Interstitial Lung Disease

Question 1

What is lung parenchyma?

Answer 1

All of the parts of the lungs involved in gas exchange - vessels, alveolar walls, bronchioles, interstitium, etc

Question 2

What part of the lungs does not fall into the category of Interstitial Lung Disease (Diffuse parenchymal lung disease)?

Answer 2

Airways proximal to broncioles

Question 3

There are 180 different diseases that fall into this category, but they all have this in common:

Answer 3

progressive dyspnea
NON PRODUCTIVE cough
tachypnea
small lung volumes
bibasilar dry rales, “velcro” crackles
CXR - patchy ground glass

Question 4

Many CT diseases can include parenchymal disease manifestations, these include:

Answer 4

RA, SLE, scleroderma, polymyositis-dermatomyositis, sjogrens

Question 5

T/F. Lung disease can precede the typical manifestations of an underlying CT disorder.

Answer 5

True!

Question 6

Most common diagnosis among patients with ILD is:

Answer 6

Idiopathic interstitial pneumonia

Question 7

What is the standard of diagnosis for ILD?

Answer 7

surgical lung BIOPSY

Question 8

A diagnosis of usual interstitial pneumonia (UIP) can be made with 90% confidence (without biopsy) in patients >65 years who have:

Answer 8

1. inspiratory crackles
2. restrictive findings on PFT
3. progressive fibrosis on CXR
4. diffuse, patchy honeycombing on CT

Question 9

What is the only definitive treatment for UIP?

Answer 9

lung transplant, with 50% 5-year survival rate

Question 10

What are some symptoms that may make a patient with sarcoidosis seek care?

Answer 10

Malaise, fever, dyspnea of insidious onset.

Skin involvement - erythema, lupus pernia on nasal rim, iritis, peripheral neuropathy, arthritis

Question 11

T/F. Like in all Interstitial lung diseases, crackles are common on examination of a patient with sarcoidosis?

Answer 11

False! May see parotid gland enlargement, hepatomegaly, splenomegaly.

Question 12

In which demographic is sarcoidosis most common?

Answer 12

Young black women

Question 13

How is sarcoidosis diagnosed?

Answer 13

Demonstration of noncaseating granulomas in a biopsy specimen. (and exclusion of other granulomatous disorders)

Question 14

What type of evaluation is indicated in all sarcoidosis patients?

Answer 14

complete OPHTHALMOLOGIC eval

Question 15

If symptoms are marked, what is the drug of choice for treatment of sarcoidosis?

Answer 15

prednisone for months-years