Restrictive Lung Diseases

Question 1

Thoracic restriction can be due to causes ……. the lungs

Answer 1

OUTWITH

Question 2

Name some skeletal causes of thoracic lung restriction.

Answer 2

Vertebrae e.g thoracic kyphoscoliosis
Ankylosing spondylitis
Rib fractures

Question 3

Name some muscular causes of thoracic lung restriction

Answer 3

Muscle weakness e.g myopathy, neuropathy
MND
Polio
Gulian Barre

Question 4

Name 2 conditions that can cause compression of the thoracic contents.

Answer 4

Ascites

Obesity

Question 5

What does thoracic restriction result in?

Answer 5

Chronic alveolar under-ventilation with low PaO2 and raised PaCO2 and reduced lung volumes

Question 6

Describe the 5 main categories of DPLD.

Answer 6

1. Acute DPLD
2. Episodic DPLD, all of which may present acutely
3. Chronic DPLD due to occupational or environmental agents or drugs.
4. Chronic DPLD with evidence of systemic disease
5. Chronic DPLD with no evidence of systemic disease

Question 7

What is DPLD? What is it also know as?

Answer 7

A group of lung diseases affecting the lung parenchymal e.g alveolar lungs/lumen
Interstitial lung disease

Question 8

What is impaired as a result of DPLD? What does this mean?

Answer 8

Alveolar gas exchange is impaired

There is an alveolar barrier to O2 exchange

Question 9

What remains normal in DPLD?

Answer 9

Alveolar ventilation

Question 10

What does the normal alveolar ventilation mean?

Answer 10

CO2 exchange is unimpaired

Question 11

What is the main cause of DPLD?

Answer 11

Fluid in the alveolar spaces

Question 12

Name a cardiac condition that could result in fluid in the alveolar spaces. Explain this.

Answer 12

LVF
Raised pulmonary venous pressure due to back pressure from the heart
Accumulation of oedema in alveolar walls and lumen

Question 13

Name other conditions which could lead to a build up of fluid in the lungs BUT with normal pulmonary pressure.

Answer 13

Leaky vessels, normal pressure
Sepsis
Trauma
ARDS
Altitude sickness

Question 14

DPLD can also be caused by …………. in alveolar spaces

Answer 14

Consolidation

Question 15

Name some causes of consolidation in alveolar spaces.

Answer 15

Pneumonia
Infarction
Rheumatoid drugs

Question 16

What kind of infarction can lead to DPLD?

Answer 16

PE

Vasculitis

Question 17

What different types of pneumonia can cause consolidation in the lungs? Give examples under each heading.

Answer 17

Viral - flu, measles, chickenpox
Bacterial - pneumococcus, TB
Fungal - HIV, pneumocystitis

Question 18

Inflammatory infiltrate in alveolar walls is another cause of DPLD

Answer 18

TRUE

Question 19

What is alveolitis?

Answer 19

Inflammatory infiltrate in alveolar walls

Question 20

Name the 2 main types of granulomatous alveolitis.

Answer 20

Extrinsic Allergic Alveolitis

Sarcoidosis

Question 21

What can EAA also be called?

Answer 21

Hypersensitivity Pneumonitis

Question 22

What type of hypersensitivity reaction is EAA?

Answer 22

Type 3

Question 23

Name a common sign of Sarcoidosis.

Answer 23

Chronic enlargement of lymph nodes

Question 24

Sarcoidosis is a …..-system disease

Answer 24

MULTI

Question 25

Name 4 common symptoms that accompany Sarcoidosis.

Answer 25

Erythema Nodosum Uveitis Myocarditis Neuropathy

Question 26

Alveolitis can also be drug induced. Name some common drugs that cause this condition.

Answer 26

Amiodarone Gold Methotrexate Bleomycin

Question 27

What toxic gas can cause alveolitis?

Answer 27

Chlorine

Question 28

Name 3 auto-immune conditions which are associated with Alveolitis.

Answer 28

SLE Polyarteritis Wegeners

Question 29

What is the conditions known as 'dust disease'?

Answer 29

Pneumoconiosis

Question 30

There are 2 types of pneumoconiosis, what are they?

Answer 30

Fibrogenic | Non-fibrogenic

Question 31

Name 2 conditions under the heading of Fibrogenic Pneumoconiosis

Answer 31

Asbestosis | Silicosis

Question 32

Name 5 signs/symptoms of DPLD.

Answer 32

``` SOB on exertion Cough Clubbing Inspiratory crackles (base) Central cyanosis ```

Question 33

What occurs as an end stage response to inflammation?

Answer 33

Pulmonary fibrosis

Question 34

The cough in DPLD is associated with a wheeze

Answer 34

FALSE | NO wheeze

Question 35

Describe what would be heard on auscultation of the lungs in a patient with DPLD.

Answer 35

Fine, inspiratory crackles | Base of lungs

Question 36

DPLD patients have reduced lung volumes. Describe this.

Answer 36

FEV1 and FVC - DECREASED | Normal ratio >75%

Question 37

People with DPLD have a normal peak flow

Answer 37

TRUE

Question 38

Those with DPLD have increased gas diffusion

Answer 38

FALSE - decreased

Question 39

Describe the arterial oxygen DESATURATION is DPLD.

Answer 39

Decreased PaO2 at rest and during exercise

Question 40

Outline some other tests that should be done in the diagnosis of DPLD.

Answer 40

1. Antibodies 2. Serum ACE and Ca 3. CXR 4. ECHO 5. CT 6. BAL 7. Biopsy

Question 41

Antibodies

Answer 41

Avian Fungal Auto-antibodies

Question 42

Serum ACE and Ca

Answer 42

Sarcoidosis

Question 43

CXR

Answer 43

Bilateral diffuse alveolar infiltrates

Question 44

ECHO

Answer 44

LVF

Question 45

CT

Answer 45

Inflammatory ground glass | Fibrotic nodular component of alveolar infiltrates

Question 46

BAL

Answer 46

Infection TB Pneumocystitis

Question 47

Biopsy

Answer 47

Rare

Question 48

What is always the FIRST step in the treatment of DPLD?

Answer 48

Remove any triggers | e.g dust, drug, allergen

Question 49

What should be given if the patient is hyperaemic?

Answer 49

O2 obvs

Question 50

What is the 1st and 2nd line of treatment in DPLD?

Answer 50

1. Systemic corticosterone e.g oral Prednisolone 2. Oral Azothioprine 3. Anti-fibrotic (IPF) 4. Anti-oxidant (IPF)

Question 51

What is the last resort for end stage disease?

Answer 51

Lung transplant

Question 52

Bilateral nodular lymphadenopathy and lung infiltrates

Answer 52

Sarcoidosis

Question 53

What type of granulomas are found in Sarcoidosis?

Answer 53

Non-ceseating