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34 Cards in this Set

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  • Back
Order of pathogenesis of diffuse ILD.
injury -> alveolitis -> cellular and ct response -> repair or fibrosis
Six agents of injury that can lead to diffuse ILD.
1. ROS
2. serine proteases
3. cationic proteins
4. immune mechanisms
5. drugs
6. arachadonic acid metabolites
A predominate Th2 type response, AKA humoral response, leads to _____.
fibrosis
A predominate Th1 type response, AKA cellular response, leads to _____.
healing
Lebow's Classification System consisted of two broad categories:
1. Acute Interstitial Pneumonias - Diffuse Alveolar Damage
2. Chronic Interstitial Pneumonias - UIP, DIP, LIP, GIP
The key to identifying UIP histologically?
spatial and temporal heterogeneity
Areas just underneath epithelial surface w/ fibroblastic proliferation, characteristic of UIP
fibroblastic foci
DIP is characterized by?
accumulations of macrophages w/in alveolar space
RBILD is only seen in?
smokers, relatively mild respods well to smoking cessation
Rapid course over typically a few weeks from onset to death.
AIP
The key difference in UIP vs. NSIP.
temporal appearance: UIP is variegated (varied across section of lung) while NSIP has more uniform appearance (mostly inflammatory, or mostly fibrotic)
____ is prominent in NSIP compared to UIP.
Interstitial inflammation
Honeycombing most frequently seen in ____
UIP
T/F: Occasionally you'll see organizing pneumonia in UIP but never in NSIP.
False. Other way around.
Hyaline membranes are occasionally seen in ____.
AIP
Most common symptoms of ILD?
dyspnea and cough (nonproductive)
Most important early sign in ILD?
tachypnea
Physical exam findings in ILD?
digital clubbing, crackles or rails when listening to chest (Velcro)
Velcro sounds in ILD heard during?
mid-inspiration, compared to late inspiration heard w/ pulmonary edema
Better prognosis: UIP or NSIP?
NSIP
UIP responds well/poorly to steroids?
poorly
DIP and NSIP respond well/poorly to steroids?
well
Three physiologic characteristics of restrictive lung disease:
reduced lung volumes, reduced compliance, diffusion impairment
People with ILD, what typically drops w/ excercise?
O2 saturation
Typically all lung volumes are _____ ______ in ILD.
reduced proportionally
On high resolution CT, abnormalities in ILD are more clustered and severe where?
on the peripheral aspects of the lung
Radiographic honeycombing is a sign of the ______ of ILD.
end stages
Two main clinical classifications of ILD:
Known and Unknown etioligies
Name some of the known etiologies of ILD:
silica, gases/fumes, pigeon droppings, drugs, radiation
Most cases of ILD are of ____ etiology.
unknown
Causes of unknown etiology ILD.
UIP, collagen vascular disease like lupus, eosinophilic pneumonias and Wegener's granulomatosis
Possible therapy for ILD?
antiinflammatories (steroids?), azothioprine, colchicine (adjunct), N-acetyl cysteine
Last ditch effort for patients w/ ILD?
lung transplant
Prognosis of UIP
50% mortality in 5 years