Pulmonary Fibrosis

Question 1

What is interstitial lung disease

Answer 1

A group of diseases affecting lung parenchyma, which eventually lead to pulmonary fibrosis (scarring throughout the lung fields)

Question 2

What are some causes of apical fibrosis

Answer 2

TRASH

TB
Radiation  - upper lobe lung cancer
Ankylosing spondylitis
Sarcoidosis
Hypersensitivity pneumonitis

“Infective causes such as TB. Iatrogenic causes such as radiation due to upper lobe lung cancer. Inflammatory causes such as ankylosing spondylitis, sarcoidosis and hypersensitivity pneumonitis”

Question 3

What are some causes of basal fibrosis

Answer 3

CUAD

Connective tissue disease eg. RA
Usual interstitial pneumonia - ie. idiopathic pulmonary fibrosis
Asbestosis
Drugs eg. amiodarone

Question 4

What is the main diagnostic test in pulmonary fibrosis

Answer 4

High resolution CT - bilateral peripheral sub-pleural reticular changes with honeycombing

Question 5

What kind of pattern would be seen on pulmonary function tests in a patient with pulmonary fibrosis

Answer 5

Restrictive

Question 6

What medications could you give to a patient with pulmonary fibrosis

Answer 6

Antifibrotic therapy - pirfenidone - if FVC 50-80%

High dose corticosteroids for acute exacerbation

Question 7

How would a patient with pulmonary fibrosis present

Answer 7

Breathlessness

Dry cough

Question 8

Does pulmonary fibrosis cause clubbing

Answer 8

Yes - 60-70%

Question 9

What would you expect to find on examination of a patient with pulmonary fibrosis

Answer 9

Clubbing
Reduced chest expansion bilaterally
Fine end inspiratory crackles

Question 10

What would you expect to find on CXR of patient with idiopathic pulmonary fibrosis

Answer 10

Reticulonodular infiltrates

Question 11

What disease is commonly found in patients with idiopathic pulmonary fibrosis

Answer 11

GORD

Question 12

What is hypersensitivity pneumonitis

Answer 12

A form of interstitial lung disease. It is due to a hypersensitivity response in an individual sensitised to an inhaled antigen

Chronic hypersensitivity pneumonitis leads to pulmonary fibrosis

Question 13

What are some examples of hypersensitivity pneumonitis

Answer 13

Farmer’s lung

Bird fancier’s lung

Question 14

How does acute hypersensitivity pneumonitis present

Answer 14

Breathlessness
Dry cough
Malaise
Fever and flu-like illness

Occures around 4-6 hrs after exposure to antigen

Question 15

How does chronic hypersensitivity pneumonitis present

Answer 15

Chronic symptoms with no specific acute episode
Increasing breathless, worse on exertion
Weight loss

*Due to continuing exposure to causative agent