Interstitial lung disease

Question 1

What is it?

Answer 1

generic term to describe conditions affecting the lung parenchyma in a diffuse manner

Question 2

Give the classification of ILD

Answer 2

1. Known cause: occupational (asbestosis), drugs, hypersensitivity pneumonitis, infections (TB, fungi, viral) GORD
2. Associated w systemic disorders: sarcoid, RA, SLE, SS CTD, sjogrens
3. Idiopathic - IPF

Question 3

Give the pathology of ILD

Answer 3

fibrosis and remodelling of the interstitial
chronic inflammation
hyperplasia of type II epithelial cells or type II pneumocytes

Question 4

How do they tend to present?

Answer 4

SOB on exertion
Non-productive paroxysmal cough 
Abnormal breath sounds 
Abnormal CXR or HRCT
Restrictive spirometry

Question 5

What is hypersensitivity pneumonitis also known as?

Answer 5

extrinsic allergic alveolitis

Question 6

What are examples of hypersensitivity pneumonitis?

Answer 6

bird fanciers lung

farmers lung - mouldy hay

Question 7

What are the acute features of hypersensitivity pneumonitis?

Answer 7

4-6hrs post exposure - SOB, dry cough, fever, riggers,

Question 8

What are the chronic features of hypersensitivity pneumonitis?

Answer 8

finger clubbing
SOB - exertional
WL
type I RF
Cor pulmonale

Question 9

What are the investigations for hypersensitivity pneumonitis, what would u find?

Answer 9

1. CXR - upper zone consolidation
2. CT - ground glass
3. FBC - ↑ ESR, ↑ WBC
4. PFTs - restrictive (acute) or mixed
5. Positive immunological response to causative antigen

Question 10

what is the management of hypersensitivity pneumonitis?

Answer 10

1. Avoid antigen

2. PO prednisolone gradually decreased

Question 11

Which lung fibroses predominantly affect the upper zones?

Answer 11

C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

Question 12

Which lung fibroses predominantly affect the lower zones?

Answer 12

IPF
CTDs e.g. SLE
Drug induced - amiodarone, methotrexate
Asbestosis

Question 13

What is sarcoidosis?

Answer 13

multisystem disorder
unknown aetiology
characterised by non-caseating granulomas commonly affecting lungs skin and eyes

Question 14

who is most commonly affected in sarcoidosis?

Answer 14

20-40yrs
FHx
Scandinavian

Question 15

How does acute sarcoidosis present?

Answer 15

swinging fever
polyarthralgia
erythema nodosum
bilateral hilar lymphadenopathy

Question 16

What are the sx of pulmonary disease in sarcoidosis

Answer 16

dry cough
SOB
CP
reduced exercise tolerance

Question 17

What investigations would u do for sarcoidosis?

Answer 17

1. CXR
2. U+E - look for renal involvement
3. Ca - hypercalcaemia
4. CT

Question 18

How would u monitor sarcoidosis ? what would u find?

Answer 18

PFTs

restrictive/obstructive/mixed pattern

Question 19

What might u see on imaging in sarcoidosis?

Answer 19

CXR - bilateral hilar lymphadenopathy
CT - irregular nodular thickening in upper/mid lungs
Ground glass opacities

Question 20

What is the treatment of pulmonary sarcoidosis?

Answer 20

Oral/ ICS - pred
Methotrexate/azathioprine
Oxygen

Question 21

What is the treatment of cutaneous sarcoidosis?

Answer 21

Topical CS

Oral CS