Interstitial lung disease Flashcards
2 genreal types of ILD
- upper lobe
2. lower lobe
DDX for upper (5)
FASST Farmer's lung (hypersensitivity) Ank spond Silicosis Sarcoidosis TB
what is farmer’s lung (HP)
- from repeated exposures
- type 3 or 4 hypersens
- can be weeks to years
**4 general causes of HP and their subtypes to know
- microbial
- farmer - thermophillic
- tobacco - asperilligus
- hot tub - mycobacterium avium - animal protein
- bird fancier
- also comforters - LMW chems
- isocyanates
- popcorn lung - butter flavor - meds
what is presentation of HP
- can be non-specific, but should be temporally related
- resp Sx
- constitutional Sx
3 timeframes of HP
acute - 4-6hrs
subacute - wks/months
chronic - long term with progressive fibrosis
5 things for HP Dx
- exposure to antigen causes HP
- clinical syndrome consitent with HP
- PFT abnormalities - obs, rest, or both with low DLCO
- radiographic abnormalities
- supportive cyto/pathology
2 Tx of HP
- removal of pathogen
2. immunosupression
what is silicosis
- occupational exposure to silical dust
- variable Sx
what is silicosis PFT
restriciton with low DLCO
imaging in silicosis
upper lobes nodules and calcificatiokns
what is sarcoidosis
inflammation rxn of non-caseating granulomatous inflammation
- cuase unknown
- can be anywhere in body, but 90% have lung
4 different presentation of sarcoidosis
- incidental findings (stage 1)
- resp Sx (stage 2,3,4
- loffgrens (subtype of 1)
- extra-pulmonary Sx
what is staging in sracoidosis
based on radiographic features
- incidental findings of hilar adenopathy
- hilar adenopathy and upper lobe nodules
- upper lobe ILD with fibrosis
- end stage fibrosis of the upper lobes
what are chances of spontaneous remission
- 70-90%
- 50-70
- 10-30
- 0
what is lofgrens
- subgroup of stage 1
- hilar adenopathy
- fever
- polyarthralgias/arthrirtis
- erythemia nososum
4 extrapulm. presentations of sarcoidosis
- skin lesions
- ocular
- Ca metabolism
- cardiac - conduction Sx
4 parts of sarcoidosis Dx
- CXR show abnormalities
- may or may not have Sx
- PFT - obs or rest with low DLCO
- path - granulomatous inflammation
Tx of sarcoidosis
1-2 - nothing
3-4 prednisone
DDx for lower lobe ILD (6)
RAAIDS Rhem arth Asbestosis Aspirations Idiopathic pulm fibrosis Drugs Scleroderma
what is connective tissue ILD
most rheumatic conditions can cause ILD
- leading cause of death in rheumatic conditons
2 rheumo conditions
- RA - uncommon manifestation of common dis
2. scleroderma - common manif. of uncommon disease
2 things for diagnosis of CT-ILD
Hx and Phx
serology
what is asbestsis
- occurs 20-30 years after exposure
- need significant exposure
what is manifestion of asbestosis
lower lobe ILD - other things are cause by asbestos, but not asbestosis
Dx and Tx of asbestosis
Dx- Hx and fibers seen on patho
Tx - none
what is idiopathic pulm fibrosis
age >50
- seems to be abberant wound healing without significant inflammation
- uncommon
- survivial 2-5 years
3 things to make IPF Dx
- rule out all other caues of ILD
- CT showing “usual interstitial pneumonia”
- may need lung biopsy
what is Tx for IPF
- NOT steroids - increases mort
- anti-fibrotic agents
5 things to include on an ILD Hx
- resp Sx
- CT disease Sx
- toxins
- exposures
- risk factors
3 parts of PhX for ILD
- resp exam
- cardiac exam
- rheum exam
5 tests to order for ILD
- PFT
- CXR
- CT
- bloods -serology, Ca,
- path - if haven’t figured it out
