Interstitial Lung Disease & occupational lung diseases Flashcards
Which parts of the lung do ILDs effect?
the alveoil and terminal bronchi
How would ILDs appear on lung function tests?
reduced FVC
reduced FEV1
ratio normal
What is the most common type of ILD?
Idiopathic interstitial pneumonia (IIP)
What is the most common type of IIP?
Idiopathic pulmonary fibrosis (IPF)
what type of ILD is sarcoidosis?
Granulomatous interstitial lung disease
Sarcoidosis comes under which type of hypersensitivity disease?
Type 4
what is the cause of sarcoidosis?
there is no known cause
What group of people is sarcoidosis more prevalent in?
Afro-Caribbean’s
non-smokers
What organs are commonly effected by sarcoidosis?
Lungs lymph nodes joints liver skin eyes
what organs are less commonly effected by sarcoidosis?
kidneys
brain
heart
nerves
what would the histopathology of sarcoidosis be?
non-caeseating granulomas
Bilateral hilar lymphadenopathy, erythema nodosum, arthritis, fever and uveitis are characteristics of what ILD?
acute sarcoidosis
lung infiltrates. skin infiltrations, peripheral lymphadenopathy and hypercalcaemia are characteristics of what ILD?
chronic sarcoidosis
what would be in your differential diagnosis for sarcoidosis?
TB
lymphoma
carcinoma
fungal infection
what investigations would you carry out for suspected sarcoidosis?
CXR CT Tissue biopsy pulmonary function test blood test (for ACE levels, calcium levels and inflammatory markers)
how would you treat acute sarcoidosis?
it’s usually self-limiting
oral steroids if it effects any vital organs
how would you treat chronic sarcoidosis?
oral steroids
immunosuppression: azathioprine, methotrexate, anti TNF therapy
what is another name for extrinsic allergic alveolitis?
hypersensitivity pneumonitis
what type of hypersensitivity does extrinsic allergic aveolitis come under?
type 3 (immune complex deposition) - lymphocytic alveolitis
what antigens can predispose you to extrinsic allergic alveolitis?
Thermophilic actinomycetes (farmers lung, malt workers etc.) Avian antigens (bird fanciers lung) Drugs (gold, bleomycin, suphasalazine)
what is the classical presentation of acute extrinsic allergic alveolitis?
what would their signs on examination be?
Flu-like symptoms (cough, SOB, fever, myalgia) a few hours after antigen exposure
pyrexia, crackles (NO WHEEZE), hypoxia
what would you see on a CXR of someone with acute extrinsic allergic alveolitis?
widespread pulmonary infiltrates
how would you treat extrinsic allergic alveolitis?
O2 if hypoxic
steroid
antigen avoidance
how would chronic extrinsic allergic alveolitis present?
clinical examination findings?
progressive cough and breathlessness over years
crackles, sometimes clubbing (unusual though)
what would you see on a CXR of someone with chronic extrinsic allergic alveolitis?
pulmonary fibrosis, particularly in the upper zones
how would you diagnose extrinsic allergic alveolitis?
detailed history of exposure
percipitins (IgG antibody testing)
if in doubt- lung biopsy
Idiopathic pulmonary fibrosis is an inflammatory disease. true or false?
false
what are some drugs that may be a secondary cause of IPF?
aminodarone busulphan bleomycin penicillamine nitrofurantoin methotrexate
how does idiopathic pulmonary fibrosis present?
progressive SOB over years
dry cough
bilateral fine inspiratory crackles and digital clubbing are signs of which ILD?
idiopathic pulmonary fibrosis
what investigations would you carry out for IPF?
lung function test
CXR
CT
transbronchial/ thorascopic lung biopsy (if CT undiagnostic)
what would you see on a CT scan of someone with idiopathic pulmonary fibrosis?
reticulonodular fibrotic shadowing (at bases and peripherals)
traction bronchiectasis
honey-combing
what would be differentials of IPF?
occupational disease connective tissue diseases LV failure sarcoidosis extrinsic allergic alveolitis
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?
Idiopathic pulmonary fibrosis
treatment for IPF includes steroids and immunosuppressants. true or false?
true.
however, these drugs will not change the course of the disease.
Pirfenidone and Nintedanib are examples of which class of drug?
antifibrotic drugs
when would a lung transplant be considered in IPF?
if the patient is young enough and has minimal comorbidities
What is the difference between simple and complicated coal worker’s pneumoconiosis?
simple only has an abnormality in CXR (lung functions are normal)
complicated has massive progressive fibrosis, restrictive lung function and SOB
inhaling coal dust if you’re a smoker increases your risk of developing what?
chronic bronchitis
what is Caplan’s syndrome?
rheumatoid pneumoconitis (in pulmonary nodules)
what are risk factors for silicosis?
long term exposure to quartz: mining foundry workers glass workers boiler workers
egg-shell calcification of hilar lymph nodes of CXR indicates which condition?
simple silicosis
what would you expect to find in lung function tests and CXR in chronic silicosis?
restrictive lung function
pulmonary fibrosis
what are the 4 main pleural diseases related to asbestos exposure (in progressively worse order)?
benign pleural plaques
acute asbestos pleurits
pleural effusion & diffuse pleural thickening
malignant mesothelioma
fever, pain, bloody pleural effusion indicates with asbestos related disease?
acute asbestos pleurtis
chest pain, pleural effusion, dyspnoea and weight loss indicates which asbestos related disease?
malignant mesothelioma
how would pulmonary fibrosis “asbestosis” present?
diffuse pulmonary fibrosis
restrictive lung function
asbestos in sputum and in lung on biopsy
smokers with asbestos exposure increase their risk of what?
bronchial carcinomas
