Interstitial Lung Disease

Question 1

Which pneumocytes produce Surfactant in the lungs?

Answer 1

Type 2 Pneumocytes

Question 2

State 4 Obstructive Respiratory Disorders

Answer 2

Asthma
Chronic Bronchitis
Emphysema
Bronchiectasis

Question 3

State 4 Restrictive Respiratory Disorders

Answer 3

Interstitial Lung Disease
- Idiopathic Pulmonary Fibrosis
- Sarcoidosis
- Pneumoconiosis
Chest Wall Neuromuscular Diseases

Question 4

What is Pulmonary Fibrosis?

Answer 4

Infiltration of alveoli and lung interstitium by mesenchymal cells and increased amounts of ECM and collagen

Question 5

Pulmonary Fibrosis can be associated with Connective tissue diseases. Give examples of 4

Answer 5

• Rheumatoid Arthritis
• Anonkylosing Spondylitis
• Systemic Sclerosis
• Dermatomyositis

Question 6

What is the diagnostic test of choice for Pulmonary Fibrosis?

Answer 6

CT scan

Question 7

How does the value of Transfer Factor change in patients with Pulmonary Fibrosis?

Answer 7

Reduced

Question 8

Give 6 examples of conditions which commonly cause Upper Zone Fibrosis of the Lung? CHARTS

Answer 8

C - Coal workers pneumoconiosis
H - Hypersensitivity pneumonitis / Histiocytosis
A - Ankylosing Spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis / Sarcoidosis

Question 9

Give example(s) of antibiotics which can cause Pulmonary Fibrosis

Answer 9

Nitrofuratoin

Question 10

Give example(s) of chemotherapy agents which can cause Pulmonary Fibrosis

Answer 10

Bleomycin, Mitomycin, Cyclophosphamide, MTX

Question 11

Give example(s) of anti-arrhythmic agents which can cause Pulmonary Fibrosis

Answer 11

Amiodarone

Question 12

Give example(s) of DMARDs which can cause Pulmonary Fibrosis

Answer 12

Gold, SSZ

Question 13

What may be visualised on CT in patients with Pulmonary Fibrosis?

Answer 13

Ground-glass appearance

Honeycombing

Question 14

What clinical features in the hands may be associated with Pulmonary Fibrosis?

Answer 14

Clubbing

Question 15

Hypersensitivity pneumonitis is a what type of Hypersensitivity reaction?

Answer 15

Type III (and Type IV) reaction

Question 16

State six examples of Hypersensitivity Pneumonitis diseases

Answer 16

Bird Fancier's Lung
Farmer's Lung
Mushroom Worker's Lung
Hot Tub Lung
Winemaker's Lung
Malt Worker's Lung

Question 17

Avian proteins are associated with which Hypersensitivity Pneumonitis?

Answer 17

Bird Fancier’s Lung

Question 18

Bird Fancier’s Lung is associated with which causative agent?

Answer 18

Avian proteins

Question 19

Mycobacterium avium are associated with which Hypersensitivity Pneumonitis?

Answer 19

Hot Tub Lung

Question 20

Saccharopolyspora Rectivirgula are associated with which Hypersensitivity Pneumonitis?

Answer 20

Farmer’s Lung

Question 21

Farmer’s Lung is associated with which causative agent?

Answer 21

Saccharopolyspora Rectivirgula

Question 22

Aspergillus Clavatus are associated with which Hypersensitivity Reaction?

Answer 22

Malt Worker’s Lung

Question 23

Malt Worker’s Lung is associated with which causative agent?

Answer 23

Aspergillus Clavatus

Question 24

Mushroom Worker’s Lung is associated with which causative agent?

Answer 24

Actinomycetes

Question 25

Actinomycetes is associated with which Hypersensitivity Reaction?

Answer 25

Mushroom Worker's Lung

Question 26

Winemaker's Lung is associated with which causative agent?

Answer 26

Botrytis Cinerea

Question 27

Botrytis Cinerea is associated with which Hypersensitivity Reaction?

Answer 27

Winemaker's Lung

Question 28

What is the main treatment for Hypersensitivity Pneumonitis?

Answer 28

High dose corticosteroids

Question 29

What is Sarcoidosis?

Answer 29

A multisystem disorder of unknown aetiology characterised by non-caeseating inflammatory granulomas

Question 30

What are the features on X-Ray in a patient with Sarcoidosis?

Answer 30

Bilateral hilar lymphadenopathy

Question 31

What are the three skin / joint features associated with a patient with Sarcoidosis?

Answer 31

Erythema nodosum - raised bumps under skin Lupus pernia - purple rash on nose Polyarthalgia - painful joints

Question 32

What enzyme and electrolyte disturbance is associated with Sarcoidosis?

Answer 32

Raised ACE Levels | Hypercalcaemia

Question 33

Give 4 examples of conditions which can cause Lower Lung Fibrosis? MIDA

Answer 33

M - Most connective tissue disorders (Except Anonkylosing Spondylitis) I - Idiopathic Pulmonary Fibrosis D - Drug-induced Fibrosis A - Asbestosis

Question 34

ASBESTOS 1. What are some changes to the lungs associated with Asbestos? 2. Are pleural plaques benign, pre-malignant or malignant? 3. Where does Asbestosis typically occur? 4. What is the most severe form of Asbestos causing mesothelioma? 5. Features of mesothelioma? 6. Diagnosis of mesothelioma?

Answer 34

1. Pleural plaques, pleural thickening, asbestosis, mesothelioma 2. Benign 3. Lower zone 4. Crocidolite (blue) form 5. SOB, chest pain, pleural effusions 6. Thoracoscopy, CT, CXR

Question 35

ALLERGIC BRONCHOPULMONARY ASPERGILLIOSIS 1. What is it? 2. What are the associated features? 3. What is the management?

Answer 35

1. ABA is due an allergy to Aspergillus spores 2. Bronchiectasis, raised Eosinophils 3. Glucocorticoids, then Itraconazole

Question 36

IDIOPATHIC PULMONARY FIBROSIS 1. What is it? 2. What are some symptoms? 3. Main finding on auscultation? 4. What are some investigations and findings on spirometry? Other investigations? 5. What is the management?

Answer 36

1. A chronic lung condition characterised by progressive fibrosis of the interstitium 2. Progressive dyspnoea, dry cough, clubbing 3. Bilateral fine end inspiratory crackles 4. Spirometry: Restrictive picture with REDUCED TLCO, CT shows ground glass appearance 5. Pulmonary rehab, Pirfenidone (anti-fibrotic), O2, lung transplant

Question 37

EXTRINSIC ALLERGIC ALVEOLIOLITIS 1. What is EEA? 2. What is Extrinsic Allergic Alveolitis also known as? 3. What is Bird Fancier's Lung caused by? 4. What is Farmer's Lung caused by? 5. What is Malt Worker's lung caused by? 6. What is Mushroom Worker's Lung caused by? 7. Where does fibrosis typically occur? 8. How is this different to Allergic Bronchopulmonary Aspergilliosis? 9. What is the management?

Answer 37

1. A condition caused by hypersensitivity induced lung damage due to a variety of inhaled organic particles 2. Hypersensitivity Pneumonitis 3. Avian protein 4. Saccharopolyspora rectivirgula 5. Aspergillus clavitus 6. Actinomytes 7. Upper / mid zones 8. EEA = No eosinophillia. ABPA = eosinophillia 9. Avoid trigger, glucocorticoids