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MOHD Keystone Exam 2 > #20 - Restrictive lung diseases > Flashcards

#20 - Restrictive lung diseases Flashcards

1
Q

List the 4 categories of diseases which cause restrictive thoracic disease

A
  • pleural (eg asbestosis, pleural effusion)
  • interstitial (eg, idiopathic pulmonary fibrosis.)
  • neuromuscular (eg, myasthenia gravis)
  • Thoracic / extrathoracic (kyphoscoliosis, obesity, ascites)
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2
Q

Symptoms associated with pleural effusion

A

Symptoms

  • dyspnea
  • chest pain (if parietal pleura inflamed)
  • can be asymptomatic if small
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3
Q

For which thoracic disorders is therapy helpful ?

A
  • pneumothorax
  • sarcoidosis (steroids)
  • Wegener’s granulomatosis
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4
Q

For which thoracic disorders is therapy NOT helpful ?

A

Idiopathic pulmonary fibrosis

-asbestosis (mesothelioma)

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5
Q

Spirometry for restrictive disorders

A

normal FEV1, reduces FVC.

Also, Low total lung capacity (as measured by helium gas dilution)

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6
Q

innervation of the pleura

A

parietal surface - pain fibers
diaphragmatic surface - phrenic nerve

visceral surface - no pain fibers.

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7
Q

T/F:

pleural pressure is positive at the functional residual capacity.

A

False. It is negative.

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8
Q

What causes a transudate in the pleural space?

A

changes in hydrostatic forces .

  • volume overload (renal failure)
  • r. atrial hypertension (CHF)
  • cirrhosis
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9
Q

What causes an exudate in the pleural space ?

A

increased leak across capillaries (active secretion of fluid!!!)

  • infection (pneumonia)
  • inflammation (rheumatoid arthritis)
  • infiltration - cancer

NOTE: These things (3I’s) obstruct the lymphatic duct, meaning that fluid normally excreted into the pleural space cannot drain.

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10
Q

First step in evaluation of a pleural effusion

A

-determine trasudate vs. exudate

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11
Q

Transudate vs. Exudate in terms of

  • protein
  • cell count
A

Transudate = protein poor, low cell count

Exudate = protein rich, cellular

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12
Q

Physical exam signs associated with pleural effusion

A
  • percussion dullness
  • absent breath sounds
  • egophony (nasally voice sound)
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13
Q

how do you tell if there is fluid vs. consolidation in the lung on X ray?

A

Meniscus = clear cut border. When meniscus is present, you know it is fluid, not consolidation.

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14
Q

How do you determine if there is enough fluid in the pleural space to tap.

A
  • ultrasound

- decubitus x ray with layering effusion (fluid moves when they lay on their side)

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15
Q

When is aspiration of fluid from pleural cavity NOT indicated?

A
  • rarely
  • very small effusions
  • CHF effusions
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16
Q

Should the aspiration needle hug the bottom or the top of the rib??

A

the top - neurovascular bundle on the bottom.

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17
Q

List LIGHT’s criteria - what are the criteria for

A

Any of these criteria define an exudate

  • pleural fluid protein / serum protein >0.5
  • pleural fluid LDH/ serum LDH >0.6
  • pleural fluid LDH >2/3 upper limit of normal serum LDH

If none of these criteria are met, it is a transudate.

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18
Q

If none of Light’s criteria are met. It is a transudate. What is the next step.

A

No need for further invasive evaluation.

Treat underlying disease (diuretics, dialysis, for renal/heart failure, etc)

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19
Q

LDH=

A

lactate dehydrogenase. a general indicator of tissue and cellular damage.

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20
Q

If light’s criteria are met, what is the probable diagnosis/ next step?

A

probable diagnosis = infection or malignancy

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21
Q

Pneumothorax symptoms

A

sudden onset chest pain and dyspnea

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22
Q

Pneumothorax =

A

air in the pleural space

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23
Q

Physical exam for pneumothorax

A
  • no breath sounds

- hyperresonance

24
Q

Primary pneumothorax is due to

A

rupture of apical subpleural blebs (no underlying disease, but common in smokers and thin people)

25
Q

Secondary pneumothorax is due to

A

pre-existing lung disease (COPD, CF, tuberculosis, etc)

26
Q

When should you suspect tension pneumothorax and what should you do?

A

-suspect when you see sudden deterioration on a ventilator, after a biopsy or central line placement.

Give 100% oxygen and immediate pleural decompression, without waiting for x ray confirmation.

27
Q

Pneumothorax therapy

A

-they can be observed if small (

28
Q

Which is more common - mesothelioma or metastasis to pleura?

A

metastasis to pleura. - lung, breast, lymphoid most common.

29
Q

Most common cause of mesothelioma. how to diagnose?

A

asbestos exposure. diagnose with a biopsy.

30
Q

Treatment/ prognosis for mesothelioma

A

pallative care - deadly disease w/ little response to chemo.

31
Q

T/F: Whether spontaneous or traumatic, a pneumothorax usually needs chest tube drainage

A

true

32
Q

What happens to compliance and elasticity in interstitial restrictive diseases ??

A

compliance goes down, elasticity goes down.

33
Q

Physical exam in interstitial restrictive diseases

A
  • clubbing

- rales/crackles heard at bases of both lungs

34
Q

4 categories of disease which cause interstitial lung disease (restrictive)

A

idiopathic - idiopathic pulmonary fibrosis.

  • occupational exposures - silicosis, asbestosis.
  • medications (chemotherapy)
  • autoimmune (rheumatoid arthritis)
35
Q

Reserve volume, total lung capacity, and diffusing capacity in restrictive diseases.

A

they are all low! Contrast w/ COPD - volumes high, diffusing capacity low

36
Q

Where does occupational lung disease usually occur? Why?

A

upper lobe, due to inhalational properties

37
Q

idiopathic pulmonary fibrosis usually targets which part of the lung?

A

lower lobe

38
Q

x ray for interstitial lung disease

A

decreased lung volume

39
Q

Workup of interstitial lung disease

A

CT is almost always done

40
Q

honeycombing happens in what disease

A

idiopathic pulmonary fibrosis.

41
Q

Granulomas in the lung suggest?

A

sarcoidosis or a foreign body exposure.

42
Q

Usual interstitial pneumonitis (fibrosis) occurs in which conditions?

A

it occurs in all interstitial conditions in late stages - “final common pathway”

43
Q

T/F - pulmonary fibrosis is usually unresponsive to therapy

A

True.

44
Q

CXR for sarcoidosis

A

hilar adenopathy

upper lobe predominance

45
Q

Treatment for sarcoid

A

steroids are effective treatment.

46
Q

T/F : Collagen vascular disease is as lethal as idiopathic pulmonary fibrosis

A

False - it has generally better prognosis, more benign

47
Q

symptoms for sarcoid

A
  • often asymptomatic

- rash preceding symptoms

48
Q

Calcification along the pleura

A

asbestosis (pathognomonic)

49
Q

If you suspect interstitial lung disease, you should test for c-ANCA and PR3-ANCA, to test for which disease?

A

wegener’s granulomatosis.

50
Q

3 primary characteristics of interstitial lung disease

A
  • lung scarring
  • reduced lung volumes
  • reduced compliance of the lung.
51
Q

most common treatment for interstitial lung disease

A

corticosteroids (may not work)

52
Q

Lung disease + Birifringent bodies in a polarizing microscope

A

silica

talc

53
Q

lung disease + bodies that look like a brown dumbell under microscopy

A

asbestos bodies

54
Q

Presentation of neuromuscular lung disease

A
  • paradoxical inward movement of abdomen (due to diaphragm weakness)
  • shallow breathing (due to diaphragm weakness)
  • recurrent infections due to reduced cough strength
55
Q

treatment for neuromuscular lung disease

A

oxygen, assisted cough.

56
Q

How is restrictive lung disease defined?

A

low total lung capacity.

MOHD Keystone Exam 2 (14 decks)

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