287 - Interstitial Lung Disease

Question 1

ILD is a group of diseases involving the ___ of the lung.

Answer 1

Parenchyma

Question 2

Typical presentation of ILD includes: (5)

Answer 2

1. Dyspnea
2. Dry stubborn cough
3. Hemoptysis
4. Wheezing
5. Chest pain

Question 3

In order to achieve diagnosis of ILD we need the combination of the following: ___ signs, ___ results, PFT (___), ___ (HRCT etc..), ___.

Answer 3

signs
results
pulmonary function tests
Imaging
Histopathology

Question 4

What are the 4 etiological groups of ILD?

Answer 4

1. Exposure (occupational/treatment related)
2. Systemic disease (connective tissue/granulomatous)
3. Idiopathic interstitial pneumonias (IPF/nonspecific)
4. Other

Question 5

IPF is more common when >___ years of age. Nevertheless, ___ and ___ are more common between the ages of ___

Answer 5

60
Sarcoidosis
CTD (Connective tissue disease)
20-40

Question 6

LAM (lymph-angio-leio-myo-matosis) is more common in young ___. Most CTD (___) are in female (beside ___- more common in male).

Answer 6

women
connective tissue disease
RA

Question 7

In ILD diseases, acute clinical presentation (days-weeks)- is more characteristic to ___, and __. Otherwise, ILD has an ___ presentation (months-years)

Answer 7

HP (hypersensitivity pneumonitis)
GPA (granulomatosis with polyangiitis)
Indolent

Question 8

The most common complaints in ILD are ___ and ___, but they do not always present.

Answer 8

Progressive exertional dyspnea

Dry cough

Question 9

Many drugs may cause ILD. mention 5:

Answer 9

1. MTX
2. Rituximab
3. Amiodarone
4. Bleomycin
5. Nitrofurantoin

Question 10

End inspiratory ____ or ___ noted at the ___ are found in most patients with IPF and may be one of the earliest signs of the disease.

Answer 10

Fine crackles
Rales
Lung bases

Question 11

Most ILD will lead to a restrictive disturbance with decreased ___, ___, ___, ___.

Answer 11

TLC (total lung capacity)
FEV1 (forced expiratory volume)
FVC (forced vital capacity)
DLCO (Diffusing capacity carbon monoxide)

Question 12

The common imaging test for suspected ILD is ___. It can help assessing the severity of the disease (___) and rule out comorbidities (___, ___). It also helps directing biopsy.

Answer 12

HRCT
Honeycombing
Emphysema
Malignancy

Question 13

Biopsy can diagnose ___ diseases.

Answer 13

Granulomatous

Question 14

Surgical biopsy with video guidance may __ the length of hospitalization. It is more beneficial when performed ___ the initiating ___

Answer 14

reduce
Before
Treatment

Question 15

IPF becomes more common with age, usually diagnose in the ___ decade of life, more in ___, usually with a history of smoking or occupational exposure. The prognosis is bad, ___ survival for ___ years

Answer 15

5-6
Men
50%
3-5

Question 16

The treatment for IPF includes anti fibrotic agents such as ___, ____ (slows down the disease), respiratory ___, ___ and ___ transplantation.

Answer 16

Nintedanib
Pirfenidone
physiotherapy
Oxygen
Lung

Question 17

What does NSIP stands for>

Answer 17

Non specific interstitial pneumonia

Question 18

NSIP is more common in non smoking ___ in the ___ decade of life. It has a good prognosis (>___ survival in 5 years), and even better in patients with cellular NSIP pattern.

Answer 18

Women
5th
80%

Question 19

When performing HRCT in NSIP (nonspecific interstitial pneumonia ) we may find diffused subpleural reticular opacities (____). Decreased ___ and traction bronchiectasis ___.

Answer 19

Ground glass
TLC
bronchiectasis

Question 20

Histopathology of NSIP includes ____ / uniform ____. The look of it is classified as ___ or __

Answer 20

Inflammation
fibrosis
Cellular
Fibrotic

Question 21

Treating NSIP is based on Immunosuppression with: (3)

Answer 21

Steroids
Cytotoxic drugs
rituximab

Question 22

What is the syndrome associated with acute IIP (Idiopathic interstitial pneumonia)?

Answer 22

Hamman-Rich syndrome

Question 23

IIP (idiopathic interstitial pneumonia) is rare but usually leads to ___. It present itself with respiratory __ and blood ___. Usually there is a ___ like prodrome.

Answer 23

death
distress
Hypoxia
UTRI

Question 24

HRCT of IIP will show: ___ and ___ in dependent areas. Treatment will be with ___ ventilation

Answer 24

Patchy ground glass
Consolidations
Mechanical

Question 25

In systemic sclerosis, ILD will present in __% of patients, sometimes with pulmonary ___.

Answer 25

50

HTN

Question 26

ILD due to rheumatoid arthritis is more common in ___ and after ___ exposure.

Answer 26

Men

Tabaco

Question 27

ILD due to dermatomyositis/polymyositis appear in up to ___ of patients with __ Ab.

Answer 27

45%

Anti synthetase

Question 28

The most common granulomatous ILD is ____.

Answer 28

Sarcoidosis

Question 29

GPA (Wegener’s disease)- we will see the involvement of the: lungs, ___, ___ ,___, ___.

Answer 29

Ears
Nose
Throat
Kidney

Question 30

Eosinophilic GPA (Churg-Strauss syndrome): the blood vessels infiltrations are ____. It is common to see chronic ____, ____. ___ is found in peripheral blood

Answer 30

Eosinophilic
Sinusitis
Asthma
Eosinophilia

Question 31

In ILD __, ___, ___ will be decreased

Answer 31

TLC
FEV
FVC

Question 32

Fibrotic bronchoscopy- the fluid can diagnose __ and cytology can suggest ___ or ___

Answer 32

DAH (Diffuse alveolar hemorrhage)
Eosinophilic pneumonia
Lipoid pneumonia

Question 33

Hemoptysis may suggest DAH (__), GPA (__) or LAM (__).

Answer 33

diffuse alveolar hemorrhage
Eosinophilic granulomatosis with polyangiitis (Churg Strauss)
lymphangioleiomyomatosis

Question 34

Fatigue is common in all ILD patients, while chest discomfort is common mostly in ___

Answer 34

sarcoidosis

Question 35

ILD causes ___ and ___, mainly between the ___ and the ___ layers.

Answer 35

inflammation
Fibrosis
Epithelial
Endothelial

Question 36

Treatment for systemic sclerosis will include __ and ___. In scleroderma patients- consider ___ / surgery to reduce reflux

Answer 36

Cyclophosphamide
Mycophenolate
PPI