Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Medicine II > Restrictive Lung Disease > Flashcards

Restrictive Lung Disease Flashcards

1
Q

what is the pulmonary interstitium?

A

Network of tissue that extends throughout both lungs, including alveolar epithelium, basement membrane, pulmonary capillary endothelium

Provides support to the alveoli and capillary beds for <b>gas exchange</b>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In normal people, can you see the pulmonary interstitium on X-rays or CT scans?

A

No!

-in normal people, the pulmonary interstitium is so thin that it can’t be seen on X-rays or CT scans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

when can you see the pulmonary interstitium on X-rays or CT scans?

A

when then pulmonary interstitium is abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

where does gas exchange occur?

A

in the alveoli across the interstitium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are pulmonary function tests (PFTs)?

A

Non-invasive tests that measure how well the lungs are expanding and contracting and how efficient the exchange of oxygen and carbon dioxide is b/w the blood and the air within the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the different types of PFTs?

A

Lung volumes, Spirometry, Spirometry before and after a bronchodilator, and diffusing capacity for carbon monoxide (DLCO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is tidal volume?

A

volume of air moved in and out during each breath (normal is 500ml = .5L of air)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is vital capacity?

A

maximum volume of air that can be exhaled after a maximal inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is residual volume?

A

volume of air remaining in the lungs after a maximal expiration

  • always some residual volume and it’s hard to measure
  • bulk of residual volume is in airways - bronchus and trachea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is total lung capacity?

A

volume of air in the lungs after maximal inspiration (includes residual volume)

Summation of 2 volumes – inspiratory and expiratory reserve volumes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the most common type of PFT?

A

spirometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what does spirometry do?

A

Measures the volume of air exhaled (after a maximal inhalation) at specific time points during a forceful and complete exhalation (patients blow as much as they can for about 6 seconds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is a spirometer? types?

A

an instrument for measuring the air

Types: incentive spirometer & peak flow meter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is an incentive spirometer?

A

effort to get patients lungs expanded to prevent post-op pneumonias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is a peak flow meter?

A

for asthma & COPD; when have chest tightness/asthma attack, will use it and see how much they can blow out

-When smooth muscles are tightening, peak flow values will be lower than normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what factors do you include in spirometry?

A

Gender, age, height, race -> all play into factors of how you fit along the “normal scale”

AA’s and Asians usually score less – so race is important to enter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is a patients PFTs compared again?

A

the pts value is compared against a predictive value

pooled data from “normal” individuals w/no hx of lung disease, resp symptoms, have normal CXR & EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what can PFTs (spirometry) help do?

A

Can help diagnose and differentiate b/w obstructive lung disease & restrictive lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is spirometry an important tool for?

A

Important tool in assessing diseases such as Asthma, COPD, Cystic Fibrosis, Pulmonary Fibrosis

Also helps you determine how well the pts therapy is going (e.g., bronchodilator)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the important parameters of a PFT?

A

FVC, FEV1, FEV1/FVC ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the FVC?

A

maximum amount of air exhaled after a maximal inhalation

Takes into account:
-Normal lung tissue, Thoracic cage, Functional respiratory muscles (diaphragm)
<b>-If low, the problem may be a restrictive disorder</b>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the FEV1?

A

amount of air exhaled in the 1st second

  • very important when looking at <b>obstructive disease</b>
  • most people can expel 70% of their vital capacity in one second

Reduced values may indicate “obstructed” or narrowed airways
(e.g., in COPD – can’t blow out as much air as a normal person can, usually < 70%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what does a low FVC indicate?

A

restrictive lung disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what does a low FEV1 indicated?

A

obstructed lung disease or narrowed airways

normal is 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the FEV1/FVC ratio?

A

-identification of airflow obstruction

< 70% predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

flow volume loop indications?

A

Stridor – indication of some type of obstruction

Unexplained dyspnea – great indication to do a PFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what maneuver do flow volume loops include?

A

includes forced inspiratory and expiratory maneuver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what does the normal vs obstructive pattern flow volume loop look like?

A

see less volume in obstruction; normal predictive value outlines what the pts value is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what does the normal vs restrictive flow volume loop look like?

A

-total volume is less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what does the diffusing capacity of carbon monoxide (DLCO) measure?

A

Measures the overall function of the alveolar-capillary membrane

Looks at how well gas exchange is happening

measure of how much CO is left behind after inhaling a known volume/concentration of different gases (including CO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what does DLCO help us directly isolate?

A

Helps us to directly isolate how well gases are diffusing across the pulmonary interstitium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is one of the greatest diagnostic benefits of DLCO?

A

differentiate the etiology of <b>restrictive lung disease</b>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how does DLCO differentiate the etiology of restrictive lung disease?

A

If DLCO is low, may be due to <b>interstitial lung disease</b>

If DCLO is normal, may be due to <b>extrathoracic cause of restriction</b>-obesity, chest wall disorder, neuromuscular disorder

-just b/c you have normal DLCO, doesn’t mean you can r/o restrictive lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is restrictive pulmonary disease?

A

Inability to completely fill their lungs with air

  • lungs are “restricted” from fully expanding
  • characterized by reduced lung volumes

Unlike obstructive lung disease (COPD, Asthma), <b>restrictive disease are associated with a decreased total lung capacity (HALLMARK)**</b>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are restrictive lung diseases associated with?

A

<b>decreased total lung capacity (HALLMARK)**</b>

obstructive lung disease - COPD/asthma, are not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what 2 groups are restrictive pulmonary diseases divided into?

A

Divided into 2 groups based on anatomical structures:

Intrinsic: diseases of the lung parenchyma, inflammation or scarring of lung tissue

Extrinsic: extra-pulmonary diseases involving the chest wall, pleura, and respiratory muscles
-obesity, myasthenia gravis, ALS, kyphoscoliosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are intrinsic restrictive pulmonary diseases?

A

diseases of the lung parenchyma, inflammation or scarring of lung tissue

(1) Idiopathic fibrotic interstitial pneumonia (formerly called Idiopathic pulmonary fibrosis)
(2) Penumoconioses
(3) Sarcoidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is medication induced interstitial lung disease?

A

These meds cause pulmonary toxicity:

  • Amiodarone
  • Methotrexate
  • Nitrofurantoin

These meds cause pulmonary toxicity when pt takes them for a chronic condition (e.g., chronic UTIs, chronic afib, arthritis, cancer)

-If only have 1 dose and develop acute SOB, that’s a hypersensitivity reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what 3 medications cause pulmonary toxicity?

A
  • Amiodarone
  • Methotrexate
  • Nitrofurantoin

*must be taken chronically for chronic diseases (UTIs, afib, arthritis cancer) to cause pulm tox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the most common daignosis among patients with interstitial lung disease?

A

idiopathic fibrosing interstitial pneumonia

41
Q

who is idiopathic fibrosing interstitial pneumonia most common in?

A

men > 50 y/o

42
Q

what is the prognosis for idiopathic fibrosing interstitial pneumonia?

A

poor prognosis (mean survival 2-5 years from time of dx)

43
Q

what kind of process is idiopathic interstitial pneumonia?

A

more of a fibrotic process than inflammatory

44
Q

what is idiopathic fibrosing interstitial pneumonia caused by?

A

repeated injury to structure or function of the alveolar epithelial cells

45
Q

risk factors for idiopathic fibrosing interstitial pneumonia?

A
  • Smoking
  • Occupational exposure (stone, metal, wood, organic dusts)
  • GERD (micro-aspiration)
46
Q

idiopathic fibrosing interstitial pneumonia clinical features (sx’s/exam)

A

Symptoms include: <b>insidious dry cough for months</b>, exertional dyspnea, fatigue, tachypnea

Examination: <b>clubbing</b> and inspiratory rales (crackles)

47
Q

what is clubbing?

A

Nail bed angle becomes smooth and tips of fingers become bulbous

<b>IRREVERSIBLE</b>

Common in <b><u>pulm diseases</u>:</b>
-<b>cystic fibrosis</b>, AV fistula, <b>idiopathic pulm fibrosis, asbestosis</b>, malignancies of the lung & pleura

Also seen with GI disease

clubbing can occur w/out an underlying disease

48
Q

is clubbing reversible or irreversible?

A

IRREVERSIBLE

49
Q

what pulmonary diseases is clubbing seen in?

A 
<b>-Cystic fibrosis</b>
-AV fistula
<b>-Idiopathic pulmonary fibrosis</b>
<b>-Asbestosis</b>
-Malignancies of the lung and pleura
50
Q

what do the PFTs show with idiopathic fibrosing interstitial pneumonia?

A

-Reduced FVC, but normal or elevated FEV1/FVC ratio

-Reduced DLCO
(fibroblasts are scarring the interstitium – making distance b/w air and cap bed wider)

-Impaired 6 min walk

51
Q

what are the most common findings of idiopathic fibrosing interstitial pneumonia on a CXR?

A

<b>reticular markings (seen in both IPF, CHF)</b>

-indicative of some type of fibrotic process of the lungs

52
Q

what do the CT scans show for IPF?

A

shows diffuse patchy fibrosis with pleural based <b>honeycombing</b>

53
Q

IPF diagnosis

A

Can be made on the basis of a characteristic presentation (symptomatology in combination with CT imaging)

<b>-Lung biopsy is usually more definitive and can help rule out other possible causes (pneumonitis, Rheumatic disease, histiocytosis) to confirm presence of interstitial pulmonary fibrosis</b>

54
Q

what is most definitive for dx of IPF and r/o of other causes?

A

<b>Lung biopsy</b>

-is usually more definitive and can help rule out other possible causes (pneumonitis, Rheumatic disease, histiocytosis) <b>to confirm presence of interstitial pulmonary fibrosis</b>

55
Q

what are the 3 txt options for IPF?

A
  • supportive care
  • medications
  • surgery
56
Q

IPF and supportive care txt

A
  • Supplemental home oxygen (if not already on it)
  • Vaccinations (influenza, pneumococcal)
  • Outpatient Pulmonary Rehab Programs
57
Q

IPF and medication txt

A

both inhibit parts of the disease pathway

<b>-Nintedanib:</b> a tyrosine kinase inhibitor
<b>-Pirfenidone (Esbriet):</b> an anti-fibrotic drug (slows down progression of the disease)

58
Q

IPF and surgery txt

A

<b>Lung transplantation</b> – not a simple process, wait list is long, eligibility is long
<b>-Age < 65 y/o</b>
<b>-Free of substance abuse (smoking, drugs)</b> - can be a past smoker, but not currently smoking
<b>-Acceptable BMI range of 20-29</b>

59
Q

what is pneumoconioses?

A

<b>“Occupational lung disease”</b>

Group of <u>interstitial lung diseases</u> caused by the <b>inhalation and deposition of inorganic particles and mineral dust with subsequent reaction of the lung</b>

<u>Include</u>:
<b>-Coal worker’s pneumoconiosis
-Silicosis
-Asbestosis</b>

60
Q

what is coal worker’s pneumoconioses caused by?

A

<b>Caused by prolonged exposure to coal dust, which is inert and cannot be removed by the body</b>

  • Leads to inflammation, fibrosis, and sometimes necrosis
  • Coal dust gets inhaled into the air sacs -> engulfed by macrophages which try to get rid of it, but can’t get rid of the coal dust -> particles become embedded in the interstitium and solidify
61
Q

what is the milder form of coal worker’s pneumoconioses?

A

Anthracosis

62
Q

what is another name for coal worker’s pneumoconioses?

A

black lung disease

63
Q

do pts have symptoms in early stages of black lung disease?

A

early in the disease, pts are usually asymptomatic

64
Q

when do sx’s for black lung disease develop and what are they?

A

symptoms such as chronic cough, fever, and dyspnea on exertion usually developed 10-15 years after exposure

65
Q

imaging and coal worker’s pneumoconioses

A

Radiographically, they may have <b>small, rounded, nodular opacities with a preference for the upper lobes</b>

Eventually, there is a <b>development of larger opacities with progressive massive fibrosis</b>
-this stage is <b><u>irreversible</u></b> and progresses despite cessation of the exposure

66
Q

at what stage is coal worker’s pneumoconioses irreversible?

A

when there are larger opacities with progressive massive fibrosis

<b>-the disease is irreversible and progresses despite cessation of the exposure</b>

67
Q

what is the prognosis like for coal worker’s pneumoconioses and is there txt for it?

A

Prognosis is poor

<b>NO TREATMENT</b>

68
Q

what is silicosis?

A

pulmonary disease caused by inhalation of crystalline silica

69
Q

occupations where silicosis occurs?

A

mining, masonry, glass manufacturing, foundry work, and sandblasting

70
Q

clinical stages of silicosis?

A

Acute, Chronic, Accelerated Silicosis

71
Q

clinical presentation of silicosis

A

Cough, Dyspnea, sometimes fever or pleuritic chest pain

72
Q

evaluation of silicosis

A
  • H&P
  • Labs (testing for Tb)
  • PFTs
  • CXR/CT
73
Q

what do the PFTs show for silicosis?

A

Decreased FEV1, and DLCO, normal FEV1/FVC ratio

DLCO may be normal but most cases it’s impaired b/c of fibrosis that is happening

74
Q

CXR/CT & silicosis

A

bilateral, diffuse, groundglass opacities (Acute)

-small, innumerable, rounded densities (Chronic)

75
Q

clinical dx of silicosis based on what 3 elements?

A
  • History of silica exposure
  • Chest imaging consistent with silicosis
  • Absence of any other diagnosis (e.g., no infectious process)

<b><i>Lung biopsy if the diagnosis can’t be made clinically</i><b></b></b>

76
Q

txt for silicosis

A
  • No proven specific therapy
  • Avoid further exposure and supportive care
  • Steroid therapy (for acute states)
  • Lung transplantation
77
Q

associated complications of silicosis

A
  • Mycobacterial infection (Tb)
  • Aspergillosis (fungal infection of the lung)
  • Lung cancer
  • Chronic kidney disease
78
Q

what is asbestosis?

A

Pneumoconiosis caused by inhalational asbestos fibers

79
Q

asbestosis clinical presentation

A

<b>Asymptomatic for at least 20-30 years after initial exposure</b>

  • Dyspnea on exertion
  • Cough
  • Weight loss
80
Q

what is seen on physical exam of asbestosis?

A
  • Inspiratory crackles

- Clubbing

81
Q

what do the PFTs show with asbestosis?

A

Reduced vital capacity and total lung capacity; Low DLCO

<b><i>-restrictive pattern</i></b>

82
Q

radiographic imaging of asbestosis (CXR, CCT)

A

CXR: thickened pleura and calcified pleural plaques

CCT: coarse honeycombing (in advanced disease); hazy ground-glass appearance of the peripheral pleural surface

83
Q

dx of asbestosis

A

-History of asbestos exposure
-Chest imaging consistent with Asbestosis
-Absence of any other diagnosis
-Bronchoalveolar lavage (limited value)
(limited b/c asbestosis is in a dormant phase for 20-30 years & it goes undetected -> damage has already been done)

84
Q

txt of asbestosis

A
  • No proven specific therapy
  • Avoid further exposure and supportive care
  • Steroid therapy (questionable b/c pleural deposits don’t get any benefit from the steroids)

<b>-Smoking Cessation (THIS IS A MUST!!!)
(increases their risk of developing lung cancer)</b>

85
Q

what is a MUST when treating asbestosis?

A

SMOKING CESSATION

86
Q

complications of asbestosis?

A

<b>Mesothelioma</b>
-Direct correlation b/w asbestosis and mesothelioma cancer of the pleura surface

<u>Txt of mesothelioma</u>: can take out entire lung or peel off tumor from lung

87
Q

what is sarcoidosis?

A

Multisystem granulomatous disorder of unknown etiology

88
Q

what organs does sarcoidosis mostly involve?

A

<b>lungs</b>

also involves lymph nodes, eyes, skin, liver, spleen, heart, nervous system

89
Q

what is sarcoidosis characterized by?

A

Characterized pathologically by the presence of <b><u>non-caseating granuloma</u></b>

(vs. caseating granuloma = Tb)

90
Q

who is sarcoidosis most common in?

A

<b>young black women</b> and Northern European whites

91
Q

clinical presentation of sarcoidosis

A

<b>-Cough (dry, hacking) - #1 (not productive cough)</b>

  • Progressive, worsening dyspnea
  • Atypical chest discomfort (almost like pleuritic type chest pain)
  • Fever/night sweats
  • Weight loss
92
Q

what is the #1 symptom of sarcoidosis?

A

Cough (dry, hacking) - (not productive cough)

93
Q

what are non-diagnostic tests for sarcoidosis?

A

Serum blood tests, ACE levels, ESR are non-diagnostic

94
Q

radiographic imaging (CXR, CT) of sarcoidosis

A

CXR: bilateral hilar adenopathy
-L/R hilum -> enlarged lymph nodes in hilum is concerning

CT: right paratracheal lymphadenopathy along with bilateral diffuse reticular infiltrates

95
Q

how do you diagnose sarcoidosis?

A

<b>NEED TISSUE BIOPSY B/C NEED TO R/O LYMPHOMA</b>

<b>Endobronchial US guided biopsy (EBUS)</b>
-get tissue from lymph node

<b>Cervical Mediastinoscopy</b>
-go thru sternal notch & get tissue from lymph node

<b>VATS Lung biopsy (Video-assisted Thoracoscopic Surgery)</b>
-take out sample of lung tissue

96
Q

txt of sarcoidosis

A

<b>Close observation</b> for asymptomatic patients

~90% of patients are responsive to a <b>tapering course of oral corticosteroids over 4-6 weeks during flare-ups</b>

97
Q

what are restrictive lung diseases characterized by?

A

reduced lung volumes (low TLC, low FVC, low DLCO)

98
Q

when is lung transplantation a viable option for IPF?

A

for pts w/end stage IPF

Clinical Medicine II (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions