Interstitial Lung Disease

Question 1

Which part of the lungs is effected in interstitial lung disease?

Answer 1

Alveoli/terminal bronchi

Question 2

What are the clinical features of interstitial lung disease?

Answer 2

Restrictive lung pattern
SOB
Dry cough

Question 3

Which hypersensitivity type is extrinsic allergic alveolitis (EAA)?

Answer 3

type 3
(can be type 4 if granulomas form)

Question 4

What causes EAA?

Answer 4

Inhalation of allergens e.g. fungal spores, avian proteins

Question 5

Give some examples of EAA

Answer 5

Bird/pigeon fancier’s lung
Farmer’s lung
Mushroom worker’s lung
Malt worker’s lung (aspergillosis)

Question 6

Give some examples of drugs that can cause EAA

Answer 6

Gold
Bleomycin
Nitrofurantoin
Sulphasalazine
Methotrexate
Rituximab

Question 7

What are the acute features of EAA?

Answer 7

Fever
Rigors
Myalgia
Dry cough
SOB
Crackles (no wheeze)

Question 8

What is seen on CXR in chronic EAA?

Answer 8

Pulmonary fibrosis –> upper lobes
Honeycombing
Ground-glass appearance

Question 9

What is the treatment for EAA?

Answer 9

Remove antigen exposure

Oral steroids

Question 10

What is pneumoconiosis and give 3 examples?

Answer 10

Lung disease caused by inhalation of dust

• Coal worker’s pneumoconiosis
• Silicosis
• Asbestosis

Question 11

What causes silicosis?

Answer 11

Inhalation of silica dust (found in rocks such as quartz)

Question 12

What is the classic radiological feature in silicosis?

Answer 12

Eggshell calcification of hilarity lymph nodes

Question 13

What are the radiological features of asbestosis?

Answer 13

Fibrosis + pleural thickening

Question 14

What is Caplan’s syndrome?

Answer 14

Combination of seropositive rheumatoid arthritis and pneumoconiosis (fibrosis)

Question 15

What is the most common interstitial lung disease?

Answer 15

Idiopathic pulmonary fibrosis

Question 16

What is the pathophysiology of idiopathic pulmonary fibrosis?

Answer 16

Lungs lay down scar tissue even though there is no need for repair
Non-inflammatory (doesn’t respond to steroids)

Question 17

What is seen on CT scan in idiopathic pulmonary fibrosis?

Answer 17

Reticulonodular fibrotic changes

Worst at lung bases

Question 18

Which organs are most commonly affected in sarcoidosis?

Answer 18

Lungs
Skin
Eyes

Question 19

What type of hypersensitivity is sarcoidosis?

Answer 19

Type 4 –> granulomatous

Question 20

Who most commonly gets sarcoidosis?

Answer 20

Women aged 20-40
Afro-Caribbean
Non-smokers

Question 21

What are some features of acute sarcoidosis?

Answer 21

Erythema nodosum
Bilateral hilar lymphadenopathy
Arthritis
Uveitis
Parotitis
Fever
(less lung involvement than when chronic)

Question 22

What are some features of chronic sarcoidosis?

Answer 22

Lung infiltrates (alveolitis)
Skin infiltrates e.g. lupus pernio
Peripheral lymphadenopathy
Hypercalcaemia 
Chronic fatigue

Question 23

What is lupus pernio?

Answer 23

Skin plaques with discolouration of nose, cheeks, lips and ears

Question 24

What would be seen on a CXR in someone with sarcoidosis?

Answer 24

Bilateral hilar lymphadenopathy + pulmonary infiltrates

Question 25

Which two serological markers would be elevated in sarcoidosis?

Answer 25

Calcium

ACE (angiotensin converting enzyme)