Interstitial Lung Disease Flashcards
A 42 yo smoker presents with two years of mild, slowly progressive breathlessness. A biopsy is taken which is reported as showing patchy accumulation of pigmented alveolar macrophages within the terminal bronchioles
What is the most likely diagnosis?
A Acute interstitial pneumonia
B Desquamative interstitial pneumonia
C Nonspecific interstitial pneumonia
D Respiratory bronchiolitis interstitial lung disease
E Usual interstitial pneumonia
D Respiratory bronchiolitis interstitial lung disease
A 55 year-old non-smoking patient presents with two months of progressive breathlessness, dry cough and weight loss despite several courses of antibiotics from their GP. CT shows bilateral areas of consolidation with peribronchial predominance.
Histology is reported as showing alveolar space plugging with granulation tissue.
What is the most likely diagnosis?
A Acute interstitial pneumonia
B Cryptogenic organising pneumonia
C Nonspecific interstitial pneumonia
D Respiratory bronchiolitis interstitial lung disease
E Usual interstitial pneumonia
B Cryptogenic organising pneumonia
A 50-year-old patient who was previously fit and well presents with a week of rapidly worsening breathlessness following a suspected viral infection around 1-2 weeks ago. CT shows diffuse ground glass changes suggestive of ARDS.
Histology is reported as showing diffuse alveolar damage with interstitial oedema, intra-alveolar hyaline membranes and fibrosis.
What is the most likely diagnosis?
A Acute interstitial pneumonia
B Cryptogenic organising pneumonia
C Nonspecific interstitial pneumonia
D Respiratory bronchiolitis interstitial lung disease
E Usual interstitial pneumonia
A Acute interstitial pneumonia
A 35 year-old smoker presents with 8 weeks of worsening breathlessness and cough.
Histology shows pigmented macrophages in alveolar airspaces.
What is the most likely diagnosis?
A Acute interstitial pneumonia
B Desquamative interstitial pneumonia
C Nonspecific interstitial pneumonia
D Respiratory bronchiolitis interstitial lung disease
E Usual interstitial pneumonia
B Desquamative interstitial pneumonia
A 65 year-old non-smoker presents with gradually progressive breathlessness and cough over a number of years.
Histology shows diffuse lymphoid infiltrates involving alveolar septae.
What is the most likely diagnosis?
A Acute interstitial pneumonia
B Desquamative interstitial pneumonia
C Lymphoid interstitial pneumonia
D Nonspecific interstitial pneumonia
E Respiratory bronchiolitis interstitial lung disease
C Lymphoid interstitial pneumonia
A 72-year-old man with no previous medical history presents with 2-3 years of progressive breathlessness. He has fine inspiratory crackles heard on examination.
HRCT is reported as showing bibasal subpleural honeycombing.
Which of the following would best describe the changes seen in histology in this condition?
A Alveolar plugging with granulation tissue
B Areas of interstitial fibrosis interspersed with normal lung
C Diffuse alveolar damage with fibroblast proliferation and intra-alveolar hyaline membranes
D Pigmented macrophages in bronchioles
E Uniform inflammation and fibrosis
B Areas of interstitial fibrosis interspersed with normal lung
This is a UIP pattern seen in idiopathic pulmonary fibrosis.
A 72-year-old man with no previous medical history presents with 2-3 years of progressive breathlessness. He has fine inspiratory crackles heard on examination.
HRCT is reported as showing bilateral basal ground glass changes and fine reticulation.
Which of the following would best describe the changes seen in histology in this condition?
A Alveolar plugging with granulation tissue
B Areas of interstitial fibrosis interspersed with normal lung
C Diffuse alveolar damage with fibroblast proliferation and intra-alveolar hyaline membranes
D Pigmented macrophages in bronchioles
E Uniform inflammation and fibrosis
E Uniform inflammation and fibrosis
This is an NSIP pattern of idiopathic pulmonary fibrosis.
A 54-year-old man attends your clinic with a 6-month history of dry cough and worsening exertional dyspnoea. He is a smoker with a history of longstanding rheumatoid arthritis (RA), not currently on treatment.
Pulmonary function testing demonstrates forced expiratory volume in 1 second (FEV 1) 40% predicted, forced vital capacity (FVC) 35% predicted, FEV1:FVC ratio 75%, total lung capacity (TLC) 42% predicted and transfer
factor corrected for alveolar volume (KCO) 15% predicted.
Which of the following would be consistent with these findings?
A. Caplan’s syndrome
B. Pulmonary arterial hypertension
C. Rheumatoid arthritis-associated interstitial lung disease (RA-ILD)
D. Rheumatoid arthritis-associated pleural effusion
E. Shrinking lung syndrome
C
The combination of restrictive spirometry with reduced lung volumes and transfer factor suggest a pulmonary parenchymal pathology. In this scenario, RA-ILD is the most likely diagnosis.
A 75-year-old patient is newly diagnosed with idiopathic lung fibrosis. He is referred to the MDT for consideration of antifibrotics and offered pirfenidone.
Which of the following best describes the mechanism of action of this drug?
A Antioxidant
B Antiinflammatory
C Inhibition of collagen synthesis and reduced fibroblast proliferation
D Inhibition of IL-4 and IL-13 pathways
E Tyrosine kinase inhibitor
C Inhibition of collagen synthesis and reduced fibrolblast proliferation
A 75-year-old patient is newly diagnosed with idiopathic lung fibrosis. He is referred to the MDT for consideration of antifibrotics and offered nintedinib.
Which of the following best describes the mechanism of action of this drug?
A Antioxidant
B Antiinflammatory
C Inhibition of collagen synthesis and reduced fibroblast proliferation
D Inhibition of IL-4 and IL-13 pathways
E Tyrosine kinase inhibitor
E Tyrosine kinase inhibitor
A patient with advanced idiopathic pulmonary fibrosis presents with worsening, dry cough that is becoming increasingly troublesome.
Which of the following should be considered?
A Doxycycline
B Carbocysteine
C Clarithromycin
D Pirfenidone
E Thalidomide
E Thalidomide
