ILD, sarcoidosis & eosinophilic lung flashcards
19 high-yield MRCP Part 1 cards from the Intellect Medicos Respiratory Medicine course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
Study these 19 cards Save progress — free account
-
What is the gold-standard investigation for interstitial lung disease?
Show answer
High-resolution CT (HRCT) of the chest.
Why? HRCT shows the pattern (reticulation, ground glass, honeycombing, traction bronchiectasis), which often gives the diagnosis without biopsy.
-
Which lung function abnormality is often the earliest in ILD?
Show answer
A reduced gas transfer (TLCO/DLCO).
Why? Thickened alveolar walls impair diffusion before lung volumes fall. Later, spirometry shows a restrictive pattern with low FVC and TLC.
-
What HRCT pattern is typical of idiopathic pulmonary fibrosis (IPF)?
Show answer
Basal, subpleural reticulation with honeycombing (usual interstitial pneumonia pattern).
Why? Honeycombing is the hallmark of IPF; inflammation is minimal, so steroids do not help.
-
What is the disease-modifying drug treatment for idiopathic pulmonary fibrosis?
Show answer
Antifibrotic therapy: pirfenidone or nintedanib.
Why? They slow the decline in FVC. Supportive care includes oxygen and pulmonary rehabilitation; lung transplant for progressive disease.
-
What is the mechanism of action of nintedanib?
Show answer
Tyrosine kinase inhibitor (blocks VEGF, FGF and PDGF receptors).
Why? These growth-factor pathways drive fibroblast proliferation. Main side effects: diarrhoea and raised liver enzymes.
-
Which skin side effect is characteristic of pirfenidone?
Show answer
Photosensitivity rash (patients should avoid sun and use sunscreen).
Why? GI upset (nausea, dyspepsia) and raised liver enzymes are also common, so LFTs are monitored.
-
What HRCT sign is characteristic of cryptogenic organising pneumonia (COP)?
Show answer
The reversed halo (atoll) sign, with patchy peripheral or peribronchial consolidation/ground glass.
Why? COP often follows an infection or drug exposure and responds dramatically to corticosteroids.
-
What is the first-line treatment for cryptogenic organising pneumonia or NSIP?
Show answer
Oral corticosteroids.
Why? These are inflammatory ILDs with good (NSIP) or excellent (COP) steroid response. Azathioprine or mycophenolate are added if steroid-dependent.
-
Name three drugs that can cause pulmonary fibrosis.
Show answer
Any three of: amiodarone, nitrofurantoin, bleomycin, methotrexate.
Why? Drug-induced ILD may improve if the drug is stopped early, so always take a drug history.
-
What type of granuloma is found in sarcoidosis?
Show answer
Non-caseating granulomas.
Why? Caseating (central necrosis) granulomas point instead to TB.
-
What is Löfgren's syndrome, and what is its prognosis?
Show answer
Acute sarcoidosis with erythema nodosum, bilateral hilar lymphadenopathy and arthralgia/arthritis; excellent prognosis, often self-limiting.
Why? It usually needs only NSAIDs/supportive care, not long-term immunosuppression.
-
Which form of sarcoidosis combines parotid enlargement, uveitis, facial nerve palsy and fever?
Show answer
Heerfordt's syndrome (uveoparotid fever).
Why? Bilateral parotid and lacrimal gland enlargement with dry eyes and mouth is called Mikulicz syndrome.
-
Why does sarcoidosis cause hypercalcaemia?
Show answer
Granuloma macrophages express 1-alpha-hydroxylase, increasing active vitamin D (calcitriol) and gut calcium absorption.
Why? This can cause hypercalciuria, nephrocalcinosis and renal impairment — an indication for treatment.
-
What gives the definitive diagnosis of sarcoidosis?
Show answer
Tissue biopsy showing non-caseating granulomas.
Why? Serum ACE is often raised but is neither sensitive nor specific enough for diagnosis.
-
What is the first-line treatment for sarcoidosis that needs treatment, and the usual second-line agent?
Show answer
Corticosteroids first-line; methotrexate (or azathioprine/hydroxychloroquine) second-line.
Why? Anti-TNF therapy is third-line. Many patients (e.g. stage I, Löfgren's) need no treatment.
-
Name three indications for treating sarcoidosis.
Show answer
Any three of: hypercalcaemia, cardiac/neurological/eye involvement, stage II with symptoms, stage III–IV disease, progressive renal impairment, severe skin disease.
Why? Asymptomatic stage I disease often resolves on its own and is observed.
-
What is the significance of lupus pernio in sarcoidosis?
Show answer
It marks chronic sarcoidosis with a poor prognosis (linked with upper airway involvement and pulmonary fibrosis).
Why? Lupus pernio is a violaceous plaque on the nose, cheeks or ears, unlike erythema nodosum which marks acute, self-limiting disease.
-
Which types of hypersensitivity cause extrinsic allergic alveolitis (hypersensitivity pneumonitis)?
Show answer
Type III and type IV.
Why? Repeated inhalation of organic antigens (e.g. bird proteins, mouldy hay) causes immune-complex and cell-mediated lung inflammation; serum precipitating IgG antibodies support the diagnosis.
-
Which parasite classically causes Löffler's syndrome (transient lung shadowing with blood eosinophilia)?
Show answer
Ascaris lumbricoides.
Why? Larvae migrate through the lungs, causing fleeting eosinophilic infiltrates.