Interstitial lung disease

Question 1

Sarcoidosis

Answer 1

Non-caseating granuloma in lung interstition
Unknown origin
Type 4 hypersensitivity reaction

Question 2

Hypersensitivity pneumonitis

Answer 2

Inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dusts
Type 3 hypersensitivity reaction

Question 3

Treatment for chronic sarcoidosis

Answer 3

Oral steroids

Immunosuppression

Question 4

Treatment for extrinsic allergic alveolitis

Answer 4

Oxygen
Steroid
Antigen avoidance

Question 5

Idiopathic pulmonary fibrosis

Answer 5

Imbalance of fibrotic repair system

Question 6

Pulmonary function test for hypersensitivity pneumonitis

Answer 6

Low FEV1 and FVC
High or normal ratio
Low gas transfer

Question 7

PFT for IPF

Answer 7

Low FEV1 and FVC
High or normal ratio
Low gas transfer
Reduced lung volume

Question 8

Pathology of Idiopathic Pulmonary Fibrosis

Answer 8

Usual Interstitial Pneumonia pattern (UIP)
Heterogenous fibrosis in alveolar walls with fibroblastic foci and destruction of architecture causing honeycombing. Inflammation is minimal.

Question 9

Treatment for IPF

Answer 9

Anti-fibrotic drugs

Lung transplant

Question 10

Simple pneumoconiosis

Answer 10

Occupational lung disease

Chest X-ray abnormality-calcification of hilar nodes

Question 11

Caplan’s syndrome

Answer 11

Rheumatoid pneumoconiosis

Question 12

Silicosis

Answer 12

15-20 years exposure to quartz

Question 13

Chronic/ complicated pneumoconiosis

Answer 13

Restrictive pattern

Pulmonary fibrosis

Question 14

Asbestos related lung disorders

Answer 14

Benign pleural plaques
Acute asbestos pleuritis
Pleural effusion and diffuse pleural thickening
Malignant mesothelioma
Bronchial carcinoma
Pulmonary fibrosis (asbestosis)

Question 15

Early stage interstitial lung disease

Answer 15

Alveolitis

Question 16

What characterises late stage alveolitis

Answer 16

Fibrosis

Question 17

What characterises early stage ILD

Answer 17

Injury with inflammatory cell infiltration

Question 18

Clinical effects of ILD

Answer 18

Hypoxia (respiratory failure) and cardiac failure

Question 19

Transbronchial biopsy

Answer 19

Special forceps used at bronchoscopy

Question 20

Thoracoscopic biopsy

Answer 20

More invasive but more reliable and generates far more tissue

Question 21

Chronic interstitial diseases

Answer 21

Idiopathic pulmonary fibrosis
Sarcoidosis
Extrinsic allergic alveolitis
Pneumoconiosis
Connective tissue diseases

Question 22

Idiopathic Pulmonary Fibrosis

Answer 22

Progressive interstitial fibrosis of no known cause

Variable associated inflammation

Question 23

Pathology of IPF

Answer 23

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

Question 24

Allergic origin of extrinsic hypersensitivity pneumonitis

Answer 24

Type 3 and type 4 hypersensitivity

Question 25

What allergen causes farmer’s lung?

Answer 25

Thermophilic bacteria in mouldy hay

Question 26

What allergen causes bird fancier’s lung?

Answer 26

Avian proteins

Question 27

What type of allergen causes malt worker’s lung?

Answer 27

Fungi

Question 28

Sarcoidosis

Answer 28

Multi-system granulomatous disease of unknown cause

Question 29

Other manifestations of sarcoidosis

Answer 29

Lymphadenopathy
Uveitis (inflammation of iris)
Erythema nordosum
Hypercalcaemia

Question 30

Pulmonary involvement in connective tissue disease

Answer 30

Pleural effusion
Rheumatoid nodules
Interstitial fibrosis

Question 31

Pneumoconiosis

Answer 31

Lung disease caused by mineral dust exposure

Question 32

Examples of types of pneumoconiosis

Answer 32

Asbestosis
Coal worker’s lung
Silicosis

Question 33

What factors does pneumoconiosis depend on? (4)

Answer 33

Particle size
Particle reactivity
Clearance of particle
Host response