Interstitial Lung Disease

Question 0

List some common causes of interstitial lung disease

Answer 0

Occupational - asbestos, silicosis, coal workers pneumoconiosis
Treatment related - radiation, methotrexate
Connective tissue disease - rheumatoid arthritis, lupus
Immunological - sarcoidosis (mon ca seating granuloma)
Idiopathic

Question 1

What is the interstitium?

Answer 1

Located in between the alveoli and capillaries

Question 2

Outline the typical clinical features of interstitial lung disease

Answer 2

Symptoms - shortness of breath, cough

Signs - cyanosis, tachycardia, tachypnoea, course crackles, right heart failure signs

Question 3

Describe the effects of inflammation and fibrosis associated with interstitial diseases, on ventilation and gas exchange

Answer 3

Decreased ventilation, decreased perfusion = hypoxia

Question 4

Describe the typical lung function results of patients presenting with interstitial lung disease

Answer 4

Restrictive deficit due to stiff lungs

Question 5

List some occupational lung diseases and the environmental factors associated with each

Answer 5

Coal workers pneumoconiosis - coal dust, silica, asbestos
Pigeon fancier’s lung - avian antigens
Asbestosis related
Farmer’s lung - fungal spores from mouldy hay
Isocyanate alveolitis - paint

Question 6

Describe the structure of the visceral and parietal pleura and the functions of pleural fluid

Answer 6

Visceral pleura - surrounds lungs
Parietal pleura - on chest wall
Pleural fluid - allows for lubrication, pleural seal

Question 7

Describe the factors influencing the formation and reabsorption of pleural fluid

Answer 7

Formation - capillary filtration
Increased production - increased hydrostatic pressure, increased permeability
Absorption - lymph drainage
Decreased absorption - decreased lymph drainage

Question 8

Define the term ‘pleural effusion’ and distinguish between the terms ‘haemothorax’, ‘chylothorax’, ‘empyema’, and simple effusion

Answer 8

Pleural effusion - fluid in the interstitium 
Haemothorax - blood
Chylothorax - lymphatic fluid
Empyema - pus
Simple effusion - free flowing

Question 9

State the difference between an exudate and transudate, and the main conditions leading to each in the case of pleural effusion

Answer 9

Exudate - high protein content:
Neoplasms
Infection
Immune - connective tissue disorder, rheumatoid arthritis, lupus
Abdominal disease - pancreatitis, ascites, sub phrenic abscess
Transudate - low protein content:
Increased hydrostatic pressure - cardiac failure
Decreased capillary oncotic pressure - nephrotic syndrome
Increased capillary permeability - sepsis

Question 10

Describe the characteristics of pleurisy and its major causes

Answer 10

Sharp, stabbing pain
Worse on inspiration, coughing
May cause shoulder pain (diaphragmatic involvement)
Causes - pleural fibrosis, pleural tumours (malignant mesothelioma), pleural effusion

Question 11

Describe how, in principle, congenital abnormalities, injury, motor and neurological diseases may affect breathing

Answer 11

Decreased ventilation

Respiratory failure

Question 12

Explain the difference between scoliosis and kyphosis

Answer 12

Scoliosis - lateral curvature of the spine

Kyphosis - increased forward curvature of thoracic spine

Question 13

Describe the blood supply, lymph drainage and innervation of the parietal viscera

Answer 13

Blood supply:
Costal - intercostals, IMA
Mediastinal - bronchial, upper diaphragmatic, IMA
Pleural - subclavian
Venous drainage - peri bronchial vena cava 
Lymph drainage:
Intercostal, internal mammary 
Innervation:
Somatic, sympathetic, parasympathetic 
Phrenic nerve
Intercostal nerves

Question 14

Describe the blood supply, lymph drainage and innervation of the visceral viscera

Answer 14

Blood supply:
Bronchial, pulmonary
Venous drainage - pulmonary
Lymph drainage:
Pulmonary 
Innervation:
Devoid of somatic