Interstitial Lung Disease

Question 1

What are interstitial Lung Diseases?

Answer 1

any disease process that affects the Lung interstitium

Question 2

Classic symptoms of ILD?

Answer 2

breathlessness

dry cough

Question 3

Granulomatous, type IV hypersensitivity disease of unknown cause

Answer 3

Sarcoidosis

Question 4

Common system involvement of Sarcoidosis

Answer 4

lungs, lymph nodes, joints, liver, skin, eyes

Question 5

What type of granuloma is found in the lung of sarcoid patients?

Answer 5

non-caseating

Question 6

Acute sarcoidosis is ____-_______

Answer 6

self-limiting

Question 7

Symptoms of acute sarcoidosis

Answer 7

erythema nodosim 
bilateral hilar lymphadenopathy 
arthritis
UVeitis 
Parotitis 
Fever

Question 8

signs of chronic sarcoidosis

Answer 8

lung infiltrates
skin infiltrates
peripheral lymphadenopathy
hypercalcaemia

Question 9

DDx with Sarcoidosis

Answer 9

TB, lymphoma, carcinoma, fungal infection

Question 10

Investigations where sarcoidosis is suspect

Answer 10

CXR
CT 
Biopsy 
Pulmonary function
Blood test

Question 11

Expected sarcoidosis findings in CXR

Answer 11

Bihilar lymphadenopathy

Question 12

Expected sarcoidosis findings in CT

Answer 12

peripheral nodular infiltrates

Question 13

Expected sarcoidosis findings in biopsy

Answer 13

non-caseating granuloma if anything

Question 14

Expected sarcoidosis findings in pulmonary function tests

Answer 14

restrictive defect
breathlessness
reduction in blood gas levels

Question 15

Blood test results in sarcoidosis

Answer 15

raised ACE
raised Calcium
raised, LFTs, CRP, Kidney

Question 16

Treatment for acute sarcoidosis

Answer 16

let it settle itself

Question 17

treatment for chronic sarcoidosis

Answer 17

oral steroids

if vital organs affected, immunosuppression (azathioprine, methotrexate, anti-TNF)

Question 18

Type III hypersensitivity reaction to antigen

Answer 18

Extrinsic allergic alveolitis - hypersensitivity pneumonitis

Question 19

Acute symptoms of extrinsic allergic alveolitis

Answer 19

cough, breathless, fever, myalgia, +/- pyrexia, +/- crackles, hypoxia

Question 20

time frame for extrinsic allergic alveolitis symptoms

Answer 20

several hours after exposure

Question 21

CXR results for acute allergic alveolitis

Answer 21

widespread pulmonary infiltrates

Question 22

Treatment for acute extrinsic allergic alveolitis

Answer 22

oxygen, steroid and antigen avoidance

Question 23

Chronic alveolitis presents with _____

Answer 23

progressive breathlessness and a cough

Question 24

Signs of chronic extrinsic allergic alveolitis

Answer 24

crackles, clubbing is unusual

Question 25

CXR signs of chronic extrinsic allergic alveolitis

Answer 25

pulmonary fibrosis, mostly in the upper zones

Question 26

PFT signs of chronic extrinsic allergic alveolitis

Answer 26

restrictive defect, low FEV1/FVC, high or normal ratio, low gas transfer

Question 27

Diagnosis of extrinsic allergic alveolitis

Answer 27

history, exam, lung biopsy, ask about the pets

Question 28

Treatment for chronic extrinsic allergic alveolitis

Answer 28

remove antigen exposure, oral steroids if breathless or low gas transfer