Pulmonology (obstructive and restrictive lung disease)

Question 1

All of the following will increase A-a gradient except:

a. emphysema
b. asthma
c. pneumonia
d. hypoventiliation
e. pulmonary hypertension

Answer 1

d. Hypoventilation will have a NORMAL A-a gradient (altitude will also)

a. emphysema is destruction of alveoli (dec. surface area)
b. asthma can cause bronchiole obstruction (decreased pressure gradient)
c. pneumonia = alveolar filling defect
e. pulm HTN causes loss of capillaries (dec. surface area)

Question 2

obstructive vs restrictive

-elevated TLC and RV

Answer 2

obstructive

b/c of air trapping and hyperventilation

Question 3

obstructive vs restrictive

-increased lung compliance

Answer 3

obstructive

“floppy” lungs - unable to exhale, reduced air flow

Question 4

obstructive vs. restrictive

-diagnosed by spirometry (FEV1/FVC

Answer 4

obstructive

Question 5

An abnormal A-a gradient is __. Indicates pathology is in the lungs with reduced gas diffusion because of (3) potential reasons

Answer 5

>

1. Decreased surface area (alveoli or capillaries)
2. Decreased pressure gradient
3. Increased diffusion distance

Question 6

Inflammatory cells playing a main role in asthma

Answer 6

eosiniphils

-create mediator soup –> bronchoconstriction and microvascular leak

Question 7

Defined as chronic productive cough for 3 months in 2 successive years

Answer 7

Chronic bronchitis (clinical aspect of COPD)

Question 8

What is the pathological defining feature of COPD?

Answer 8

emphysema - enlargement of airspaces w/ destruction of alveoli
*mucosal inflammation and fibrosis

Question 9

Asthma or COPD?

-airway inflammation by CD8 T cells and macrophages/ neutrophils

Answer 9

COPD

-leads to IRREVERSIBLE airflow limitation

Question 10

Asthma or COPD?

-DLCO (diffusion capacity) will be decreased

Answer 10

COPD

-asthma does NOT affect the lung parenchyma, just the airway. DLCO will be normal or increased

Question 11

P[A-a] O2 = ___

Answer 11

[150 - (PaCO2/ 0.8)] - PaO2

Question 12

Asthma is diagnosed by __, with an FEV1 drop of >20% at or before 5th dose

Answer 12

metacholine challenge

-if negative, this can rule OUT asthma

Question 13

Normal peak flow variation is __%

Answer 13

20%

if more variation than this throughout the day, it means you have asthma

Question 14

True/False - Asthma can be treated with a LABA (long acting beta agonist)

Answer 14

False - LABA alone is contraindicated

Question 15

Which is FALSE regarding the treatment/ management of COPD?

a. ICS can be used alone
b. LABA and LAMA can be used alone
c. roflumilast is used for frequent exacerbations
d. treating asthma in childhood can alter natural history
e. smoking cessation is key to treatment

Answer 15

a. is false- ICS are only used in combo w/ LABA

In asthma, ICS are the cornerstone of therapy

Question 16

LIGHT’s criteria for pleural effusions

Answer 16

Any 1 of the following defined EXUDATE:
- Pleural fluid/ serum total protein >0.5
-Pleural fluid/ serum LDH >0.6
-Pleural fluid LDH >2/3 upper limit of normal serum LDH
If none are met –> TRANSUDATE

Question 17

transudate or exudate?

-occurs because of increased capillary filtration pressure

Answer 17

transudate

examples = volume overload in CHF or renal failure

Question 18

transudate or exudate?

-caused by infection, inflammation, infiltration (cancer)

Answer 18

exudate
causes increased LEAK across capillaries
=protein and cell rich fluid

Question 19

transudate or exudate?

-occurs because of decreased plasma oncotic pressure

Answer 19

transudate

examples = cirrhosis, nephrotic syndrome

Question 20

True/ false - a transudate pleural effusion requires further workup of underlying disease

Answer 20

False - transudate you can just treat (caused by fluid overload)
However, if exudate, the ddx is extensive and further workup is required (infection? cancer?)

Question 21

Caused by asbestos exposure and may present with bloody exudate effusion

Answer 21

mesothelioma (primary neoplasm of the pleura)

-confirm dx by pleural biopsy

Question 22

Name 3 interstitial lung diseases that present with LOWER lobe involvement

Answer 22

1. Idiopathic
2. RA
3. Scleroderma / collagen vascular disease
   “IRS”

Question 23

Name 2 interstitial lung diseases that present with UPPER lobe involvement

Answer 23

1. Sarcoidosis (+ hilar adenopathy, granuloma)

2. Silicosis (birefringent particles from sandblasting)

Question 24

Name 2 interstitial lung diseases that present with DIFFUSE lung involvement

Answer 24

1. Drugs

2. Asbestos

Question 25

Abnormally curved spine causing restrictive lung disease

Answer 25

Kyphoscoliosis

extrathoracic/ thoracic cause