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Restrictive Lung Disease Flashcards

(56 cards)

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1
Q

What is the pulmonary interstitium

A

network of tissue that extends throughout both lungs that provides support to the alveoli and capillary beds for gas exchange

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2
Q

PFTs

A

non invasive tests that measure how well the lings are expanding and contractions and how efficient gas exchange is

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3
Q

Tidal volume

A

volume of air moved in and out during each breath

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4
Q

Vital capacity

A

maximum volume of air that can be exhaled after a maximal inspiration

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5
Q

Residual volume

A

volume of air remaining in the lungs after maximal inspiration

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6
Q

Total lung capacity

A

volume of air in the lungs after maximal inspiration

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7
Q

What does spirometry measure

A

the volume of air exhaled at specific time points during a forceful and complete exhalation

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8
Q

What are the three values spirometry generate

A

FVC, FEV1 and the FEV1/FVC ratio

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9
Q

What does spirometry help differentiate between

A

obstructive and restrictive lung disease

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10
Q

What is FVC

A

maximum amount of air exhaled after a maximal inhalation

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11
Q

What is FEV1

A

amount of air exhaled in the first second

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12
Q

What is normal FEV1

A

about 70% or above

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13
Q

What does the FEV1/FVC ratio show

A

air flow obstruction (<70%)

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14
Q

When would you do flow volume loops

A

when patient has stridor or unexplained dyspnea

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15
Q

Obstructive flow volume loop

A

concave appearance

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16
Q

Restrictive flow pattern loop

A

smaller loop

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17
Q

FEV1, FVC and FEV1/FVC ratio in obstructive lung disease

A

FEV1- normal (mild disease) or decreased (mod/severe disease)

FVC- normal (mild/mod disease) or decreased (severe disease)

FEV1/FVC ratio- <70%

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18
Q

FEV1, FVC and FEV1/FVC ratio in restrictive lung disease

A

FEV1- normal or decreased

FVC- decreased

FEV1/FVC ratio- normal or increased (greater than or equal to 70)

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19
Q

What is the benefit of DLCO

A

differentiate the etiology of restrictive lung disease

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20
Q

Low DLCO

A

interstitial lung disease

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21
Q

What does DLCO measure

A

the overall function of the alveolar capillary membrane

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22
Q

Normal DLCO

A

extrathoracic cause or restriction (obesity, chest wall disorder, neuromuscular disorder)

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23
Q

What is restrictive disease associated with

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A

decreased total lung capacity

24
Q

Intrinsic restrictive pulmonary disease

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A

diseases of the lung parenchyma, inflammation or scarring of the lung tissue

(idiopathic fibrotic disease, pneumoconioses, sarcoidosis)

25
Extrinsic restrictive pulmonary disease
extra-pulmonary diseases involving the chest wall, pleura and respiratory muscles (obesity, myasthenia gravis, ALS, kyphoscoliosis)
26
What medications induce interstitial lung disease
amiodarone, methotrexate, nitrofuranotoin
27
Risk factors for idiopathic fibrosing interstitial pneumonia
- smoking - occupational exposure (stone, metal, wood, organic dust) - GERD (micro-aspiration)
28
Symptoms of idiopathic fibrosing interstitial pneumonia
- insidious dry cough - exertional dyspnea - fatigue - tachypnea
29
Exam characteristics for idiopathic fibrosing interstiital pneumonia
- clubbing | - inspiratory rales
30
PFTs in idiopathic fibrosing interstitial pneumonia - FVC, FEV1/FVC ratio - DLCO
- reduced FVC - normal or elevated FEV1/FVC ration - Reduced DCLO - impaired 6 minute walk
31
Idiopathic firbosing interstitial pneumonia on CXR? | CT?
CXR- increase in reticular markings | CT- diffuse patchy fibrosis with pleural based honeycombing
32
Definitive diagnosis of idiopathic fibrosing interstitial pneumonia
lung biopsy, can also help rule out other causes
33
Treatment options for idiopathic fibrosing interstitial pneumonia
- supportive care (supplemental o2, vaccinations, pulm rehab) - medications - surgery (lung transplant)
34
What medications are used for idiopathic fibrosing interstitial pneumonia
Nintedanib (tyrosine kinase inhibitor) | Pirfenidone (anti-fibrotic drug)
35
Qualifications for lung transplant
- age <65 - free of stubstance abuse - acceptable BMI range of 20 to 29
36
Pneumoconioses
interstitial lung disease caused by the inhalation and deposition of inorganic particles and mineral dust with subsequent reaction of the lung
37
Clinically important pneumoconioses
- coal workers pneumoconiosis - silicosis - asbestosis
38
What is the milder form of coal worker's pneumoconioses
anthracosis
39
When do symptoms of coal worker's pneumoconioses begin to develop? What are they?
10-15 years after exposure chronic cough, fever, DOE
40
What shows up on radiography with coal worker's pneumoconoises
smaller, rounded, nodular opacities with a preference with the upper lobe
41
Clinical stages of silicosis
acute, chronic, accelerated
42
Clinical presentation of silicosis
- cough - dyspnea - possible fever or pleuritic chest pain
43
PFTs with silicosis
- decreased FEV1 and DCLO | - normal FEV1/FVC ratio
44
Findings on CXR/CT with silicosis
acute- bilateral, diffuse, groundglass opacities | chronic- small, innumerable rounded densities
45
What are the 3 key elements diagnosis of silicosis is based on
- history of silica exposure - chest imaging consistant with silicosis - absence of any other diagnosis
46
Treatment of silicosis
* no proven specific therapy - avoid further exposures - supportive care - steroid therapy - lung transplant
47
Associated complications with silicosis
- mycobacterial infection - asergillosis - lung cancer - chronic kidney disease
48
Clinical presentation of asbestosis
* asymptomatic for 20-30 years after exposure - dyspnea on exertion - cough - weight loss
49
PFTs in asbestosis
- reduced vital capacity and total lung capacity | - low DCLO
50
Complication in asbestosis
malignant mesothelioma
51
Sarcoidosis
multisystem granulomatous disorder of unknown etiology
52
What is sarcoidodsis characterized by
presence of non-caseating granuloma
53
Clinical presentation of sarcoidosis
- dry, hacking cough - progressive worsening dyspnea - atypical chest discomfort - fever/night sweats - weight loss
54
Radiographic imaging for sarcoidosis? CXR? CT?
CXR- bilateral hilar adenopathy | CT- right paratracheal lymphadenopathy along with bilateral diffuse reticular infiltrates
55
How to diagnose sarcoidosis
- endobronchial US guided biopsy - cervical mediastinoscopy - VATS lung biopsy
56
Treatment of sarcoidosis
- observation is asymptomatic | - tapering course of abx over 4 to 6 weeks

Pulmonary (3 decks)

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