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1st Year Medicine > Interstitial Lung Disease > Flashcards

Interstitial Lung Disease Flashcards

1
Q

What does interstitial disease cause?

A

Impaired gas transfer and a restrictive lung pattern.

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2
Q

What are the symptoms of interstitial lung disease?

A

Breathlessness and a dry cough.

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3
Q

What types of interstitial lung disease do we get?

A

Acute, episodic or chronic.

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4
Q

What are some general causes of interstitial lung disease?

A

Can be part of a systemic disease,
Environmental - exposure to an agent e.g. A drug or radiation.
Hypersensitivity - mouldy hay or avian proteins.

idiopathic e.g. Connective tissue disease or fibrosing alveolitis.

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5
Q

What are the two stages of change in interstitial lung disease and what do they involve?

A

Early - alveolitis - injury with inflammatory cell infiltration.
Late - characterised by fibrosis.

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6
Q

What causes the clinical effects of interstitial lung disease?

A

Effects due to hypoxia (respiratory failure) and cardiac failure.

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7
Q

What test should we do to diagnose the cause of interstitial lung disease?

A

Trans bronchial biopsy and thorascopic biopsy.

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8
Q

What biopsy is better and why?

A

Thorascopic as it is more reliable and generates more tissue.

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9
Q

What are the different types of chronic interstitial lung disease?

A

Fibrosing alveolitis,
sarcoidosis,
extrinsic allergic alveolitis (hypersensitivity pneumonitis), pneumoconiosis
and connective tissue disease.

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10
Q

What are other names for fibrosing alveolitis and what is it?

A

Cryptogenic fibrosing alveolitis or usual interstitial pneumonia.
It is a progressive interstitial fibrosis of an unknown cause.

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11
Q

What finding in the hands is common in fibrosing alveolitis?

A

Finger clubbing.

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12
Q

What is the pathology of fibrosing alveolitis?

A

Subpleural and basal fibrosis.
Inflammatory component variable.
Terminal lung structure replaced by dilated spaces surrounded by fibrous walls.

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13
Q

What is extrinsic allergic alvaolitis otherwise called and what is it?

A

Hypersensitivity pneumonitis.
It is an acute or chronic inflammatory disease of the small airways and interstitium with occasional granulomas.

It is allergic in origin, type III or IV reaction.

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14
Q

What are the causes of EAA?

A

Thermopilic bacteria e.g. Farmers lung.
Avian proteins e.g. Bird fanciers lung.
Fungi - malt workers lung.

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15
Q

What can we detect from blood tests for EAA? What happens in unusual cases?

A

Precipitins e.g. Antibodies are often detectable in serum. Unusual cases come to biopsy.

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16
Q

What is sarcoidosis? What causes it?

A

Multi system granulomatous disorder (type 4 hypersensitivity reaction) of unknown cause. Pulmonary involvement is common. Most cases are mild and self limiting.

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17
Q

What are the common areas that sarcoidosis affects?

A

Lungs, lymph nodes, joints, liver, skin and eyes.

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18
Q

What are less common areas involved in sarcoidosis?

A

Kidneys, brain, nerves and heart.

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19
Q

What population of patients is sarcoidosis less common in?

A

Smokers.

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20
Q

What are 4 other manifestations of sarcoidosis?

A

Uveitis, erythema nodosum, lymphadenopathy and hypercalcaemia.

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21
Q

What are manifestations of acute sarcoidosis? And what is the treatment?

A

Erythema nodosum, bilateral hilar lymphadenopathy, arthritis, uveitis, parotitis and fever.
It is self limiting.

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22
Q

What are manifestations of chronic sarcoidosis? And what is the treatment?

A

Lung infiltrates (alveolitis), skin infiltrations, peripheral lymphadenopathy and hypercalcaemia.
Oral steroids are given if a vital organ is affected e.g. Lung, eyes, heart and brain.
Immunosuppression.
Monitor CXR and pulmonary function test for years.

23
Q

What are the tests for sarcoidosis? What are they looking for?

A

CXR - BHL.
CT of lungs - peripheral nodular infiltrate.
Tissue biopsy.
Pulmonary function - restrictive pattern due to infiltrates.
Blood tests - ACE levels as a marker of activity (not diagnostic), raised calcium and increased inflammatory markers.

24
Q

What types of pulmonary involvement do we get in connective tissue disease?

A

Interstitial fibrosis (less severe than fibrosing alveolitis). Pleural effusions and rheumatoid nodules.

25
Q

What is pneumoconiosis?

A

Lung disease caused by mineral dust exposure e.g. Asbestosis or silicosis.

26
Q

What factors does pneumoconiosis depend upon?

A

Particle size, particle reactivity, clearance of particle and host response.

27
Q

What is asbestos and its different shapes?

A

A silicate.
Serpentine -curved
Straight - amphibole.

28
Q

What can asbestos exposure cause?

A

Parietal pleural plaques, interstitial fibrosis (asbestosis), bronchial carcinoma and mesothelioma.

29
Q

What are the symptoms of acute EAA?

When do symptoms occur?

A

Cough, breathlessness, fever, myalgia.

Classically symptoms occur several hours after acute exposure.

30
Q

What are the symptoms of chronic EAA?

A

Progressive breathlessness and cough.

31
Q

What are the signs of acute EAA?

A

Maybe pyrexia, crackles but no wheeze and hypoxia.

32
Q

What is the treatment of acute EAA?

A

Oxygen, steroid and antigen avoidance.

33
Q

What are the investigations of chronic EAA?

A

History of exposure, precipitins (IgG antibodies to antigen).
Lung biopsy if in doubt.

34
Q

What is the treatment of chronic EAA?

A

Remove antigen exposure and give oral steroids of breathless or has low gas exchange.

35
Q

What causes chronic EAA?

A

Repeated low dose antigen exposure over years.

36
Q

What are the signs of chronic EAA?

A

May be crackles, clubbing is rare.

37
Q

What will we see on pulmonary function tests for chronic EAA?

A

Restrictive defect - low FeV1 and FVC. High or normal ration.
Low gas transfer.

38
Q

What is the most common interstitial lung disease?

A

Idiopathic pulmonary fibrosis.

39
Q

What are secondary causes of pulmonary fibrosis?

A

Rheumatoid, SLE, systemic sclerosis and asbestosis.

40
Q

What is the clinical presentation of pulmonary fibrosis?

A

Progressive breathlessness and a dry cough.

41
Q

What do we see on examination for pulmonary fibrosis?

A

Clubbing, bilateral fine inspiratory crackles.

42
Q

What investigations do we do for pulmonary fibrosis? What will we find?

A

Pulmonary function tests - reduced FEV1 and FVC with normal or raised FEV1/FVC ratio. Reduced lung volumes and low gas transfer.
CXR - bilateral infiltrates.
CT scan - fibrotic change worse at lung bases. Ground glass appearance suggests reversible alveolitis.
Lung biopsy - not necessary if CT scan is diagnostic.

43
Q

What is the pathology of pulmonary fibrosis?

A

Chronic inflammatory infiltrate.

Neutrophils and fibrosis in alveolar walls +/- intra alveolar macrophages.

44
Q

What is the prognosis for pulmonary fibrosis?

A

Most patients progress into respiratory failure and are dead in 5 years.

45
Q

What do we see on investigation for Simple pneumoconiosis?

A

Chest X-ray abnormality but no impairment if lung function.

46
Q

What is silicosis? What causes it? What signs does it have?

A

Simple pneumoconiosis.
15-20 years exposure to Quartz - mining, foundry, glass, boilers.
Shows egg shell calcification of hilar nodes on chest X-ray only.

47
Q

What are the symptoms of chronic silicosis?

A

Restrictive pattern with pulmonary fibrosis.

48
Q

Where were people exposed to asbestos?

A

Mining, construction, shipbuilding, boilers and piping and with cars e.g. Brakes.

49
Q

What is the pathogenesis of asbestos contact to mesothelioma?

A

Contact ==> Asymptomatic benign pleural plaques ==> acute asbestos pleuritis ==> pleural effusion and diffuse pleural thickening ==> malignant mesothelioma.

50
Q

What signs and symptoms do you get with acute asbestos pleuritis?

A

Fever, pain, bloody pleural effusion.

51
Q

What is malignant mesothelioma?

A

Incurable pleural cancer. Presents with chest pain and pleural effusion. No available treatment. Fatal within two years.

52
Q

Where will we find asbestos bodies?

A

In sputum and lung biopsy.

53
Q

What is the pulmonary interstitium?

A

Alveolar lining cell types 1 and 2. Thin elastin rich connective component containing capillary blood vessels.

1st Year Medicine (64 decks)

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