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Interstitial and Occupational Lung Disease Flashcards

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1
Q

What does interstitial disease interfere with and what is the lung pattern?

A

Interferes with gas transfer

Restrictive lung pattern

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2
Q

Give two symptoms of interstitial disease?

A

Breathlessness and dry cough

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3
Q

What class of interstitial lung disease is part of systemic disease, exposure to agent or idiopathic?

A

Chronic interstitial lung disease

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4
Q

Name two granulomatous interstitial lung diseases?

A

Sarcoidosis

Extrinsic allergic alveolitis

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5
Q

Name a granulomatous type 4 hypersensitivity disease of unknwon cause?

A

Sarcoidosis

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6
Q

What are the 6 common system involvements in sarcoidosis?

A
  1. Lungs
  2. Lymph nodes
  3. Joints
  4. Liver
  5. Skin
  6. Eyes
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7
Q

What type of granuloma does sarcoidosis have?

A

Non-caseating

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8
Q

What patients is sarcoidosis less common in?

A

Smokers

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9
Q

What are the two types of sarcoidosis?

A

Acute

Chronic

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10
Q

Give 5 clinical features of acute sarcoidosis?

A 
Erythema nodosum
Bilateral hilar lymphadenopathy
Arthritis
Uveitis, parotitis
Fever
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11
Q

Give 5 clinical features of chronic sarcoidosis?

A 
Lung infiltrates (alveolitis)
Skin infiltrations
Peripheral lymphadenopathy
Hypercalcaemia
Other organs: renal, myocardial, neurologicalm hepatitis, splenomegaly
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12
Q

Give four differential diagnosises of sarcoidosis?

A

TB (tuberculin test -ve)
Lymphoma
Carcinoma
Fungal infection

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13
Q

On a CXR of sarcoidosis what will you see?

A

Bilateral hilar lymphadenopathy

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14
Q

On a CT scan of lungs with sarcoidosis, what might you see?

A

Peripheral nodular infiltrate

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15
Q

What would you look for in a tissue biopsy of sarcoidosis?

A

Non-caseating granuloma

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16
Q

In pulmonary function of sarcoidosis, what causes the restrictive defect?

A

Lung infiltrates

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17
Q

With a blood test for sarcoidosis, what 3 things would suggest diagnosis?

A
  1. Angiotensin Converting Enzyme (ACE) levels as activity marker
  2. Raised calcium
  3. Increased inflammatroy markers
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18
Q

What is the treatment for acute sarcoidosis?

A

Self-limiting condition = no treatment, steroids if vital organ affected

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19
Q

What is the treatment for chronic sarcoidosis?

A

Oral steroids

Immunosuppression (e.g. azathioprine, methotrexate, anti-TNF therapy)

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20
Q

What clinical feature of the eyes can suggest sarcoidosis?

A

Iritis

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21
Q

What is another term for extrinsic allergic alveolitis?

A

Hypersensitivity pneumonitis

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22
Q

What type of reaction is extrinsic allergic alveolitis?

A

Type III hypersensitivity (immune complex deposition) reaction to antigen

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23
Q

Give three causes of extrinsic allergic alveolitis?

A
  1. Thermophilic actinomycetes (farmers lung, malt workers, mushroom workers)
  2. Avian antigens (bird fanciers lung)
  3. Drugs (gold, bleomycin, sulphasalazine)
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24
Q

What does this description describe: cough, breathless, fever, myalgia, symptoms occur several hours after acute exposure, signs (+/- pyrexia, crackles, no wheeze, hypoxia) and on CXR widespread pulmonary infiltrates?

A

Acute extrinsic allergic alveolitis

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25
What is the treatment for acute extrinsic allergic alveolitis?
Oxygen Steroid Antigen avoidance
26
What causes chronic extrinsic allergic alveolitis?
Repeated low dose antigen exposure over time (years)
27
What condition does this describe: Progressive breathlessness and cough, signs (may be crackles, clubbing is unusual), CXR = pulmonary fibrosis - most commonly in the upper zones?
Chronic extrinsic allergic alveolitis
28
What will the pulmonary function tests be like in chronic extrinsic allergic alveolitis?
``` Restrictive defect (Low FEV1 & FVC, high or normal ratio, low gas transfer - TLCO) ```
29
What three factors do you use to diagnose chronic extrinsic allergic alveolitis?
History of exposure | Precipitins (IgG antibodies to guily antigen, lung biopsy if in doubt)
30
What treatment is there for chronic extrinsic allergic alveolitis?
Remove antigen exposure, oral steroids if breathless or low gas transfer
31
What is formerly known as cryptogenic fibrosing alveolitis?
Idiopathic pulmonary fibrosis
32
Is idiopathic pulmonary fibrosis an inflammatory disease?
No N.B More common in smokers
33
What are rheumatoid, SLE, systemic sclerosis, asbestos, (drugs - amiodarone, busulphan, bleomycin, penicillamine, nitrofurantoin, methotrexate all secondary causes of?
Pulmonary fibrosis
34
What would you find on clinical presentation of idiopathic pulmonary fibrosis?
Progressive breathlessness (several years) and dry cough
35
What would you find on examination of idiopathic pulmonary fibrosis?
Clubbing | Bilateral fine inspiratory crackles
36
What would you find on investigation of idiopathic pulmonary fibrosis, including PFTs?
Restrictive defect on PFTs - reduced FEV1 and FVC with normal or raised FEV1/FVC ratio, reduced lung volumes and low gas transfer
37
What would you see on CXR of idiopathic pulmonary fibrosis?
Bilateral infiltrates
38
What might you see on a CT scan in idiopathic pulmonary fibrosis?
Reticulonodular fibrotic change, worse at the lung bases. The presence of "ground-glass" suggests reversible alveolitis; fibrosis is irreversible.
39
Give 4 differential diagnosis of idiopathic pulmonary fibrosis?
1. Mitral valve disease 2. Left ventricular failure 3. Sarcoidosis 4. Extrinsic allergic alveolitis
40
Describe the pathology of idiopathic pulmonary fibrosis?
Chronic inflammatory infiltrate (neutrophils and fibrosis in alveolar walls +/- intra-alveolar macrophages)
41
What is coal workers pneumoconiosis?
Simple pneumoconiosis
42
What is there an abnormality with in coal workers pneumoconiosis?
CXR (no impairment of lung function - often associated with chronic obstructive pulmonary disease)
43
What does complicarted pneumoconiosis lead to?
Progressive massive fibrosis = restrictive pattern with breathlessness
44
What is Caplan's syndrome?
Rheumatoid pneumoconiosis (pulmonary nodules)
45
What causes silicosis?
15-20 years exposure to quartz (e.g. mining, foundry workers, glass workers, boiler workers)
46
What disease has egg-shell calcification of hilar nodes?
Silicosis
47
What lung pattern is present in chronic silicosis?
Restrictive pattern
48
What do mining, construction, shipbuilding, boilers and piping and automotive components like brake linings all have in common?
Asbestos exposure
49
Name 4 features of pleural disease caused by asbestos?
1. Benign pleural plaques - asymptomatic 2. Acute asbestos pleuritis - fever, pain, bloody pleural effusion 3. Pleural effusion and diffuse pleural thickening - restrictive impairment 4. Maligannt mesothelioma - incurable pleural cancer.
50
How does malignant mesothelioma present?
With chest pain and pleural effusion
51
What does heavy, prolonged exposure of asbestos cause?
Asbestosis - pulmonary fibrosis
52
Where can you find asbestos in a patient with asbestosis?
Asbestos bodies in sputum | Asbestos fibres in lung biopsy
53
What is interstitial disease?
Any disease process affecting lung interstitium (i.e. alveoli, terminal bronchi)
54
What is a thin elastin-rich connetive componenet containing capillary blood vessels?
Pulmonary interstitium
55
What cells are present in pulmonary interstitium?
Alveolar lining cells
56
What are the two stages in interstitial lung disease?
1. Early stage is alveolitis (injury with inflammatory cell infiltration) 2. Late stage characterised by fibrosis
57
What are the two biopsies in interstitial lung disease?
Transbronchial biopsy - special forceps used at bronchoscopy | Thoracoscopic biopsy - more invasive but more reliable and generates far more tissue
58
Name 5 chronic intersitial diseases?
1. Fibrosing alveolitis 2. Sarcoidosis 3. Extrinsic allergic alveolitis (hypersensitivity pneumonitis) 4. Pneumoconiosis 5. Connective tissue disease
59
What involves progressive interstitial fibrosis or unknown cause, variable associated inflammation and finger clubbing?
Fibrosing alveolitis
60
What are three pathalogical features of fibrosing alveolitis?
Subpleural and basal fibrosis Inflammatory component variable Terminally lung structure replaced by dilated spaces surrounded by fibrous walls
61
What condition does late honeycombing on histology appear in?
Fibrosing alveolitis
62
Extrinsic allergic alveolitis can either be a chronic inflammatory disease or allergic origin - what are the three features of chronic inflammatory disease?
Small airways Interstitium Occasional granulomas
63
What does thermophilic bacteria cause?
Farmer's lung
64
What do avian proteins cause?
Bird fanciers lung
65
What does fungi cause?
Malt workers lung
66
What is uveitis (occurs with sarcoidosis)?
Inflammation of iris
67
Name 3 pulmonary involvements in connective tissue diseases?
1. Interstitial fibrosis (milder than fibrosing alveolitis) 2. Pleural effusions 3. Rheumatoid nodules
68
What is pneumoconiosis? Give examples?
Lung disease caused by mineral dust exposure. Examples include asbestosis, coal workers lung and silicosis
69
What is asbestos?
A silicate
70
What asbestos fibres are safe and which ones are dangerous?
Serpentine (curved) asbestos fibres are safe | Straight (amphibole) asbestos highly dangerous
71
What four things can asbestos cause?
1. Parietal pleural plaques 2. Interstitial fibrosis (asbestosis) 3. Bronchial carcinoma 4. Mesothelioma

Resp JL (27 decks)

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