Interstitial lung disease - Clinical Approach

Question 1

What is the preferred test for ILD?

Answer 1

High resolution chest CT (HRCT)

(CXR for screening; if you suspect ILD, order it first)

Question 2

Which findings indicate ILD on HRCT?

Answer 2

reticular, nodular or mixed pattern

Question 3

What are the HRCT findings of ILD referred to as?

Answer 3

“Honeycomb Lung”

Question 4

Initial presentation of ILD (4)

Answer 4

1. progressive dyspnea w/exertion
2. non-productive cough
3. crackles
4. digit clubbing

(may be seen w/rheumatoid arthritis)

Question 5

Which disease might be seen with interstitial lung disease?

Answer 5

rheumatoid arthritis

Question 6

Sarcoidosis is an inflammatory _________ disease.

Answer 6

non-caseating granulomatous

Question 7

In sarcoidosis, which 3 organs are typically affected?

(other than lung, hilar lymph nodes and eyes)

Answer 7

1. skin
2. cranial nerves
3. salivary glands

Question 8

In sarcoidosis, which 2 metabolic markers are elevated?

Answer 8

1. calcium
2. ACE

Question 9

Sarcoidosis symptoms (5)

Answer 9

1. fever
2. weight loss
3. red, raised rash
4. red, watery eyes
5. arthritis

Question 10

Drug-induced ILD is commonly caused by which drugs (7)?

Answer 10

1. Amiodarone
2. Aspirin
3. Bleomycin (chemo Rx)
4. Methotrexate
5. Nitrofurantoin
6. Talc (mixed into IV street drugs)
7. Terbutaline

Question 11

Granulomatosis w/polyangiitis (wegener’s) symptoms

Answer 11

1. hemoptysis
2. joint pain
3. sinus inflammation

Question 12

Which laboratory finding is seen in Granulomatosis w/polyangiitis?

Answer 12

p-ANCA

(proteinase 3 Ab)

Question 13

Which medication is used to treat granulomatosis w/polyangiitis?

Answer 13

cyclophosphamide

Question 14

What tests would you order if sarcoidosis is expected (6)?

Answer 14

1. biopsy (any organ affected)
2. blood tests
3. CXR
4. pulmonary function
5. bronchoscopy
6. mediastinoscopy

Question 15

What radiographic finding is seen in sarcoidosis (or acutely: Lofgren’s), that is NOT seen in lymphomas?

TQ!!!! Do NOT confuse w/Loffler’s syndrome (parasitic diz)

Answer 15

1-2-3 sign: separation of the nodes (hilar adenopathy and heart)

Question 16

Which cells are elevated in drug-induced ILD?

Answer 16

eosinophils

Question 17

Which lung sound would you hear in drug-induced ILD?

Answer 17

crackles

(sometimes pleural rub)

Question 18

Answer 18

ILD

Question 19

Radiographic findings of Granulomattosis w/Polyangiitis (3)

Answer 19

1. nodules
2. alveolar opacification
3. pleural opacities

Question 20

Which ILD is reversible?

Answer 20

Drug-induced

Question 21

What is Lofgren’s syndrome?

Answer 21

acute sarcoidosis illness

Question 22

Lofgren’s syndrome symptoms (2)

not seen unless acute sarcoid illness

Answer 22

1. fever
2. arthralgia

(granulomatosis w/polyangiitis also has joint pain)