Pulmonary fibrosis and restrictive lung disease

Question 1

What is restrictive lung disease

Answer 1

Physical reduction in potential maximum lung disease

Question 2

what are causes of restriction

Answer 2

Problem of compliance: e.g fibrosis

Increase in dead space: e.g. effusion, pus

Question 3

What are causes of obstructive lung disease

Answer 3

Obstruction of large airways: Asthma/COPD, bronchitis

Obstruction of small airways: bronchiolitis. bronchiectasis

Question 4

What is obstructive lung disease

Answer 4

Increased effort to reach near normal lung volume due to narrowing of airways

Question 5

How to distinguish between restrictive and obstructive

Answer 5

Spirometry (best of 3) which measures fvc and fev1

Question 6

WHta is fev1

Answer 6

Volume exhaled in the first second after deep inspiration and forced expiration (normal is >80%)

Question 7

What is fvc

Answer 7

total volume of air that can be forcibly exhaled in one breath from maximal inhalation (normal is >80%)

Question 8

What is FEV1 and FVC like in obstructive disease

Causes

Answer 8

FEV1<80%
FVC>80%
FEV1/FVC<0.7

COPD, asthma, bronchiectasis (however bronchiectasis is first restrictive then becomes obstructive)

Question 9

What is FEV1 and FVC like in restrictive disease

Causes

Answer 9

FEV1<80%
FVC<80%
Therefore FEV1/FVC normal (i.e. >0.7)

CausesL lung-related e.g. fibrosis, occupation related lung disease, oedema, or non lung related such as obesity and pregnancy and scoliosis

Question 10

What is pulmonary fibrosis

Answer 10

Diffuse scarring of the lung parenchyma

Question 11

Focal pulmonary fibrosis diseases

Answer 11

Occupational lung diseases

affects lymphoid tissue

Question 12

Interstitial pulmonary fibrosis diseases

Answer 12

Extrinsic allergic alveolitis

affects parenchyma

Question 13

Replacement pulmonary fibrosis

Answer 13

RA, TB, connective tissue disorders (direct damage due to disease)

Question 14

Apical fibroses of the lung

Answer 14

TEA SHOP

TB
Extrinsic allergic alveolitis
Ankylosing spondylosis

Sarcoid
Histiocytosis
Occupational (berylliosis, silicosis)

Question 15

BAsal fibroses of the lung

Answer 15

DR CIA

Drugs (amiodarone, methotrexate, nitrofurantoin)
Rheumatoid arthritis

Connective tissue disease
Idiopathic pulmonary fibrosis
Asbestosis

Question 16

What is beryllosis caused by
What is silicosis caused by
What is asbestosis caused by

Answer 16

Berylium inhalation
Silica/silicon inhalation
Asbestos inhalation

Question 17

More occupational disease causing extrinsic allergic alveoli’s causing tertiary fibrosis

Answer 17

Pigeon Fancier’s lung (Bird dander/droppings)

Farmer;s lung- hay/crop mould

Malt worker’s lung- hop moulds

Question 18

Blood investigations for suspected breathlessness

Answer 18

ABG: T2RF (hypoxic and hypercapnic)
CRP
Special tests: Immunoglobulins etc

Imagine: CXR, CT (honeycombing)

Spirometry: restrictive deficit
Lung biopsy if in doubt

Question 19

Symptoms of fibrosis

Answer 19

Shortness of breath (dyspnea)
A dry cough.
Fatigue.
Unexplained weight loss.
Aching muscles and joints
Clubbing