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IM- INTERSTITIAL LUNG DISEASE iLD)

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tonystep1's version from 2017-08-31 12:02

ILD Classification

Question Answer
Environmental Lung Diseasesa. Coal worker's pneumoconiosis
b. Silicosis
c. Asbestosis
d. Berylliosis
ILD associated with granulomasa. Sarcoidosis-other organs in addition to the lungs are involved
b. Histiocytosis X
c. Wegener's granulomatosis
d. Churg-Strauss syndrome
Alveolar filling diseasesa. Goodpasture's syndrome
b. Idiopathic pulmonary hemosiderosis
c. Alveolar proteinosis
Hypersensitivity lung diseasesa. Hypersensitivity pneumonitis
b. Eosinophilic pneumonitis
Drug Induced ILDamiodarone, nitrofurantoin, bleomycin, phenytoin, illicit drugs
ILD associated with connective tissue disordersrheumatoid arthritis, scleroderma,
SLE, mixed connective tissue disease
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ILD Clinical Features

Question Answer
ILD symptomsa. Dyspnea (at first with exertion; later at rest)
b. Cough (nonproductive)
c. Fatigue
d. Other symptoms may be present secondary to another condition (such as a
connective tissue disorder)
ILD signsa. Rales at the bases are common
b. Digital clubbing is common (especially with idiopathic pulmonary fibrosis)
Signs of Advanced DiseaseSigns of pulmonary HTN and cyanosis in advanced disease
Sign that is common with idiopathic pulmonary fibrosisDigital clubbing is common
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Diagnosis

Question Answer
CXR findings for ILDa. Findings are usually nonspecific.
b. Typical diffuse changes are noted (reticular, reticulonodular, ground glass,
honeycombing).
PFTs FEV1/FVCA restrictive pattern is noted: FEV/FVC ratio is increased
Lung VolumesAll lung volumes are
low
Diffusing capacity in ILD patientsLow diffusing capacity
Differential diagnosis of Clubbing of the fingersDifferential diagnoses vary and include pul monary diseases (lung cancer, cystic fibrosis, interstitial lung
disease, empyema, sarcoidosis, and mesothelioma), congenital heart disease, bacterial endocarditis, biliary
cirrhosis, inflammatory bowel disease, and primary biliary cirrhosis
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ILDs Clinical Features

Question Answer
Sarcoidosis typical Young patient with constitutional symptoms, respiratory complaints, erythema nodosum, blurred vision, and bilateral hilar adenopathy
Histiocytosis X Cigarette smoker with dyspnea and nonproductive cough with lytic bone lesions on CT and honeycomb lung on CXR
Wegner's granulomatosis Patient with upper and lower respiratory infections, glomerulonephritis, and pulmonary nodules with tissue biopsy result of c-antineutrophilic cytoplasmic antibodies
Churg-Strauss syndromePatient with asthma, pulmonary infiltrates, rash, and eosinophilia, whose biopsy test results reveal perinuclear antineutrophilic cytoplasmic antibody
Coal worker's pneumoconiosis Patient presents with history of exposure to coal dust and has pneumoconiosis characterized by fibrosis.
Asbestosis50 yr old Patient with history of living in apartments from the 1920s , presents with nonspecific symptoms, and CXR shows hazy infiltrates with bilateral linear opacities.
SilicosisRetired miner with exertional dyspnea and cough with sputum.
BerylliosisPatient presents with granulomatous disease, skin lesions, and hypercalcemia.
Hypersensitivity pneumonitis (extrinsic allergic alveolitis)Chemical worker presents with flu like symptoms and CXR shows pulmonary infiltrates.
Eosinophilic pneumoniaPatient presents with fever and peripheral eosinophilia, CXR shows peripheral pulmonary infiltrates
Goodpasture's syndromePatient presents with hemoptysis, dyspnea, and glomerulonephritis.
Pulmonary alveolar proteinosisPatient presents with dry,cough,dyspnea, hypoxia, and rales; CXR shows ground glass appearance with bilateral alveolar infiltrates that resemble a bat shape.
Idiopathic pulmonary fibrosisMale with history of smoking presents with gradual onset of progressive dyspnea, nonproductive cough; CXR results show ground glass or honeycombed appearance.
Cryptogenic organizing pneumonitis (COP)Patient presents with cough, dyspnea, and flu like symptoms; bilateral patchy infiltrates on CXR
Radiation pneumonitisPatient with history of thoracic irradiation for lymphoma presents with low grade fever, cough, chest fullness, dyspnea, pleuritic chest pain, hemoptysis, acute respiratory distress. CXR is normal, but CT scan shows diffuse infiltrates.
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ILD Treatment and Management

Question Answer
SarcoidosisMost cases resolve in 2 years and require no treatment, systemic corticosteroids are the treatment of choice.
Sarcoidosis patient refractory to corticosteroidsMethotrexate is used
Histiocytosis XCorticosteroids are sometimes effective, lung transplantation may be necessary
Wegener's granulomatosisTreatment usually includes immunosuppressive agents and glucocorticoids.
Churg-Strauss syndromeTreat with systemic glucocorticoids
Coal worker's pneumoconiosistbd
AsbestosisNo specific treatment is available
SIlicosisTreatment involves removal from exposure to silica
BerylliosisGive glucocorticoid therapy for both acute and chronic berylliosis
Hypersensitivity pneumonitis (extrinsic allergic alveolitis)Treatment involves removal of the offending agent and sometimes glucocorticoids.
Eosinophilic pneumoniaTreatment with glucocorticoids is usually very effective, but relapses may occur
Goodpasture's syndromePrognosis is poor; treat with plasmapheresis, cyclophosphamide, and corticosteroids
Pulmonary alveolar proteinosistbd
Idiopathic pulmonary fibrosisNO effective treatment is available.
Cryptogenic organizing pneumonitis (COP)Spontaneous recovery may occur, but corticosteroids are used most commonly >60% patient recover
Radiation pneumonitisThe treatment of choice is corticosteroids
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