Interstitial Lung Disease

Question 1

what is it

Answer 1

affects parenchyma of lung in a diffuse way. chronic inflam +- progressive interstitial fibrosis

Question 2

features

Answer 2

non productive paroxysmal cough, abnormal breath sounds, abnormal CXR or CT, restrictive spirometry, dyspnoea on exertion

Question 3

how is ILD classified

Answer 3

those with known cause, those associated with systemic disease, idiopathic

Question 4

ILD those with known cause

Answer 4

occupational/environmental, drugs (nitrofurantoin, bleomycin, amiodarone, sulfasalazine; hypersensitivity eg EAA, infections- TB, viral, fungi, GOR

Question 5

ILD thos assoc with systemic disease

Answer 5

sarcoidosis, RA, UC, autoimmune thyroid, SLE, systemic sclerosis, Sjogren

Question 6

ILD idiopathic

Answer 6

idiopathic pulmonary fibrosis, cryptogenic organising pneumonia, lymphocytic interstitial pneumonia

Question 7

what is the commonest cause of ILD

Answer 7

idiopathic pulmonary fibrosis

Question 8

symptoms IPF

Answer 8

dry cough, arthralgia, exertional dyspnoea, malaise, weight loss

Question 9

signs IPF

Answer 9

cyanosis, clubbing, fine end ins crackles

Question 10

complications IPF

Answer 10

resp failure, incr risk lung cancer

Question 11

tests IPF

Answer 11

blood- ABC decr O2, incr CRP, incr Ig, ANA, rheum factor. CXR,CT, Spirometry, BAL, lung biopsy

Question 12

what does the CXR show IPF

Answer 12

decr lung vol, bilat lower zone reticulonodular shadows, honeycomb lung

Question 13

what may BAL show in IPF

Answer 13

alveolitis- incr lymphocytes, neutrophils and eosinophils incr

Question 14

management IPF

Answer 14

O2, pulmonary rehab, opiates, palliative

Question 15

prognosis IPF

Answer 15

50%

Question 16

differentials fibrotic shadowing on CXR

Answer 16

upper zone- TB, EAA, AS, sarcoid, radiotherapy; middle zone- PMF; lower zone- IPF, asbestosis