Restrictive Lung Diseases Flashcards Preview

Pulmonology > Restrictive Lung Diseases > Flashcards

Flashcards in Restrictive Lung Diseases Deck (37)
Loading flashcards...
1
Q

In general, what happens to lung volume in restrictive diseases

A

it is reduced

2
Q

when considering restrictive diseases, what is our broad definition - location in lung and pathologic process

A

inflammatory dz of the lower respiratory tract (alveolar dz) - fibrosis

3
Q

what do we see on CXR for restrictive lung dz

A

reduction in lung volume - see the diaphragms elevated

4
Q

define intrinsic restriction and provide example

A

restriction due to alterations in lung - interstitial fibrosis

5
Q

define extrinsic restriction

A

restriction due to alterations in surrounding structure

6
Q

there are 2 types of intrinsic lung disorders causing restriction. In addition to interstitial lung dz, what is the other?

A

resection of the lung tissue

7
Q

(pathoma) - what is the PFT definition of restrictive dz (3 things)

A

1) dec FEV1
2) greater dec FVC
3) inc FEV1/FVC ratio

8
Q

for extrinsic disorders causing restriction of lung, what are the 3 main categories?

A

1) dz of pleura
2) dz of chest wall
3) neuromuscular disorders

9
Q

for interstitial lung dz, what is the predominantly affected component (1) of what structure (2)

A

1) connective tissue

2) alveolar wall

10
Q

ILD affects 2 things - lung volume and diffusion capacity. what is the most important determinant of diffusion capacity?

A

surface area

Thus in ILD, volume is dec, so surface area is dec, and diffusion capcity is dec

11
Q

what happens to expiratory airflow in ILD

A

it is not affected; this is not an obstructive disorder

12
Q

Compare the percentages of macrophage, lymphocyte, and neurophil in lung vs peripheral blood (just most common to least common)

A

blood - neutrophils, lymphocytes, then monocytes

Lung - macrophages, lymphocytes, then neutrophils least common

13
Q

comparing the two etiologies of restrictive ILD, granulomatous and nongranulomatous, which one is more lethal, i.e. more fibrotic

A

nongranulomatous is more fibrotic, and thus more lethal

granulomas are still reversible, thus less fibrotic

14
Q

if you see nongranulomatous ILD, what should be your first thought as to cause of the ILD?

A

look at medications pt may be taking

15
Q

what 3 drugs should you be worried about in pt w/ nongranulomatous ILD

A

1) amiodarone - one of most common anti-arrhythmic drugs (MUST KNOW)
2) Bleomycin
3) nitrofurantion

16
Q

what form of therapy, not a drug, can cause nongranulomatous ILD?

A

external radiation

17
Q

if you do not know the etiology of the ILD fibrosis, and you see granulomas, what is the the dx

A

sarcoidosis - it is a dx of exclusion

18
Q

If you do not know the etiology of the ILD and you do not see granulomas (nongranulomatous), what are the two broad categories of causes

A

1) Idiopathic interstitial penumonias

2) ILD w/ connective tissue diseases

19
Q

what are 4 environmental causes of ILD fibrosis?

A

1) asbestos fibers
2) coal dust
3) cotton dust
4) pigeon droppings

20
Q

the hypoxemia of ILD is mostly due to what?

A

V/Q mismatch - V is decreased compared to Q

21
Q

what is the CO2 status of a patient with ILD? and why?

A

ILD - hypocapnia due to hyperventilation

22
Q

what happens to the A-a gradient in ILD

A

A-a gradient increases

23
Q

what is the hallmark finding of ILD (regarding oxygen status)

A

Exercise induced hypoxemia

says could be on exam

24
Q

Define exercise induced hypoxemia in terms of A-a gradient

A

A-a gradient is normal at rest, but it increases during exercise

25
Q

PFT in ILD - what are hallmark findings

1) TLC
2) VC
3) diffusing capacity
4) expiratory airflow

A

1) reduced TLC
2) reduced VC
3) reduced diffusing capacity
4) normal expiratory airflow

26
Q

again, recall the definition of restrictive lung dz in terms of FEV1, FVC, and FEV1/FVC ratio

A

FEV1 is dec
FVC is dec even more
FEV1/FVC is inc
(this might be tested - know how to diff from obstructive dz)

27
Q

To differentiate obstructive vs restrictive pathology, what values do we look for in the FEV1/FVC ratio for each (ranges)

A

obstructive - FEV1/FVC less than 70

restrictive - FEV1/FVC greater than 80

28
Q

what is the most common symptom of ILD?

A

dyspnea

29
Q

what are the common clinical signs of ILD?

1) breathing pattern
2) auscultation of lungs
3) inspection of PVD
4) heart pathology
5) oxygen status

A

1) tachypnea
2) crackles “velcro” rales
3) digital clubbing
4) cor-pulmonale, late
5) cyanosis, late

30
Q

what is the buzzword radiologic finding of ILD that suggests end stage lung dz

A

honeycomb

31
Q

what is the buzzword radiologic finding of ILD that suggests early-stage lung dz

A

ground glass

32
Q

what is the buzzword radiologic finding of ILD that suggests in-between stage lung dz

A

interstitial markings (reticulo-nodular)

33
Q

is ground glass appearance reversible?

A

yes - can be treated

34
Q

what are the 5 components of diagnosis of ILD

A

1) extensive history
2) physical exam - evaluate symptoms and signs
3) look at radiographs
4) PFTs
5) BAL and lung biopsy (not necessary every time)

35
Q

Know about BAL

A

Muthiah told this guy to talk about it, it must be impt

36
Q

know that lung resection can cause restrictive pathology

A

remove part of lung, TLC must decrease, and so on

37
Q

in what fraction of patients can the dx of restrictive lung disease be made with just PFT and radiology? what fractioin requires lung biopsy?

A

PFT + radiology - 2/3 of pts

lung biopsy - 1/3