restrictive thoracic diseas

Question 1

causes of thoracic restriction out with the lungs

Answer 1

• skeletal eg kyphoscoliosis
• muscle weakness
• abdominal obesity / ascites
  = results in chronic alveolar under ventilation with low PaO2 (reduced SaO2) and raised PaCO2 and reduced lung volumes

Question 2

what does interruption of arterial barrier result in?

Answer 2

mismatch of ventilation and perfusion

Question 3

diseases of alveolar structures (alveolar walls/lumen - lung parenchyma) results in

Answer 3

• impaired alveolar gas exchange
• alveolar barrier to O2 exchange
• CO2 exchange unimpaired as alveolar ventilation normal

Question 4

what is Diffuse Parenchymal Lung Disease (DPLD) or interstitial lung disease?

Answer 4

a group of diseases hat affect the interstitium (the tissue and space around the alveoli)

Question 5

Cardiac po oedema

Answer 5

• in alv walls and lumen

- due to raised Po venous pressure ie LVF

Question 6

non cardiac po oedema

Answer 6

• normal po venous pressure with leaky po capilliareis

- due to sepsis or trauma or altitude sickness

Question 7

infectiveness pneumonia (alv air space)

Answer 7

• viral eg influenza
• bacterial eg pneumococcus, TB
• fungal eg HIV
• parasitic eg toxocara

Question 8

infarction (alv air space)

Answer 8

• pulmonary emboli/ vasculitis

Question 9

extrinsic allergic alveolitis (alv walls)

Answer 9

• farmers lung
• avian (pigeon)
• type 3 reaction
• hypersensitivity pneimonitis

Question 10

sarcoidosis (alv walls)

Answer 10

• multi system disease
• lymphadenopathy
• erythema nodosum

Question 11

dust diseases

Answer 11

fibrogenic = asbestois, silicosis
non-fibrogenic = siderosis (iron), stanosis (tin), baritosis (barium)

Question 12

carcinomatosis

Answer 12

• lymphatic / blood spread

Question 13

eosinophlic type 1/3 allergic response

Answer 13

• drugs
• fungal
• parasites
• autoimmune
• nitrofurantoin
• aspergillosis
• toxocara, ascaros, filaria,
• churg strauss, polyarteritis

Question 14

what are the clinical syndromes of DPLD?

Answer 14

Breathless on exertion
Cough but no wheeze
Finger clubbing
Inspiratory Lung crackles
Central cyanosis (if hypoxaemic)
Pulmonary fibrosis occurs as end stage response to chronic inflammation
*velcro*

Question 15

what is the diagnosis of DPLD?

Answer 15

• history eg occupation, drugs, pets, arthiritis
• reduced lung volumes eg reduced FEV1, reduced FVC = normal ration >75%
• reduced gas diffusion
• arterial oxygen desaturation
• bilateral diffuse alveolar infiltrates on chest XRAY

Question 16

treatment of DPLD

Answer 16

• remove trigger factor
• treat reverisble alveolitis with immuno-supressives
• 1st line treatment = systemic steroids ie oral prednisolone ICS is not effective
  2nd line treatment - oral azathioprine
• O2 if hypoxic