Restrictive/Inflammatory Lung Disease Flashcards
How is Restrictive lung disease defined?
By reduced lung volumes:
TLC <80%
FRC (TGV) <80%
Symmetrically reduced FEV1 and FVC
How does compliance relate to Volume and Pressure?
Compliance is deltaV/deltaP
At a given pressure, volume is lower in ____________ (restrictive/obstructive) diseases. This disease makes it hard to _____________ (inhale/exhale)
Restrictive
Hard to inhale because of decreased compliance
At a given pressure, volume is higher in ____________ (restrictive/obstructive) diseases. This disease makes it hard to _____________ (inhale/exhale)
Obstructive
Hard to exhale (this is a gross simplification. It increases resistive work and therefore both inspiration and expiration)
How can you distinguish between Restrictive Lung Disease and Restrictive Physiology?
- Slope of P-V curve is reduced in restrictive lung disease
- DLCO/VA is reduced in RLD
What causes gas exchange to decrease in restrictive lung disease?
- Loss of Alveolar surface area
- Diffusion limitation (thickening)
*Don’t cause significant gas exchange problems unless severe*
What would go on the differential for an acute Restrictive Process?
- Pulmonary edema
- ARDS/DAD (caused by injury)
- Pneumonia
- Plueral Effusion
What would go on the differential for an acute Restrictive Process?
- Interstitial lung disease
- Plueral Fibrosis/plaque
- Plueral effusion
What 2 things must be true in order to diagnose a mixed obstructive and restrictive disease?
- Reduced Lung Volumes (Restrictive)
- FEV1/FVC
What is ILD?
Interstitial Lung Disease
It is a bunch of disorders characterized by inflammation or scarring of lungs.
The most common cause of ILD is….
Systemic diseases such as:
- RA
- Scleroderma
- Lupus
What physical exam finding are classic for ILD?
“Velcro-like” crackles.
What is the treatment pattern for treating ILD?
- Remove offending exposure
- Immunosuppression
- Oxygen
- Transplant
What do you use to treat IPF?
Idiopathic Pulmonary Fibrosis: Use Nintedanb and Pirfenidone
What does imaging of IPF show?
- Reticulation around the edge of lungs (normally clear within 1-2 cm)
- Honeycombing**
- Ground Glass infiltrate
** differentiates between Nonspecific Interstitial Pneumonia and IPF
True or False: Smoking may result in ILD after pts are 60 yo.
True
Smoking related ILD involving a young smoker, with cysts and nodules on a CT is most likely:
Pulmonary Langerhans Cell Histiocytosis (PLCH)… man I bet it took them forever to come up with that acronym.
Which pneumonia is diagnosed by extracting fluid and observing eosinophils? What other condition does this mimic?
Acute/Chronic Eosinophilic Pneumonia.
Acute Mimics ARDS
Chronic Eosinophilic Pneumonia is usually associated with:
Asthma
What is the hallmark of Sarcoidosis?
Non caseating granuloma (collection of inflammatory cells)
What is the usual presentation of Sarcoidosis?
Usually before 40yo. Commonly affects African Americans more than White Americans. Has bulky lymphnodes on chest Xray
True or false, sarcoidosis is caused by TB.
False: Granulomas can be caused by TB as well as sarcoidosis. Sarcoidosis is idiopathic.
NSIP (nonspecific interstitial pneumonia) differs from IPF in that:
- Pts are more likely to be younger and female.
- It responds to anti-inflammatory therapy
What is organizing pneumonia?
- Formerly called BOOP.
- May be idiopathic or secondary to CVD, drugs, HP, aspiration.
- Noninfectious.
- Treated with steroids
Lymphangioleiomyomatosis is characterized by
- Peribronchovascular proliferation of smooth muscle cells that form cysts and nodules.
- Mutation in tuberous sclerosis gene
- Renal tumors
What can cause chest wall restriction?
Basically anything from the skin in:
- Skin disorders
- Obesity
- Severe scoliosis
- Respiratory muscles
- Pleural Disease
