Restrictive Lung Dz

Question 1

Acute respiratory distress syndrome (ARDS)

Answer 1

Acute lung injury w/ acute and persistent lung inflammation and increased vascular permeability.

Question 2

4 clinical features of ARDS

Answer 2

Acute onset
Bilateral infiltrates w/ pulmonary edema
Hypoxemia
No evidence of elevated atrial pressure

Question 3

Some causes of ARDS

Answer 3

Sepsis
Trauma
Pneumonia
Severe trauma
Drugs, alcohol

Question 4

ARDS Patho

Answer 4

Inflammatory injury to alveoli results in diffuse alveolar damage.
Lungs receive disproportionate amount of cardiac output.
Surfactant is lost

Question 5

Honeycomb chest x-ray =?

Answer 5

Proliferative stage of ARDS

Question 6

ARDS Diagnosis

Answer 6

BNP - low levels
Echocardiography
Pulmonary artery cath

Question 7

ARDS Mgmt

Answer 7

Almost all pt's require mechanical ventilation
Sedation, avoid neuromuscular blockade
Analgesia
Nutritional support
DVT, GI prophylaxis
PEEP

Question 8

Asbestosis

Answer 8

Inhalation of asbestos fibers
Chrysotile responsible for most US cases
Slowly progressive
Malignant mesothelioma

Question 9

Asbestosis Findings

Answer 9

20 - 30 yr latent period
Dyspnea on exertion
Fine bibasilar crackles, clubbing

Question 10

Asbestosis radiography findings

Answer 10

Shaggy heart and ground glass appearance

Honeycombing in late stages

Question 11

Bronchiolitis Obliterans (BO)

Answer 11

Chronic airway rejection in lung transplant patients due to:
Acute rejection
CMV pneumonitis
Noncompliance from immunosuppressives.

Question 12

BO Presentation

Answer 12

Usually indolent URI type sx
Exertional dyspnea
Hyperinflation
Pseudomonas colonization

Question 13

BO Diagnosis

Answer 13

45% of lung transplant recipients develop this by 5 years.

Usually made on patients who develop declining spirometry without acute illness

Question 14

BO Tx

Answer 14

Change meds
Photopheresis
Retransplantation
25 - 50% mortality

Question 15

Hypersensitivity Pneumonitis

Answer 15

AKA extrinsic allergic alveolitis, farmers lung

Immunologic rxn to inhaled agent (agricultural dusts, bioaresols, reactive chemical species)

Question 16

HP Risk factors

Answer 16

Farmers and bird fanciers have an elevated risk
Plastic manufacturing, Painting
smoking REDUCES risk
Genetic factors

Question 17

HP presentation

Answer 17

May follow heavy exposure to antigen
Abrupt onset of FLS, dyspnea, chest tightness
Tachypnea, fine rales

Question 18

HP Tx

Answer 18

Removal from antigen
Should subside in 12 hrs
glucocorticoids for initial recovery

Question 19

Interstitial Lung Dz

Answer 19

DIffuse parenchymal lung diseases, collectively referred to as ILD.
All have similar features
Extensive reconstruction of pulmonary architecture

Question 20

Interstitial Pulmonary Fibrosis

Answer 20

50% idiopathic
Progressive exertional dyspnea and cough
hazy x-ray, then nodules, then linear opacities
Usually die of resp. failure within 3-6 yrs
Affects adults >40

Question 21

IPF Tx

Answer 21

May not be helpful….
Glucocorticoids
Immunosupressives
Antioxidants

Question 22

Sarcoidosis

Answer 22

A multisystem granulomatous disorder of unknown etiology
Characterized by noncaseating granulomas in involved organs.
Typically affects young adults

Question 23

Sarcoidosis Presentation

Answer 23

Bilateral hilar adenopathy
Pulmonary reticular opacities
Skin, joint and eye lesions
Lung involvement in 90% of patients
Dyspnea, cough, CP

Question 24

Pulmonary Sarcoidosis Tx

Answer 24

Spontaneous remission may occur

Glucocorticoids, daily

Question 25

Drug-induced pulmonary dz

Answer 25

Eosinophilic Pneumonias

present 2-10 days after drug started

Question 26

Radiation-induced lung injury

Answer 26

Radiation pneumonitis
Radiation fibrosis
Dose-limiting damage

Question 27

Radiation-induced lung injury presentation

Answer 27

Early non-productive cough
Dyspnea on exertion
Low grade fever
pleuritic CP
Fine crackles
Pulmonary HTN

Question 28

Radiation-induced lung injury Tx

Answer 28

Corticosteroids

Inhibition of collagen synthesis

Question 29

Pneumoconiosis

Answer 29

nonneoplastic reaction of the lung to inhaled mineral or organic dust
Silicosis, coal workers