Interstitial Lung disease

Question 1

what are the two key symptoms of interstitial lung disease?

Answer 1

dyspnoea

dry cough

Question 2

what medication can cause interstitial lung disease?

Answer 2

bleomycin 
busulfan 
amiodarone 
nitrofurantoin 
sulfasalazine 
methotrexate 
methysergide

Question 3

other than medication what else can cause interstitial lung disease?

Answer 3

asbestosis, silicosis

hypersensivity pneumonitis

TB, viral, fungal infections

Question 4

what systemic disease is interstitial lung disease associated with?

Answer 4

sarcoidosis 
RA
SLE
systemic sclerosis 
sjogrens 
MCTD (mixed connective tissue disease - lupus, scleroderma and polymyositis)
UC
ankylosing spondylitis

Question 5

what causes upper lobe interstitial lung disease ?

Answer 5

Aspergillosis : ABPA
Pneumoconiosis: Coal, Silica
Hypersensitivity pneumonitis 
Negative, sero-arthropathy
TB

Question 6

what causes lower lobe interstitial lung disease ?

Answer 6

Sarcoidosis (mid zone)
Medication 
Asbestosis
Idiopathic pulmonary fibrosis
Rheum: RA, SLE, Scleroderma, Sjogren’s, PM/DM

Question 7

what type of hypersensivity reaction occurs in hypersensivity pneumonitis

Answer 7

Type 3 and 4

type 4 - granuloma formation and obliterative bronchiolitis

Question 8

state three causes of hypersensivity pneumonitis ?

Answer 8

􏰀 Bird fancier’s lung: proteins in bird droppings

􏰀 Farmer’s / mushroom worker’s

􏰀 Malt worker’s lung: Aspergillus clavatus

Question 9

what is the acute presentation of hypersensivity pneumonitis ?

Answer 9

fever, dry cough, malaise, dyspnoea, crackles

Question 10

what is the chronic presentation of hypersensivity pneumonitis ?

Answer 10

increasing dyspnoea
wt loss
Type 1 resp failure
cor pulmonale

Question 11

what are 4 histopathy features of hypersensivity pneumonitis ?

Answer 11

upper zone disease

foamy histiocytes

bronchiolitis obliterans

soft centracinar epitheloid granuloma

Question 12

what investigations should be done for hypersensivity pneumonitis ?

Answer 12

Bloods
CXR
spirometry (restrictive)
bronchoalveolar lavage

Question 13

what would bronchoalveolar lavage show for hypersensivity pneumonitis ?

Answer 13

↑ lymphocytes and mast cells

Question 14

what appearance will the lung have on CXR with hypersensivity pneumonitis ?

Answer 14

honeycomb lung

fibrosis

Question 15

what is the medical treatment for hypersensivity pneumonitis ?

Answer 15

avoid exposure

steroids (acute/long term)

compensation may be payable (UK industrial injuries Act)

Question 16

what is another name for idiopathic pulmonary fibrosis ?

Answer 16

cryptogenic fibrosing alveolitis

Question 17

what age and gender is most affected by idiopathic pulmonary fibrosis ?

Answer 17

middle age

males

Question 18

what is the commonest cause of interstitial lung disease?

Answer 18

idiopathic pulmonary fibrosis

Question 19

what are the symptoms of idiopathic pulmonary fibrosis ?

Answer 19

dry cough 
dyspnoea
maliase
arthralgia 
obstructive sleep apnoea

Question 20

what are the signs of idiopathic pulmonary fibrosis ?

Answer 20

cyanosis
clubbing
crackles (fine, end inspiratory)

Question 21

what are the complications of idiopathic pulmonary fibrosis ?

Answer 21

increased risk of lung carcinoma
type 2 resp failure
cor pulmonale

Question 22

what antibodies can be positive with idiopathic pulmonary fibrosis ?

Answer 22

ANA (anti nuclear antibody) -30%

RF (rheumatoid factor) -10%

Question 23

would idiopathic pulmonary fibrosis have increased or decreased lung volume on CXR?

Answer 23

decreased lung volume due to fibrosis

Question 24

what imaging can be done for idiopathic pulmonary fibrosis after CXR?

Answer 24

high resolution CT

Question 25

what investigations can be done for idiopathic pulmonary fibrosis ?

Answer 25

``` bloods (CRP, ANA, RF, ABG) CXR HRCT spirometry lung biopsy bronchoalveolar lavage DTPA scan (may reflect disease activity) ```

Question 26

what is the management for idiopathic pulmonary fibrosis ?

Answer 26

``` smoking cessation pulmonary rehabilitation O2 therapy anti-fibrotics (pirferidone, nitedanib) surgery - lung transplant (only cure) ```

Question 27

what is 5YS for idiopathic pulmonary fibrosis ?

Answer 27

50%

Question 28

state three industrial lung diseases?

Answer 28

Coal-workers Pneumoconiosis Silicosis Asbestosis

Question 29

what work environment is associated with asbestosis ?

Answer 29

Demolition and ship building

Question 30

what does asbestosis increase the risk of?

Answer 30

mesothelioma

Question 31

what are the signs and symptoms of mesothelioma

Answer 31

Chest pain, wt. loss, clubbing, recurrent effusions, dyspnoea.

Question 32

how is a diagnosis of mesothelioma made?

Answer 32

pleural biopsy

Question 33

what is the average survival of asbestosis?

Answer 33

<2yrs

Question 34

what work environment is associated with silicosis ?

Answer 34

Quarrying, sand-blasting

Question 35

what does the CXR for Coal-workers Pneumoconiosis look like?

Answer 35

CXR: upper zone fibrotic masses

Question 36

what does the CXR for silicosis look like?

Answer 36

Upper zone reticular shadowing and egg shell | calcification of hilar nodes → progressive massive fibrosis

Question 37

what are 5 histopathological features of idiopathic pulmonary fibrosis ?

Answer 37

basal and posterior fibrosis type 2 pneumocyte hyperplasia proliferating fibroblastic foci smooth muscle and vascular proliferation evidence of new and old injury

Question 38

what is the biopsy of idiopathic pulmonary fibrosis described as?

Answer 38

usual interstitial pneumonitis

Question 39

What is the management of the industrial dust lung diseases? (Coal-workers Pneumoconiosis, silicosis and asbestosis)

Answer 39

avoid exposure claim compensation from UK industrial injuries Act

Question 40

which industrial lung diseases can have the complication of progressive massive fibrosis ?

Answer 40

Coal-workers Pneumoconiosis silicosis

Question 41

what are the three types of asbestosis ?

Answer 41

white (Chrysotile) - least fibrogenic blue (Crocidolite) - most fibrogenic brown (Amosite) - least common

Question 42

what chemo can be used for malignant mesothelioma ?

Answer 42

pemetrexed and cisplatin