis obliterans

Answer 19

Small airway inflammation and scarring
Rare and severe

Subtype: Bronchiolitis obliterans syndrome –> chronic allograft rejection after lung tx

Question 20

Sarcoid - epid and ix

Answer 20

young adults and older adults >60
Women >men, common in black population

Serum ACE level
CXR - hilar lymphadenopathy
Histo - Non caseating granulomas

Question 21

Sarcoid - CF, Mx

Answer 21

Mutliple ex
-Lungs 90% - mediastinal lymphadenopathy, pul fibrosis,

Others
mononeuritis multiplex, nephrocalcinosis, heart block, erythema nodosum, lupus pernio, uveitis etc

Mx- Steroids, immunosuppression, lung tx