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Respiratory > Restrictive Lung Disease > Flashcards

Restrictive Lung Disease Flashcards

1
Q

What is the physiological definition of restrictive lung disease?

A

FVC is <80% of normal

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2
Q

What volumes are affected in restrictive lung disease?

A

All are reduced - VC, RV, ERV, IC, TLC and TV

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3
Q

What is the marker of restrictive lung disease?

A

Vital capacity
VC < 80% is abnormal

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4
Q

What is used to determine FVC?

A

Spirometry

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5
Q

What are some interstitial lung diseases?

A

Idiopathic pulmonary fibrosis
Sarcoidosis
Hypersensitivity pneumonitis

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6
Q

What are some pleural causes of restrictive lung disease?

A

Pleural effusions
Pneumothorax
Pleural thickening

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7
Q

Explain pleural effusions

A

There is an excessive collection of fluid in the pleural cavity
Has restricted pattern of lung airflow

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8
Q

Explain a pneumothorax

A

A collapsed lung that occurs when air enters into the pleural cavity
This causes chest pain and breathlessness

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9
Q

Explain pleural thickening

A

Increase of bulkiness of one or both of the pulmonary pleura
Can be due to asbestos exposure
TB can also cause pericardium thickening

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10
Q

What are some skeletal causes for restrictive lung disease?

A

Kyphoscoliosis
Ankylosing spondylitis
Thoracoplasty
Rib fractures

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11
Q

What is kyphoscoliosis?

A

An abnormality of the spine causing excessive curvature of the upper back. This causes pain and stiffness

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12
Q

What is ankylosing spondylitis?

A

A type of arthritis in the spine, causing inflammation and gradual fusing of the vertebrae

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13
Q

What is a thoracoplasty?

A

Thoracoplasty is a surgical technique initially designed to permanently collapse tuberculous cavities by resection of ribs from the chest wall
Volume in right is one side is increased and calcification can occur

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14
Q

Explain rib fractures and restrictive lung condition?

A

If sore then cant expand rib
If in CF then can be dangerous as can bring up a lot of sputum

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15
Q

Describe amyotrophic lateral sclerosis and restrictive lung disease?

A

This is caused by muscles
Muscles cant inflate lungs

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16
Q

What are some sub-diaphragmic causes of restrictive lung disease?

A

Obesity and pregnancy

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17
Q

Where is the interstitium?

A

It is between the epithelium of the alveolus and endothelium of the capillary

18
Q

Describe the interstitium?

A

Is very thin and if thickened can cause shortness of breath

19
Q

What are interstitial lung diseases?

A

There are over 200 diseases causing thickening of the interstitium and can result in pulmonary fibrosis

20
Q

What is sarcoidosis?

A

Multisystem granulomatous disease of unknown cause
Granuloma is a cluster of inflammatory cells

21
Q

What is the histological hallmark of sarcoidosis?

A

Non-caseating granuloma

22
Q

What is Erythema nodosum?

A

Is reddish, painful, tender lumps most commonly located in the front of the legs
Is skin inflammation
Patients with sarcoidosis can present with this rash

23
Q

What is anterior uveitis?

A

Inflammation of the iris and ciliary body - not middle of eye
Painful red eye

24
Q

Describe skin lesions and sarcoidosis?

A

Skin lesions are granulomatous so show hallmark of sarcoidosis

25
Q

Where do granulomas tend to be located?

A

At areas of skin trauma - scars or tattoos

26
Q

What is lupus pernio?

A

Is a nasal lesion which can be a clinical presentation of chronic sarcoidosis
Treated with steroid injections and other therapies

27
Q

Who usually gets sarcoidosis?

A

Adults under 40 years old
More women then men
Happens world wide

28
Q

How do we investigate sarcoidosis?

A

History and exam
CXR
Then pulmonary function tests, bloods, urinalysis, ECG, TB skin test and eye exam

29
Q

What would further investigation of sarcoidosis involve?

A

Bronchoscopy including transbronchial biopsies and endobronchial US

30
Q

What surgical biopsies may be needed in sarcoidosis?

A

Mediastinoscopy
Video assisted thoracoscopy lung biopsy (VATS) - uncommon

31
Q

Describe stage 1 -4 of sarcoidosis on CXR?

A

1 - bulky lymph glands - paratracheal nodes
2 - spotty lungs
3 - interstitial change
4 - fibrotic advancement

32
Q

Does stage affect prognosis?

A

Stage 1 has highest of 55-90%
Then lower is stage 4 is 0% as now fibrotic change which is irreversible

33
Q

How should sarcoidosis be treated in patient with mild disease, no vital organ involvement and normal lung function?

A

No treatment

34
Q

How should you treat a patient with erythema nodosum/ arthralgia?

A

NSAIDs - non-steroidal anti-inflammatory drugs

35
Q

How would you treat a patient with skin lesions/ anterior uveitis or cough?

A

Tropical steroids rather than systemic drugs

36
Q

What is the treatment for a patient who has cardiac, neurological sarcoid, eye disease not responding to topical Rx?

A

Systemic steroids ex. prednisolone
Also used if patient has hypercalcaemia

37
Q

What are some respiratory complications of sarcoidosis?

A

Progressive resp. failure
Bronchiectasis
Aspergilloma can give haemoptysis or pneumothorax

38
Q

What is idiopathic pulmonary fibrosis?

A

Is chronic scarring lung disease and breathing becomes increasingly more difficult
Gives the honeycomb lung
Has fibroblastic focus - collagen factory

39
Q

What is the typical presentations of IPF?

A

Chronic breathlessness, cough, clubbed and crackles
Failed prescription for LVF or infection
Typically 60-70 can commoner in men

40
Q

What are the options of management for a patient with IPF?

A

Refer to ILD clinic
Medical options - oral anti-fibrotic (prifenidone, nintedanib) and palliative care
Transplant

41
Q

What is hypersensitivity pneumonitis?

A

When lungs develop an immune response to something you breath in and causes inflammation of lung tissue

42
Q

What are the causes of hypersensitivity pneumonitis?

A

Birds and pigeons
Hay
Malted whiskey factory - lungs reacting against factory

Respiratory (24 decks)

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