Restrictive Lung Disease Flashcards

1
Q

Other words for restrictive lung disease

A

Interstitial, diffuse lung disease

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2
Q

What is the lung interstitium

A

The connective tissue space around airways and vessels and between basement membranes of alveolar walls. In normal they’re in contact

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3
Q

Signs of restrictive lung disease

A

Reduced lung compliance, low FEV1 and FVC but normal ratio, reduced gas transfer (Tco and Kco), ventilation perfusion imbalance

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4
Q

How is diffuse lung disease found

A

Abnormal CT or CXR, dyspnoea, respiratory failure, heart failure

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5
Q

Diffuse alveolar damage associations

A

Major trauma, chemical injury, circulatory shock, drugs, infection, radiation, autoimmune

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6
Q

How many ribs can you see in a normal CXR

A

Posterior 10 ribs (less with restrictive, more with obstructive)

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7
Q

Exudative stage of DADS

A

Edema and inflammation and dense eosinophilic hyaline membranes

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8
Q

Proliferative stage of DADs

A

Interstitial inflammation and fibrosis

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9
Q

Histological features of DADs

A

Protein rich oedema, fibrin, hyaline membranes, denuded basement membranes, epithelium and fibroblast proliferation, scarring

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10
Q

Sarcoidosis

A

A multisystem granulomatous disorder of unknown aetiology

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11
Q

Histopathology of sarcoidosis

A

Epithelial and giant cell granulomas, associated fibrosis, little lymphoid infiltrate

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12
Q

Who does sarcoidosis affect

A

Young adults, more females than men, more African Americans in USA, in temperate climates

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13
Q

Organs involved in sarcoidosis

A

Lymph nodes, lung, spleen, liver, skin eyes skeletal muscle, bone marrow, salivary glands

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14
Q

How does sarcoidosis present in young adults

A

Painful joints, swollen fat under skin, bilateral lymphadenopathy

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15
Q

Antigens in hypersensitivity pneumonitis

A

Thermophilic actinomycetes, bird/animal proteins eg faeces, fungi, chemicals

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16
Q

Acute Hypersensitivity pneumonitis presentation

A

Fever, dry cough, myalgia, chills, crackles, tachypnoea, wheeze, precipitating antibody

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17
Q

Chronic hypersensitivity pneumonitis presentation

A

Insidious, malaise, SOB, cough, crackles and some wheeze

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18
Q

Histopathology of hypersensitivity pneumonitis

A

Type 3 and 4 immune complex mediated hypersensitivity reactions, soft Centri-acinar epitheloid granulomas, Upper zone

19
Q

Causes of usual interstitial pneumonitis

A

Connective tissue diseases, drug reaction, post infection, industrial exposure. But most are idiopathic

20
Q

Histopathology of UIP

A

Patchy interstitial chronic inflammation, type 2 pnuemocyte hyperplasia (surfactant), smooth muscle and vascular proliferation. Evidence of both old and new injury

21
Q

UIP in clinic

A

Idiopathic Pulmonary fibrosis

22
Q

IPF signs

A

Elderly and m>f, dyspnoea, cough, basal crackles, cyanosis, clubbing. Most dead within 5 years. CXR shows basal posterior fibrosis and honeycombing, reduced gas transfer

23
Q

Physiological definition of restriction

A

Forced vital capacity <80% of normal

24
Q

Parts of the body that can cause restrictive disease

A

Lungs, pleura, nerve, muscle, bone

25
Pleural causes of restriction
Pleural effusion, pnuemothorax, pleural thickening
26
Skeletal causes of restriction
``` Kyphoscoliosis Ankylosing spondylitis Thoracoplasty Rib fractures Amyotrophic lateral sclerosis ```
27
Sub diaphragmatic causes of restriction
Obesity | Pregnancy
28
What is the interstitium
Space between alveolar epithelium and capillary endothelium, usually thin
29
What are interstitial lung diseases
Diseases causing thickening of the interstitium and which can result in pulmonary fibrosis (sarcoidosis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis)
30
What is sarcoidosis
A multisystem granulomatous disease of unknown cause. Non caseating granuloma
31
Symptoms of sarcoidosis
Erythema nodosum, swollen eye (anterior uveitis), skin lesions, cough
32
Investigations for sarcoidosis
History and exam and CXR Then pulmonary function tests, bloods, urinalysis, ECG, TB skin test, eye exam Then bronchoscopy including biopsies and EBUS
33
CXR signs of sarcoidosis
Nodal adenopathy, snow storm look,
34
Surgical biopsies for sarcoidosis
Mediastinoscopy and VATS
35
How should mild sarcoidosis be treated (no vital organ involvement, normal lung function,few symptoms)
No treatment
36
How should sarcoidosis with erythema nodosum or arthralgia (joint pain) be treated
NSAIDS
37
How should sarcoidosis with skin lesions/anterior uveitis/ cough be treated
Topical steroids
38
How should sarcoidosis with cardiac/neurological /eye disease not responding / Hypercalcaemia be treated
Systemic steroids
39
Respiratory complications of sarcoidosis
Progressive respiratory failure Bronchiectasis Aspergilloma, haemoptysis, pnuemothorax
40
Typical presentation of idiopathic pulmonary fibrosis
Chronic breathlessness and cough, 60-70 years old, failed infection/left ventricular failure treatment / clubbed fingers and crackles
41
Idiopathic Pulmonary fibrosis CXR
Fluffy base
42
Median survival for IPF
3 years
43
Treatment for IPF
Lung transplant. Possibly oral anti fibrotics eg pirfenidone, nintedanib, palliative care
44
Causes of hypersensitivity pneumonitis
Hay, birds etc