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Respiratory YR3 > Case 5 - Interstitial Lung disease > Flashcards

Case 5 - Interstitial Lung disease Flashcards

1
Q

What are the 4 main types of interstitial lung disease?

A
  • Usual intersitial pnuemonia (UIP)
  • Non-specific intersitial pneumonia (NSIP)
  • Extrinsic allergic alveolitis
  • Sarcoidosis
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2
Q

What is important to ask about in the history for ILD?

A
  • Occupation and environmental history - did they have exposure to asbestos (asbestosis), dust (silicosis) or coal (pneumoconiosis)
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3
Q

Pattern seen on pulmonary function tests for ILD

A

Restrictive

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4
Q

What investigations should be done for any new ILD diagnosis?

A

See if have any of the conditions associated with development of ILD including:
* ANA - CT disease OR SLE
* ENA - CT
* Rh F - RA
* ANCA - vasculitis
* Anti GBM - pulmonary renal disease
* ACE - sarcoidosis
* IgG to serum precipitins eg pigeon, budgie - can check for extrinsic allergic alveolitis
* HIV

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5
Q

Most common type of ILD

A

Usual interstitial pneumonia (UIP) - was known as idiopathic pulmonary fibrosis previously

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6
Q

Classical examination findings for UIP

A
  • Clubbing
  • Reduced chest expansion
  • Fine inspiratory crepitations (like velcro - usually best heard basal/axillary areas)
  • Pulmonary HTN features?
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7
Q

Cause of extrisnic allergic alveolitis

A
  • AKA hypersensitivity pneumonitis
  • Inhalation of organic antigen to which the individual has been sensitised
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8
Q

Presentation of EAA

A
  • ACUTE - short period from exposure, 4-8hrs, usually reversible, spontaneously settle in 1-3 days, can recurr
  • Or CHRONIC - chronic exposure (months-years), less reversible
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9
Q

Common drugs that can cause allergic alveolitis

A
  • Amiodarone
  • Bleomycin
  • Methotrexate
  • Nitrofurantoin
  • Penicillamine
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10
Q

What is sarcoidosis?

A
  • Multisystem inflammatory condition of unknown cause
  • Commonly involves resp system but can affect nearly all organs
  • Immunological response
  • 50% –> spontaneous remission, others –> progressive
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11
Q

Histology of sarcoidosis

A
  • Non-caseating granuloma
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12
Q

Simple investigations for sarcoidosis

A
  • Pulmonary function tests
  • CXR - can stage 1-4
  • Urinary calcium
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13
Q

Bloods for sarcoidosis

A
  • Renal function
  • ACE
  • Calcium
  • LFTs
  • ECG
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14
Q

Cardiac tests for sarcoidosis

A
  • ECG
  • 24hr ECG
  • ECHO
  • Cardiac MRI
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15
Q

Sarcoidosis neurological investigation

A
  • MRI head (NOT CT) if headaches present
  • Could be neurosarcoid
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16
Q

ILD treatment principles

A
  • Depends on underlying cause/pathology
  • Occupational/enviromental exposure - remove
  • Avoid drug if caused by this
  • Stop smoking
  • MDT approach
  • Treat infective exacerbations
  • O2 if resp failure
  • Palliative care
  • Transplantation?
17
Q

Specialist medication for ILD

A
  • Pirfenidone - slows progression, anti-fibrotic assessed via MDT for this
18
Q

Symptoms of ILD

A
  • SOB
  • Non-productive cough
  • Fatigue
  • Mild pain in chest
  • Decreased appetite
19
Q

Clinical signs of ILD

A
  • Clubbing
  • Widespread inspiratory crackles - velcro like
  • Decreased chest expansion
20
Q

CXR sign for ILD

A
  • Alveolar shadowing/reticulonodular pattern of consolidation
  • Unclear cardiac borders
21
Q

Spirometry results for restrictive pattern

A

FEV1/FVC - normal, >0.7
FEV1 - normal/decreased
FVC - decreased

22
Q

Cause of alveolar shadowing in CXR

A
  • Parenchyma disease
  • Cotton wool like appearance
23
Q

What is definitive test which confirms ILD?

A

High resolution CT - honeycombing

24
Q

Difference between UIP and NSIP?

A

Different patten on CT scan

25
Q

Other effects of sarcoidosis

A
  • Skin - erythema nodosum
  • Eyes - uveitis
  • Lungs - fibrosis
26
Q

Why is UIP called pneumonia when its not an infection and it’s fibrosis?

A
  • On histology, cells look similar to when they do in pneumonia
27
Q

Main drugs that cause pulmonary fibrosis

A
  • Nitrofurantoin
  • Amiodarone
  • Bleomycin
  • Methotrexate
28
Q

ILD in upper and lower lobes example causes

A

Upper:

Hypersensitivity pneumonitis
Ankylosing spondylitis
Radiotherapy
TB

Lower:

Rheumatoid arthritis
Asbestosis
Idiopathic
Drugs
Sarcoid

29
Q
A

Respiratory YR3 (14 decks)

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