interstitial lung dz

Question 1

ILD

Answer 1

Accumulation of inflammation in the interstitium; progressive scarring leads to lung/air sac stiffening and once this happens its irreversible

Question 2

idiopathic chronic multisystemic inflammatory non-caseating granulomatous disease
aka– small patches of swollen tissue (granulomas) develop in organs

Answer 2

sarcoidosis

Question 3

risk factors for sarcoidosis

Answer 3

black females

Question 4

treatment for sarcoidosis

Answer 4

prednisone

Question 5

sx of sarcoidosis

Answer 5

50% asymptomatic
* dry cough
* intrathoracic lymphadenopathy
* erythema nosoum or lupus pernio
* eyes involvement

Question 6

most accurate way to diagnose sarcoidosis vs best initial test

Answer 6

tissue biopsy is most accurate
chest radiographs is best initial

Question 7

finding of sarcoidosis on chest radiographs & PFT

Answer 7

bilateral hilar lymphadenopathy on radiographs
restrictive findings (normal or increased ratio)

Question 8

• Chronic progressive fibrosing interstitial pneumonia of unknown etiology

Answer 8

idiopathic pulmonary fibrosis

Question 9

risk factors for IPF

Answer 9

men over 50
cigarette smoking!!

Question 10

• dry cough
• SOB then fatigue
• clubbing
• bibasilar end-inspiratory crackles/rales

Answer 10

pulmonary fibrosis sx

Question 11

“reticular opacities” (honey combing) at lung bases should make you think of?

Answer 11

pulmonary fibrosis

Question 12

life expectancy of IPF

Answer 12

3-4yrs

Question 13

CT scan shoes usual interstitial pneumonia, reticular honeycombing, focal ground-glass opacification & surgical path/histo. shows UIP

Answer 13

IPF

Question 14

tx of IPF (2)

Answer 14

• steroids for exacerbations (can worsen prognosis)
• lung transplant is only cure

Question 15

• chronic fibrotic lung diseases secondary to inhalation of mineral dust

Answer 15

pneumoconiosis

Question 16

4 pneumoconiosis talked about in lecture

Answer 16

asbestosis
silicosis
coal workers pneumo.
hypersentivity pneumonitis

Question 17

which asbestos fiber is harder to remove, more toxic and reaches deeper into lungs

Answer 17

amphiboles

Question 18

most common form of exposure to asbestos

Answer 18

general community exposre

other forms: work, bystander

Question 19

asbestosis pathophys

Answer 19

1. deposition & transmigration of the fibers
2. macrophage accumulation then fibroblasts
3. fibrosis increases over time
   - functions as tumor initaiator and promoter

Question 20

• smoking
• DOE
• nonproductive cough
• bibasilar end-inspiratory rales
• RHF if advanced
• clubbing
• reduced chest expansion

Answer 20

asbestosis

NOTE: sx similar to IPF, before imagings use history as guide!

Question 21

PFT and ABG findings with asbestosis

Answer 21

• PFT– restrictive
• ABG may show resp. Alkalosis

Question 22

CXR: diffuse reticonodular infiltrates at lung bases “shaggy heart borders”
CT: ground-glass, pleural thickening & calcified pleural plaques by border

Answer 22

asbestosis findings

Question 23

3 major effects of asbestos exposure

Answer 23

• pleural and pulmonary fibrosis
• cancers of resp. tract
• mesothelioma

Question 24

caused by inhaling silica dust

Answer 24

silicosis

Question 25

caused by inhaling coal mine dust

Answer 25

coal workers pneumoconiosis/black lung dz

Question 26

* eggshell calcifications on hilar & mediastinal nodes * biopsy shows dust-laden macrophages & loose reticulin fibers * non specific tx * often asymptomatic but can have DOE, dry cough, rales, fatigue

Answer 26

silicosis

Question 27

* chest radiograph: small nodules predominantly in upper lung w/ hyperinflationof lower lobes in **obstructive** pattern (resembles emphysema) * biopsy (not needed) shows black lungs-- interstitial pigment deposition and anthracitic macrophage * tx includes pulm rehab

Answer 27

CWP/black lung

Question 28

* Results from repeated inhalation of/sensitization to aerosolized organic antigens

Answer 28

hypersensitivity pneumonitis

Question 29

* acute: rapid on set of flu like sxs, fever, chills, cough, dyspnea, myalgias 4-8 hrs after prolonged exposure to antigen * chronic: DOE, cough, crackles, insp squeaks * farmers lung from moldy hay * restrictive component * CT-- upper lobe predominance, ground glass and fibrosis, honeycombing

Answer 29

hypersentivity pneumonitis

Question 30

tx of hypersensitivity pneumonitis

Answer 30

avoid exposures steroids lung transplant