Interstitial Lung Disease Flashcards
1
Q
What is ILD?
A
- Umbrella term describing a number of conditions that affect lung parenchyma
2
Q
What are the examples of ILD?
A
- Usual Interstitial Pneumonia (UIP)
- Non-specific Interstitial Pneumonia (NSIP)
- Extrinsic Allergic Alveolitis
- Sarcoidosis
- Occupational (asbestosis, berylliosis, silicosis)
3
Q
What are the clinical features of ILD?
A
- Dyspnoea on exertion
- non productive paroxysmal cough
- abnormal breath sounds
- restrictive spirometry
- reduce DLCO
- ground glass appearance on high resolution CT
4
Q
What ix would you order for new diagnosis of ILD?
A
- ANA
- RhF
- ANCA
- Anti-GBM
- HIV
5
Q
What is the commonest type of ILD?
A
- Usual Interstitial Pneumonia
6
Q
What are the classical findings of UIP?
A
- General
- Clubbing, reduced chest expansion
- SOB, dry cough >3months, clubbing
- Auscultation
- bibasal fine inspiratory crackles
7
Q
What Ix would you order for UIP?
A
- Bloods
- ABG - T2RF
- CRP high
- Immunoglobulins high
- ANA, RhF
- Imaging
- CXR
- CT
- Spirometry - restrictive
- BAL - high neutrophils, high lymphocytes
- Lung biopsy - diagnose
8
Q
How would you Mx UIP?
A
- Supportive care
- O2
- Pulmonary rehabilitation
- Pirfenidone - antifibrotic and anti-inflammatory
- Nintedanib- monoclonal antibody targeting tyrosine kinase
9
Q
What is Hypersensitivity Pneumonitis known as?
A
- Extrinsic Allergic Alveolitis
10
Q
What is EAA?
A
- T3 Hypersensitivity reaction to environmental allergen > parenchymal desctruction
11
Q
What is the clinical presentation of EAA?
A
- Acute (4-8hrs form exposure)
- Reversible
- Spontaneously settle 1-3 days
- Fever, rigors, myalgia, dry cough, dyspnoea
- Fine basal crackles
- Chronic (months-years)
- Less reversible
- clubbing, dyspnoea, loss of weight
- T1RF
- Cor Pulmonale
12
Q
What Ix would you perform for acute EAA?
A
- Acute
- Bloods
- FBC - neutrophilia
- Hgh ESR
- ABG
- serum antibodies
- Lung function test
- reversible restrictive defect
- CXR
- Bloods
13
Q
What are the CXR features of acute EAA?
A
- Majority normal
- numerous poorly define opacities
- ground glass opacities
- fine reticulation
14
Q
What Ix would you order for chronic EAA?
A
- Bloods
- serum antibodies
- CXR
- upper-zone fibrosis
- honeycomb lung (coarse reticular opacities)
- cardiomegaly
- CT
- nodules
- ground glass appearance
- extensive fibrosis
- Lung function test
- restrictive defect
- Bronchoalveolar lavage
- high lymphocytes, high mast cells
15
Q
List examples of specific causes of EAA
A
- Bird-fanciers lung is a reaction to bird droppings
- Farmers lung is a reaction to mouldy spores in hay
- Mushroom workers’ lung is a reaction to specific mushroom antigens
- Malt workers lung is a reaction to mould on barley
16
Q
How would you Mx EAA?
A
- Acute
- Remove allergen
- Give O2 (35-60%)
- PO prednisolone 40mg/24h
- Chronic
- Avoid allergen
- Long term steroid
- Chest physiotherapy
17
Q
What are examples of drug-induced pulmonary fibrosis?
A
- antibiotics - nitrofurantoin.
- methotrexate
- amiodarone
- cancer chemotherapy drugs.
- biological agents used to treat cancer or immune disorders
18
Q
A
19
Q
Describe the cell type and associated disease in a bronchioalveolar lavage
A
- Haemosiderin Laiden macrophage - Alveolar bleeding
- Giant cell - Giant cell interstitial pneumonia
- High CD4 - Sarcoidosis
- Eosinophils - Allergic Bronchopulmonary aspergillosis
- neutrophils - ILD
- Lymphocytosis - Hypersensitivity Pneumonitis
20
Q
What causes fibrosis on the upper lobes?
*CHARTS
A
- C- Coal worker’s pneumoconiosis
- H - Histiocytosis/ hypersensitivity pneumonitis
- A - Ankylosing spondylitis
- R - Radiation
- T - Tuberculosis
- S - Silicosis/sarcoidosis
