Interstitial Lung Disease Lecture Powerpoint

Question 1

1 presenting symptom of patient with interstitial lung disease

Answer 1

Dyspnea

Question 2

Interstitial lung disease definition and subgroups we focus on (6)

Answer 2

• Group of nonmalignant, noninfectious disease of the lower respiratory tract that is characterized by damage to alveolar walls and lung parenchyma by varying degrees of inflammation and fibrosis, lung tissue is damaged, alveolar walls become inflamed, and scarring or fibrosis begins in the interstitium causing the lungs to become stiff
• Idiopathic pulmonary fibrosis, pneumoconiosis, hypersensitivity pneumonitis, occupational lung disease, drug induced/iatrogenic interstitial lung disease, sarcoidosis

Question 3

Inhaled particulate matter is incredibly difficult to…

Answer 3

….remove from the lungs

Question 4

3 distinct patterns different that characterize types of ILD

What is a hallmark finding of all ILD?

Answer 4

• acute inflammatory changes
• fibrotic changes
• lung destruction

-Restrictive pattern on PFT

Question 5

MUC5B promotor gene

Answer 5

Associated gene that has potential to act as a predisposing factor to interstitial lung disease

Question 6

Risk factors for interstitial lung disease (5)

Answer 6

• mostly idiopathic
• allergies to drugs, fungi, helminths, etc
• toxin drugs such as AMIODARONE** or methotrexate (chemotherapeutic agent)*
• inorganic dusts such as asbestos or siderosis (iron exposure)
• systemic diseases such as IBS or cancer

Question 7

Most common cause of interstitial lung disease and what population does it typically affect

Answer 7

Idiopathic pulmonary fibrosis often associated with older male patients

Question 8

Interstitial lung disease clinical presentation (4)

Answer 8

• dyspnea*** most common
• dry irritating cough
• SOB on exertion
• lack of wheezing and sputum production till much later in dz state!!!

Question 9

Interstitial lung disease diagnostic studies (5)

Answer 9

• CBC with diff (detecting eosinophilia, hemolytic anemia, normocytic anemia)
• ESR/Sed rate (useful to see progress of disease state, indicates inflammation)
• ANA positive (autoimmune disease states)
• CXR with prominant interstitial markings
• PFT’s ALL lung volumes are reduced (normal FEV1/FVC ratio)

Question 10

Hilar and mediastinal lymphadenopathy on a chest x ray is often associated with…

Answer 10

…sarcoidosis, silicosis, and some lymphomas

Question 11

Ground glass findings, honeycombing, what is the confirmatory diagnostic study for these?

Answer 11

• CXR findings that appear as diffuse stringy lung infiltrate that is fortunately reversible
• CXR irreversible fibrotic tissue findings on the x ray that appear as more thick shaped lung infiltrate that indicate a poor prognosis
• High resolution CT

Question 12

Bronchoalveolar lavage and normal/abnormal findings

Answer 12

Taking a lavage during bronchoscopy of the bronchi using saline rinse

• Normal findings >90% alveolar macrophages (low neutrophils so no bacterial infection and low eosinophils so no foreign body/parasite)
• Abnormal findings include increased lymphocyte percentage or other leukocytes (indicates sarcoidosis if increased T helper, hypersensitivity pneumonitis if decreased T helper, all ILD if increased neutrophils, some drug induced can cause eosinophils)

Question 13

Transbronchial biopsy

Answer 13

Using a flexible bronchoscope, is minimally invasive and done in outpatient procedure, but has very small tissue sampling and sometimes too small to make pathologic diagnosis but can be confirmatory for sarcoidosis

Question 14

Thorascopic biopsy (VATS)

Answer 14

More invasive using small incisions in the thorax where the scope is inserted, provides larger tissue pieces than transbronchial biopsy as well as shorter hospital stay and less post op discomfort despite requiring general anesthesia and being difficult to obtain deep samples

Question 15

Open lung biopsy

Answer 15

Provides definitive diagnosis of interstitial lung disease but is most invasive requiring general anesthesia and long recovery time

Question 16

Idiopathic pulmonary fibrosis distinct characteristic (and what does it mean about prognosis?) and treatment (3)

Answer 16

• diffusing capacity (DLCO) is generally reduced (this means BAD prognosis)
• Short course prednisone (6-12 weeks), pulmonary rehab, supplemental O2

Question 17

Sarcoidosis distinct characteristics (3) and treatment (1)

Answer 17

• Mostly affects north american blacks, presents with iritis and uveitis, presents with hilar or mediastinal lymph node enlargement
• many improve spontaneously without, abnormal cxr is not indication for treatment, 1st line treatment is corticosteroids

Question 18

Sarcoidosis staging (0-III)

Answer 18

0 - normal
I - hilar adenopathy only
II - hilar adenopathy and parenchymal involvement
III - parenchymal involvement alone

Question 19

Hypersensitivity pneumonitis (pneumoconiosis)

Answer 19

-occupational interstitial lung disease due to inhaled organic dusts and chemicals, leads to type III hypersensitivity, acute phase starts 4-6 hrs after exposure with chills, fever, sweating, malaise, and chronic sees pulmonary fibrosis and right sided heart failure

Question 20

Hypersensitivity pneumonitis (pneumoconiosis) treatment (2)

Answer 20

• corticosteroids

- inhalers

Question 21

___ is the most toxic particulate often found in sand blasters and foundry workers

Answer 21

Silicosis

Question 22

There are more than ___ causes of Interstitial lung disease

Answer 22

200