Interstitial Lung Disease

Question 1

4 prototypical ILD symptoms?

Answer 1

Dyspnea, cough, crackles during inspiration, and digital clubbing

Question 2

ILD evaluation must include history of 5 things?

Answer 2

Occupation, hobbies, environmental, travel and drugs

Question 3

What are the 5 lung diseases caused by RA?

Answer 3

IPF, bronchiectasis, pulmonary rheumatoid nodules, Pulmonary vasculitis, and pleural disease

Question 4

What is characteristic of pleural disease that he talked about?

Answer 4

Low pleural glucose

Question 5

3 lung diseases SLE can cause?

Answer 5

ILD, PHTN and pleural disease

Question 6

Most common autoantibody in scleroderma associated with ILD?

Answer 6

SCL

Question 7

2 most common auto antibodies in SLE associated with ILD?

Answer 7

ANA and Histone

Question 8

What is the chem drug he wants us to know causing ILD?

Answer 8

Bleomycin

Question 9

What is the cardiac Antiarrhythmics agent he wants us to know causing ILD?

Answer 9

Amiodarone

Question 10

What is the antibiotic he wants us to know causing ILD?

Answer 10

Nitrofurantoin

Question 11

What is the early and late phase of ILD after radiation?

Answer 11

1-3 months

6-12 months causing fibrosis

Question 12

3 symptoms of acute Hypersensitivity pneumonitis?

Answer 12

Dyspnea, cough and fever

Question 13

What did he say should be our focus with hypersensivity pneumonitis?

Answer 13

Figure out the chronic ones that are silent so they don’t develop irreversible fibrosis

Question 14

Two big differences between ILD and COPD?

Answer 14

ILD is more rapid decline and COPD is slower decline

ILD has non productive cough and COPD has a very productive cough

Question 15

What is the treatment choice for non IPF?

Answer 15

Corticosteroids

Question 16

What are the two drugs for IPF only?

Answer 16

Pirfenidone and nintedanib

Question 17

What is the clinical characterization and histo characterization of AIP?

Answer 17

Rapid onset of dyspnea and respiratory failure.

Diffuse alveolar damage leading to fibrosis

Question 18

Next questions are AIP vs. IPF.

What patient population of each?

Answer 18

AIP: all ages, mostly adults
IPF: almost exclusively adults

Question 19

Chest X ray pattern?

Answer 19

AIP: diffuse, symmetrical and bilateral
IPF: asymmetrical and favors upper or lower lobes.

Question 20

What is the difference in onset of the two?

Answer 20

AIP: abrupt
IPF: gradual

Question 21

Best way to diagnose for AIP vs. IPF?

Answer 21

AIP: biopsy
IPF: history, imaging, PFTs

Question 22

What is the treatment of choice for sarcoidosis?

Answer 22

Prednisone

Question 23

What is a patient exposed to if they hang out in caves?

Answer 23

Silica

Question 24

3 lung conditions associated with scleroderma?

Answer 24

Pulmonary fibrosis, pulmonary HTN, and aspiration.

Question 25

Parasternal heave/lift is associated with what two conditions?

Answer 25

Pulmonary HTN and RV enlargement

Question 26

What will you see on Chest x ray for asbestos?

Answer 26

Pleural plaques on the periphery

Question 27

4 things we will see on patient presentation for sarcoidosis?

Answer 27

Erythema Nodosum
Arthralgia
Hilar adenopathy
Fever

Question 28

What kind of cough is found in hypersensitivity pneumonitis?

Answer 28

Dry cough

Question 29

Two histo ways to categorize ILD?

Answer 29

Inflammation leading to fibrosis and granulomatous

Question 30

What is the main difference between interstitial pneumonia and idiopathic fibrosis?

Answer 30

We call a disease or condition UIP when we know the underlying process or cause. We call it idiopathic pulmonary fibrosis when we don’t know the underlying cause.

Question 31

Big time histo difference between UIP and NSIP?

Answer 31

Honeycombing is in UIP

Question 32

What diagnostic tool can he crucial to determine distribution and extend of a specific ILD?

Answer 32

High resolution CT