p.26
Definition and Classification of Restrictive Lung Disease
What is the title of the handbook mentioned?
Handbook of Clinical Medicine, 5th Edition.
p.14
Clinical Features and Symptoms of ILD
What is the primary focus of the Respiratory section in the Handbook of Clinical Medicine?
To provide comprehensive information on respiratory diseases and their management.
p.17
Definition and Classification of Restrictive Lung Disease
What does the red arrow in the figure indicate?
The right lung field edge.
p.29
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
In which patients is fungal and parasitic pneumonia more likely to occur?
In severely immunocompromised patients.
p.8
Differential Diagnosis for ILD
How can the differential diagnosis for ILD be categorized?
By cause and by the zone it affects: upper vs lower.
p.29
Clinical Features and Symptoms of ILD
What extra-pulmonary features may be present in pneumonia?
Headache, arthralgia, vague RUQ pain (hepatitis).
p.23
Management Principles for ILD
What is a key point in managing a chest drain?
Use an underwater seal to prevent air ingress.
p.36
Clinical Features and Symptoms of ILD
What is the primary focus of the Respiratory section in the Handbook of Clinical Medicine?
To provide comprehensive information on respiratory diseases and their management.
p.17
Definition and Classification of Restrictive Lung Disease
What do the white arrows in the figure show?
The space between the pleura at the level of the hilum.
p.1
Clinical Features and Symptoms of ILD
What are the clinical features and risk factors in patients with suspected ILD?
Identifying clinical features and risk factors is essential for diagnosis.
p.1
Investigations and Diagnostic Techniques for ILD
What is important to distinguish in investigations for ILD?
Diagnosis, aetiology, and complications.
p.35
Investigations and Diagnostic Techniques for ILD
What follow-up is needed after pneumonia treatment?
Follow-up CXR after 8 weeks to ensure resolution of consolidation.
p.17
Definition and Classification of Restrictive Lung Disease
What is a right-sided pneumothorax?
A condition where air enters the pleural space on the right side, causing lung collapse.
p.29
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What type of pneumonia is more likely to have resistant organisms?
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP).
p.13
Management Principles for ILD
What type of support may be required for patients with hypoventilation?
Non-invasive ventilator support at night and sometimes home oxygen.
p.30
Clinical Features and Symptoms of ILD
What is tachypnoea a sign of in pneumonia?
Consolidation resulting in impaired gas exchange.
p.34
Management Principles for ILD
What is the recommended antibiotic treatment for Community-Acquired Pneumonia (CAP)?
IV co-amoxiclav 1.2g TDS plus oral clarithromycin 500mg BD for 7 days.
p.36
Pathogenesis and Aetiology of ILD
What institution is associated with the Respiratory 190 notes?
RCSI (Royal College of Surgeons in Ireland).
p.8
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What are some associated underlying conditions that are risk factors for developing restrictive lung disease?
Various underlying conditions, including smoking history, are risk factors.
p.27
Clinical Features and Symptoms of ILD
What are the key clinical features of pneumonia?
Fever, cough, difficulty breathing, chest pain, and sputum production.
p.6
Clinical Features and Symptoms of ILD
What are some symptoms associated with underlying connective tissue disease?
Fever, weight loss, arthritis, skin rashes, eye inflammation, dry eyes.
p.6
Clinical Features and Symptoms of ILD
What is the most common presentation of Sarcoidosis?
Lofgren’s syndrome (Fever, lymphadenopathy, arthralgia, and erythema nodosum).
p.24
Management Principles for ILD
When is drainage indicated in pleural disease?
In empyema or complicated para-pneumonic effusion (pH < 7.2) and malignancy.
p.15
Management Principles for ILD
What should be outlined for patients with pneumothorax?
Investigations, management principles, and prognosis.
p.29
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
Which bacteria are more common in hospital-acquired pneumonia?
Gram-negative bacteria such as Pseudomonas and Klebsiella.
p.31
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
Which medications can increase the risk of pneumonia in immunocompromised individuals?
Steroids, post-transplant medications, biologics.
p.28
Definition and Classification of Restrictive Lung Disease
What is pneumonia?
A type of lower respiratory tract infection (LRTI) diagnosed through clinical and radiological evidence of infection.
p.6
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What types of exposures are associated with ILD?
Smoking, bird racing, farming, coal mining, stone cutting.
p.9
Investigations and Diagnostic Techniques for ILD
What does spirometry reveal in restrictive lung disease?
Normal FEV1/FVC ratio (>0.7), reduced FVC, reduced TLC, and reduced DLCO.
p.5
Clinical Presentation and Management of Sarcoidosis
What type of lung disease is sarcoidosis classified as?
A type of restrictive lung disease.
p.8
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
How is smoking history related to Idiopathic Pulmonary Fibrosis (IPF)?
Smoking history is associated with an increased risk of developing IPF.
p.21
Investigations and Diagnostic Techniques for ILD
What does a CXR diagnose in relation to pleural conditions?
Pleural effusion, but not necessarily the underlying cause.
p.1
Management Principles for ILD
What should be outlined in the management of ILD?
Management principles and treatment of complications.
p.9
Investigations and Diagnostic Techniques for ILD
What features on HRCT are consistent with idiopathic pulmonary fibrosis?
Traction bronchiectasis and honeycombing.
p.33
Clinical Features and Symptoms of ILD
What does the CURB-65 scale assess?
Prognosis of 30-day mortality and treatment guidance for pneumonia.
p.23
Management Principles for ILD
What is the first step in managing a pneumothorax in an emergency?
Give oxygen supplementation via non-rebreather mask (except in COPD cases).
p.20
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What are the risk factors for tension pneumothorax?
Trauma and being a ventilated patient.
p.28
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What is the most common infectious cause of death in Ireland and the UK?
Community Acquired Pneumonia (CAP).
p.8
Differential Diagnosis for ILD
What are some blood-borne insults that can affect the lower zone?
Rheumatoid arthritis, Asbestos, Scleroderma, Cryptogenic fibrosing alveolitis, and certain drugs.
p.10
Investigations and Diagnostic Techniques for ILD
What is the significance of an autoantibody screen in ILD?
ANA, ANCA, and RhF may be positive in connective tissue disease (CTD).
p.4
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What are some malignancies associated with ILD?
Lymphangitic carcinomatosis and Histiocytosis X.
p.15
Management Principles for ILD
What principles should be outlined for the management of pleural effusion?
Management may include thoracentesis, drainage, and addressing the underlying cause.
p.17
Complications Associated with ILD
What are some conditions associated with pleural disease?
Liver failure, renal failure, and hypoalbuminaemia.
p.1
Differential Diagnosis for ILD
How can ILD be categorized?
Based on aetiology through differential diagnosis.
p.31
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What are the commonest risk factors for pneumonia?
Alcohol abuse, smoking, COPD and other chronic lung conditions, nursing home residency.
p.25
Complications Associated with ILD
What are the possible outcomes of pneumothorax?
Respiratory or cardiac arrest.
p.27
Differential Diagnosis for ILD
What is the purpose of formulating a differential diagnosis in pneumonia?
To identify other possible conditions based on clinical presentation.
p.31
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What are some aspiration risk factors for pneumonia?
Epilepsy, impaired swallow (e.g., post-stroke, MND, impaired consciousness due to alcohol excess or medications).
p.27
Investigations and Diagnostic Techniques for ILD
What should an investigation plan for pneumonia include?
Assessment of severity, which may involve chest X-ray, blood tests, and sputum cultures.
p.6
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What past medical history factors are relevant to ILD?
Recurrent antibiotic use, radiotherapy, chemotherapy, polio, a. fib (amiodarone).
p.4
Definition and Classification of Restrictive Lung Disease
What is Interstitial Lung Disease (ILD)?
A type of restrictive lung disease characterized by fibrosis and inflammation in the lung interstitium.
p.34
Management Principles for ILD
What is the antibiotic treatment for Hospital-Acquired Pneumonia (HAP)?
IV piperacillin-tazobactam 4.5g TDS (or reduce to BD for renal impairment) with possible MRSA cover using vancomycin for 7 days.
p.24
Management Principles for ILD
What is VATS used for in pleural disease?
VATS decortication for empyema or VATS pleurodesis for malignant pleural effusion.
p.26
Definition and Classification of Restrictive Lung Disease
What institution is associated with the Respiratory 180 notes?
RCSI (Royal College of Surgeons in Ireland).
p.21
Investigations and Diagnostic Techniques for ILD
What should be done immediately for a tension pneumothorax?
Do not wait for imaging; treat it immediately.
p.18
Clinical Features and Symptoms of ILD
What history may be present in cases of secondary pneumothorax?
History of chronic lung disease or smoking.
p.31
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What conditions are associated with immunocompromised status that increase pneumonia risk?
HIV/AIDS, diabetes mellitus, chronic kidney disease (CKD), chronic liver disease, malnutrition.
p.9
Investigations and Diagnostic Techniques for ILD
When is histological confirmation not needed in ILD diagnosis?
If CT findings match clinical features and pulmonary function tests (PFTs).
p.34
Management Principles for ILD
What should be done if a patient with pneumonia is in septic shock and severe hypoxia?
Treat with boluses of IV crystalloid fluids, refer to ICU for vasopressor support if BP does not improve, and consider intubation and ventilation for severe hypoxia.
p.25
Prognosis of ILD Based on Aetiology
What is the prognosis for primary and most secondary pneumothoraces?
Almost all recover with conservative treatment.
p.22
Investigations and Diagnostic Techniques for ILD
What is the purpose of assessing platelets before chest drain insertion?
To screen for thrombocytopenia.
p.3
Pathogenesis and Aetiology of ILD
What happens to lung function as fibrosis progresses in ILD?
It leads to architectural distortion of the lung, resulting in lung restriction, measured as reduced FVC and total lung capacity.
p.12
Management Principles for ILD
What is a common acute management strategy for ILD?
Oxygen supplementation as required.
p.24
Investigations and Diagnostic Techniques for ILD
What is the purpose of the pressure-regulating bottle in chest drainage?
To maintain appropriate pressure during fluid collection.
p.21
Investigations and Diagnostic Techniques for ILD
What is the meniscus sign associated with?
Right sided unilateral pleural effusion.
p.20
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What are the risk factors for primary pneumothorax?
Tall & thin body type, male gender, and cigarette smoking.
p.13
Complications Associated with ILD
What complications can arise from chronic hypoxia in ILD?
Pulmonary hypertension and cor pulmonale (right heart failure).
p.8
Differential Diagnosis for ILD
What mainly affects the lower zones in ILD?
Mainly blood-borne insults.
p.18
Clinical Features and Symptoms of ILD
What symptoms may indicate pleural malignancy?
Pleuritic chest pain, dyspnoea, cough, weight loss, night sweats, and fatigue.
p.1
Definition and Classification of Restrictive Lung Disease
What does restrictive lung disease include?
Interstitial lung disease and chest wall disease, such as scoliosis.
p.3
Pathogenesis and Aetiology of ILD
What is the effect of interstitial damage in ILD on oxygen diffusion?
It results in decreased ability of oxygen to diffuse from the alveolus to the capillary, reducing diffusing capacity measured by DLCO.
p.3
Definition and Classification of Restrictive Lung Disease
What is the most common type of idiopathic interstitial lung disease?
Idiopathic Pulmonary Fibrosis (UIP Pattern).
p.29
Clinical Features and Symptoms of ILD
What are common symptoms of pneumonia?
Fever & chills, productive cough, dyspnoea, pleuritic chest pain, and extra-pulmonary features.
p.13
Clinical Features and Symptoms of ILD
How does chest wall disease affect breathing?
It can cause hypoventilation, leading to type 2 respiratory failure.
p.15
Clinical Features and Symptoms of ILD
What are the key clinical features of a patient presenting with pneumothorax?
Symptoms may include sudden chest pain and shortness of breath.
p.1
Prognosis of ILD Based on Aetiology
How is ILD prognosis informed?
By the aetiology of the disease.
p.35
Complications Associated with ILD
What are some complications associated with pneumonia?
Parapneumonic effusion, empyema, lung abscess, cavitation, acute respiratory distress syndrome, bronchiectasis, severe sepsis/septic shock, and end organ damage.
p.13
Complications Associated with ILD
What is the main cause of death in chest wall disease?
Chest infections due to hypoventilation.
p.8
Differential Diagnosis for ILD
What are some inhaled insults that can affect the upper zone?
Coal, Histiocytosis, Ankylosing spondylitis, Radiation, TB, Sarcoidosis.
p.24
Management Principles for ILD
When may drainage be indicated aside from empyema?
In symptomatic effusions.
p.6
Clinical Features and Symptoms of ILD
What are the 3 C’s of ILD clinical features?
Cough, Clubbing, Crackles.
p.9
Pathogenesis and Aetiology of ILD
What is the significance of pleural plaques in ILD?
They indicate asbestos exposure.
p.33
Clinical Features and Symptoms of ILD
What blood pressure readings are included in the CURB-65 scale?
Systolic <90 or diastolic <60 mmHg.
p.24
Investigations and Diagnostic Techniques for ILD
Where should a chest drain be inserted?
In the triangle of safety between the lateral border of pectoralis major, the mid-axillary line, and a horizontal line at the level of the nipple.
p.11
Investigations and Diagnostic Techniques for ILD
What should be assessed regarding bones and soft tissue in a CXR?
Check for no fractures and no subcutaneous emphysema.
p.32
Investigations and Diagnostic Techniques for ILD
What imaging tests are used to diagnose pneumonia?
CXR (Chest X-Ray) or CT (Computed Tomography).
p.23
Management Principles for ILD
What is the first step in managing pleural effusion?
Treat the underlying cause, such as antibiotics for pneumonia or TB.
p.3
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What are some known associations with ILD?
Pneumoconiosis, asbestos, coal, connective tissue diseases, and certain medications.
p.10
Investigations and Diagnostic Techniques for ILD
When is an ABG check needed in ILD?
In acute presentation and for long-term oxygen therapy (LTOT).
p.19
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What does tar staining indicate in relation to pleural diseases?
It is a risk factor from smoking.
p.9
Investigations and Diagnostic Techniques for ILD
What imaging technique is used for diagnosing Interstitial Lung Disease (ILD)?
High-resolution CT (HRCT) thorax.
p.27
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What are common risk factors for pneumonia?
Age, smoking, chronic lung diseases, immunocompromised state, and recent respiratory infections.
p.15
Differential Diagnosis for ILD
How can pneumothorax be differentiated from tension pneumothorax?
Based on clinical and radiological assessment.
p.23
Management Principles for ILD
What procedure is performed in a tension pneumothorax?
Needle Thoracentesis at the 2nd intercostal space in the mid-clavicular line with a 14g cannula.
p.20
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What are the causes of exudative pleural effusion?
Pneumonia, malignancy, tuberculosis, asbestos exposure, and connective tissue diseases like rheumatoid arthritis.
p.11
Clinical Presentation and Management of Sarcoidosis
What does the CXR of a patient with sarcoidosis typically show?
A diffuse reticulo-nodular pattern in a peri-hilar distribution and bilateral hilar enlargement.
p.5
Clinical Presentation and Management of Sarcoidosis
What are some signs of sarcoidosis?
Lacrimal gland enlargement, parotid gland enlargement, cranial nerve palsy.
p.28
Pathogenesis and Aetiology of ILD
What is the most common pathogen causing pneumonia?
Streptococcus pneumoniae.
p.7
Clinical Features and Symptoms of ILD
What is tachypnoea and why does it occur in ILD?
Tachypnoea is rapid breathing due to reduced oxygen exchange.
p.24
Clinical Features and Symptoms of ILD
What condition is indicated by a left-sided pneumothorax?
A collection of air in the pleural space on the left side.
p.23
Management Principles for ILD
What does it indicate if a chest drain is not bubbling?
It suggests that the pneumothorax has resolved.
p.12
Management Principles for ILD
What non-pharmacological treatment is recommended for Idiopathic Pulmonary Fibrosis (UIP)?
Physiotherapy and long-term oxygen supplementation.
p.22
Investigations and Diagnostic Techniques for ILD
What is the significance of spirometry in respiratory investigations?
To diagnose an underlying lung condition.
p.3
Differential Diagnosis for ILD
What is a common pitfall regarding the names of ILD?
The names have changed frequently, causing confusion, such as IPF previously being called cryptogenic organizing alveolitis.
p.16
Definition and Classification of Restrictive Lung Disease
What are the two types of pleural effusion?
Exudative and Transudative.
p.19
Differential Diagnosis for ILD
What underlying conditions may be indicated by signs during examination?
CTD (Connective Tissue Disease), Cystic fibrosis, COPD.
p.34
Management Principles for ILD
What are the key prevention strategies for pneumonia?
Smoking cessation, pneumococcal vaccination, annual influenza vaccination, following SALT guidelines for nutrition if at risk of aspiration, and practicing handwashing and good respiratory etiquette.
p.18
Clinical Features and Symptoms of ILD
What are the symptoms of pleural effusion?
Pleuritic chest pain, dyspnoea, and cough.
p.31
Differential Diagnosis for ILD
What are some differential diagnoses for pneumonia?
Non-infective exacerbation of COPD or asthma, pulmonary embolus, lung cancer, non-infectious pneumonia.
p.27
Management Principles for ILD
What is an appropriate management plan for pneumonia?
Antibiotics, supportive care, and monitoring for complications.
p.23
Management Principles for ILD
What is the management for a primary pneumothorax or small secondary pneumothorax <2cm and asymptomatic?
Give 100% oxygen, observe, and monitor.
p.27
Complications Associated with ILD
What complications can arise from pneumonia?
Pleural effusion, lung abscess, and respiratory failure.
p.12
Management Principles for ILD
What are the key prevention strategies for Interstitial Lung Disease (ILD)?
Reduce risk of exposures, smoking cessation, and vaccination against COVID-19, influenza, and pneumococcus.
p.20
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What is a common cause of pleural malignancy?
Asbestos exposure leading to mesothelioma and metastasis.
p.15
Definition and Classification of Restrictive Lung Disease
What are the two layers of the pleura?
Parietal pleura (outer layer) and visceral pleura (inner layer).
p.5
Complications Associated with ILD
What are some complications associated with sarcoidosis?
Osteoporosis, erythema nodosum, nasal cutaneous sarcoid lesions.
p.11
Investigations and Diagnostic Techniques for ILD
What is the normal ratio of cardiac size to thoracic width in a CXR?
Cardiac:Thoracic width < 50%.
p.7
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What does tar staining indicate in a patient?
Smoking as a risk factor for lung disease.
p.10
Complications Associated with ILD
What does an ECHO assess in ILD?
Cor pulmonale and pulmonary hypertension.
p.16
Definition and Classification of Restrictive Lung Disease
What is pleural effusion?
The accumulation of fluid in the pleural space.
p.32
Investigations and Diagnostic Techniques for ILD
What does an ABG test reveal in pneumonia?
Hypoxia, raised lactate, and possible respiratory alkalosis or mixed acidosis.
p.32
Investigations and Diagnostic Techniques for ILD
What is the purpose of blood cultures in pneumonia?
To identify the aetiology and detect sepsis.
p.16
Pathogenesis and Aetiology of ILD
What are the types of pneumothorax?
Simple, tension, primary, secondary, spontaneous, and traumatic.
p.34
Management Principles for ILD
What is the Sepsis 6 protocol for acute management of pneumonia?
Complete within 60 minutes: administer oxygen, take blood cultures, give IV antibiotics, measure lactate, provide fluids, and monitor urine output.
p.1
Clinical Presentation and Management of Sarcoidosis
What are the clinical presentations of sarcoidosis?
They need to be outlined along with a plan for investigations and management.
p.5
Differential Diagnosis for ILD
What are some causes of hypoventilation syndrome?
Nerve, neuromuscular junction, respiratory muscle, central and sleep-related issues.
p.9
Investigations and Diagnostic Techniques for ILD
What should be done if the pattern fits in ILD diagnosis?
Avoid unnecessary biopsy; however, sarcoidosis should be confirmed via bronchoscopy or EBUS.
p.28
Pathogenesis and Aetiology of ILD
How do pathogenic microorganisms typically enter the lower respiratory tract?
Via inhalation, micro-aspiration, or haematogenous spread.
p.34
Management Principles for ILD
What medium-term management strategies should be employed during an inpatient stay for pneumonia?
Chest physiotherapy, nebulised saline, DVT prophylaxis with LMWH, and maintaining oxygen saturation above 94%.
p.10
Investigations and Diagnostic Techniques for ILD
What does spirometry reveal in restrictive lung disease?
FEV1/FVC ratio is normal (>0.7), but FVC and TLC are reduced.
p.10
Investigations and Diagnostic Techniques for ILD
What is the recommendation regarding surgical lung biopsy in ILD?
Avoid if possible due to significant complications; if necessary, target the least risky site.
p.5
Complications Associated with ILD
What can sarcoidosis lead to in terms of cardiac issues?
Cardiac arrhythmia, heart block, sudden death.
p.12
Management Principles for ILD
What disease-modifying medication is used for Idiopathic Pulmonary Fibrosis?
Pirfenidone and Nintedanib.
p.7
Clinical Features and Symptoms of ILD
What ocular symptoms may suggest an underlying connective tissue disease?
Iritis or conjunctivitis.
p.12
Management Principles for ILD
When are steroids indicated for Sarcoidosis?
If there is progressive disease, cardiac or neuro sarcoid, hypercalcaemia, or ocular sarcoid threatening vision.
p.32
Investigations and Diagnostic Techniques for ILD
What urinary antigens are tested for in pneumonia?
Pneumococcal and legionella antigens.
p.20
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What conditions are associated with secondary pneumothorax?
COPD, asthma, cystic fibrosis, IPF, and connective tissue disorders like Marfan’s Syndrome.
p.28
Definition and Classification of Restrictive Lung Disease
What are the types of pneumonia classification?
Community Acquired Pneumonia (CAP), Hospital Acquired Pneumonia (HAP), and Ventilator Associated Pneumonia (VAP).
p.24
Management Principles for ILD
What is a potential issue with drainage in pleural disease?
Reoccurrence unless a permanent drain or VATS/Talc pleurodesis is used.
p.15
Differential Diagnosis for ILD
What is a key step in formulating a differential diagnosis for pleural effusion?
Informed by the results of thoracentesis.
p.31
Differential Diagnosis for ILD
What are examples of non-infectious pneumonia?
Cryptogenic Organising Pneumonia (COP), eosinophilic pneumonia, interstitial lung disease (ILD).
p.15
Clinical Features and Symptoms of ILD
What key signs and symptoms should be elicited when evaluating a patient with pleural effusion?
Symptoms may include dyspnea, cough, and pleuritic chest pain.
p.13
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What is a potential risk associated with asbestos exposure in ILD?
Mesothelioma and bronchogenic carcinoma.
p.11
Investigations and Diagnostic Techniques for ILD
What is the first step in the CXR interpretation checklist?
Airway: midline, no obvious deformities, no paratracheal masses.
p.34
Management Principles for ILD
What should be monitored in the acute management of pneumonia?
Oxygen saturation, blood cultures, lactate levels, fluid intake, and urine output.
p.10
Investigations and Diagnostic Techniques for ILD
What is the DLCO in ILD compared to chest wall disease?
DLCO is reduced in ILD but normal in chest wall disease.
p.2
Pathogenesis and Aetiology of ILD
What is a common cause of chest wall disease?
Neurological or muscular conditions impairing ventilatory function.
p.32
Investigations and Diagnostic Techniques for ILD
What does a high CRP level indicate?
It indicates infection and is used to monitor treatment.
p.19
Clinical Features and Symptoms of ILD
What physical sign is seen in tension pneumothorax due to obstructed venous return?
Raised JVP (Jugular Venous Pressure).
p.16
Definition and Classification of Restrictive Lung Disease
What is pneumothorax?
The accumulation of air in the pleural space.
p.16
Pathogenesis and Aetiology of ILD
What conditions can cause exudative pleural effusion?
Pneumonia, malignancy, TB, asbestos, and connective tissue disease.
p.13
Prognosis of ILD Based on Aetiology
How do sarcoidosis, COP, and hypersensitivity pneumonitis typically respond to steroids?
They usually remit with steroids but may progress to irreversible fibrosis.
p.33
Clinical Features and Symptoms of ILD
What respiratory rate is considered in the CURB-65 scale?
Respiratory Rate ≥ 30/min.
p.35
Management Principles for ILD
What underlying factors should be addressed in pneumonia management?
Underlying cause and risk factors.
p.5
Clinical Presentation and Management of Sarcoidosis
What is a common granulomatous condition associated with sarcoidosis?
Interstitial lung disease.
p.33
Clinical Features and Symptoms of ILD
What does a CURB-65 score of 0-1 suggest?
Mild community-acquired pneumonia.
p.28
Differential Diagnosis for ILD
What is a common pitfall in diagnosing pneumonia?
Other non-infective causes of lung consolidation may also be termed 'pneumonia'.
p.19
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What is a risk factor for primary spontaneous pneumothorax?
Being male, tall, and thin.
p.2
Pathogenesis and Aetiology of ILD
What characterizes idiopathic pulmonary fibrosis (IPF) histology?
Fibroblastic foci and 'honey combing'.
p.2
Definition and Classification of Restrictive Lung Disease
What is interstitial lung disease (ILD) also known as?
Diffuse parenchymal lung disease.
p.32
Investigations and Diagnostic Techniques for ILD
What abnormalities might be seen in LFTs during pneumonia?
LFTs may be deranged, particularly with legionella and mycoplasma.
p.30
Clinical Features and Symptoms of ILD
What does peripheral cyanosis indicate in pneumonia?
Low oxygen due to impaired gas exchange.
p.20
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What conditions lead to transudative pleural effusion?
Heart failure, liver failure, renal failure, and hypoalbuminaemia.
p.2
Definition and Classification of Restrictive Lung Disease
What is restrictive lung disease?
Any disease that restricts lung expansion, resulting in decreased lung volume, increased work of breathing, and inadequate ventilation and/or oxygenation.
p.4
Pathogenesis and Aetiology of ILD
How does fibrosis affect gas exchange in the lungs?
Fibrosis between alveoli decreases gas exchange and reduces oxygen transfer.
p.4
Investigations and Diagnostic Techniques for ILD
What do UIP and NSIP refer to in the context of ILD?
UIP (usual interstitial pneumonia) and NSIP (non-specific interstitial pneumonia) refer to patterns of fibrosis seen on high-resolution CT Thorax.
p.3
Definition and Classification of Restrictive Lung Disease
What are some examples of granulomatous ILD?
Sarcoidosis and hypersensitivity pneumonitis.
p.30
Clinical Features and Symptoms of ILD
What are common signs of sepsis in pneumonia?
HR >90 BPM, Resp Rate >20, Altered mental status, Temp >38.3 or <36, WCC >12 or <4.
p.32
Investigations and Diagnostic Techniques for ILD
Why is CT more sensitive than CXR in pneumonia diagnosis?
CXR may miss up to 1/3 of cases.
p.32
Investigations and Diagnostic Techniques for ILD
What does a Full Blood Count (FBC) indicate in pneumonia?
WCC <4 or >12 indicates SIRS criteria.
p.22
Differential Diagnosis for ILD
How is a small pneumothorax defined?
Less than 2 cm between the lung margin and chest wall.
p.22
Investigations and Diagnostic Techniques for ILD
What are the criteria for Light’s Criteria to determine exudate?
Pleural fluid protein: serum protein >0.5, pleural fluid LDH: serum LDH >0.6, pleural fluid LDH >2/3 ULN.
p.7
Complications Associated with ILD
What signs may indicate cor pulmonale during a cardiovascular exam?
Elevated JVP, loud P2, parasternal heave, tricuspid regurgitation, pulsatile hepatomegaly, lower limb pitting oedema.
p.19
Clinical Features and Symptoms of ILD
What condition is indicated by decreased breath sounds?
Pleural effusion or pneumothorax.
p.23
Management Principles for ILD
What should be done for a secondary pneumothorax >2cm or symptomatic?
Insert a chest drain in the safety triangle on the side of the pneumothorax.
p.7
Clinical Features and Symptoms of ILD
What physical sign may suggest neuromuscular disease in a patient with restrictive lung disease?
Chest wall deformity or mobility aids at bedside.
p.2
Definition and Classification of Restrictive Lung Disease
How can restrictive lung disease be classified?
As chest wall disease and interstitial lung disease.
p.12
Management Principles for ILD
When are steroids indicated in the management of ILD?
For steroid-responsive ILD where inflammation is predominant.
p.7
Management Principles for ILD
What is a common method of oxygen supplementation in ILD patients?
Acute or chronic use of nasal prongs.
p.11
Investigations and Diagnostic Techniques for ILD
What should be observed about the diaphragms in a CXR?
Costophrenic angles should be sharp with no air underneath.
p.10
Investigations and Diagnostic Techniques for ILD
What histological finding is associated with Sarcoidosis?
Non-caseating granulomas.
p.23
Management Principles for ILD
What symptomatic treatments can be provided for pleural effusion?
Oxygen, anti-pyretics, and analgesia.
p.32
Investigations and Diagnostic Techniques for ILD
What is the purpose of U&E tests in pneumonia?
To estimate eGFR and assess for pre-renal AKI.
p.2
Pathogenesis and Aetiology of ILD
What is the primary alteration in lung parenchyma seen in ILD?
Extensive alteration usually with fibrosis.
p.16
Pathogenesis and Aetiology of ILD
What is primary pneumothorax?
Pneumothorax with no underlying lung disease.
p.4
Clinical Features and Symptoms of ILD
What is a key feature of lungs affected by Idiopathic Pulmonary Fibrosis (IPF)?
Irreversibly enlarged damaged alveoli and bronchioles with cystic air spaces ('honeycombing').
p.23
Management Principles for ILD
What is the next step if a pneumothorax does not resolve after 3 days?
Consider pleurodesis: Video-Assisted Thoracoscopic Surgery (VATS).
p.3
Definition and Classification of Restrictive Lung Disease
What does the UIP pattern refer to?
It refers to particular radiological and histological findings.
p.22
Investigations and Diagnostic Techniques for ILD
What is the purpose of serum protein and serum LDH tests?
Needed for Light’s Criteria.
p.4
Differential Diagnosis for ILD
What are the imaging characteristics of IPF compared to NSIP?
IPF has UIP features, while NSIP shows more inflammatory (ground-glass) changes.
p.3
Pathogenesis and Aetiology of ILD
What is Farmer’s Lung caused by?
Exposure to thermogenic actinomyces, hay, or mold.
p.5
Complications Associated with ILD
What renal complications can arise from sarcoidosis?
Nephrocalcinosis, hypercalciuria, renal calculi.
p.12
Management Principles for ILD
What is the role of NSAIDs in the management of Sarcoidosis?
80% of patients with Lofgren’s syndrome will see remission on treatment with NSAIDs alone.
p.16
Definition and Classification of Restrictive Lung Disease
What is pleural disease?
A heterogeneous group of conditions that affect the pleural cavity.
p.7
Clinical Features and Symptoms of ILD
What type of lung sounds are associated with fibrosis in ILD?
Fine end-inspiratory crepitations that do not move on coughing.
p.2
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What is the estimated prevalence of idiopathic pulmonary fibrosis (IPF)?
2.8-19 per 100,000 people per year.
p.7
Clinical Features and Symptoms of ILD
Which conditions are associated with clubbing in ILD?
Idiopathic Pulmonary Fibrosis (IPF) and Asbestos exposure.
p.11
Investigations and Diagnostic Techniques for ILD
What does equal volume assessment in a CXR involve?
Counting the ribs and looking for mediastinal shift.
p.11
Investigations and Diagnostic Techniques for ILD
What fine details should be examined in a CXR?
The pleura and lung parenchyma.
p.7
Clinical Features and Symptoms of ILD
What is central cyanosis and how can it be assessed?
Cyanosis observed under the tongue, indicating low oxygen levels.
p.12
Management Principles for ILD
What is the management approach for inhalation ILD caused by inorganic dust?
Avoidance of the causative agent.
p.12
Management Principles for ILD
How does inhalation ILD caused by organic dust respond to treatment?
It acutely responds well to steroids.
p.32
Investigations and Diagnostic Techniques for ILD
What does a sputum culture test for in pneumonia?
Microbial culture and antibiotic sensitivity, including acid-fast bacilli.
p.16
Pathogenesis and Aetiology of ILD
What is secondary pneumothorax?
Pneumothorax with underlying chronic lung disease.
p.12
Management Principles for ILD
What are steroid-sparing agents used for long-term immunosuppression in ILD?
Methotrexate and Azathioprine.
p.32
Investigations and Diagnostic Techniques for ILD
What does CXR or CT show in pneumonia?
Evidence of consolidation; opacification may be seen.
p.22
Investigations and Diagnostic Techniques for ILD
What is thoracentesis used for?
To obtain a sample of pleural fluid and narrow down the cause using Light’s criteria.
p.2
Pathogenesis and Aetiology of ILD
What are some examples of neuromuscular diseases that can lead to restrictive lung disease?
Muscular dystrophy, Myasthenia Gravis, Guillain-Barré syndrome.
p.11
Investigations and Diagnostic Techniques for ILD
What is important to note about the hilum in a CXR?
May see hilar enlargement (sarcoid, aortic dissection) and hardware (sternotomy, PPM, central line, ET tube).
p.22
Differential Diagnosis for ILD
What measurement is used to determine the size of a pneumothorax?
Chest x-ray at the level of the hilum.
p.7
Clinical Features and Symptoms of ILD
What does reduced chest expansion indicate in ILD?
Reduced lung volume due to ILD or chest wall disease.
p.16
Epidemiology and Risk Factors for Interstitial Lung Disease (ILD)
What has contributed to the decline in mesothelioma cases?
Reduced exposure to asbestos.
