Interstitial Lung Disease

Question 1

type I vs Type II pneumocyte

Answer 1

Type I Pneumocyte – flattened region of gaseous
transport/diffusion, vulnerable to injury

• Type II Pneumocyte – polygonal site of surfactant
synthesis. Can proliferate and re-form alveolar epithelial
surface

Question 2

functions of interstitial lung disease

Answer 2

• Supporting lung
• Fluid balance
• Repair and remodeling
• Gas exchange across epithelial/endothelial layers

Question 3

4 common clnical presentation of parenchymal/intersitital lung disease

Answer 3

1. cough
2. dyspnea
3. abnormal imaging
4. hypoxemia

Question 4

Question 5

examples of acute. subacute, or chronic ILD

Answer 5

acute: acute interstitial pneumonia, acute hypersensitivity pneumonitis
subacute: drug-induced ILD, connective tissue disease ILD, sarcoidosis

Chronic: idiopathic pulmonary fibrosis, chronic hypersensitivity pneumonitis

Question 6

Associated medical condiitins of ILD

Answer 6

1. connective tissue dusease/rheumatoid/Autoimmune
2. asthma, COPD,
3. smoking
4. cancer history– nodules
5. GERD

Question 7

name a few drugs that can contribute to ILD

Answer 7

• macrobid (think UTIs)
• methotrexate
• radiation (cancer)– symptoms of acute radiation pneumonitiis develops 4-12 weeks following radiation, can be late and develop 6-12 months

Question 9

physical exam findings of ILD

Answer 9

ILD prevents oxygenation because the connective tissues/nodules prevent effective gas exchange. may even reduce volumes if bad enough.

thus, evidence of hypoexmia would be noted

low SPO2, cyanosis, cold, easily exertionable, dyspnea, wheezing, tired, clubbing, VELCROW LIKE CRACKLES AND INSPIRATORY SQUEAKS, PULMONARY HYPERTENSION

Question 10

cor pulmonale indicates___ sided heart filaure

Answer 10

right sided heart failure. You might hear velcrow like cracles

 Can have co-morbidities such as CAD, lung cancer,
emphysema, pulmonary HTN, OSA, GERD,
depression, anxiety

Question 11

what pulmonary function testing findings would indicate interstial lung disease?

Answer 11

• FVC/FEV1 ratio is kind of normal, it’s not low. so it’s not obstructive.

low fvc and low fev 1 and low DLCO (the transfusion/perfusion is low therefore there might be thickening)

Question 12

why is ILD considered restriction over obstructive

Answer 12

the FEV1/FEV ratio will be indiviaully low but together wiill be normal. it’s restrictvie because small lunfs from scarrign making them shrink.

Question 13

wy does ILD present with low DLCO

Answer 13

• diffusion limitation across fibrotic/thicker interstitium
• spO2 normal at rest, plummets with exertion.

Question 14

CBC finding that could point towards chronic hypoxemia

Answer 14

polycythemia vera

Question 15

outline findings on this xray

Answer 15

nodules in lower base of lungs

• hard dto ditinguish vasculature and hilum areas

deviation in trachea

enlarged heart or just lots of clouding

Question 16

what findings are seen on these CT

Answer 16

trapped air and ground glass opacity

• calssic ILD

Question 17

classic finding on this CT

Answer 17

honey comb lung indicating end stage ILD