Week 5 - Restrictive and Obstructive Lung Disease

Question 1

Answer 1

4

Question 2

Answer 2

Question 3

Answer 3

Question 4

Answer 4

Question 5

Answer 5

Question 6

What does TLCO measure?

Answer 6

Measures how well oxygen and carbon dioxide are transferred between the alveoli (air sacs) and the blood in the pulmonary capillaries

Question 7

How does KCO differ from TLCO?

Answer 7

KCO is TLCO that is adjusted for alveolar volume - i.e. measures the transfer of CO in alveoli that are ventilated.

Both are reduced by V/Q mismatch conditions.
KCO is not diminished by extra thoracic restrictive conditions -whereas TLCO is - therefore helps you distinguish the cause.

Question 8

Why does the FEV1:FVC ratio increase in restrictive lung disease?

Answer 8

Restrictive lung disease - lungs are smaller - therefore FVC decreases, but less than FEV1 - therefore ration increases.

Question 9

What can cause restriction to the lungs?

Answer 9

Damage to the parenchyma (inflammation and fibrosis) - e.g. pulmonary fibrosis, sarcoidosis, pneumoconiosis

Pleural disease (P Eff, pneumo/haemothorax, calcification, mesothelioma)
Obesity
Chest wall disease (NMD, palsy, kyphosis/scoliosis)

Question 10

In lung fibrosis - where is the primary site of injury?

Answer 10

The interstitium - between the cells and basement membrane - thickens and stiffens = reduced transfer of O2

Question 11

What are the RF for lung fibrosis?

Answer 11

Question 12

How can Sx for lung fibrosis present?

Answer 12

SOB - worsening progressively
Cough
Fatigue
Weight loss
Crackles

Question 13

How can you differentiate an AI cause for lung fibrosis?

Answer 13

AI / Collagen vascular - can also have difficulty swallowing, cold hands, joint pains, weight loss, skin rash

Question 14

What are the clinical signs of lung fibrosis?

Answer 14

Clinical signs à ↑ RR, Tachypnoea, Dyspnoea, Clubbing, CVS - ↑ JVP, perip oedema, loud P2 heat (signs of cor pulmonale). Low O2 sats – desats on exertion.

If AI can have – RA, skin changes (telangiectasia, Raynaud’s), joint signs, eye signs

Question 15

What is it called when we dont know what is causing fibrosis of the lungs?

Answer 15

Idiopathic pulmonary fibrosis (IPF)

M>F

Question 16

What is the average length of surivival from diagnosis of IPF?

Answer 16

2.5-3.5 years

Often sudden exacerbation (infection) & decline – dramatic decrease in LF à death

Question 17

What does honeycombing and bronchial dilation on CT suggest?

Answer 17

IPF

Question 18

What does spirometry show in IPF?

Answer 18

Question 19

What Rx is given for IPF?

Answer 19

Symptomatic
Antifibrotic
Palliative (if young poss transplant)

Question 20

What investigations can you do to investigate whether a P has pulmonary fibrosis or not?

Answer 20

Bloods - FBCs, U&Es, AI screen
CXR
HRCT
Spirometry
TLCO and KCO

Question 21

What type of respiratory failure is caused by pulmonary fibrosis?

Answer 21

T1

Question 22

Which type of pulmonary fibrosis is associated with AI or collagen vascular disease?

Answer 22

Non-Specific Interstitial Pneumonia

(is actually pneumonitis not a pneumonia)

Question 23

How does NSIP differ from IPF in terms of Ps?

Answer 23

Younger Ps affected
Not associated with smoking
M = F (whereas in IPF - M>F)

Question 24

Extensive ground glass changes, small lungs and reticule-nodular changes on imaging suggests?

Answer 24

NSIP

Question 25

Which collagen-vascular diseases can cause NSIP?

Answer 25

Scleroderma RA SLE

Question 26

Why is it important to distinguish IPF from NSIP?

Answer 26

NSIP has a better prognosis and responds to anti-inflammatories whereas IPF won't.

Question 27

How is NSIP managed?

Answer 27

Question 28

Which drugs can cause pulmonary fibrosis?

Answer 28

Amiodarone Nitrofurantoin Bleomycin + more

Question 29

Answer 29

Erythema nodosum Bilateral hilar lymphadenopathy

Question 30

A P with SOB Cough Fever Night sweats Weight Loss Arthralgia Reduced appetite Myalgia Anterior uveitis Lymphadenopathy Erythema Nodosum Bilateral hilar lymphadenopathy Could have?

Answer 30

Pulmonary sarcoidosis DDs = TB, Vasculitic conditions, lymphoma

Question 31

What is sarcoidosis?

Answer 31

Multisystem granulomatous disease – unknown aetiology (thought poss infection, dusts, minerals, beryllium, congenital – may be immune response to inhaled antigen) Creates non-caseating granulomas – often in multiple organs. Primarily affects the lungs May resolve spontaneously OR may progress to pulmonary fibrosis

Question 32

What is the average of age of sarcoidosis?

Answer 32

20-50

Question 33

What types of sarcoidosis can you have?

Answer 33

Acute (Loefgren's), chronic and asymptomatic

Question 34

Answer 34

Question 35

What finding in the bloods that can suggest sarcoidosis?

Answer 35

Hypercalcaemia Abnormal LFTs

Question 36

Which other organ systems can be affected by sarcoidosis?

Answer 36

Pretty much any

Question 37

How is sarcoidosis diagnosed?

Answer 37

Clinical + radiological + histological features

Question 38

How is pulmonary sarcoidosis staged by CXR?

Answer 38

0-IV 0 = normal lungs IV = bad lungs

Question 39

Non-caseating epithelioid-cell granulomas + multi-nucleated cells with asteroid bodies, Schumann bodies and bifringent crystalline particles + minimal necrosis - suggests what?

Answer 39

Sarcoidosis

Question 40

Why do you get hypercalcaemia and hypercalciuria in sarcoidosis?

Answer 40

Vit D is increased by macrophages in the granulomas => inc Ca

Question 41

What is the outcome of sarcoidosis?

Answer 41

Question 42

How is sarcoidosis managed?

Answer 42

Question 43

Answer 43

Pleural effusion

Question 44

How much pleural fluid is produced and cycled through the pleura each day?

Answer 44

1L

Question 45

What types of fluid can you get in the pleural space?

Answer 45

Transudate Exudate

Question 46

How can you differentiate between transudate and exudate?

Answer 46

Exudate = Fluid protein : serum protein > 0.5 Fluid LDH : serum LDH >0.6 Fluid LDH - >2/3rds ULN of normal serum LDH Therefore - exudate is high in protein and LDH Transudate = Fluid protein : serum protein <0.5 Fluid LDH : serum LDH <0.6 Fluid LDH < 2/3rds ULN of normal serum LDH

Question 47

What causes exudate in the pleura?

Answer 47

Malignancy Infection AI disease Chylothorax (blocked lymphatics)

Question 48

What causes transudate in the pleura?

Answer 48

Congestive cardiac failure Low albumin - often caused by nephrotic syndrome or liver failure

Question 49

What are the clinical signs of pleural effusion?

Answer 49

Question 50

Answer 50

Question 51

What are the RF for spontaneous pneumothorax (i.e. primary pneumothorax)?

Answer 51

Tall and thin Asthma Collagen vascular disease

Question 52

What can cause secondary pneumothorax?

Answer 52

COPD Pulmonary fibrosis Cystic fibrosis

Question 53

How is pleural effusion managed?

Answer 53

Question 54

What can cause chest wall disease?

Answer 54

Question 55

What can cause mixed obstructive and restrictive lung disease?

Answer 55

Smoking = emphysema and pulmonary fibrosis Pulmonary sarcoidosis Obesity in smokers

Question 56

When is TLC reduced and when is it increased?

Answer 56

TLC = reduced in restrictive disorders Increased in obstructive disorders (air trapping)

Question 57

What do the following all do to TLCO? - V/Q mismatch - PE - Emphysema - Interstitial lung disease - External lung restriction

Answer 57

Decrease TLCO

Question 58

What does inc pul capillary BV (e.g. high cardiac output, polycythaemia, pulmonary haemorrhage) do to TLCO?

Answer 58

Increases it

Question 59

What is KCO used to differentiate?

Answer 59

Can differentiate whether restriction is intra or extrathoracic. If extra-thoracic restriction, KCO is not reduced (but TLCO will be).