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Respiratory > Lung Disease > Flashcards

Lung Disease Flashcards

1
Q

what is interstitial lung disease

A

any disease process affecting lung interstitium (tissue and space around air sacs i.e. alveoli, terminal bronchi)

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2
Q

what does ILD interfere with

A

gas transfer

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3
Q

what type of lung pattern does interstitial lung disease produce

A

restrictive

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4
Q

what are the symptoms of ILD

A

breathlessness dry cough

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5
Q

what are the three types of interstitial lung disease

A

acute, episodic, chronic

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6
Q

describe the three main factors of chronic lung disease

A

part of systemic disease, exposure to agent, idiopathic

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7
Q

describe sarcoidosis- immunologically, it causes and the systems it invloves

A

granulomatus; type 4 hypersensitivity, non caseating granulomas, multisystem involvement; lungs, lymph nodes, joints, liver, skin. idiopathic

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8
Q

what are the two types of sarcoidosis

A

acute, chronic; lung infiltrates- alveolitis

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9
Q

what are the differential diagnosis of sarcoidosis

A

TB, lymphoma, carcinoma, fungal infection

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10
Q

how is sarcoidosis diagnosed

A

CXR and CT scan- if not blood test

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11
Q

how is acute sarcoidosis treated

A

self limiting, steroids if vital organ affected

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12
Q

how is chronic sarcoidosis treated

A

with oral steroids- sarcoidosis very sensitive to steroids, immunosupression

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13
Q

what needs to happen after the treatment of sarcoidosis

A

monitor chest x-ray and pulmonary function for several year- often relapses

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14
Q

what are the symptoms of sarcoidosis

A

small patches of red and swollen skin, usually affects lungs and skin

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15
Q

what eye condition can be caused by sarcoidosis what how is it treated

A

uveitis, steroid drops

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16
Q

describe the histology of sarcoidosis

A

non-caseating, multinucleated giant cells

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17
Q

what is extrinsic allergic alveolitis a form of

A

hypersensitivity pneumonitis, type 3 hypersensitivity

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18
Q

what are the two forms of extrinsic allergic alveolitis

A

acute and chronic

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19
Q

what are the symptoms of acute E.A.A

A

cough, breathless, fever, myalgia

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20
Q

how is acute E.A.A treated

A

oxygen, steroid and antigen avoidance

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21
Q

describe chronic E.A.A

A

repeated low odse antigen exposure over time

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22
Q

what are the symptoms of chronic E.A.A

A

progressive breathlessness and cough, maybe crackles

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23
Q

what will an x ray show in chronic E.A.A

A

CXR show pulmonary fibrosis, commonly in upper lung

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24
Q

what will a PFT show in chronic E.A.A

A

restrictive defect ( low FEV1 and FVC, high/normal ratio, low gas transfer)

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25
Q

how is chronic E.A.A treated

A

remove antigen exposure, oral steroids

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26
Q

what might a CXR show in sarcoidosis

A

bilateral hilar lymphadenopathy or enlargement and lung infiltrates

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27
Q

what is the most common form of ILD

A

idiopathic pulmonary firbrosis

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28
Q

is idiopathic pulmonary fibrosis an inflammatory condition

A

no

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29
Q

what is thought to cause IPF

A

imbalance of fibrotic repair system, related to gastric reflux, more common in smokers

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30
Q

what are the secondary causes of IPF

A

rheomatoid, asbestos, drugs

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31
Q

what is the clinical presentation of IPF

A

progressive breathlessness over many years, dry cough, clubbing, bilateral inspiratory crackles,

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32
Q

how does IPF show on a PFT

A

restrictive defect, low gas transfer

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33
Q

how does IPF show on a CXR

A

bilateral infiltrates, interstitial scarring

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34
Q

how does IPF show on a CT scan

A

reticulonodular fibrotic shadowing, worse at bases and periphery. traction bronchiectasis, honey-combing cystic changes

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35
Q

how is IPF diagnosed

A

history (ask about occupation), examination and radiology tests

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36
Q

what needs to be done is presentation is atypical

A

lung biopsy

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37
Q

describe the pathology of IPF

A

interstitial pneumonia pattern, heterogeneous fibrosis in alveolar walls causing honey-combing

38
Q

how is IPF treated

A

anti firbrotic treatments slow progress do not reverse- pirfenidone and nintedanib

39
Q

when are steroids used to treat IPF

A

never, only work with inflammatory ILD

40
Q

what is coal workers pneumoconiosis

A

simple pneumoconiosis (restrictive lung disease cause by inhalation of dust)

41
Q

what is complicated pneumoconiosis

A

progressive massive firbosis

42
Q

what causes chronic bronchitis

A

coal dust + smoking

43
Q

what is chronic bronchitis

A

inflamed bronchial tubes with excessive mucous production

44
Q

what is caplans syndrome and what causes it

A

rheumatoid pneumoconiosis- when a patient with rheumatoid arthritis gets exposed to coal dust and gets cavitating nodules in lung

45
Q

what is rheumatism

A

inflammation and pain in the joint

46
Q

what does an CXR of simple coal workers pneumoconiosis

A

abnormality- miliary dots, shadows

47
Q

what symptoms does simple (coal workers) pneumoconiosis present

A

none- risk of developing complication later

48
Q

what causes silicosis

A

15-20 years exposure to quartz (mining, glass workers, boiler workers, foundry workers)

49
Q

what does a CXR of silicosis show

A

eggshell calcification of hilar nodes

50
Q

how is chronic silicosis characterised

A

restrictive pattern, pulmonary fibrosis

51
Q

what does a CXR of a simple pneumconiosis (silicosis) show

A

miliary nodular appearance

52
Q

describe progressive massive fibrosis

A

balls of fibrous tissue that grow and engulf the lungs

53
Q

what does exposure to barium cause

A

baritosis

54
Q

describe asbestosis

A

pulmonary fibrosis due to heavy, prolonged exposure to asbestos

55
Q

what are the 4 pleural diseases relating to asbestos

A

benign pleural plaques (asymptomatic)
acute asbestos pleuritis (fever, pain, bloody pleural effusion), pleural effusion and diffuse pleural thickening (restrictive impairment), malignant mesothelioma (incurable pleural cancer)

56
Q

what are the presenting symptoms of malignant mesothelioma

A

chest pain and pleural effusion

57
Q

what is pleural effusion

A

build up of fluid in pleural space

58
Q

what does asbestos multiply the risk of in smokers

A

bronchial carcinoma

59
Q

how do fibrous cause fibrosis

A

cause abnormal behaviour in macrophages and fibres laid down

60
Q

what is pulmonary interstitium

A

alveolar lining cells (type 1 and 2), thin elastic-rich connective component containing capillary blood vessels

61
Q

describe the effect of early stage alveolitis on the alveolar walls

A

injury with inflammatory cell infiltration

62
Q

what is acute ILD exemplified by

A

adult respiratory distress syndrome

63
Q

what is late stage interstitial lung disease characterised by

A

fibrosis

64
Q

what do patients with ILD present with

A

clinical effects due to hypoxia- respiratory failure and cardiac failure. Also seen on radiology

65
Q

what can cause interstitial lung disease

A

environment (minerals, drugs, radiation- HYPERSENSITIVITY), unknown- idiopathic (connective tissue diseases, idiopathic pulmonary fibrosis)

66
Q

what is idiopathic pulmonary fibrosis

A

progressive fibrotic disease

67
Q

what types of biopsy used to diagnose interstitial lung disease

A

transbronchial, thoracoscopic more invasive but more reliable

68
Q

what conditions are associated with chronic interstitial lung disease

A

idiopathic pulmonary fibrosis, sarcoidosis, extrinsic allergic alveolitis (hypersensitivity pneumonitis), pneumoconiosis, connective tissue diseases

69
Q

what symptoms are associated idiopathic pulmonary fibrosis

A

progressive interstitial fibrosis, variable associated inflammation, finger clubbing

70
Q

what is sub pleural

A

between the pleura and body wall

71
Q

describe the pathology of lungs during idiopathic pulmonary fibrosis

A

subpleural and basal fibrosis, terminal structure replaced by dilated spaces surrounded by fibrous walls, alveolar walls thickened

72
Q

how does idiopathic pulmonary fibrosis affect gas exchange

A

impaired due to thickened alveolar walls

73
Q

what is associated with late stage idiopathic pulmonary fibrosis

A

honeycombing

74
Q

what are parts of the airway involved with chronic inflammatory disease

A

small airways, interstitium

75
Q

describe inflammatory interstitial expansion and what it leads to

A

when tissue expanded by inflammatory tissue (not fibrosis). will eventually lead to fibrosis and scarring if inflammation persists

76
Q

what is EAA

A

extrinsic allergic alveolitis

77
Q

what causes inflammatory interstitial expansion

A

extrinsic allergic alveolitis

78
Q

what is sarcoidosis

A

multi system granulomatous disorder of unknown cause

79
Q

what immune response leads to granuloma formation

A

type 4 ( t cell mediated)

80
Q

what are the other manifestations of sarcoidosis

A

uveitis, erythema nodosum, lymphadenopathy, hypercalcaemia (abnormal calcium metabolism)

81
Q

what eventually happens to granulomas in interstitial lung disease

A

calcify

82
Q

what connective tissue diseases affect the lungs

A

intersitial fibrosis, pleural effusions, rheumatoid nodules (can form in the lungs)

83
Q

what is milder, idiopathic pleural fibrosis or interstitial fibrosis

A

interstitial

84
Q

what is a differential diagnosis for rheumatoid nodules

A

TB

85
Q

what is pneumoconiosis

A

group of occupational (restrictive) lung diseases caused by mineral dust exposure

86
Q

name three forms of pneumoconiosis

A

asbestosis, coal workers lung, silicosis

87
Q

what is the lungs reaction to inhalation of coal dust

A

fibrosis

88
Q

what are the pathological features of coal miner lung

A

pigmentation, fibrosis, scarring and nodular scarring

89
Q

what does pneumoconiosis dependant on

A

particle size, reactivity of particle, clearance of particle, host response

90
Q

which shape of asbestos are most dangerous

A

straight

91
Q

what results from the inhalation of asbestos

A

parietal pleural plaques, interstitial fibrosis (asbestosis), bronchial carcinoma, mesothelioma

Respiratory (26 decks)

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