Interstitial Lung Disease & occupational lung diseases

Question 1

Which parts of the lung do ILDs effect?

Answer 1

the alveoil and terminal bronchi

Question 2

How would ILDs appear on lung function tests?

Answer 2

reduced FVC
reduced FEV1
ratio normal

Question 3

What is the most common type of ILD?

Answer 3

Idiopathic interstitial pneumonia (IIP)

Question 4

What is the most common type of IIP?

Answer 4

Idiopathic pulmonary fibrosis (IPF)

Question 5

what type of ILD is sarcoidosis?

Answer 5

Granulomatous interstitial lung disease

Question 6

Sarcoidosis comes under which type of hypersensitivity disease?

Answer 6

Type 4

Question 7

what is the cause of sarcoidosis?

Answer 7

there is no known cause

Question 8

What group of people is sarcoidosis more prevalent in?

Answer 8

Afro-Caribbean’s

non-smokers

Question 9

What organs are commonly effected by sarcoidosis?

Answer 9

Lungs
lymph nodes
joints
liver
skin
eyes

Question 10

what organs are less commonly effected by sarcoidosis?

Answer 10

kidneys
brain
heart
nerves

Question 11

what would the histopathology of sarcoidosis be?

Answer 11

non-caeseating granulomas

Question 12

Bilateral hilar lymphadenopathy, erythema nodosum, arthritis, fever and uveitis are characteristics of what ILD?

Answer 12

acute sarcoidosis

Question 13

lung infiltrates. skin infiltrations, peripheral lymphadenopathy and hypercalcaemia are characteristics of what ILD?

Answer 13

chronic sarcoidosis

Question 14

what would be in your differential diagnosis for sarcoidosis?

Answer 14

TB
lymphoma
carcinoma
fungal infection

Question 15

what investigations would you carry out for suspected sarcoidosis?

Answer 15

CXR
CT
Tissue biopsy
pulmonary function test
blood test (for ACE levels, calcium levels and inflammatory markers)

Question 16

how would you treat acute sarcoidosis?

Answer 16

it’s usually self-limiting

oral steroids if it effects any vital organs

Question 17

how would you treat chronic sarcoidosis?

Answer 17

oral steroids

immunosuppression: azathioprine, methotrexate, anti TNF therapy

Question 18

what is another name for extrinsic allergic alveolitis?

Answer 18

hypersensitivity pneumonitis

Question 19

what type of hypersensitivity does extrinsic allergic aveolitis come under?

Answer 19

type 3 (immune complex deposition)
- lymphocytic alveolitis

Question 20

what antigens can predispose you to extrinsic allergic alveolitis?

Answer 20

Thermophilic actinomycetes (farmers lung, malt workers etc.)
Avian antigens (bird fanciers lung)
Drugs (gold, bleomycin, suphasalazine)

Question 21

what is the classical presentation of acute extrinsic allergic alveolitis?
what would their signs on examination be?

Answer 21

Flu-like symptoms (cough, SOB, fever, myalgia) a few hours after antigen exposure
pyrexia, crackles (NO WHEEZE), hypoxia

Question 22

what would you see on a CXR of someone with acute extrinsic allergic alveolitis?

Answer 22

widespread pulmonary infiltrates

Question 23

how would you treat extrinsic allergic alveolitis?

Answer 23

O2 if hypoxic
steroid
antigen avoidance

Question 24

how would chronic extrinsic allergic alveolitis present?

clinical examination findings?

Answer 24

progressive cough and breathlessness over years

crackles, sometimes clubbing (unusual though)

Question 25

what would you see on a CXR of someone with chronic extrinsic allergic alveolitis?

Answer 25

pulmonary fibrosis, particularly in the upper zones

Question 26

how would you diagnose extrinsic allergic alveolitis?

Answer 26

detailed history of exposure percipitins (IgG antibody testing) if in doubt- lung biopsy

Question 27

Idiopathic pulmonary fibrosis is an inflammatory disease. true or false?

Answer 27

false

Question 28

what are some drugs that may be a secondary cause of IPF?

Answer 28

``` aminodarone busulphan bleomycin penicillamine nitrofurantoin methotrexate ```

Question 29

how does idiopathic pulmonary fibrosis present?

Answer 29

progressive SOB over years | dry cough

Question 30

bilateral fine inspiratory crackles and digital clubbing are signs of which ILD?

Answer 30

idiopathic pulmonary fibrosis

Question 31

what investigations would you carry out for IPF?

Answer 31

lung function test CXR CT transbronchial/ thorascopic lung biopsy (if CT undiagnostic)

Question 32

what would you see on a CT scan of someone with idiopathic pulmonary fibrosis?

Answer 32

reticulonodular fibrotic shadowing (at bases and peripherals) traction bronchiectasis honey-combing

Question 33

what would be differentials of IPF?

Answer 33

``` occupational disease connective tissue diseases LV failure sarcoidosis extrinsic allergic alveolitis ```

Question 34

A pathology report of: "usual interstitial pneumonia pattern, heterogenous fibrosis in alveolar walls with fibroblastic foci and destruction of archetecture (honey-combing). minimal inflammation" would indicate which ILD?

Answer 34

Idiopathic pulmonary fibrosis

Question 35

treatment for IPF includes steroids and immunosuppressants. true or false?

Answer 35

true. | however, these drugs will not change the course of the disease.

Question 36

Pirfenidone and Nintedanib are examples of which class of drug?

Answer 36

antifibrotic drugs

Question 37

when would a lung transplant be considered in IPF?

Answer 37

if the patient is young enough and has minimal comorbidities

Question 38

What is the difference between simple and complicated coal worker's pneumoconiosis?

Answer 38

simple only has an abnormality in CXR (lung functions are normal) complicated has massive progressive fibrosis, restrictive lung function and SOB

Question 39

inhaling coal dust if you're a smoker increases your risk of developing what?

Answer 39

chronic bronchitis

Question 40

what is Caplan's syndrome?

Answer 40

rheumatoid pneumoconitis (in pulmonary nodules)

Question 41

what are risk factors for silicosis?

Answer 41

``` long term exposure to quartz: mining foundry workers glass workers boiler workers ```

Question 42

egg-shell calcification of hilar lymph nodes of CXR indicates which condition?

Answer 42

simple silicosis

Question 43

what would you expect to find in lung function tests and CXR in chronic silicosis?

Answer 43

restrictive lung function | pulmonary fibrosis

Question 44

what are the 4 main pleural diseases related to asbestos exposure (in progressively worse order)?

Answer 44

benign pleural plaques acute asbestos pleurits pleural effusion & diffuse pleural thickening malignant mesothelioma

Question 45

fever, pain, bloody pleural effusion indicates with asbestos related disease?

Answer 45

acute asbestos pleurtis

Question 46

chest pain, pleural effusion, dyspnoea and weight loss indicates which asbestos related disease?

Answer 46

malignant mesothelioma

Question 47

how would pulmonary fibrosis "asbestosis" present?

Answer 47

diffuse pulmonary fibrosis restrictive lung function asbestos in sputum and in lung on biopsy

Question 48

smokers with asbestos exposure increase their risk of what?

Answer 48

bronchial carcinomas