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Clin Med, Path, Pharm > test 7.2 > Flashcards

test 7.2 Flashcards

1
Q

Definition of restrictive lung disease

A

Characterized by reduction in lung volume. (TLC, VC, or resting lung volume)

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2
Q

What are the two groups of restrictive lung disease?

A 
Lung parenchyma (intrinsic):  air spaces fill with exudates and debris
Extraparenchyma (extrinsic): dz of chest wall, pleura, and respiratory muscles
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3
Q

Types of intrinsic restrictive lung disease

A

Sarcoidosis
Idiopathic pulmonary fibrosis
Interstitial lung disease (asbestosis, pneumoconiosis, meds, drugs, radiation, hypersensitivity pneumonitis, rheumatoid arthritis, lupus, scleroderma)
ARDS, IRDS

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4
Q

Types of extrinsic restrictive lung disease

A

Myasthenia gravis
Guillain Barre
Kyphosis and chest wall deformities
Dz that restricts lower throacic or abdomen volume (obesity, hernia, ascites)

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5
Q

True or false: Restrictive lung dz preserves airflow and resting lung volume

A

True

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6
Q

How do you measure airflow and resting lung volume?

A

functional residual capacity (FRC)

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7
Q

Which step is passive, lung inflation or lung deflation?

A

Deflation

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8
Q

Volume of air in the lungs with respiratory muscles fully relaxed so no airflow is present

A

FRC

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9
Q

Multisystem inflammatory disease of unknown etiology (esp.lungs, lymph nodes, skin)

A

sarcoidosis

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10
Q

How does sarcoidosis present?

A

Non-necrotizing granulomas in lungs and intrathroacic lymph nodes. Exaggerated immune response from T cells

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11
Q

What race has greater prevalence and severity of sarcoidosis?

A

African Americans

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12
Q

Typically age of onset of sarcoidosis

A

24-45

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13
Q

fever, weight loss, arthralgia, DOE, crackles, skin lesions, uveitis, lupus pernio

A

Sarcoidosis

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14
Q

How is sarcoidosis staged?

A

CXR

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15
Q

Bilateral hilar lymphadenopathy stage

A

1

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16
Q

BHL & infiltrates stage

A

2

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17
Q

Infiltrates stage

A

3

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18
Q

Fibrosis stage

A

4

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19
Q

What do non-caseating granulomas secrete?

A

Vit D like hormone (causes hypercalcemia and hypercalciuria), ACE (ACE levels are high)

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20
Q

What will pulmonary function tests show?

A

Decreased VC and DLCO, pulm. htn, O2 drops w/ 6. min of walking

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21
Q

Measures the ability of lungs to transfer gas from inhaled air to the RBCs in pulmonary capillaries

A

DLCO

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22
Q

Mainstay of therapy for sarcoidosis

A

Corticosteroids

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23
Q

Sarcoidosis and can’t tolerate steroids

A

Methotrexate

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24
Q

Given for cutaneous lesions, hypercalcemia, neruological, bone lesions of sarcoidosis

A

Chloroquine

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25
Qualifications for lung transplant with sarcoidosis
Stage 4 with VC <40%
26
Follow up of sarcoidosis
CXR and PFT every 6-12 months | Annual slit lamp eye exam
27
Specific form of chronic, progressive interstitial scarring of unknown cause
Idiopathic pulmonary fibrosis
28
Prognosis of IPF
Poor, 2-5 year survival from time of dx
29
Epithelial-fibroblastic dz that causes diffuse epithelial cell disorganization
IPF pathophys
30
88% of IPF pts have this
Obstructive sleep apnea (OSA)
31
How does IPF present?
DOE, non-productive cough, weight loss, low grade fevers, fatigue, arthralgias
32
IPF PE
Inspiratory crackles PH Digital clubbing
33
Symptoms of PH
RV heave Increasd JVP Pedal edema Tricuspid regurgitation
34
IPF CXR findings
Reticular opacities, predominantly at lung bases (honeycombing) HIgh-res CT shows patchy reticular opacities
35
IPF treatment
``` Treat comorbidities Smoking cessation Oxygen therapy Vaccination (flu and pneumococcal) Lung transplant? ```
36
Specific form of chronic, progressive interstitial scarring of known cause
Interstitial Lung Disease
37
Asbestosis, silicosis, pneumoconiosis cause what type of lung dz?
ILD
38
Medication, drug, radiation caused scarring is what type of disease?
ILD
39
Hypersensitivity pneumonitis is a cause for what type of disease?
ILD
40
Collagen vascular diseases like rheumatoid arthritis, lupus, and scleroderma cause what type of scarring lung disease?
ILD
41
Result of ILD where increased interstitial tissue replaces normal capillaries and alveoli?
Decreased perfusion
42
What are the four leading coal producing states?
Wyoming West Virginia Kentucky Pennsylvania
43
Coal mining can give you what disease?
pneumoconiosis
44
What medications can cause ILD?
``` Nitrofurantoin ASA Methotrexate Amiodarone Propanolol ```
45
What drugs can cause ILD?
Heroin Methadone Cocaine Propoxyphene
46
What is cause of hypersensitivity pneumonitis that can cause ILD?
Bird-breeder's lungs (bird dropping) Farmer's lungs (moldy hay) Humidifier lungs (hot tubs, air conditioners) Chemical worker's lungs (resins, plastics, paints)
47
Connective tissue diseases that cause ILD
scleroderma, rheumatoid arthritis, SLE, Sjogren's syndrome, polymyositis
48
S/Sx of ILD
``` DOE non-productive cough Decreased DLCO Diffuse inspiratory rales/wheezing Fever, chills, malaise ```
49
ILD CXR findings
Interstitial opacities (GROUND GLASS)
50
ILD Treatment
``` Corticosteroids Immunosuppressive (cyclosporine) Oxygen therapy Pulmonary rehab Transplant? Vaccines: pneumococcal, influenza ```
51
Characterized by bilateral pulmonary infiltrates and severe hypoxemia with diffuse alveolar injury leading to respiratory failure
ARDS
52
What are the two types of ARDS?
Direct (toxic inhalation) | Indirect (sepsis)
53
What is the mortality rate of ARDS if 3 organ systems fail?
99%
54
Pathophys of ARDS
Increased permeability of alveolar-capillary barrier, Main sites of injury are vascular endothelium (sepsis) or alveolar epithelium (aspiration). promotes pulmonary edema
55
What % of ARDS pts have no identifiable risk factor?
20
56
Aspiration of gastric contents, sepsis, pancreatitis, multiple long bone fx, burns, transfusions, CABG sx, and drug OD are risk factors for what?
ARDS
57
ARDS presentation
Critically ill, multi-system organ failure | Illness develops 12-28 hrs after event
58
PEEP and CPAP acronyms
PEEP: Positive end expiratory pressure CPAP: Continuous positive airway pressure
59
ABG in ARDS
initially resp. alkalosis with progression to acidosis
60
CXR in ARDS
bilateral pulmonary infiltrates (evolve rapidly, most severe in first 3 days)
61
ARDS treatment
No drugs proven beneficial. Ventilator support PEEP, VTE, stress ulcer prophylaxis
62
Hyaline membrane disease
IRDS
63
Impaired surfactant synthesis, leading to atelectasis, hypoventilation and hypoxemia
IRDS
64
True or False: IRDS is related to prematurity (26-32 weeks) of infants
True
65
IRDS risk factors
``` prematurity maternal diabetes C section delivery Perinatal asphyxia FH of IRDS ```
66
S/Sx of IRDS
Cyanosis, apnea, rapid breathing, grunting, nasal flaring, decreased urine output
67
Diagnosis of IRDS
ABGs, CXR, lab tests (r/o infx)
68
IRDS treatment
CPAP Surfactant Warm, moist oxygen Maintain ideal body temp, calm setting, carefully manage nutrition and fluids, treat infx right away
69
Rare autoimmune disorder where antibodies form against acetylcholine receptors at neuromuscular junction of skeletal muscles
Myasthenia gravis
70
How does myasthenia gravis cause restrictive lung dz?
Respiratory muscle weakness (extrinsic)
71
Autoimmune d/o when immune system attacks myelin sheath that surrounds peripheral nerves causing weakness
Guillain Barre syndrome-- | Respiratory muscle weakness causes extrinsic restrictive lung dz
72
Pickwickian syndrome
Obesity hypoventilation syndrome
73
Obesity effects on breathing
Daytime hypercapnia Extrinsic restrictive lung dz High diaphragm

Clin Med, Path, Pharm (12 decks)

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