Restrictive Lung Diseases

Question 1

What is the physiological definition of restriction?

Answer 1

Forced vital capacity <80% of normal

Question 2

What happens to all the volumes and capacities during restrictive lung disease?

Answer 2

They all get smaller

Question 3

What is the marker of restriction?

Answer 3

Vital capacity

Question 4

What is the marker of obstruction?

Answer 4

FEV1

Question 5

What are anatomical causes of restriction?

Answer 5

Lung 
Pleura
Muscle 
Bone 
Other

Question 6

What are lung causes of restriction?

Answer 6

Interstitial lung diseases (idiopathic pulmonary fibrosis, sarcoidosis, hypersensitivity pneumonitis)

Question 7

What are the pleural causes of restriction?

Answer 7

Pleural effusions (fluid in pleural space), pneumothorax (air in pleural space), pleural thickening

Question 8

What are skeletal causes of restriction?

Answer 8

Kyphoscoliosis
Ankylosis spondylitis
Thoracoplasty
Rib fractures

Question 9

What are muscular causes of restriction?

Answer 9

Amyotrophic lateral sclerosis

Question 10

What are subdiaphragmatic causes of restriction?

Answer 10

Obesity and pregnancy

Question 11

Where is the interstitium?

Answer 11

Tiny space between epithelium of alveoli and endothelium of the capillary

Question 12

What are interstitial lung diseases?

Answer 12

Thickening of the interstitium lead to pulmonary fibrosis (lung fibrosis)

Question 13

What is the shitologivsl hallmark for sarcoidosis?

Answer 13

Non caseating granuloma

Question 14

What does erthyma nodosum mean?

Answer 14

Red nodules (lumpy)

Question 15

What are the differential diagnoses for erythema nodosum?

Answer 15

Sarcoidosis
Infection
Some medications

Question 16

Are granuloma found in the biopsy of erythema nodosum?

Answer 16

No

Question 17

If a patient is suspected to have sarcoidosis what must you do to their eyes?

Answer 17

Have them checked by a spec list like an optician.

Question 18

Where do granulomatus traditionally locate?

Answer 18

In areas of skin trauma such as tattoos or scars

Question 19

Who normally gets sarcoidosis?

Answer 19

Under 40s
Women > Men
World wide

Question 20

How do you investigate it?

Answer 20

History and examination 
CXR 
Pulmonary function tests 
Bloods 
Urine analysis 
Eye exam

Question 21

What do you see in CXR of sarcoidosis?

Answer 21

Enlarged glands

Question 22

What is seen in CXR of stage 2 disease in sarcoidosis?

Answer 22

Spotty lungs

Question 23

What is seen in CXR of stage 3 disease in sarcoidosis?

Answer 23

Interstitial change

Question 24

What is seen in CXR of stage 4 disease in sarcoidosis?

Answer 24

Fibrotic lung disease

Question 25

What further assessment can be done for sarcoidosis?

Answer 25

Bronchoscopy including trans bronchial biopsies and endobronchial ultrasound

Question 26

What surgical biopsies may be needed?

Answer 26

Medistinoscopy | Video assisted thoracoscopic lung biopsy

Question 27

How is mild disease in sarcoidosis treated?

Answer 27

No treatment

Question 28

How is erythema nodosum treated from sarcoidosis?

Answer 28

NSAIDS

Question 29

How are skin lesions from sarcoidosis treated?

Answer 29

Topical steroids

Question 30

How do you treat cardiac, neurological and eye disease that isn't responding to topical rx in sarcoidosis?

Answer 30

Systemic steroids

Question 31

What is the typical symptoms for idiopathic pulmonary fibrosis?

Answer 31

Chronic breathlessness and cough

Question 32

What is the typical age group for Idiopathic pulmonary fibrosis?

Answer 32

60-70 years of age

Question 33

What are the main signs of idiopathic pulmonary fibrosis?

Answer 33

Finger clubbing and crackles that don't go away.

Question 34

What is the median survival for idiopathic pulmonary fibrosis?

Answer 34

3 years

Question 35

What drugs can be used to slow down the lung fibrosis in idiopathic pulmonary fibrosis?

Answer 35

Oral anti-fibrotic Pirnfenidone Nintedanib Palliative care

Question 36

What are surgical options for idiopathic pulmonary fibrosis?

Answer 36

Transplant