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medicine > interstitial & occupational lung disease > Flashcards

interstitial & occupational lung disease Flashcards

1
Q

what is an interstitial disease?

A

any disease which affects the lung interstitium (i.e alveoli & terminal bronchi).

it interferes with gas transfer and produces a restrictive pattern on spirometry

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2
Q

what are the two main symptoms of interstitial disease?

A

(progressive) breathlessness and dry cough

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3
Q

how can interstitial disease be classified?

A

acute, episodic or chronic

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4
Q

how does chronic interstitial disease arise?

A

as part of systemic disease, due to exposure to a damaging agent and idiopathically

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5
Q

whats is sarcoidosis?

A

a multi-system granulamatous (type IV) hypersensitivity disease to an unknown antigen

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6
Q

what are the common organs involved in sarcoidosis?

A

lungs, lymph nodes, liver, skin, joints and eyes

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7
Q

sarcoidosis is less common in smokers. true/false

A

true

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8
Q

what are the characteristics of acute sarcoidosis?

A

erythema nodosum, bilateral hilar lymphadenopathy, arthritis, uveiti, parotidis, fever

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9
Q

what are the characteristics of chronic sarcoidosis?

A

lung infiltrates (alveolitis), skin infiltrates, peripheral lymphadenopathy, hypercalcaemia, splenomegaly

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10
Q

what investigations would we do for suspected sarcoidosis? what would we expect to see?

A

CXR (BHL), CT scan (peripheral nodular infiltrate), biopsy (non-caseating granulomas) , spirometry (restrictive defect), bloods (raised ACE, raised calcium, inc. inflam markers)

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11
Q

how would we treat acute and chronic sarcoidosis?

A

acute - usually self limiting

chronic - oral steroids (if vital organ affected) and immunosuppression (azathioprine, methotrexate & anti-TNF)

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12
Q

do we monitor people who have/have had sarcoidosis?

A

YES

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13
Q

what is extrinsic allergic alveolitis (EAA)?

A

a type III hypersensitivity reaction to an allergen causing lymphocytic alveolitis (hypersensitivity pneumonitis)

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14
Q

what causes EAA?

A

allergens such thermophilic actionmycetes, avian antigens and certain drugs

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15
Q

what is the acute presentation of EAA?

A

symptoms occur hours after exposure, cough, breathlessness, fever, myalgia, crackles with NO wheeze, hypoxia, widespread pulmonary infiltrates on CXR

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16
Q

how do we treat acute EAA?

A

oxygen, steroids & avoidance

17
Q

what is the presentation of chronic EAA?

A

progressive breathlessness, cough, crackles, upper zone fibrosis on CXR, restrictive spirometry, reduced TLCO, precipitins on serology

(NO CLUBBING!)

18
Q

how do we treat chronic EAA?

A

oral steroids (+breathless/low TLCO) and avoidance/removal of antigen

19
Q

what is idiopathic pulmonary fibrosis (IPF)?

A

fibrosis of the lung interstitium due to an imbalance in fibrotic repair system of unknown causes

20
Q

what is the most common interstitial lung disease?

A

IPF

21
Q

is IPF an inflammatory disease?

A

NO

22
Q

IPF is less common in smokers. T/F

A

False

23
Q

what are some causes of pulmonary fibrosis?

A

rheumatoid arthritis, SLE, sclerosis, asbestos, drugs (amiodarone, methotrexate, etc)

24
Q

how does IPF present?

A

progressive breathlessness, dry cough, clubbing, bilateral fine inspiratory crackles, restrictive spirometry, reduced TLCO, bilateral infiltrates on CXR, reticulonodular (honeycombing) fibrotic change worst at lung bases

25
Q

what does ground-glass on a CT scan suggest?

A

reversible alveolitis

26
Q

what is the pathology of IPF?

A

chronic inflammatory infiltrate with neutrophils and fibrosis in alveolar walls with/without intra-alveolar macrophages

27
Q

how to we treat IPF?

A

nothing really works. oxygen if hypoxic, lung transplant in young patients.

28
Q

what is pneumoconiosis?

A

a disease of the lungs due to the inhalation of dust characterised by inflammation, coughing and fibrosis

29
Q

what is simple pneumoconiosis?

A

chest x-ray abnormalities only

30
Q

what is complicated pneumoconiosis?

A

impairment of lung function associated breathlessness and restrictive spirometry due to progressive mass fibrosis

31
Q

what is Caplan’s syndrome?

A

rheumatoid pneumoconiosis

32
Q

what is silicosis?

A

simple (egg shell calcification of hilum) or restrictive defect due to prolonged exposure to quartz (mining, foundry worker, etc)

33
Q

what can exposure to high dose asbestos cause?

A

plerual plaques, acute pleuritis, pleural effusion/thickening, mesothelioma, diffuse pulmonary fibrosis (asbestosis) & bronchial carcinoma

34
Q

in asbestosis we find asbestos fibres in the sputum and asbestos bodies in the lung. T/F

A

False - asbestos bodies in the sputum and asbestos fibres in the lung

35
Q

how does pleuritis present?

A

pain, fever, blood pleural effusion

36
Q

how does mesothelioma present?

A

chest pain & pleural effusion

medicine (7 decks)

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