Pulmonology (obstructive and restrictive lung disease) Flashcards
All of the following will increase A-a gradient except:
a. emphysema
b. asthma
c. pneumonia
d. hypoventiliation
e. pulmonary hypertension
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)
obstructive vs restrictive
-elevated TLC and RV
obstructive
b/c of air trapping and hyperventilation
obstructive vs restrictive
-increased lung compliance
obstructive
“floppy” lungs - unable to exhale, reduced air flow
obstructive vs. restrictive
-diagnosed by spirometry (FEV1/FVC
obstructive
An abnormal A-a gradient is __. Indicates pathology is in the lungs with reduced gas diffusion because of (3) potential reasons
>
- Decreased surface area (alveoli or capillaries)
- Decreased pressure gradient
- Increased diffusion distance
Inflammatory cells playing a main role in asthma
eosiniphils
-create mediator soup –> bronchoconstriction and microvascular leak
Defined as chronic productive cough for 3 months in 2 successive years
Chronic bronchitis (clinical aspect of COPD)
What is the pathological defining feature of COPD?
emphysema - enlargement of airspaces w/ destruction of alveoli
*mucosal inflammation and fibrosis
Asthma or COPD?
-airway inflammation by CD8 T cells and macrophages/ neutrophils
COPD
-leads to IRREVERSIBLE airflow limitation
Asthma or COPD?
-DLCO (diffusion capacity) will be decreased
COPD
-asthma does NOT affect the lung parenchyma, just the airway. DLCO will be normal or increased
P[A-a] O2 = ___
[150 - (PaCO2/ 0.8)] - PaO2
Asthma is diagnosed by __, with an FEV1 drop of >20% at or before 5th dose
metacholine challenge
-if negative, this can rule OUT asthma
Normal peak flow variation is __%
20%
if more variation than this throughout the day, it means you have asthma
True/False - Asthma can be treated with a LABA (long acting beta agonist)
False - LABA alone is contraindicated
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
a. is false- ICS are only used in combo w/ LABA
In asthma, ICS are the cornerstone of therapy
LIGHT’s criteria for pleural effusions
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
transudate or exudate?
-occurs because of increased capillary filtration pressure
transudate
examples = volume overload in CHF or renal failure
transudate or exudate?
-caused by infection, inflammation, infiltration (cancer)
exudate
causes increased LEAK across capillaries
=protein and cell rich fluid
transudate or exudate?
-occurs because of decreased plasma oncotic pressure
transudate
examples = cirrhosis, nephrotic syndrome
True/ false - a transudate pleural effusion requires further workup of underlying disease
False - transudate you can just treat (caused by fluid overload)
However, if exudate, the ddx is extensive and further workup is required (infection? cancer?)
Caused by asbestos exposure and may present with bloody exudate effusion
mesothelioma (primary neoplasm of the pleura)
-confirm dx by pleural biopsy
Name 3 interstitial lung diseases that present with LOWER lobe involvement
- Idiopathic
- RA
- Scleroderma / collagen vascular disease
“IRS”
Name 2 interstitial lung diseases that present with UPPER lobe involvement
- Sarcoidosis (+ hilar adenopathy, granuloma)
2. Silicosis (birefringent particles from sandblasting)
Name 2 interstitial lung diseases that present with DIFFUSE lung involvement
- Drugs
2. Asbestos
Abnormally curved spine causing restrictive lung disease
Kyphoscoliosis
extrathoracic/ thoracic cause
