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HLB > Restrictive, Mixed Restrictive and Obstructive Lung Disease > Flashcards

Restrictive, Mixed Restrictive and Obstructive Lung Disease Flashcards

1
Q

AAFB

A

acid and alcohol fast bacilli

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2
Q

DPLD

A

Diffuse parenchymal lung disease

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3
Q

IPF

A

idiopathic pulmonary fibrosis

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4
Q

LDH

A

Lactate Dehydrogenase

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5
Q

NSIP

A

non-specific interstitial pneumonitis

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6
Q

SLE

A

systemic lupus erythematosus

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7
Q

Lung Function Test

A
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8
Q

Restrictive Lund disease diagram

A
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9
Q

Restriction diagram

A
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10
Q

Causes of restriction (4)(3)(5)(0)(4):

A
  • Parenchymal lung disease (DPLD):
  • Pulmonary fibrosis
  • Sarcoidosis
    -Pneumoconiosis
  • Pleural disease:
  • pleural effusion
  • pneumothorax
  • haemothorax
  • pleural calcification, thickening
  • mesothelioma
  • Obesity:
  • Chest wall disease:
  • neuromuscular disease
  • diaphragmatic palsy
  • kyphosis
  • scoliosis
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11
Q

Diffuse Parenchymal Lung Disease diagram:

A

Damage to lung parenchyma leads to inflammation and fibrosis
Injury causes release of chemicals that damage epithelium leading to inflammation and fibrosis (go over inflammatiton)

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12
Q

Fibrosis of the Lungs:

A
  • fibrosis of the lungs leads to scarring
  • primary site of injury of the interstitium: the space between the epithelial cells and endothelial basement membrane
  • lungs become thick and stiff
  • there is reduction transfer of oxygen from the alveolar space into the lung capillaries
  • patients become breathless
  • oxygen saturation will drop
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13
Q

History in suspected diffuse parenchymal lung disease:

A
  • Occupation: asbestos, pneumoconiosis
  • Pets: birds (pigeons, budgies, parakeets),cats, dogs
  • Drugs: amiodaron, nitrofurantoin, chemotherapy
  • Exposure to Radiation, including radiotherapy
  • Systemic enquiry: autoimmune diseases
  • HIV
  • family history
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14
Q

Symptoms in patients with Diffuse Parenchymal Lung Disease:

A
  • breathlessness, progressively worsening
  • cough
  • fatigue
  • weight loss
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15
Q

Symptoms specific to autoimmune disease/collagen vascular disease:

A
  • difficulty swallowing
  • cold hands
  • joint pains
  • weight loss
  • skin rash
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16
Q

Clinical Examination in Diffuse Parenchymal Lung Disease:

A
  • high respiratory rate at rest (tachypnoea, dyspnoea)
  • clubbing
  • fine bibasal crackles
  • cardiovascular examination
  • Increased JVP, peripheral oedema, loud P2 heart sound
  • low oxygen saturation and desaturation on exertion
  • Features of autoimmune disease:
    • skin changes: telangiectasia, Raynaud’s phenomena
  • joint signs
  • eye signs
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17
Q

High respiratory rate, clubbing, fine bibasal crackles, breathless likely to be

A

pulmonary fibrosis (DPLD)

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18
Q

Idiopathic pulmonary fibrosis definition

A

IPF is a distinctive type of chronic fibrosing interstitial pneumonia of an unknown cause limited to the lungs

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19
Q

Prevalence of idiopathic pulmonary fibrosis

A

6-14.6/100,000

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20
Q

Prevalence of idiopathic pulmonary fibrosis in over 75 yrs.

A

175/100,000

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21
Q

Idiopathic Pulmonary Fibrosis usually presents in what age group?

A

Over 50 yrs

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22
Q

Which gender does idiopathic pulmonary fibrosis present in?

A

Male more than female

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23
Q

Does idiopathic pulmonary fibrosis have any occupational history of relevance?

A

No

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24
Q

Does idiopathic pulmonary fibrosis have any features of autoimmune disease?

A

No

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25
Can idiopathic pulmonary fibrosis be famial?
Yes
26
Presentation of Idiopathic Pulmonary Fibrosis
- progressively worsenign shortness of breath over 2 years - dry cough - crackles (fine babasil) - clubbing - weight loss - hypoxic
27
Prognosis of idiopathic pulmonary fibrosis
- gradual deterioration - median length of survival from diagnosis: 2.5-3.5 years - exacerbations and sudden decline
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Idiopathic pulmonary fibrosis
29
HRCT of idiopathic pulmonary fibrosis
watch this part of lecture
30
Idiopathic pulmonary fibrosis: lung function:
- FVC decreases - FEV1 normal or slightly low - FEV1/FVC increases - reduced transfer factor/diffusing capacity (TLCO)
31
Management of Idiopathic pulmonary fibrosis: 4 types of treatment:
- Symptomatic Treatment - Antifibrotic Treatment - Lung Transplantation under the age of 60 - Palliative Care
32
Is Idiopathic pulmonary fibrosis associated with smoking?
Yes
33
Management of Idiopathic pulmonary fibrosis: Symptomatic Treatment:
- cough: mucolytics - hypoxia treated with long term oxygen therapy
34
Management of Idiopathic pulmonary fibrosis: Antifibrotic Therapy:
- Pirfenidone - Nintedanib (not a cure but can stabilise) (limiting factors are side effects)
35
What is Non - Specific Interstitial Pneumonia (NSIP) associated with?
- associated with autoimmune disease/ collagen vascular disease
36
Median age affected by non-specific interstitial pneumonia
40-50 yrs
37
Which gender does non - specific interstitial pneumonia affect more?
Affects both equally
38
Does non-specific interstitial pneumonia have an association with smoking?
No
39
Symptoms of non-specific interstitial pneumonia
- progressively worsening breathlessness over 1 year - cough - crackles - clubbing - fatigue - weight loss
40
NSIP Associated with Collagen Vascular Disease
- Scleroderma (CREST/Systemic Sclerosis) - Rheumatoid arthritis - SLE
41
Non-specific interstitial pneumonia has a worse prognosis than IPF. True or False? Why?
False Better prognosis as can treat underlying autoimmune disease, which ease symptoms
42
Non-specific interstitial pneumonia responds better to anti-inflammatory drugs than IPF. True or False?
True
43
Chest x-ray of NSIP
Small lungs with reticulo-nodular changes
44
CT NSIP
Ground glass changes
45
Management of NSIP
- treatment of underlying condition - immunosuppression - long term oxygen therapy - palliative care
46
Prognosis of IPF and NSIP graph
47
Sarcoidosis (5) :
- multisystem granulomatous disease - unknown cause/aetiology - characterised by non-caseating granulomas, often in multiple organs - sarcoidosis primarily affects the lungs - may resolve spontaneously, can recur and may progress to pulmonary fibrosis
48
Aetiology of sarcoidosis:
- infection: - remnants of microbial organisms - organic dusts, metals, minerals, solvents, pesticides, wood stoves - beryllium results in pulmonary granulomas - can run in families
49
Clinical Presentation of Sarcoidosis: gender:
- slightly higher in women
50
Clinical Presentation of Sarcoidosis: age:
- 20-50 (smaller peak larger than 60 years??)
51
Clinical Presentation of Sarcoidosis: ethnicity:
- higher in Scandinavian, Afro-Caribbean and African American women
52
Clinical Presentation of sarcoidosis: incidence:
- overall, 5/100,000
53
Clinical Presentation of Sarcoidosis: Prevalence:
- most common ILD in the UK
54
Clinical Presentation of sarcoidosis: association:
- TB - lymphoma
55
Symptoms of acute sarcoidosis are: - duration - self-limiting
- short duration - self-limiting
56
Symptoms of chronic sarcoidosis: - duration - self-limiting - changes
- longer duration - not self-limiting - persistent radiological changes
57
Asymptomatic sarcoidosis would be diagnosed by an
incidental finding
58
Symptoms and Signs of acute sarcoidosis:
- fever - arthralgia: aching joints - anterior uveitis: painful red eyes - breathlessness - reduced appetite - night sweats - myalgia - erythema nodosum: painful red lumps on lower legs - lymphadenopathy: swollen lymph nodes - weight loss - Loefgren's syndrome: erythema nodosum and BHL (bilateral hilar lymphadenopathy) - responds to oral prednisone - good prognosis
59
Erythema Nodosum
painful red lumps on lower legs
60
Anterior Uveitis
painful red eyes
61
Chronic Pulmonary Sarcoidosis symptoms (10)
- progressively worsening breathlessness - reduced exercise tolerance - cough - fatigue - anorexia - weight loss Neurological Symptoms, bone pain, skin lesions (EN, lupus pernio in 25%), renal stones Differential diagnoses: wide, cancer Lung: any diffuse parenchymal disease
62
If a patient comes in with acute exacerbation of IPF, with an infection, can be given
- steroids - obvs antibiotics - steroids are not a long term solution
63
Organ involvement in Sarcoidosis: What % have pulmonary involvement? What % have evidence of only lung involvement?
- 90% have pulmonary involvement - 50% have evidence of only lung involvement
64
Which organs can be involved in sarcoidosis? (
- Skin - Joints and Muscles - Heart - Lacrimal glands - GI system - Lymph nodes - Liver - Bone - Kidneys - Pancreas - Eyes - Spleen - Salivary Glands - Nasal - Brain
65
Clinical Approach in Sarcoidosis:
- History: occupational, family - Examination - Chest X-Ray - Full lung function test - Blood tests - Urinalysis - ECG - Ophthalmologic examination - Tuberculin skin test - no definition diagnostic test for sarcoidosis - diagnosis made with compatible clinical, radiological and histopathological features
66
Radiological Staging of Sarcoidosis:
- Stage 0: Normal chest X ray (5-0%) - Stage I: Bilateral Hilar Lymph nodes (45%-65%) most common presentation, no treat lymph nodes - Stage II: Nodes + upper zone parenchymal disease (25=30%) - Stage III: parenchymal disease upper zones - Stage IV: end stage pulmonary fibrosis Treatment begins with steroids in stage 2 and other medication
67
Lung Function In Sarcoidosis:
- restrictive pattern - airflow obstruction - can have both mixed restrictive and obstructive lung function
68
Other Investigations in Sarcoidosis:
- Serum ACE: produced by activated macrophages in granulomas - Hypercalcaemia due to increased Vitamin D by macrophages in granulomas - Hypercalciuria (high calcium in urine) - ACE = angiotensin converting enzyme
69
Natural History of Sarcoidosis:
- 2/3: remission within 10 years; stage 1 60% complete resolution within 2 years - 1/3: progression with significant organ damage - 1-5%: die secondary to respiratory failure, cardiac arrhythmia, neurosarcoidosis
69
Natural History of Sarcoidosis:
- 2/3: remission within 10 years; stage 1 60% complete resolution within 2 years - 1/3: progression with significant organ damage - 1-5%: die secondary to respiratory failure, cardiac arrhythmia, neurosarcoidosis
70
Management of Acute Sarcoidosis:
Oral Prednisolone
71
Management of Asymptomatic or Stage I Sarcoidosis:
observation
72
Management of Stage II, III, IV Sarcoidosis:
prednisolone (steroid)
73
Management of progressive Sarcoidosis:
- immunosuppressive drugs - methotrexate - mycophenolate mofetil
74
Main differential diagnosis for Stage I and Stage II Sarcoidosis is
differential diagnosis
75
Differential diagnoses for Stage III and Stage IV include
other DPLD
76
Pleural Disease (5):
- Pleural Effusion - Pneumothorax - Haemothorax - Pleural Thickening - Mesothelioma
77
Pleural Disease: Pleural Effusion:
- fluid in the pleural space - exudate = thick pleural effusion - transudate = thin pleural effusion - sharp pain, which is worse on inspiration; pleural chest pain
78
Pleural Disease: Pneumothorax:
- air in pleural space, damage to parenchyma pops (anything could be emphysema) - spontaneous - traumatic: procedural, penetrating trauma, rib fracture, barotrauma - tall, skinny male (white)
79
Pleural Disease: Haemothorax:
- blood in the pleural space - traumatic injury
80
Pleural Disease: Pleural Thickening:
pleura thicken
81
Pleural Disease: Mesothelioma:
cancer of the pleura
82
Pleural Effusion diagram
83
Purpose of pleural fluid
lubricates pleural space, avoids friction when lungs move
84
What is the amount of pleural fluid produced and cycled through the pleural space?
1L
85
86
87
Pleural Aspiration (Thoracocentesis)
- pleural fluid can be taken at the bedside with ultrasound guidance, local anaesthetic and a needle. - Pleural Drainage if patient is symptomatic
88
Pleural Effusion: when examining a patient, what would you see?
- complaining of chest pain maybe - breathless - not moving equally or symmetrically; eg left PE, left side of chest will not rise as much as the right side - reduced chest wall movement on the side of the effusion - dullness on percussion on the side of the effusion: this is the most reliable clinical finding - decreased tactile vocal fremitus and vocal resonance on the side of the effusion - bronchial breathing above the effusion - tracheal deviation away from side of a large effusion
89
Name procedure
Pleural aspiration
90
Diagnostic sample of pleural effusion:
- Biochemistry: protein and lactate dehydrogenase (LDH) - Microbiology: microscopy, culture and sensitivity, acid and alcohol fast bacilli (AAFB) looking for infections (TB) - Cytology: abnormal cells (cancer)
91
Types of pleural effusion:
- exudate - transudate
92
Type of pleural effusion is determined by:
- protein - lactate dehydrogenase (LDH) - serum protein (ACE) - serum LDH
93
What is used to differentiate between an exudate PE and transudate PE?
Light's Criteria
94
Exudate Pleural Effusion: - pleural fluid protein/serum protein - pleural fluid LDH/serum LDH - pleural fluid LDH
- >0.5 - >0.6 - > 2/3 of upper limit of normal serum LDH - more protein
95
Transudate pleural effusion: - pleural fluid protein/serum protein - pleural fluid LDH/serum LDH - pleural fluid LDH
- < 0.5 - < 0.6 - < 2/3 of upper limit of normal serum LDH - less protein
96
Causes of Pleural Effusion: Transudate:
- low protein, reduced oncotic pressure, normal pleura - Congestive cardiac failure - Low albumin caused by nephrotic syndrome or liver failure
97
Causes of Pleural Effusion: Exudate:
- unhealthy pleura - malignancy - infection (pneumonia, tuberculosis, emphysema) - autoimmune disease - chylothorax (due to blocked lymphatics)
98
Clinical Signs of Pleural Effusion
- reduced chest wall movement on the side of the effusioni
99
Pneumothorax
100
Pneumothorax classification:
- Primary: spontaneous - Secondary: due to underlying disease
101
Large pneumothorax can cause mediastinum to be deviated. True or False?
True
102
Tension pneumothorax
- tension builds up - can cause cardiac arrest
103
Primary Pneumothorax Classification: Risk Factors:
- tall and thin: to do with pressure gradients - asthma - collagen vascular disease
104
Secondary Pneumothorax Classification: Risk Factors:
- COPD - Pulmonary Fibrosis - Cystic Fibrosis
105
Pleural Disease
106
Chest Wall Disease
- results in difficulty expanding the lungs - does not directly affect oxygenation, lung structure is normal but can't ventilate - presents with progressively worsening breathlessness
107
Chest Wall Disease Risk Factors:
- obesity - neuromuscular: motor neuron disease, muscular dystrophy, poliomyelitis, diaphragmatic palsy - musculoskeletal: kyphosis, scoliosis
108
109
Combination of obstructive and restrictive diseases: smoking:
- emphysema - pulmonary fibrosis
110
Combination of obstructive and restrictive diseases: pulmonary sarcoidosis:
- endobronchial sarcoidosis - fibrosis
111
Combination of obstructive and restrictive diseases: Obesity in a smoker:
- obstruction - restriction
112
What will spirometry show in a restrictive lung disease? 1 = Increased FEV1 2 = Reduced FEV1 3 = Increased FVC 4 = Decreased FVC 5 = Decreased FEV1/FVC ratio
4
113
Which of these statements about idiopathic pulmonary fibrosis is true? 1 = is a restrictive lung disease 2 = is a type of malignancy 3 = has an excellent prognosis 4 = can be treated with antibiotics 5 = is common in young females
1
114
Which organ is most commonly affected by sarcoidosis? 1 = eyes 2 = kidneys 3 = lungs 4 = skin 5 = spleen
3
115
Which of these statements about pleural effusion is true? 1 = can cause an obstructive lung disease 2 = can be caused by heart failure 3 = there is no pleural fluid in healthy lungs 4 = important to measure calcium in the fluid 5 = is always associated with a bad outcome
2
116
Which of these conditions can cause a restrictive lung disease? 1 = kyphosis 2 = obesity 3 = pulmonary fibrosis 4 = sarcoidosis 5 = all of these
5

HLB (49 decks)

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