1. what is traction bronchiectasis? and which Ix and which disease?
    • airway dilatation due to lung fibrosis
    • seen on CT
    • classical of idiopathic pulmonary fibrosis
  2. What is the differential diagnosis for interstitial lung disease?
    • Pneumoconioses (organic, inorganic)
    • Sarcoidosis
    • Idiopathic pulmonary fibrosis aka Fibrosing alveolitis
    • Goodpasture’s syndrome
    • Vasculitis: Wegener’s granulomatosis, Churg Strauss
    • Post ARDS
    • CT disease: scleroderma, rheumatoid arthritis
  3. if you need to do a BAL, how do you know you have an adequate sample?
    • there will be FEWER ciliated respiratory cells
    • there will be alveolar macrophages
  4. on BAL if cells are: bilobed and granular cells, what are these?
  5. What would an increase in lymphocytes indicate?
  6. What would increase in neutrophils indicate?
    Idiopathic pulmonary fibrosis
  7. on auscultation what would you hear with idiopathic pulmonary fibrosis?
    Bibasal fine end-inspiratory crackles
  8. when Idiopathic pulmonary fibrosis is rapidly progressive, what is this termed?
    Hamman-Rich syndrome
  9. what is the age and gender more in Idiopathic pulmonary fibrosis?
    • m>f
    • 60+ years
  10. what does end stage Idiopathic pulmonary fibrosis look like?, why?
    honeycomb lung as interstitial fibrosis leading to cystic AIR spaces
  11. what is the difference between interstitial lung disease and left heart failure on CXR?
    LHF: big heart
  12. what are the signs of Idiopathic pulmonary fibrosis on CXR, also in advanced disease?
    • reduced lung volume
    • bilateral lower zone reticulo-nodular shadows
    • advanced disease: honeycomb lung
  13. which investigation is key in the diagnosis of Idiopathic pulmonary fibrosis?
    CT scan as more sensitive than CXR
  14. what is the management of Idiopathic pulmonary fibrosis?
    • many have irreversible disease, unresponsive to treatment
    • give prednisolone for 4 weeks then re-asses and reduce dose
    • alternative: cyclophosphamide
    • monitor with: CXR, lung function tests, symptom check
    • lung transplant
  15. what age and ethnic group does sarcoidosis affect?
    • 20-40yo
    • afro-caribbean
  16. how does acute sarcoidosis often present?
    • erythema nodosum
    • polyarthralgia
    • usually resolves spontaneously
  17. what are the symptoms of pulmonary sarcoidosis?
    • dry cough
    • progressive dyspnoea
    • reduced ex tolerance
    • chest pain
  18. what is the CXR sign of sarcoidosis? how is it different from lymphoma?
    • bilateral hilar lymphadenopathy
    • lymphoma (no separation between heart and node enlargement)
  19. what are the extra-pulmonary manifestations of sarcoidosis?
    • lymphadenopathy
    • hepatomegaly
    • splenomegaly
    • eyes: uveitis, keratoconjuncivitis sicca, glaucoma, conjunctivitis
    • phalangeal bone cysts
    • enlargement of lacrimal and parotid glands
    • Bell's palsy
    • neuropathy
    • meningitis
    • brainstem and spinal syndrome
    • erythema nodosum
    • lupus pernio
    • subcut nodules
    • cardiomyopathy
    • hypercalcaemia
    • renal stones
    • hypercalciuria
    • arrhythmias
    • pituirary dysfunction
  20. what are the blood results for sarcoidosis?
    • increased ESR
    • lymphopenia
    • inc LFT
    • inc ACE
    • inc Ca
  21. what would lung functions tests show in sarcoidosis?
    • reduced lung volumes
    • impaired gas transfer
    • restrictive defects
  22. what would tissue biopsy of sarcoidosis show?
    non caseating granulomata
  23. what does BAL in sarcoidosis show?
    • active: inc lymphocytes
    • pulm fibrosis: inc neutrophils
  24. what would US of the kidney and liver look like in sarcoidosis?
    • nephrocalcinosis
    • hepatosplenomegaly
  25. what would bone x-rays in sarcoidosis show?
    punched out lesions in terminal phalanges
  26. why do patients with bilateral hilar lymphadenopathy not require treatment?
    majority recover spontaneously
  27. what is the treatment of acute sarcoidosis?
    • bed rest
    • NSAIDs
  28. If pleural fluid was clear, what does this indicate?
    normal or transudate/exudate (protein)
  29. if pleural fluid was turbid or yellow?
    • Empyema
    • parapneumonic effusion (inflammation of pleura caused by pneumonia makes an effusion but is NOT infected…whereas empyema is infected!)
  30. If pleural effusion was bloody what could that be due to?
    • Trauma
    • Malignancy
    • Pulmonary infarction
  31. If pleural effusion was bloody what could that be due to?
    • Trauma
    • Malignancy
    • Pulmonary infarction
  32. NB it is normal to see mesothelial cells pleural fluid in the pleural effusion
  33. If there are too many mesothelial cells pleural fluid, what may this indicate?
    Pulmonary infarction
  34. If there are abnormal mesothelial cells pleural fluid, what does this indicate?
  35. If there are multinucleated giant cells in the pleural fluid what does this indicate?
    Rheumatoid arthritis
  36. If there are lupus erythematosus cells pleural fluid, what does this indicate?
  37. is normal to see mesothelial cells in the pleural fluid?
  38. If there are abnormal, multinucleate, pleomorphic cells in the pleural fluid, what is the differential?
    • Malignant mesothelioma
    • Metastasised adenocarcinoma: exclude by immunohistochemistry
  39. when performing a CT guided biopsy, what must you warn the patient?
    risk of rebleed, haemoptysis, pneumothorax
  40. what must 3 things need to be done before doing a CT guided lung biopsy?
    • 1. warn pt of risk (rebleed, haemoptysis, PT)
    • 2.
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