interstitial lung disease

Question 1

what is idiopathic pulmonary fibrosis

Answer 1

chronic lung condition characterised by progressive fibrosis of the interstitium of the lungs

Question 2

features of idiopathic pulmonary fibrosis

Answer 2

progressive exertional dyspnoea
bibasal fine end inspiratory crepitations
dry cough
clubbing

Question 3

investigations for idiopathic pulmonary fibrosis

Answer 3

spirometry: restrictive pattern
reduced transfer factor
imaging: bilateral interstitial shadowing (typically small, irregular opacities- ground glass)-
- high resolution CT investigation of choice
ANA positive in 30%

Question 4

management of idiopathic pulmonary fibrosis

Answer 4

pulmonary rehab
some evidence for pirfenidone
supplementary oxygen and lung transplant

Question 5

what is extrinsic allergic alveolitis

Answer 5

(hypersensitivity pneumonitis)
condition caused by hypersensitivity induced lung damage due to variety of inhaled organic particles
thought to be largely caused by immune complex mediated tissue damage (type III)

Question 6

examples of occupations that may cause extrinsic allergic alveolitis

Answer 6

bird fanciers lung: avian proteins from bird droppings
farmers lung
malt worker’s lung
mushroom workers lung

Question 7

acute presentation of extrinsic allergic alveolitis

Answer 7

4-8hours after exposure
dyspnoea
dry cough
fever

Question 8

chronic presentation of extrinsic allergic alveolitis

Answer 8

lethargy
dyspnoea
productive cough
anorexia and weight loss

Question 9

investigations for extrinsic allergic alveolitis

Answer 9

imaging: upper/mid zone fibrosis
bronchoalveolar lavage: lymphocytosis
serologic assays for specific IgG antibodies
blood: NO eosinophilia

Question 10

management of extrinsic allergic alveolitis

Answer 10

avoid allergen
oxygen
oral glucocorticoids