Lung fibrosis

Question 1

what are causes of lung fibrosis occurring in the upper lobes?

Answer 1

Coal workers pneumocosis 
Hypersensitivity pulmonary fibrosis
Ankylosing spondylitis 
Radiation 
TB
Sarcoidosis

Question 2

what are causes of lung fibrosis occurring in the lower lobes?

Answer 2

asbestosis
idiopathic pulmonary fibrosis
connective tissue diseases e.g. SLE (except ankylosing spondylitis)
drugs: amiodarone, bleomycin, methotrexate

Question 3

what are the presentation of sarcoidosis?

Answer 3

acute (Leydig’s syndrome)

• bilateral hilar lymphadenopathy
• swinging fever
• pilyarthralgia
• erythema nodosum

insidious

• dyspnoea
• non-productive cough
• malaise
• weight loss

skin - lupus permit
hypercalcaemia
- bones, stones ,groans and psychic moans

Question 4

what investigations would you carry out if you suspected sarcoidosis?

Answer 4

U&E: hypercalcaemia 
ACE: elevated 
ESR: elevated 
tissue biopsy: non-caseating granulomas 
spirometry: restrictive pattern 
CXR: BHL, infiltrations, fibrosis

Question 5

what pattern of spirometry occurs with lung fibrosis?

Answer 5

restrictive pattern
FEV1/FVC > 70%
FEV1 and FVC both reduced

Question 6

how is sarcoidosis managed?

Answer 6

steroids if CXR stage 2 or 3 if symptomatic, hypercalcaemia or heart/eye/neuro involvement

Question 7

what is sarcoidosis?

Answer 7

multisystem disorder characterised by non-caveating granulomas with unknown aetiology

Question 8

why does sarcoidosis cause hypercalcaemia?

Answer 8

macrophages in granulomas cause increased conversion of vitamin D to active form (1,25 hydroxycholecalciferol)