Interstitial lung disease

Question 1

course idiopathic pulmonary fibrosis

Answer 1

end stage lung, cor pulmonale

Question 2

mesothelioma, arises from ____,
when?

Answer 2

arises from mesothelial cells of pleura 25-40 years after exposure

no relationship to smoking

Question 2

bronchogenic carcinoma

Answer 2

in asbsetos related disease

additional risk with smoking

20 years after first exposure

Question 2

complications asbestos related diseases

Answer 2

cor pulmonale

caplan syndrome

Question 3

Caplan syndrome of complicated coal worker’s pneuoconiosis

Answer 3

CWP with rheymatoid nodules

Question 4

histo coal worker’s pneuoconisis

Answer 4

antrascosis black pigment

fibrous opacity with pink fibrous tissue

Question 4

types of hyeprsensitivity pnuemonitis

Answer 4

famers lung - themophilic actinomycetes bacteria saccharopolypora rectivirgula

silo fillers disease - plant material gases

Byssinosis - textile workers

Question 5

clinical and laboratory findings intersitital lugn

Answer 5

dry cough

dypsnea

late inspiratory crackles, bibasilar

cor pulmonale

CXR - bilateral reticulondular infiltrates

Question 6

____ pigment in coal worker’s pneumoconiosis

Answer 6

antrhacotic pigment

Question 7

exposure progression in hypersensitivity pneumonitis

Answer 7

first exposure - IgG in serum

second - antibodies > immune complexes >interstital inflammation

chornic exposure: glanuloma formation (type IV response)

Question 8

CXR and histo idiopathic pumonary fibrosis

Answer 8

increased interstitial markings (fibrosis) in lower zones

honeycomb cysts

fibroblasctic plugs

Question 9

hypersensitivity pneumonitis

Answer 9

inhaled antigen producing granulomatous interstitial pneumonitis

Question 10

pathology SLE interstitial lung disease

Answer 10

peleual effusion (young woman with effusion = sle)

Question 11

presentation sarcoidosis

Answer 11

Skin: nodular granulomatous lesions, lupus pernio, erythema nodosum

**Eye: **uveitis

**liver: **granulomatous hepatitis

**other: **enlarged salivary and lacrimal glands, Diabetes insipidous, Bone marrow and spleen involvement

Question 12

pathogenesis idiopathic pumonary fibrosis

Answer 12

repeated injury > alveolitis > cytokine release > interstitial fibrosis

Question 13

pathogenesis sarcoidosis

Answer 13

disorder of immune regulation

antigen > CD4 interaction > cytokines > monocytes+histiocytes recruited > non-necrotizing granumloma formation

Question 13

infiltrate of farmer’s lung hypersensitivitiy penumonitis

Answer 13

thermophilinic actinomycetes - saccharopolyspora rectivirgula

Question 14

berylliosis tissue reaction

site of acquirement

Answer 14

granulomatous inflammation

nuclear and airspace industry (beryllium)

Question 15

complications silicosis

Answer 15

cor pulmonale

caplan syndrome (rheumatoid nodules)

increased risk for TB (silicotuberculosis) and cancer

Question 16

CXR sarcoidosis

Answer 16

bialteral hilar adenopathy

reticulonular shadows in lungs

Question 17

interstitial granuloma distribution in sarcoidosis

other histo

Answer 17

lympathic distribution pattern

langhans giant cells

epitheliod histiocytes

Question 19

simple coal workers pneumoconiosis vs complicated

Answer 19

progressive massive fibrosis

Question 20

histo complicated coal worker’s penumoconiosis

Answer 20

fibrous opacities > 1cm

with/without central necrosis

massive fibrosis

caplan syndrome (rheumatoid nodules)

(no increased incidence of TB or cancer)

Question 21

distribution of fibrous opacities in simple coal workers pneumoconiosis

Answer 21

upper lobes and upper-lower lobes

coal dust adjacent to respiratory bronchioles

Question 23

aveolitis =

Answer 23

damage to pneumocytes and endothelial cells

Question 24

in anthracosis, anthracotic pigment found in

Answer 24

intersitial compartment and lymph nodes

Question 25

pathology systemic sclerosis (scleroderma) interstitial lung disease

Answer 25

interstitial fibrosis

pulmonary vascular hypertrophy

(commonest casue of death in these patients)

Question 26

histo hypersensitivity pneumonitis

Answer 26

intersitital and alveolar inflammatory cell infiltrates

peri-bronchilar accentuation

ill-defined granulomas

(biopsy may be needed)

Question 27

two forms of asbestos

Answer 27

serpentine

amphibole - straight and rigid

Question 28

tissue appearance asbsestos related disease

Answer 28

deposits in respiratory bronchioles, ducts and alveoli

ferringinous boides - macrophages, fibers coated with ferritin (iron and protein)

benign pleural plaques

diffuse interstital fibrosis

Question 29

collagen vascular diseases seen in interstitial lung disease

Answer 29

SLE (50% have interstiial lung)

RA

systemic sclerosis (scleroderma)

Question 30

demographics sarcoidosis

Answer 30

AA:whites 10:1)

F:M 2:1

70%< 40 years

non smokers

Question 31

most common occupational disease

Answer 31

silicosis

Question 33

pathogenesis silicosis

Answer 33

quartz activates macrophages > cytokines > fibrogenesis

Question 34

pathology RA interstitial lung disease

Answer 34

rhematoid nodules (caplan syndrome+pneumoconiosis)

interstitial fibrosis,

pleural effusion

Question 35

distribution of particles in pneumoconiosis

Answer 35

1-5um particles reach bifurcation of bronchioles and alveolar ducts

Question 36

lab findings sarcoidosis

Answer 36

increased ACE levels

hypercalcemia

polyclonal gammopathy

cutaneous anergy - no response to skin antigens(CD4 consumed)

Question 38

pneumoconioses =

Answer 38

non-neoplastic lung disease in response to inhalation of mineral dust

Question 39

types of interstitial lung disease

Answer 39

ARDS

Fibrosing lung disorders (pneumoconioses)

Granulomatous disorders (sarcoidosis)

idiopathic interstitital pneumonias

Question 40

multisystem granulomatous disease of unknown etiology

Answer 40

sarcoidosis

Question 41

end stage interstitial fibrosis (seen in idiopathic pulmoanry fibrosis)

hito

Answer 41

honeycomb lung (irregular dilatation of adjacent airwaus due to interstitial fibrosis)