ILD + asbestosis

Question 1

what is ILD

Answer 1

Rnage of lung diseases affecting the parenchyma - cellular infiltration of alveoli, interstitium and distal AWs -> fibrosis
Lungs are smal and stiff

Question 2

Common ILDs

Answer 2

Isiopathic pulmonary fibrosis
Sarcoidosis
Hypersemsitivity pneumonitis

Question 3

O/E with ILD

Answer 3

Loss of chest expansion
Crackles - fibrosis, fine crackles, dry cough, restrictive
Coarse = bronchiectasis, wet cough, obstructive

Question 4

CXR in ILD

Answer 4

increased bilateral symmetrical interstitial markings with basal predominance
Lost of lines, reticular, small nodules
heart border shaggy and indistinct = hallmark of fibrosis

Question 5

Lung function tsts in ILD

Answer 5

FEV1/FVC - normalor increased -
FEV1 normal or reduced, FVC reduced much = more
Reduced TLCO = restritive pattern

Question 6

What investigation do afet evidence of fibrosis

Answer 6

CT thorax abdo
Dont lung biopsy - high morbidity and mortaltiy

Question 7

CT scan of lung in ILD

Answer 7

Subplural reticulation and honeycombed change

Question 8

Risks for ILD

Answer 8

Environmental/occupational exposures eg dust, asbestos, pets, birds
Drugs - methotrextae, nitrofurantoin, amiodarone
CTD - RA - autoantibodies anti CCP

Question 9

Progression of ILD

Answer 9

Gets worse before symptoms show - vital picked up early, most preferably pre clinical

Question 10

Supportive treatment ILD

Answer 10

Oxygen, rehab, morphine
Treat SOB and pain

Question 11

Cure for ILD

Answer 11

Only lung transplant
Upper limit is 65 for single - often too old

Question 12

Medication for ILD and side effects

Answer 12

Pirfenidone/nintedanib - antifibrotics improve survival
GI upset, photosensitive rash

Question 13

Features of IPF

Answer 13

progressive exertional dyspnoea
bibasal fine end-inspiratory crepitations on auscultation
dry cough
clubbing

Question 14

Forms of asbestos

Answer 14

Setpentine - long curly white (chrystolite)
Amphibole - blue (crocidolite) and brown (amosite)

Question 15

Which from of asbestos is more fibrogenic

Answer 15

Ampiboe - blue and brown, stronger, shorter rigid needles cant be cleared

Question 16

Asbestos exposure

Answer 16

• mining or dilling absestos
• Industrial uses
• construction, insulation, fireproofing, brake linings, ship building, pipe-fitting, boiler fitting, carpentry, pluming and electrical repair.

Question 17

How long does asbestosis take to happen after expsoure

Answer 17

15-20 years, can be over 40

Question 18

Where is most affected in asbestosis

Answer 18

Subpleural of lower lobe w relative central spacing

Question 19

Diagnosis of asbestosis

Answer 19

Structural pathology + exposure history + exclusion of other causes

Question 20

Management of asbestosis

Answer 20

Avoid exposure and smoking cessation
Flu and pneumonia vaccine
Pulm rehab
Screen for other diseases caused by asbestos
Long term O2 therapy
No evidence for antifibrtoics

Question 21

What does asbestos esp increase the risk of

Answer 21

All forms of lung cancer esp mesotherlioma

Question 22

Other conditions can be caused by asbestos

Answer 22

Asbestos related pleural disease
Pleural plaques
benign asbestos pleural effusion
Diffuse pleura thicening
Malignant mesothelioma

Question 23

What is benign asbestos pleural effusion and when does it ovcur

Answer 23

unilateral pleural effusion within 0 years of exposure to asbestos

Question 24

Investigations for BAPE

Answer 24

Fluid = exudate, blood stained
Positive PET scans (less than inflam/malign)

Question 25

Management of BAPE

Answer 25

Often spontaneously resolves after few months Repeat aspirationns or pleurodesis if need Can -> fibrosis

Question 26

What is diffuse pleural thickening

Answer 26

Fibrsosi of pleura often following BAPE

Question 27

What see on CXR/CT in duffuse pleural thickening

Answer 27

XRAY - smooth conglomerate opacity along pleura CT pleura >3mm thick

Question 28

Features of DPT

Answer 28

Pain, SOB Reduced FVC, low TLCO, KCO normal or elevated

Question 29

What causes mesothelioma

Answer 29

Crocidolite - most carcinogenic asbestos

Question 30

How confirm mesotheluoma

Answer 30

If effusion - thoroscopy US or CT guided biopsies otherwise

Question 31

Treatment for malignant mesothelioma

Answer 31

universally fatal Can give cisplatin and pemetrexed if fit enough No benefit from surgery Emerging antiPD1 drugs zumabs

Question 32

Conditions qualifying for industrial injuries displacement benefity

Answer 32

- Diffuse pleural thickening - Asbestosis - Mesothelioma - Lung cancer ass w asbestos exposure

Question 33

Criteria for industrial injuries displacement benefity

Answer 33

- Clear hisotry of asbestos exposure at work - Not self employed - If employer no longer in business - one off payment government via Pneumoniciosis act 1979 - Amount reflects severity of disability and age at diagnosis - Next of kin can make claims within 12 months of patients death

Question 34

How long can make claims against employers in cicl courts

Answer 34

Within 3 years of diagnosis Clear and precise documentation essential

Question 35

Referral for malignant mesothelioma

Answer 35

Urgent CXR if >40 and -2 of ollowing unexplained -1 of following unexplained and ever smoked -1 of following unexplained and asbestos exposure -SOB -Cough -chest pain -weight loss -appetite loss -fatigue Consider - clubbing, pleural chest signs OE

Question 36

Gold standard investigation IPF

Answer 36

High Res CT

Question 37

When can you give antifibrotics IPF

Answer 37

FVC 50-80% Treatment stopped if disease progression - loss of 10% FVC in 12 months

Question 38

Prognosis in IPF, mesothelioma

Answer 38

IPF - 3-4 years Mesothelioma - 12 months