Week 8 - ILD Flashcards

1
Q

What is interstitial lung disease?

A

-A group of diseases which affect the interstitium of the lung and diffuses into surrounding structures including the alveoli and bronchioles

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2
Q

What cells are involved in ILD?

A

-Epithelial, endothelial, mesenchymal, macrophages, recruited inflammatory cells

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3
Q

Why in ILD is there decreased pO2 but increased pCO2?

A
  • Initially due to solely effects on ventilation as alveoli are full of inflammatory exudate
  • Eventually because diffusion of gases is affected due to thickening of interstitium and also due to decreased perfusion due to destruction of capillaries
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4
Q

What is a characteristic sign of ILD on a CT?

A

-Honeycombing

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5
Q

How will the onset of symptoms be in ILD?

A

-Gradual decline

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6
Q

What are the two commonly presenting symptoms with ILD?

A

-Shortness of breath and cough

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7
Q

What respiratory symptoms are not present on presentation of ILD?

A
  • Haemoptysis
  • Wheeze
  • Chest tightness
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8
Q

What respiratory signs might be present in ILD?

A
  • Clubbing
  • Cyanosis
  • Tachycardia
  • Dyspnoea
  • Signs of RHF
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9
Q

What are the 5 categories which cause interstitial lung disease?

A
  • Occupational
  • Treatment related
  • Connective tissue disease
  • Immunological
  • Idiopathic
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10
Q

Name some occupational ILD?

A
  • Asbestosis

- Coal worker’s pneumoconiosis

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11
Q

Give some examples of treatments which predispose to ILD?

A
  • Methotrexate (rheumatoid arthritis)
  • Radiation
  • Chemotherapy
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12
Q

Name 2 connective tissue diseases which cause ILD?

A
  • Systemic Lupus Erythema

- Rheumatoid arthritis

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13
Q

Name an immunological cause of ILD

A

-Sarcoidosis

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14
Q

What type of pattern is shown in spirometry in ILD?

A

-Restrictive

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15
Q

What is the most common ILD?

A

-Idiopathic pulmonary fibrosis

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16
Q

At what age do patients with idiopathic pulmonary fibrosis usually present?

A

-60-80s

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17
Q

What is the median survival age for idiopathic pulmonary fibrosis?

A

-3 years

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18
Q

How is ILD usually diagnosed?

A

-CT

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19
Q

How does asbestos cause ILD?

A
  • Inhaled fibres of asbestos penetrate the lung and activate an inflammatory response forming asbestos plaques.
  • This inflammation results in diffuse pleural thickening which is chronic in nature
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20
Q

What malignancy risk is increased with asbestosis?

A

-Mesothelioma

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21
Q

What is sarcoidosis?

A

-Autoimmune condition of idiopathic nature characterised by non-caseating granuloma formation all over the body, especially in lumgs, lymphnode and liver

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22
Q

Give two differential diagnosis for sarcoidosis

A
  • Lymphoma

- TB

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23
Q

What type of cough is present in ILD?

A

-dry

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24
Q

What is pleuritic chest pain?

A

-Sharp, knife like pain, worse with inspiration

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25
Q

Describe pleural fluid turnover

A

-15ml produced per day by capillary filtration of parietal pleura and absorption by lympatic drainage via mediastinaal and diagphragmatic regions

26
Q

What can cause decreased absorption of pleural fluid?

A
  • Lymphoma causing lymphatic blockage

- Elevated systemic venous pressures

27
Q

What can cause an increased production of pleural fluid?

A
  • Increase in hydrostatic pressure of pulmonary capillaries
  • Increased capillary permeability ie shock
  • Decreased oncotic pressure in capillaries ie low albumin
  • Peritoneal fluid seek through diaphragm
28
Q

What is a pleural effusion?

A

-Increase in the pleural fluid in the pleural cavity

29
Q

What types of pleural fluid can collect in the pleural space? Give examples of their causes

A
  • Transudate eg HF, cirrhosis
  • Exudate eg infection
  • haemothorax eg trauma
  • Empyema eg TB
  • chylothorax (chylomicrons) eg lymphatic interruption
30
Q

Where is the most common primary tumour in metastatic pleural malignancy?

A

-Breast or lung

31
Q

Describe the innervation to the pleura

A
  • Parietal = somatic + symp/parasymp from phrenic (C3, C4, C5) and intercostals
  • Viscreal = no somatic
32
Q

What is a primary pneumothorax?

A

-A spontaneously developed pneumothorax in an otherwise healthy individual

33
Q

What is a secondary pneumothorax?

A

-Pneumothorax which occurs when there is underlying lung pathology

34
Q

What type of medical procedure is associated with iatrogenic pneumothoraces?

A

-Central lines

35
Q

What are the symptoms of a pneumothorax?

A
  • Pleuritic chest pain

- Dyspnoea

36
Q

What is a non-modifiable risk factor in pneumthoraces?

A

-Men

37
Q

Name the most important modifiable risk factor in pneumothoraces

A

-Smoking

38
Q

What is the chance of a primary pneumothorax recurring within 4 years?

A

-54%

39
Q

What is defined as a small pneumothorax? How is this treated?

A
  • Less than 2cm

- Observation if there is not significant SOB, Discharge id no SOB with early outpatient review

40
Q

What is defined as a large pneumothorax?

A

->2cm

41
Q

Which patients should have treatment regardless of size of a pneumothorax?

A

-Those who are short of breath

42
Q

What is first line treatment for all primary pneumothoraces needing intervention? When is it used in secondary pneumothoraces?

A
  • Simple aspiration

- Initial treatment in secondary whom are minimally SoB

43
Q

What procedure is performed is simple aspiration fails to resolve a pneumothorax?

A

-Insert a chest drain

44
Q

What is the first line of treatment in a secondary pneumothorax?

A

-Chest drain

45
Q

Besides simple aspiration and chest drains, what other procedures can be performed to resolve a pneumothorax?

A
  • Open thorocotomy and pleurectomy
  • Surgical talc
  • Thoracoscopy
46
Q

What is a tension pneumothorax? How is the diagnosis made?

A
  • Air drawn into the pleural space has no way to escape during expiration -> mediastinum pushed over to opposite hemithorax and kinking/compression of great veins occurs -> will lead to cardiovascular arrest
  • Clinical diagnosis made of index of suspicion not radiological diagnosis as it is an acute medical emergency
47
Q

What are the signs of a tension pneumothorax?

A
  • Respiratory distress
  • Tachycardia
  • Hypotension
  • Distended neck veins
  • tracheal deviation
48
Q

Name some congenital chest wall diseases which can effect ventilation

A
  • Scoliosis/kyphosis
  • Pectus deformities
  • Muscular dystrophy
49
Q

Name some acquired chest wall diseases which can effect ventilation

A
  • Trauma
  • Iatrogenic
  • Ankylosing Spondylitis
  • MND
50
Q

What is ankylosing spondylitis?

A

-Chronic inflammatory disease of spine and sacroileal joints of unknown cause

51
Q

What problems can arise with chest wall disease?

A

-Ventilation, clearing of secretions and atelectasis

52
Q

What is atelectasis?

A

-collapsed lung

53
Q

What is the interstitium?

A

-Collection of supporting tissues within the lung

54
Q

What are the functions of the pleura?

A
  • Reduce friction

- Allows synchronous movement of lung and chestwall

55
Q

Why is there reduced compliance of the lung in acute farmer’s lung?

A

-Massive inflammation causes increased vascular permeability, hypoxaemia and decreased lung compliance

56
Q

How do you treat an episode of farmer’s lung?

A

-Corticosteroids

57
Q

What is pleurisy?

A

-Inflammation of the pleura

58
Q

When does pleural fibrosis occur?

A

-Unabsorbed pleural effusion

59
Q

What causes the lungs to be smaller than normal in ILD?

A

-Fibrosis decreases expansion due to decreased compliance and increased elastic recoil

60
Q

What causes micro-nodular shadowing on a CXR?

A

-Inflammatory exudate

61
Q

Why does inflammation of alveoli reduce lung compliance?

A
  • Alveoli walls are thickened and infiltrated with lymphocytes ad other immune cells. Exudate fills the alveoli and can fill lumen of bronchiole
  • Compliance is reduced
62
Q

Why is CT better than CXR in ILD?

A

-CT can detect changes earlier than CXR