Sketchy Path: Restrictive Lung Disease (Overview)

Question 1

Restrictive lung diseases are all characterized by decreased _____________.

Answer 1

compliance (like the little kid tearing up his compliance contract outside the window)

Question 2

What spirometry values are characteristic of restrictive lung disease?

Answer 2

• Decreased TLC (like the turned over Total Load Capacity vegetable cart)
• Elevated FEV/FVC due to decreased FVC (like the FVC sign sagging below the FEV sign)
• Decreased FRC because of decreased RV (like the residual cart turned over)

Question 3

_____________ is the amount of air left in the lungs after a normal exhalation.

Answer 3

FRC

Question 4

What signs and symptoms are suggestive of intrinsic restrictive lung disease?

Answer 4

• Dyspnea (maid struggling to breathe as she tightens the corset)
• Cough (woman coughing)
• “Velcro-like” rales at the lung bases (like the velcro coming undone on the woman’s shirt near the bottom of her torso)

Question 5

What x-ray patterns are typical of instrinsic restrictive lung disease?

Answer 5

Diffuse, reticulonodular pattern bilaterally (like the lacy, nodular pattern on the woman’s corset)

This is often described as “ground glass” (like the ground mirror).

Question 6

Long-term restrictive lung disease can lead to _______________.

Answer 6

pulmonary arterial hypertension (like the woman pulling the red strings tight) with progression to cor pulmonale (like the ship in the CORked bottle)

This occurs due to obliteration of capillary beds.

Question 7

What extrinsic things can cause restrictive lung disease?

Answer 7

• Pleural diseases like effusion, plaques, or mesothelioma (represented by the governor’s blue vest)
• Neuromuscular diseases (like the muscular guy who can’t telegraph news to Parliament because his telegraph wire is severed)
• Spinal disorders like scoliosis and ankylosing spondylitis (like the spines on the locked drawers)
• Obesity (overweight governor)

Question 8

Although obesity-related restrictive lung disease can have the same spirometry profile as the other restrictive lung diseases, it is most common to see __________________.

Answer 8

selective decreases in ERV (like how the governor has depleted his Extra ReserVes from the safe)

Question 9

Chronic obesity hypoventilation syndrome can lead to _________________.

Answer 9

low PaO2 and high PaCO2

Question 10

The extrinsic restrictive lung diseases can cause ______________, long-term.

Answer 10

PAH and cor pulmonale (like the strained red strings on the governor’s vest and the CORked ship in a bottle)

Question 11

It’s very important to know that the pulmonary physical exam of a patient with an extrinsic restrictive lung disease will be ___________.

Answer 11

normal; the x-ray patterns, cough, and crackles discussed in another card apply only to intrinsic lung diseases

Question 12

The ______________ restrictive lung diseases present with decreased DLCO.

Answer 12

intrinsic (like the plastic garbage on the ground outside the window by the woman who represents the intrinsic lung diseases)