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ICP EXAM 2, ICP Exam 2 Prescription Writing, Pain Management,
Nutrition, Exercise, Gender Affirming Care, Pain
What is Interstitial Lung Disease (ILD)? - Ans *Umbrella term* for heterogenous group
of disorders, characterized by *varying* patterns of *lung inflammation* and *fibrosis*
The term arises from the *histological* appearance that the *interstitium* is ab normal,
although the alveoli, airways, blood vessels, and pleura are often altered as well
ILD arises from - Ans identified cause or idiopathic
*3 MC*:
sarcoidosis
cryptogenic organizing pneumonia
idiopathic
many causes of ILD - connective tissue dis eases, treatment -related or drug -induced
diseases, primary and idiopathic diseases, occupational and environmental diseases,
inorganic disease, etc.
what are some classifications of ILD? - Ans Connective Tissue Diseases
Treatment -Related or Drug -Induced Diseases
Primary and Idiopathic Diseases
Occupational and Environmental Diseases
Inorganic
Organic
Bird breeder's/Farmer's lung
some ILDs are more common in women, such as - Ans those resulting from
*autoimmune* diseases, also known as *connective tissue disorders*
occupational exposure causes of ILD are more common in - Ans men
Most ILDs occur in people older than? - Ans 50 yrs of age
what are some common identifiable risk factors for ILD? - Ans environmental exposures
such as down, mold, silic one, and asbestos
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reactions to drugs such as chemotherapeutic agents, tyrosine kinase inhibitors,
amiodarone, and nitrofurantoin
radiation therapy
connective tissue disease including rheumatoid arthritis, scleroderma, and myositis
pathologic acid ref lux
both tobacco and drug use
some have increased genetic susceptibility
Concerning PE Findings for ILD? - Ans shortness of breath (especially with exertion)
cough (dry)
tachypnea
bibasilar end -inspiratory dry crackles
pulmonary hypertension
cyanosis
clubbing
ILD Hallmarks: - Ans *restriction* of lung volumes and reduced diffusing capacity
demonstrated by pulmonary function tests
potentially reversible unless fibrosis, once fibrosis occurs, restrictive patterns are
IRREVERSIBLE
Diffusion abnormalities can result from - Ans loss of functional capillaries from fibrosis
emphysema
pulmonary hypertension
what are granulomatous changes that may be seen? - Ans accumulation of T
lymphocytes, macrophages, and epithelioid cells into granulomas i n lung parenchyma
ILD Etiology - Ans lungs are constantly exposed to potentially noxious stimuli
lung injury leads to regeneration, repair, or remodeling responses that can result in
restoration of normal tissue, inflammation, or fibrosis
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alveolar epi thelial damage from repeated injuries promotes migration of inflammatory
cells into the lungs
if regeneration or repair of the epithelium fails, remodeling occurs
a fibrotic milieu promotes proliferation of fibroblasts and collagen deposition
ILD Differential - Ans ILD
Pneumoconiosis
HfpEf early heart failure
Long term bacteiral or early lung infection
PE
Ferri's is essentially the same but adds COPD, pulmonary HTN, metastatic malignancy,
and vasculitis
what is MDD? - Ans Multidisciplinary discussion, which is considered *standard of care*
to diagnose ILD
includes pulmonologist, radiologist, pathologist
they review exposure history, exam findings, PFTs, lab tests, and HRCT
surgical lung biopsy may be done and should be considered esp if diagnosis remains
unclear
ILD Workup/Diagnostics - Ans 1) History and physical (exposures, CTD, malignancies,
etc.)
2) Pulmonary function tests
3) Chest imaging
- Chest radiograph, Chest CT
4) Bronchoalveolar lavage
5) Lung biopsy
- Transbronchial biopsy, Open lungs
6) Video -assisted thorascopic surgery (VATS) biopsy
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