Interstitial Lung Disease

Question 1

Presentation of interstitial lung disease?

Answer 1

Dry cough, SOBOE, myalgia, fine inspiratory crackles.

CXR - shows diffuse infiltrates.
Spirometry shows a restrictive pattern - FEV1/FVC = >0.7%\
ABG - Type 1 resp failure (hypoxia only)

Question 2

Management of interstitial lung disease?

Answer 2

Conseravative, pulmonary rehab, oxygen, steroids if exacerbation.

Question 3

CT scan sign for idiopathic pulmonary fibrosis?

Answer 3

Honey combing

Question 4

What type of worker is predisposed to silicosis?

Answer 4

Stonemason and pottery

Question 5

What type of worker is predisposed to abestosis?

Answer 5

Ship building and power station workers.

Question 6

Who is predisposed to Berylliosis?

Answer 6

Aerospace industry

Question 7

Who is predisposed to byssinosis?

Answer 7

Cotton workers

Question 8

Who gets a hypersensitive pneumonitis?

Answer 8

Farmers, bird fancier’s lung

Question 9

X ray findings in pulmonary fibrosis?

Answer 9

Ground glass appearance.

Asbestosis usually affects the Lower zone.

Question 10

Management of idiopathic pulmonary fibrosis?

Answer 10

Not much can be done, 50% die within 5 years.

General: smoking cessation, pulmonary rehab, oxygen.

Anti-fibrotic agents: Perfenidone

Question 11

What is sarcoidosis?

Answer 11

A multi-system, chronic granulomatous disorder of unknown origin

Question 12

What type of granulomas in sarcoidosis?

Answer 12

Non- caseating

Question 13

Presentation of sarcoidosis?

Answer 13

Usually affects adults 20-40.
More common in Afro-Caribbean’s and women.

• Dry cough, SOB, reduced Exercise tolerance.
  Lymphadenopathy, polyarthritis, erythema nodosum

Hypercalcamia

Bell’s palsy, neuropathy

Question 14

Investigations for sarcoidosis?

Answer 14

Bloods: Raised ESR, raised ACE, Raised WCC, Raised Calcium

Increased urinary excretion of calcium.

DCLO: Normal or reduced.

Spirometry: Restrictive pattern

Question 15

Management of sarcoidosis

Answer 15

Not all patients require active treatment, indications for treatment are:

• Interstitial lung disease
• Hypercalcaemia
• Cardiac/neurological/uveitis involvement

Mainstay of treatment is oral/inhaled steroids +/- immunosuppression

Question 16

Pathophysiology of extrinsic allergic alveolitis? (Hypersensitivity pneumonitis)

Causes?

Answer 16

A type 3 hypersensitivity reaction. Associated with deposition of IgG and immune complexes.

Spores from hay: Farmers lung
Protein in bird poo: Pigeon fancier’s lung
Aspergillosis from malt: malt workers lung.

Question 17

Management of extrinsic allergic alvelitis?

Answer 17

Acute: remove allergen, oxygen, tapered dose of oral steroids

Chronic: Allergen avoidance, long term steroids.

Symptoms typically occur 4-6 hours after exposure.

Question 18

CXR in extrinsic allergic alveolitis?

Answer 18

Upper lobe fibrosis and honey combing

Question 19

Caplan syndrome is the association between what 3 things:

Answer 19

1) Rheumatoid
2) Pulmonary rheumatoid nodules
3) Coal miner’s pneumoconiosis

Question 20

X ray signs in silicosis?

Answer 20

Upper lobe fibrosis and egg shell calcification at the hilar nodes.

Question 21

Upper zone fibrosis would suggest what diseases?

Answer 21

Extrinsic allergic 
ANk spon 
XRT induced 
Saroid
TB

Question 22

Lower zone fibrosis suggests what 2 diseases?

Answer 22

Idiopathic pulmonary fibrosis

Asbestosis