Restrictive Thoracic disease

Question 1

What causes outwith the lungs cause restriction?

Answer 1

1. Skeletal (eg spinal curvature/ traumatic multiple rib fracture)
2. Muscle weakness in Intercostal muscles/diaphragm (myopathy/neuropathy/meylopathy)
3. Abdominal obesity/ ascites/ pregnancy

Question 2

What does type II respiratory failure cause?

Answer 2

hypo-ventilation
low PaO2
reduced lung volumes

Question 3

Aa barrier means?

Answer 3

Alveolar-arterial barrier

Question 4

Which gas can be easily passed through the Aa barrier?

Answer 4

CO2

Question 5

DPLD is an example of disease in which lung structure?

Answer 5

Alveoli

Question 6

DPLD does what to partial pressures in the alveoli?

Answer 6

decreased PaO2

normal CO2

Question 7

What is the most common cause of fluid in the alveolar air spaces?

Answer 7

Cardiac pulmonary oedema

raised pulmonary venous pressure

Question 8

Non cardiac pulmonary oedema is due to?

Answer 8

leaky pulmonary capillaries

sepsis/trauma

Question 9

Consolidation is?

Answer 9

when alveolar air space becomes filled with infection

Question 10

What can cause infective consolidation pneumonia?

Answer 10

viral
bacterial
fungal
parasites

Question 11

Pulmonary emboli and vasculitis can cause?

Answer 11

Pulmonary Infarction

Question 12

other causes of BOOP? (broncheolitis oblierans organising pneumonia)

Answer 12

rheumatoid disease
drugs
cryptogenic

Question 13

Extrinsic allergic alveolitis is which type of reaction?

Answer 13

IgG mediated type 3 hypersensitivity pneumonitis reaction

Question 14

farmers lung and avian flu are an example of?

Answer 14

Extrinsic- allergic- alveolitis

Question 15

what are the two branches of granulomatous alveolitis?

Answer 15

1. extrinsic allergic alveolitis

2. sarcoidosis

Question 16

What is sarcoidosis?

Answer 16

multi-system disease
rash on legs
inflammation in eyes/heart/nerves
Granulomatous alveolitis in lungs

Question 17

Drugs that induce alveolitis?

Answer 17

amiodarone

bleomycin/methotrexate

Question 18

what is pulmonary fibrosis?

Answer 18

An alveolitis that lays down collagen in the alveolar wall (simultanously to neutrophilic response)

Question 19

What conditions are pulmonary fibrosis associated with?

Answer 19

idiopathic pulmonary fibrosis

rheumatoid

Question 20

Pneumoconiosis is?

Answer 20

dust disease

Question 21

Fibrogenic pneumoconiosis examples?

Answer 21

Asbestosis

Silicosis

Question 22

Non-fibrogenic pneumoconiosis examles?

Answer 22

siderosis
stanosis
baritosis

Question 23

Cancers associated with carcinomatosis?

Answer 23

adenocarcinomas-
bronchus
breast
prostate
colon
stomach

Question 24

where are eosinophils in DPLD?

Answer 24

lung tissue

Question 25

clinical symptoms and signs of DPLD?

Answer 25

Breathless on exertion
cough-no wheeze
Finger clubbing
Inspiratory lung crackles
Central cyanosis (if hypoxaemic)
Pulmonary fibrosis at end stage

Question 26

Diagnosis of DPLD?

Answer 26

History
Reduced lung volumes
(decreased FEV1 and FVC)
Reduced gas diffusion (DLCO)
Arterial oxygen desaturation 
(decreased PaO2 and SaO2)
Presence of specific antibodies
Serum ACE and Ca in sarcoid
Bilateral diffuse alveolar infiltrates on CXR
ECG to diagnose secondary pulmonary hypertension
Bronchoalveolar lavage or induced sputum (exclude pneumocystis/TB etc.)
Transbronchial/ thorascopic lung biopsy

Question 27

treatment DPLD?

Answer 27

remove trigger factor
immuno-suppressives for alveolitis (danger of secondart infection)
corticosteroids (higher doeses than asthma)
Anti-fibrotic drugs (pirfenidone, nintedaninb)
O2 if hypoxic
LUNG TRANSPLANT

Question 28

Should inhaled steroids be used for DPLD?

Answer 28

NO!

Question 29

what do drugs like pirfenidone and nintedanib do?

Answer 29

prevent any further fibrosis of lungs

Question 30

ground glass reversible inflammation can be treated with?

Answer 30

corticoteroids