Interstitial Lung Disease

Question 1

What is the most common presentation of interstitial lung disease?

Answer 1

Idiopathic Pulmonary Fibrosis

Question 2

What drugs are known to cause pulmonary fibrosis?

Answer 2

nitrofurantoin, methotrexate, amioderone, Bleomycin

Question 3

What is classical presentation of idiopathic pulmonary fibrosis?

Answer 3

Older aged patient with progressively worsening dysponoea and SOB on exertion
Cough
Finger clubbing
Bilateral inspiratory crackles

Question 4

What are Ix and findings for idiopathic pulmonary fibrosis and which is gold standard?

Answer 4

FBC - Rule out other causes
PFT - Restrictive pattern
DLco - Reduced
CXR - shows bilateral lower zone nodular Reticulated shadows
High Resolution CT - GOLD Standard Ground glass appearance

Question 5

What is mainstay of management for idiopathic pulmonary fibrosis?

Answer 5

Pulmonary rehabilitation

Poor prognosis of expected life expectancy of 3-5 years from diagnosis

Question 6

What is Sarcoidosis?

Answer 6

A chronic granulomatous disorder characterised by non-caseating granulomas.

Question 7

What are classical features of Sarcoidosis?

Answer 7

Pulmonary symptoms most common - dry cough and dysponoea
Flu like illness
Cutaneous - erythema nodosum
Anterior uevitis and dry eyes

Question 8

What is the Ix for sarcoidosis?

Answer 8

CXR
Bloods - Raised ACE and ESR
Spirometry

Question 9

What is classical findings for sarcoidosis on CXR?

Answer 9

Bilateral perihilar lymphadenopathy in early disease

Progresses to infiltration and finally pulmonary fibrosis

Question 10

What is management of sarcoidosis?

Answer 10

Asymptomatic and early disease - monitor
Symptomatic or progessive disease: Cytotoxics e.g. Methotrexate or hydrochloroquinine.
Cutaneous features - topical corticosteroids

Question 11

What is Acute Respiratory Distress Syndrome?

Answer 11

Acute non-cardiogenic pulmonary oedema and lung inflammation resulting in severe respiratory difficulty

Question 12

What is the most common cause of Acute Respiratory Distress Syndrome?

Answer 12

Sepsis - particularly resulting from lung pathology

Question 13

What are other causes of Acute Respiratory Distress Syndrome?

Answer 13

Aspiration, Pancreatitis, Pneumonia, DIC

Question 14

What would you expect to see on a chest X ray for Acute Respiratory Distress Syndrome?

Answer 14

Bilateral infiltrates

Question 15

What is the management of Acute Respiratory Distress Syndrome?

Answer 15

Optimise oxygenation
Sedation to ensure adequate ventilation
Putting patients in prone position alters chest wall mechanics and is shown to improve outcome for patients with ARDS
Treat underlying cause

Question 16

What investigations can be used to distinguish Acute Respiratory Distress Syndrome from cardiogenic pulmonary oedema?

Answer 16

Echo cardiogram

Pulmonary capillary wedge pressure - if elevated suggests cardiogenic.

Question 17

Exposure to asbestos can cause what lung conditions (3 and their definition) ?

Answer 17

Asbestosis - interstitial lung disease
Benign plural plaques - not premalignant and generally asymptomatic
Mesothelioma - cancer of the lung pleura