Interstitial Lung disease

Question 1

interstitial lung disease

Answer 1

radiologically diffuse infiltrates
histologically by distortion of the gas exchanging units
Physiologically by restriction of lung volumes and impaired oxygenation

Question 2

Implies that the inflammatory process is limited specifically to the area between the alveolar epithelial and capillary endothelial basement membrane

Answer 2

interstitial

Question 3

Common features of ILD (HISTORY)

Answer 3

Chronic non productive cough

Progressive exertional dyspnea

Question 4

Common features of ILD (PE)

Answer 4

tachypnea +/- respiratory distress
cyanosis and clubbing
Bibasilar inspiratory crackles

Question 5

Common features of ILD (Imaging)

Answer 5

Intestitial pattern

Question 6

Common features of ILD (PFTs)

Answer 6

Restrictive pattern

DLCo Reduced

Question 7

Suspect CTD in ILD if

Answer 7

MSK Pain
Weakness
Fatigue
Joint pains and swelling
Photosensitivity
Raynauds Phenomenon
Pleuritis
Dry Eyes or mouth

Question 8

Drug induced ILD

Answer 8

Antibiotics (Nitro, sulfasalazine)
Anti-Inflam (Aspirin)
Chemotherapeutic
Miscellaneous
Illicit drugs

Question 9

Silicates

Answer 9

Silicosis
ASbestosis
Talcosis
Hydrated aluminum silicate
Fuller's earth
Nepheline
Aluminum silicates
Portland cement
Mica
Beryllium

Question 10

Carbon

Answer 10

Coal dust (“coal worker’s pneumoconiosis”)

Graphite (“carbon pneumoconiosis”)

Question 11

Metals

Answer 11

Tin (Stannosis)
Aluminum
Hard metal dusts
Iron(siderosis, arc welder's lung)
Antimony
Hematite
Mixed dusts
Barium poweder
CuSO4
Rare eaths

Question 12

Inhaled organic dusts

Answer 12

Hypersensitivity pnemonitis

Question 13

Chemical sources

Answer 13

Synthetic fiber lung
Bakelite worker’s lung
Vinyl chloride, polyvinyl chloride powder

Question 14

gases

Answer 14

Oxygen
Oxides of nitrogen
SO2
Chlorine gas
Methyl isocyanate

Question 15

Fumes

Answer 15

Oxides of zinc, copper, manganese, cadmium, iron, magnesium, brass, selenium, tin and antimony

Diphenylmethane diisocyanate

Trimellitic anhydride toxicity

Question 16

Vapors

Answer 16

Hydrocarbons
Thermosetting resins
Toluene diisocyanate
Mercury

Question 17

Environmental sampling

Answer 17

Detector tubes
Indoor air quality sampling
Gas chromatography
Dust Sampling

Question 18

Coined by zenker in 1867 to denote changes in the lungs caused by retention of inhaled dusts.

Answer 18

Pneumoconiosis

Question 19

Management of ILD

Answer 19

No specific treatment is available

Therapy is directed largely at the complications of the disease

Question 20

A diffuse intestitial fibrosis of the lung resulting from inhalation and retention of considerable numbers of asbestos fibers, usually after prolonged exposure

Answer 20

Asbestosis

Question 21

CXR Asbestosis

Answer 21

Irregular small opacities in lower lung fields

Question 22

Indicator of asbestos exposure

Answer 22

Asbestos-related pleural plaques

• most common manifestation of inhalation, retention and biologic effects

Question 23

Duration of ILD prior to diagnosis

Answer 23

Acute <3 weeks
SubAcute 3-12 weeks
Chronic >12 weeks

Question 24

Ausculation of ILD

Answer 24

velcro rales

Question 25

Typical HRCY Findings

Answer 25

``` Bilateral (rarely unilateral) Lower Lobe predominance Sub-pleural reticular abnormalities Minimal or no ground-glass changes Honeycombing Traction bronchiectasis ```

Question 26

A key element in the diagnosis of some ILDs

Answer 26

Lung biopsy

Question 27

Indications of lung biopsy

Answer 27

to assess disease activity To exclude neoplasm or infection to identify a more treatable condition to establish a definitive Dx before starting a treatment with serious side effects To provide a specific diagnosis in patients with (Atypically or progressive pattern, a normal or atypical chest x-ray features)

Question 28

Relative contradications for lung biopsy

Answer 28

honey combing or evidence of end stage disease Severe pulmonary dysfunction Major operative risk

Question 29

Bronchoscopy

Answer 29

It is often initial procedure of choice

Question 30

Endobronchial lesions

Answer 30

Sarcoidosis | Wegener's granulomatosis

Question 31

Inflammation and structure of the major airways

Answer 31

Wegener's granulomatosis

Question 32

Surgical Biopsy

Answer 32

Video-assisted thoracoscopic lung biopsy is the preferred method of obtaining lung tissue