Interstitial Lung Disease

Question 1

How to confirm diagnosis of interstitial lung disease?

Answer 1

Clinical features and high resolution CT

Question 2

What does high resolution CT show?

Answer 2

Ground glass appearance

Question 3

Management of interstitial lung disease?

Answer 3

Gone oxygen if hypoxia
Remove or treat underlying cause
Stop smoking
Physiotherapy/ pulmonary rehab
Pneumococcal flu vaccine
Palliative care
Lung transplant

Question 4

What is idiopathic pulmonary fibrosis?

Answer 4

Unknown cause, over 50, sob and dry cough for more than 3 months

Question 5

What can you find on examination of idiopathic pulmonary fibrosis?

Answer 5

Clubbing and i basal fine inspiration crackles

Question 6

Prognosis of idiopathic pulmonary fibrosis?

Answer 6

2-5 years

Question 7

2 medications that slow progression of idiopathic pulmonary fibrosis?

Answer 7

1. Pirfenidone- antifibrotic and anti-inflammatory
2. Nintedanib- tyrosine kinase

Question 8

Drug induced pulmonary fibrosis is caused by?

Answer 8

MANC
Methotrexate
Amiodarone
Nitrofunatoin
Cyclophosphamide

Question 9

Secondary pulmonary fibrosis is due to?

Answer 9

RASS
Rheumatoid arthritis
Alpha 1 antitrypsin deficiency
SLE
Systemic sclerosis

Question 10

What is hypersensitivity pneumonitis?

Answer 10

Type 3 reaction- parenchyma inflammation

Question 11

What would you find with bronchoalveolar lavage in hypersensitivity pneumonitis?

Answer 11

Mast cells and lymphocytes

Question 12

Examples of hypersensitivity pneumonitis?

Answer 12

Bird fancier lung: avian proteins from droppings
Farmer lung: saccharopolyspora rectivirgula
Mushroom workers: aspergillus clavatus
Malt workers lung: thermophilic actinomycetes

Question 13

How to manage hypersensitivity pneumonitis?

Answer 13

Oxygen, remove allergen, steroids

Question 14

Which condition is similar to pneumonia on CXR and had similar symptoms of cough, fever, sob lethargy?

Answer 14

Cryptogenic organising pneumonia- lung biopsy definitive investigation.
Treatment systemic corticosteroids

Question 15

What can asbestosis cause?

Answer 15

Lung fibrosis
Pleural thickening and plaques
Adenocarcinoma
Mesothelioma

Question 16

What would spirometry show in IPF?

Answer 16

Restrictive picture: FEV1 normal or reduced and FVC reduced hence FEV1/FVC increased

Question 17

What can IPF cause?

Answer 17

Impaired gas exchange, hence reduced transfer factor

Question 18

Investigation of choice in IPF?

Answer 18

CT- honeycombing , CXR- bilateral shadowing reticular opacities

Question 19

What does asbestosis normally cause?

Answer 19

Lower lung fibrosis

Question 20

Features of asbestosis?

Answer 20

Dyspnoea/ reduced exercise tolerance
Clubbing
Bilateral end inspiratory crackles
Restrictive pattern on lung function test and reduced gas transfer

Question 21

Possible features of mesothelioma?

Answer 21

Progressive sob
Chest pain
Pleural effusion

Question 22

Mean survival for mesothelioma?

Answer 22

8-14 months

Question 23

Which occupations put yo at risk of developing silicosis?

Answer 23

Mining, slate works, foundries, potteries

Question 24

What are the features of silicosis?

Answer 24

Upper zone fibrosing lung disease, egg shell calcification of hilar lymph nodes

Question 25

What is a risk factor for developing tuberculosis?

Answer 25

Inhalation of silica ( toxic to macrophages)

Question 26

How does coal dust cause coal workers pneumoconiosis?

Answer 26

Dust in engulfed by alveolar and interstitial macrophages in the bronchioles. They are then moved by the macrophages via the mucocilary elevator and removed from body as mucus. However prolonged exposure causes macrophages to accumulate in alveoli starting an immune response causing damage to lung tissue

Question 27

What are the 2 types of pneumoconiosis?

Answer 27

Simple and progressive massive fibrosis

Question 28

What is simple pneumoconiosis?.

Answer 28

Most commonest type, patients are asymptomatic. Increases the risk of lung disease COPD. 30% of those with stage 3 will lead to progressive massive fibrosis

Question 29

Staging of simple pneumoconiosis?

Answer 29

1. Some opacities but normal lung markings visible 2. Large number of opacities but normal lung markings visible 3. Large number of opacities with normal lung not visible

Question 30

What happens in progressive massive fibrosis?

Answer 30

Round fibrotic masses commonly in upper lobes. Patients will be sob and cough, possibly black sputum.

Question 31

What will a lung function test show for progressive massive fibrosis?

Answer 31

Obstructive/ restrictive picture

Question 32

What will CXR show for progressive massive fibrosis?

Answer 32

Upper zone fibrosis

Question 33

Spirometry for progressive massive fibrosis?

Answer 33

Normal or slightly reduced FEV1 but reduced FVC- restrictive

Question 34

Management of pneumoconiosis?

Answer 34

Avoid exposure to coal dust and other respiratory irritants (smoking) Manage symptoms of chronic bronchitis Patients may be eligible for compensation via the industrial injuries act

Question 35

Presentation of extrinsic allergic alveolitis?

Answer 35

Sob, cough fever, in chronic stages productive cough, lethargy , anorexia and weight loss

Question 36

Management of extrinsic allergic alveolitis?

Answer 36

Oral glucocorticoids