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Year One - Respiratory System > Interstitial Lung Disease > Flashcards

Interstitial Lung Disease Flashcards

1
Q

What is interstitial lung disease (ILD)?

A

It is defined as a group of inflammatory conditions that affect the lung interstitium

This inflammation results in fibrosis formation

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2
Q

What is the lung interstitium?

A

It is the space between an alveolus and its surrounding capillaries

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3
Q

What is the pathophysiological consequence of interstitial lung disease?

A

Due to fibrosis formation, there is increased diffusion distance for oxygen to travel from the alveoli to the surrounding capillaries

Therefore, gas exchange in the lungs is compromised

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4
Q

What are the five classifications of interstitial lung disease?

A

Idiopathic Pulmonary Fibrosis

Secondary Pulmonary Fibrosis

Drug Induced Pulmonary Fibrosis

Hypersensitivity Pneumonitis (HP)

Asbestosis Induced Pulmonary Fibrosis

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5
Q

What is the most common classification of interstitial lung disease?

A

Idiopathic pulmonary fibrosis

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6
Q

What is idiopathic pulmonary fibrosis?

A

It is defined as pulmonary fibrosis with no cause

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7
Q

What are the two risk factors associated with idiopathic pulmonary fibrosis?

A

Male Gender

50 - 70 Years Old

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8
Q

What is secondary pulmonary fibrosis?

A

It is defined as pulmonary fibrosis due to an underlying pathological condition

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9
Q

What are the ten conditions associated with secondary pulmonary fibrosis?

A

Alpha-1 Antitrypsin Deficiency

Rheumatoid Arthritis

Systemic Lupus Erythematous (SLE)

Ankylosing Spondylitis

Systemic Sclerosis

Silicosis

Sarcoidosis

Pneumonia

Tuberculosis

Histiocytosis

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10
Q

What is silicosis?

A

It is a chronic lung disease caused by inhaling large amounts of silica dust - usually related to a mining occupation

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11
Q

What is a CXR feature of silicosis?

A

Egg-shell calcification of hilar nodes

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12
Q

What two pneumonia organisms cause interstitial lung disease?

A

Mycoplasma pneumonia

Pneumocystis pneumonia

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13
Q

What six drugs are associated with interstitial lung disease?

A

Methotrexate

Amiodarone

Bleomycin

Cyclophosphamide

Nitrofurantoin

Radiation Therapy

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14
Q

Which two cancer radiation therapies are associated with interstitial lung disease?

A

Breast Cancer

Lung Cancer

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15
Q

When does interstital lung disease tend to present following radiation therapy course completion?

A

6 - 12 months

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16
Q

What is another term for hypersensitivity pneumonitis (HP)?

A

Extrinsic allergic alveolitis (EAA)

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17
Q

What is hypersensitivity pneumonitis?

A

It is a condition in which hypersensitivity induced lung damage results due to the inhalation of organic particles

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18
Q

What hypersensitivity reaction is associated with hypersensitivity pneumonitis?

A

Type III hypersensitivty

However, type IV is thought to occur in the chronic phase

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19
Q

What are the four allergens associated with hypersensitivity pneumonitis? What are the specific terms used to refer to these conditions?

A

Bird Droppings (Bird-Fanciers Lung)

Hay Mouldy Spores (Farmers Lung)

Mushrooms (Mushroom Workers Lung)

Barley Mould (Malt Workers Lung)

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20
Q

When does the acute phase occur in hypersensitivity pneumonitis, following exposure to an allergen? What are the three acute clinical features?

A

4 - 8 hours

Dyspnoea

Dry Cough

Fever

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21
Q

When does the chronic phase occur in hypersensitivity pneumonitis, following exposure to an allergen? What are the four chronic clinical features?

A

Weeks to Months

Lethargy

Dyspnoea

Productive Cough

Weight Loss

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22
Q

What are two specific investigations used to diagnose hypersensitivity pneumonitis?

A

Blood Tests

Bronchoalveolar Lavage

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23
Q

What two blood test results indicate hypersensitivity pneumonitis?

A

IgG Antibody Positive

No Eosinophilia

24
Q

What bronchoalveolar lavage feature indicates hypersensitvity pneumonitis?

A

Lymphocytosis

25
Q

What are the two management options of hypersensitivty pneumonitis?

A

To avoid precipitating factors

Oral glucocorticoids

26
Q

What is asbestosis induced pulmonary fibrosis?

A

It is defined as pulmonary fibrosis due to an inhalation of asbestosis

27
Q

Which eight causes of interstital lung disease lead to upper zone fibrosis?

A

CHARTS

Coal Worker’s Pneumoconiosis

Histiocytosis/Hypersensitivity Pneumonitis

Ankylosing Spondylitis

Radiation

Tuberculosis

Silicosis/Sarcoidosis

28
Q

Which four causes of interstital lung disease lead to lower zone fibrosis?

A

Idiopathic Pulmonary Fibrosis

Drug Induced

SLE

Asbestosis

29
Q

What are the six clinical features associated with interstitial lung disease?

A

Progressive Dyspnoea

Chronic Dry Cough > 3 Months

Bibasal Fine -End Inspiratory Crepitations

Percussion Dullness

Finger Clubbing

Raynaud’s Phenomenon

30
Q

What are the four investigations used to diagnose interstitial lung disease?

A

Spirometry

Chest X-Ray (CXR)

High-Resolution CT Scan

Bronchoscopy

31
Q

What is spirometry?

A

It involves the conduction of tests that measure the volume and flow of air during exhalation and inhalation

32
Q

What three metrics are obtained from spirometry?

A

Forced Expiratory Volume 1 (FEV1)

Forced Vital Capacity (FVC)

FEV1 : FVC

33
Q

What is FEV1?

A

It is defined as the volume that has been exhaled at the end of the first second of forced expiration

34
Q

What is FVC?

A

It is is defined as the volume that has been exhaled after a maximal expiration, following a full inspiration

35
Q

What two spirometry results indicates interstitial lung disease?

A

It is indicated by a restrictive pattern, in which both FVC and FEV1 are reduced, resulting in FEV1 : FVC > 70%

Decreased TCLO levels

36
Q

What is the feature of interstitial lung disease on CXR?

A

Bilateral interstitial shadowing, usually small, irregular peripheral opacities

37
Q

What is the gold standard investigation used to diagnose interstitial lung disease?

A

High resolution CT scan

38
Q

What are the four features of interstitial lung disease on a high resolution CT scan?

A

Ground Glass Appearance

Honeycombing

Traction Bronchiectasis

Reticular Opacites

39
Q

What is honeycombing?

A

It is defined as the cluster of cystic airspaces

40
Q

What is traction bronchiectasis? Why is this a feature of interstitial lung disease?

A

It is defined as the dilation of airways

This is due to the airways being pulled apart by fibrosis in surrounding areas

41
Q

What are reticular opacities? Why is this a feature of interstitial lung disease?

A

They are defined as pulmonary opacities due to reduced gas exchange

This is caused by thickening of the lung interstitium

42
Q

What is bronchoscopy?

A

It involves the insertion of a small camera into the bronchi

43
Q

How is bronchoscopy used to diagnose interstitial lung disease?

A

It enables direct visualisation of the parenchymal lung disease

It allows a biopsy of this tissue to be obtained for histological examination

44
Q

In hypersensitivity pneumonitis, what two bronchoscopy histology results are shown?

A

Increased lymphocytes

Mast cells

45
Q

In what five ways do we conservatively manage interstitial lung disease?

A

Underlying Pathology Management

Smoking Cessation

Pulmonary Rehabilitation

Annual Influenza Vaccination

One-Off Pneumococcal Vaccination

46
Q

What classification of interstitial disease can be pharmacologically managed?

A

Idiopathic pulmonary fibrosis

47
Q

What are the two pharmacological options for idiopathic pulmonary fibrosis?

A

Pyridones

Monoclonal Antibodies

48
Q

Name a pyridone used to manage idiopathic pulmonary fibrosis

A

Pirfenidone

49
Q

What is the mechanism of action of pirfenidone?

A

It is an antifibrotic and anti-inflammatory that is administered to slow down the progression of disease

50
Q

Name a monoclonal antibody used to manage idiopathic pulmonary fibrosis

A

Nintedanib

51
Q

What is the mechanism of action of nintedanib?

A

It inhibits the action of tyrosine kinase which are involved in the formation of fibrosis

52
Q

In what other circumstance can we pharmacologically manage interstitial lung disease? What drugs can be administered?

A

In cases where the underlying cause is related to connective tissue diseases or sarcoidosis

Steroids and steroid sparing agents

53
Q

What steroid is used to manage interstitial lung disease related to connective tissue diseases or sarcoidosis?

A

Prednisolone

54
Q

What two steroid sparing agents are used to manage interstitial lung disease related to connective tissue diseases or sarcoidosis?

A

Azathioprine

Mycophenolate

55
Q

What criteria is used to determine whether interstitial lung disease patients should be administered LTOT?

A

Resting PaO2 < 7.3kPa

OR

Resting PaO2 < 8kPa With Peripheral Oedema, Polycythaemia, Pulmonary Hypertension

56
Q

What surgical management option can be used in interstitial lung disease?

A

Lung transplant

57
Q

When is lung transplant considered to manage interstitial lung disease?

A

It is only considered in individuals with severely impacted quality of life, despite optimum pharmacological management

Year One - Respiratory System (14 decks)

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