Interstitial lung disease

Question 1

What causes fibrosis in the upper zones?

Answer 1

CHARTS 
Coal worker's pneumoconiosis 
Hypersensitivity pneumonitis 
Ankylosing spondylitis 
Radiation 
TB 
Sarcoidosis/silicosis

Question 2

What causes apical fibrosis?

Answer 2

Ank spond

Question 3

What causes lower zone fibrosis?

Answer 3

IRA SAD
Idiopathic pulmonary fibrosis
RA
Aspiration pneumonia 
Scleroderma 
Asbestosis 
Drugs

Question 4

What is sarcoidosis?

Answer 4

Multisystem granulomatous disorder of unknown cause

Characterised by non caseating granulomas

Question 5

Who is sarcoidosis seen in?

Answer 5

20-40yo
Women
Afro-Caribbean more

Question 6

What is the presentation of sarcoidosis?

Answer 6

Acute= fever, erythema nodosum, polyarthralgia, bilateral hilar lymphadenopathy 
Non productive cough, dyspnoea, wheeze 
Chronic fatigue, weight loss 
Arthralgia 
Lymphadenopathy 
Uveitis

Question 7

What investigations are done for sarcoidosis?

Answer 7

CXR 
Bloods- FB, U&Es, LFTs, Ca
Lung function tests 
Biopsy 
ECG

Question 8

What is seen on CXR with sarcoidosis?

Answer 8

Bilateral hilar lymphadenopathy
Pulmonary fibrosis- upper zone dominance
Displaced hilum

Question 9

What is the management of sarcoidosis?

Answer 9

Corticosteroids if symptomatic, eye, heart or near involvement, or hypercalcaemia

Question 10

What is usual interstitial pneumonitis?

Answer 10

Umbrella term for progressive fibrosis and chronic inflammation of interstitium

Question 11

What can cause usual interstitial pneumonitis?

Answer 11

Idiopathic 
Connective tissue disease- usually RA 
Drug induced pulmonary fibrosis 
Post infection 
Industrial exposure- asbestosis, silicosis

Question 12

What drugs can cause drug induced pulmonary fibrosis?

Answer 12

Amiodarone 
Methotrexate 
Sulfasalazine 
Cyclophosphamide 
Nitrofurantoin

Question 13

What is the presentation of asbestosis?

Answer 13

SOB, dry cough
Reduced exercise tolerance
Lower lobe fibrosis
Associated with mesothelioma

Question 14

What investigations are done for usual interstitial pneumonitis?

Answer 14

CXR

CT

Question 15

What is the appearance of UIP on CXR?

Answer 15

Honeycomb damage of peripheries and lower portions of lungs

Question 16

What is the management of UIP?

Answer 16

Oxygen therapy

Lung transplant

Question 17

What is the prognosis for UIP?

Answer 17

Very variable

Generally 3-5years

Question 18

What is idiopathic pulmonary fibrosis?

Answer 18

Excessive collagen deposition in pulmonary interstitium

Question 19

Who is idiopathic pulmonary fibrosis seen in?

Answer 19

60-70yo

Men > women

Question 20

What is the presentation of idiopathic pulmonary fibrosis?

Answer 20

Insidious onset SOB 
Dry cough 
Clubbing 
Bibasal inspiratory crackles 
Weight loss

Question 21

What investigations are done for idiopathic pulmonary fibrosis?

Answer 21

CT= imaging of choice
CXR
Spirometry
Biopsy

Question 22

What is the appearance of idiopathic pulmonary fibrosis on CXR?

Answer 22

Bilateral interstitial shadowing

Ground glass appearance –> honeycomb

Question 23

What is the management of idiopathic pulmonary fibrosis?

Answer 23

Antifibrotic
Lung transplant
Pulmonary rehab

Question 24

What is the prognosis for idiopathic pulmonary fibrosis?

Answer 24

Poor

Question 25

What is hypersensitivity pneumonitis?

Answer 25

Inflammation of alveoli caused by type III and IV hypersensitivity reactions

Question 26

What are some examples of hypersensitivity pneumonitis?

Answer 26

Bird fancier's lung | Farmer's lung

Question 27

What is the presentation of hypersensitivity pneumonitis?

Answer 27

``` Acute= 4-8 hours after exposure -SOB, dry cough, fever Chronic -SOB, cough, crackles, wheeze -low grade illness ```

Question 28

What investigations are dene for hypersensitivity pneumonitis?

Answer 28

FBC, CRP, ESR= no eosinophilia CXR= upper/mid zone fibrosis Bronchoalveolar lavage= raised lymphocytes and mast cells

Question 29

What is the management of hypersensitivity pneumonitis?

Answer 29

Avoid allergen | Corticosteroids

Question 30

What is the presentation of pulmonary eosinophilia?

Answer 30

Cough Weight loss Night sweats

Question 31

What investigations are done for pulmonary eosinophilia?

Answer 31

CXR FBC= high eosinophils Bronchoalveolar lavage= eosinophilia

Question 32

What is the management of pulmonary eosinophilia?

Answer 32

Steroids

Question 33

What is the presentation of allergic bronchopulmonary aspergillosis?

Answer 33

SOB, wheeze, cough Proximal bronchiectasis Previous diagnosis of asthma

Question 34

What investigations are done for allergic bronchopulmonary aspergillosis?

Answer 34

FBC, IgA= raised CXR Aspergillus= +

Question 35

What is the management of allergic bronchopulmonary aspergillosis?

Answer 35

Steroids

Question 36

What are the stages of sarcoidosis?

Answer 36

``` 1= bilat hilar lymphadenopathy 2= BHL + interstitial infiltrates 3= diffuse interstitial infiltrates 4= diffuse fibrosis ```