Pulm- DPLD and ILD

Question 1

Best way to diagnose DPLD or ILDs?

Answer 1

High resolution CT is the diagnostic tool of choice–it gives the best resolution

Question 2

When should a diagnosis of DPLD and ILD be considered?

Answer 2

once infection, heart failure, and COPD has been ruled out

Question 3

When should one use biopsy to diagnose?

Answer 3

Video assisted thorascopic lung biopsy should be used for patients with disparate findings on history, physical exam, imaging, and lab studies

Question 4

What is the primary form of management for smoking-related diffuse parenchymal lung disease?

Answer 4

Smoking cessation!

Question 5

How does hypersensitivity pneumonitis happen?

Answer 5

It occurs as a result of an immunologic response to repetitive inhalation of antigens

Question 6

What are the most common antigens causing a hypersensitivity pneumonitis

Answer 6

thermophilic actinomycetes, fungi, bird droppings

Question 7

When does acute hypersensitivity pneumonitis occur? How does it present?

Answer 7

It occurs within 48 hours of a high level exposure and will often be associated with fevers, flulike symptoms, cough, shortness of breath. symptoms usually wane within 48 hours after removal of exposure

Question 8

What are the radiological findings of acute hypersensitivity pneumonitis?

Answer 8

bilateral hazy opacities, ground glass opacities, centrilobular micro nodules that are upper and mid lung predominant

Question 9

How does subacute or chronic forms of a hypersensitivity pneumonitis occur

Answer 9

chronic low-level exposures to inhaled antigens

Question 10

What is the treatment for hypersensitivity pneumonitis?

Answer 10

The treatment is to remove the offending agent, GCs are for those with more severe symptoms and for those with evidence of fibrosis

Question 11

What are the 5 most common drugs that can cause a lung toxicity?

Answer 11

Amiodarone, Methotrexate, Nitrofurantoin, Busulfan, Blemoycin

Question 12

How does radiation induced parenchymal lung disease present?

Answer 12

radiation pneumonitis usually occurs 6-12 weeks after exposure

GC can be use for moderate to severe disease, ,mild disease may not need them

Question 13

What is the epidemiological presentation of IPF?

Answer 13

Older than 60
Gradual onset of dyspnea over several years with cough
Inspiratory crackles at the bases
Severe disease shows right sided heart failure or evidence of secondary pulmonary hypertension

Question 14

What is the estimated survival for IPF?

Answer 14

3-5 years

Question 15

Should you intubate someone with worsening respiratory failure due to IPF?

Answer 15

No. Guidelines recommend against mechanical ventilation because it is terminal

Question 16

What is the only therapy for IPF

‘

Answer 16

Lung transplantation

Question 17

What is the general pathology of Cryptogenic Organizing Pneumonia?

Answer 17

patchy process that involves proliferation of granulation tissue within alveolar ducts, alveolar spaces, and surrounding areas of chronic inflammation

Question 18

What are common causes of COP?

Answer 18

Acute infections, autoimmune disorders like rheumatoid arthritis

Question 19

What is the presentation of COP usually

Answer 19

They usually present over 6-8 weeks and mimic community acquired pneumonia

Symptoms are usually <3 months duration

Peripheral nodules or masses

Question 20

How is diagnosis established?

Answer 20

Usually after a course of txt for infection doesn’t work, bronchoscope or surgical lung biopsy may be necessary

Question 21

What is the prognosis of COP?

Answer 21

It is favorable with a good response to GCs

Question 22

What is sarcoidosis?

Answer 22

It is a multi system granulomatous disease of unclear cause with a predilection for the lung. Pulmonary involvement occurs in >90% of patients

Question 23

How is sarcoidosis usually determined?

Answer 23

It is usually discovered incidentally on chest imaging.

Question 24

Describe the radiographic patterns of sarcoidosis and the relationship to prognosis

Answer 24

0-normal

I-hilar LAD, normal lung parenchyma; >90% will have spontaneous resolution w/o treatment

II-hilar LAD with abnormal lung parenchyma; approximately 20% rate of spontaneous improvement w/o treatment

III- No LAD, abnormal lung parenchyma, about 20% spontaneously resolve

IV-Parenchymal changes with fibrosis and architectural distortion

Question 25

What is the main therapy for sarcoidosis?

Answer 25

GCs! Treatment is usually limited to those with evidence of clinical symptoms from organ dysfunction. It is usually a long steroid taper

Bc there is a high rate of spontaneous resolution most protocols favor a period of observation without therapy

Initiate GCs if there is physiologic impairment based on disease

Question 26

What is lymphangioleiomyomatosis?

Answer 26

It is a rare disorder that causes cyst formation in the lungs, particularly in ppl with tuberous sclerosis