Interstitial lung disease

Question 1

What is sarcoidosis?

Answer 1

• A multisystem inflammatory disease of unknown aetiology that predominantly affects the lungs and intrathroracic lymph nodes
• It is characterised by non-necrotising granulomatous inflammation

Question 2

What is the presentation of sarcoidosis?

Answer 2

•Approx. 5% asymptomatic 
•Presentation is dependent on the extent and severity of the organ involved 
•Systemic symptoms in approx 45%: 
 - fever 
 - anorexia
 - fatigue 
 - night sweats
 - weight loss
 - chest pain 
 - cough and breathlessness 
 - rare = haemoptysis

Question 3

What are the clinical signs of sarcoidosis?

Answer 3

• Pulmonary findings
• Dermatological manifestations - nodules
• Ocular manifestation
• Cardiac manifestation - may hear a rub
• Neurologic manifestations

Question 4

What are the lung signs of sarcoidosis?

Answer 4

• Dyspnoea
• Cough
• Vague chest discomfort
• Wheezing

Question 5

Explain the stages of sarcoidosis from x ray

Answer 5

• Represent radiogrpahic patterns
• Do not indicate disease severity or changes in pulmonary function
• 4 stages

Question 6

Stage 1 sarcoidosis

Answer 6

Bilateral hilar lymphadenopathy without infiltration

Question 7

Stage 2 sarcoidosis

Answer 7

Bilateral hilar lymphadenopathy with infiltration

Question 8

Stage 3 sarcoidosis

Answer 8

Infiltration alone

Question 9

Stage 4 sarcoidosis

Answer 9

• Fibrotic bands
• Bullae
• Hilar retraction
• Bronchiectasis
• Diaphragmatic tenting

Question 10

What is idiopathic pulmonary fibrosis the clinical manifestation of?

Answer 10

Usual interstitial pneumonia

Question 11

How many lobes does the left lung have?

Answer 11

2

Question 12

What are the signs and symptoms of idiopathic pulmonary fibrosis?

Answer 12

• Progressive breathlessness (worse with exercise)
• Bibasilar crackles
• Peripheral interstitial pattern
• fatigue and weakness
• Apetite and weight loss
• Clubbing
• Hacking dry cough

Question 13

What are the top 6 causes of pulmonary fibrosis?•

Answer 13

• Occupational and environmental
• Drug induced
• Connective tissue disorders
• Primary disease
• Idiopathic
• Genetic

Question 14

Which drugs can cause pulmonary fibrosis?

Answer 14

• Amiodarone
• Nitrofurantoin
• Methotrexate
• Cocaine

Question 15

What connective tissue diseases cause pulmonary fibrosis?

Answer 15

• Lupus
• Rheumatoid arthritis
• Scleroderma

Question 16

Which primary diseases cause pulmonary fibrosis?

Answer 16

• Sarcoidosis

* LAM

Question 17

How can you diagnose pulmonary fibrosis?

Answer 17

•HRCT
•If difficult to diagnose: Video-assisted thorascopic surgery (VATS)
- 3 biopsies

Question 18

What is extrinsic allergic alveolitis?

Answer 18

• Immunologically mediated inflammatory reaction in the alveoli and in the respiratory bronchioles
• T cell mediated response

Question 19

What are the causes of Extrinsic allergic alveolitis?

Answer 19

• Organic dusts
• Moulds
• Foreign proteins
• Some chemicals

Question 20

Give 3 examples of EAA

Answer 20

• Farmers lung - mouldy hay
• Cheese washers lung - penicillium casei
• Suberosis - cork dust mould

Question 21

What are the symptoms of EAA?

Answer 21

• Flu like illness
• Cough
• High fever
• Chills
• Dyspnoea
• Chest tightness
• Malaise
• Myalgia

Question 22

What are the symptoms of chronic EAA?

Answer 22

• Dyspnoea in strain
• Sputum production
• Fatigue
• anorexia
• Weight loss

Question 23

What is the appearance of acute HSP on chest x ray?

Answer 23

• numerous poorly defined small opacities thought both of the lungs
• Sometimes sparing of the apices and bases
• Airspace disease: usually seen as ground glass opacities
• Fine reticulation may occur
• Zonal distribution

Question 24

Describe the pathology of chronic HSP

Answer 24

• Bronchiolocentric pattern
• NNGI
• Foamy macrophages in alveolar spaces
• Chronic interstitial inflammation
• Organising pneumonia