Interstitial Lung Disease, The Pleura And Chest Wall

Question 1

What is the interstitium of the lungs?

Answer 1

Space in between alveoli and bloodstream

Needed to function

Question 2

What is the role of the lung interstitium?

Answer 2

Release cytokines
Conduit for things to leave circulation and vice versa
Collagen formation

Question 3

Interstitial diseases can affect many different parts of anatomy/physiology, name a few

Answer 3

Acini
Bronchioles 
Mesenchyme 
Alveoli lumen 
Epithelia 
Macrophages 
Bronchiolar lumen 
Inflammatory cells 
Ventilation
Diffusion 
Perfusion

Question 4

Interstitial lung disease is what type of defect

Answer 4

Restrictive

Question 5

What would the FEV1/FVC ratio for ILDs look like

Answer 5

FEV1 reduced
FVC reduced
Therefore ratio about normal

Question 6

What is a common CXR finding for ILD?

Answer 6

Haziness

Looks like lace over the lungs

Question 7

What do we call the rounded cystic areas in ILD?

Answer 7

Honeycombing

Question 8

What are the 2 main symptoms of any ILD?

Answer 8

Chronic shortness of breath

Chronic cough

Question 9

Give some signs on examination that would chest ILD

Answer 9

Clubbing 
Cyanosis 
Tachycardia 
Tachypnoea 
Signs of RH failure 
Decreased chest movement 
Coarse crackles

Question 10

What are the classifications of ILDs?

Answer 10

Occupational 
Treatment related 
Connective tissue disease
Immunological 
Idiopathic

Question 11

What is the largest group of ILDs?

Answer 11

Idiopathic

Question 12

Name some causes of occupational ILD

Answer 12

Asbestos
Silicone
Coal dust (coal workers pneumoconiosis)

Question 13

Name some treatments that can cause ILD

Answer 13

Radiation 
Methotrexate 
Nitrofurantoin (given for UTI) 
Amiodarone 
Chemotherapy

Question 14

Name some connective tissue diseases that can lead to ILD

Answer 14

Rheumatoid arthritis 
SLE (lupus)
Polymyositis 
Scleroderma 
Sjogren's

Question 15

Name some immunological problems that can cause ILD

Answer 15

Sarcoidosis (granulomas)

Hypersensitivity pneumonitis

Question 16

Describe idiopathic pulmonary fibrosis (IPF)

Answer 16

Commonest ILD
60-80 years 
Median survival = 3 years 
Often diagnosed via CT 
There are new therapies to treat: antifibrotics and vegF inhibitors

Question 17

Define asbestosis

Answer 17

Interstitial lung disease caused by asbestos

Question 18

Other than asbestosis, what other problems can asbestos exposure lead to?

Answer 18

Asbestos plaques
Diffuse pleural thickening 
Benign asbestos pleural effusions
Mesothelioma 
Bronchogenic lung cancer
Rounded atelectasis

Question 19

Describe sarcoidosis

Answer 19

Often asymptomatic 
Sometimes a cough and rash 
Lung function tests can be normal or abnormal 
Non-caseating granulomas 
Differential: lymphoma and TB

Question 20

What is the treatment for sarcoidosis?

Answer 20

Sometimes no treatment
Steroids
Methotrexate

Question 21

Which pleura has somatic innervation?

Answer 21

Only the parietal

Question 22

Describe pleuritic pain

Answer 22

Sharp
Severe
Worse with inspiration

Question 23

What is the rate of pleural fluid turnover?

Answer 23

15 ml/day

Question 24

How can liver cirrhosis affect the pleura?

Answer 24

Lack of production of albumin
Decreased oncotic pressure
Increased production of pleural fluid

Question 25

What changes would cause increased production of pleural fluid?

Answer 25

Increased hydrostatic pressure capillaries Increased permeability Decreased oncotic pressure capillaries

Question 26

What would cause decreased absorption of the pleural fluid?

Answer 26

Lymphatic blockage | Elevated systemic venous pressure

Question 27

To be called an exudate, pleural protein divided by serum protein must be ...

Answer 27

> 0.5 | And LDH > 0.6

Question 28

What might we analyse pleura fluid for?

Answer 28

``` Appearance Cell count Protein PDH pH Glucose Cytology ```

Question 29

What is pleural empyema?

Answer 29

Pockets of fluid | Not evenly affecting the lung

Question 30

What are the most common cancers to send mets to the lungs?

Answer 30

Breast Renal Colon

Question 31

What are the different types of pneumothorax?

Answer 31

Primary - in otherwise healthy people Secondary - underlying lung disease Iatrogenic - eg. Central lines

Question 32

What are the main symptoms of pneumothorax?

Answer 32

Pleuritic chest pain | Dyspnoea

Question 33

How is a pneumothorax treated?

Answer 33

Look at CXR Observation High flow oxygen Possibly a chest pain needed

Question 34

What are the signs of a tension pneumothorax?

Answer 34

CVS compromise - tachycardia, hypotension Decreased chest expansion Hyperresonance and absent breath sounds on side of pneumothorax Shift of mediastinum to opposite side Hypoxaemia

Question 35

Name some congenital chest wall abnormalities

Answer 35

Pectus deformities Scoliosis Kyphosis Muscular dystrophy

Question 36

Name some acquired causes of chest wall disease

Answer 36

Trauma Iatrogenic Ankylosing spondylitis Motor neurone disease

Question 37

Name some consequences of a chest wall disease

Answer 37

``` Ventilation failure Poor clearance of secretions Pneumonia Sleep disordered breathing Atelectasis ```