Restrictive Thoracic Disease

Question 1

What is the umbrella term for the diseases within the lungs?

Answer 1

Interstital lung Disease (ILD)

Question 2

Is gas exchange affected in ILDs?

Answer 2

O2 exchange impaired at alveolar-arteriolar barrier

CO2 exchange unimpaired since it is a very soluble gas

Question 3

What is the effect on PaO2 and PaCO2?

Answer 3

Decreased PaO2

Normal PaCO2

Question 4

What is the cause of non-cardiopulmonary oedema?

Answer 4

leaky capillaries due to sepsis, trauma or altitude sickness

Question 5

What are some causes of consolidation of alveolar air spaces?

Answer 5

Infective pneumonia
Infarction (pulmonary emboli/vasculitis)
Organising pneumonias

Question 6

What is alveolitis?

Answer 6

Inflammatory infiltration of alveolar walls

Question 7

Which type of hypersensitivity reaction is extrinsic-allergic-alveolitis?

Answer 7

type 3

Question 8

Give examples of extrinsic-allergic-alveolitis.

Answer 8

Farmers lung - the mould (aspergillus)

Bird fancier’s lung - avian proteins

Question 9

What is another name for extrinsic allergic alveolitis?

Answer 9

Hypersensitivity pneumonitis

Question 10

What is a multi-system disease characterised by alveolitis, lymphadenopathy, erythema nodosum, uveitis, myocarditis and neuropathy?

Answer 10

sarcoidosis

Question 11

Which anti-arrhythmic can cause drug-induced alveolitis?

Answer 11

Amiodarone

Question 12

Which auto-immune diseases can cause alveolitis?

Answer 12

SLE
polyarteritis
Churg-Strauss syndrome

Question 13

Rheumatoid and idiopathic are types of what?

Answer 13

pulmonary fibrosis

Question 14

Dust disease is the common name for?

Answer 14

pneumoconiosis

Question 15

What are the 2 classifications of pneumoconiosis?

Answer 15

fibrogenic

non-fibrinogenic

Question 16

Asbestosis and silicosis are examples of which type of dust disease?

Answer 16

fibrogenic

Question 17

What are the clinical signs of ILD?

Answer 17

SOB on exertion
cough, no wheeze
finger clubbing
inspiratory crackles
central cyanosis (if hypoxaemic)

Question 18

What is the end stage response to the chronic inflammation of ILD?

Answer 18

pulmonary fibrosis

Question 19

What would the lung volumes (FEV1, FVC and ratio) of a person with ILD be?

Answer 19

Reduced FEV1 and FVC
normal ratio >75%
peak flow normal

Question 20

Which serum components would be raised in sarcoid?

Answer 20

Ca and ACE

Question 21

What sort of things do you look out for in the patient’s history?

Answer 21

occupation
pets
drugs
arthritis

Question 22

What would a diagnostic CXR of ILD show?

Answer 22

bilateral diffuse alveolar infiltrates

Question 23

what does pulmonary fibrosis look like on CXR?

Answer 23

ground glass

Question 24

Why would an ECHO be done in the diagnostic process of ILD?

Answer 24

to rule out heart failure and to diagnose pulmonary hypertension

Question 25

What is the initial treatment before drugs for ILD?

Answer 25

Remove any trigger factor (dust, drug, allergen).

Treat any reversible alveolitis.

Question 26

What are the first line drugs?

Answer 26

systemic steroids - oral prednisolone

Question 27

Would you give a patient with ILD inhaled corticosteroids?

Answer 27

no they are not effective

Question 28

What are the second line drugs?

Answer 28

oral azanthioprine - steroid sparring

Question 29

The second line drug is also used in a GI condition, which one?

Answer 29

IBD