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Clin Med, Path, Pharm > test 7.2 > Flashcards

test 7.2 Flashcards

1
Q

Definition of restrictive lung disease

A

Characterized by reduction in lung volume. (TLC, VC, or resting lung volume)

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2
Q

What are the two groups of restrictive lung disease?

A 
Lung parenchyma (intrinsic):  air spaces fill with exudates and debris
Extraparenchyma (extrinsic): dz of chest wall, pleura, and respiratory muscles
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3
Q

Types of intrinsic restrictive lung disease

A

Sarcoidosis
Idiopathic pulmonary fibrosis
Interstitial lung disease (asbestosis, pneumoconiosis, meds, drugs, radiation, hypersensitivity pneumonitis, rheumatoid arthritis, lupus, scleroderma)
ARDS, IRDS

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4
Q

Types of extrinsic restrictive lung disease

A

Myasthenia gravis
Guillain Barre
Kyphosis and chest wall deformities
Dz that restricts lower throacic or abdomen volume (obesity, hernia, ascites)

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5
Q

True or false: Restrictive lung dz preserves airflow and resting lung volume

A

True

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6
Q

How do you measure airflow and resting lung volume?

A

functional residual capacity (FRC)

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7
Q

Which step is passive, lung inflation or lung deflation?

A

Deflation

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8
Q

Volume of air in the lungs with respiratory muscles fully relaxed so no airflow is present

A

FRC

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9
Q

Multisystem inflammatory disease of unknown etiology (esp.lungs, lymph nodes, skin)

A

sarcoidosis

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10
Q

How does sarcoidosis present?

A

Non-necrotizing granulomas in lungs and intrathroacic lymph nodes. Exaggerated immune response from T cells

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11
Q

What race has greater prevalence and severity of sarcoidosis?

A

African Americans

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12
Q

Typically age of onset of sarcoidosis

A

24-45

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13
Q

fever, weight loss, arthralgia, DOE, crackles, skin lesions, uveitis, lupus pernio

A

Sarcoidosis

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14
Q

How is sarcoidosis staged?

A

CXR

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15
Q

Bilateral hilar lymphadenopathy stage

A

1

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16
Q

BHL & infiltrates stage

A

2

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17
Q

Infiltrates stage

A

3

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18
Q

Fibrosis stage

A

4

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19
Q

What do non-caseating granulomas secrete?

A

Vit D like hormone (causes hypercalcemia and hypercalciuria), ACE (ACE levels are high)

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20
Q

What will pulmonary function tests show?

A

Decreased VC and DLCO, pulm. htn, O2 drops w/ 6. min of walking

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21
Q

Measures the ability of lungs to transfer gas from inhaled air to the RBCs in pulmonary capillaries

A

DLCO

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22
Q

Mainstay of therapy for sarcoidosis

A

Corticosteroids

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23
Q

Sarcoidosis and can’t tolerate steroids

A

Methotrexate

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24
Q

Given for cutaneous lesions, hypercalcemia, neruological, bone lesions of sarcoidosis

A

Chloroquine

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25
Q

Qualifications for lung transplant with sarcoidosis

A

Stage 4 with VC <40%

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26
Q

Follow up of sarcoidosis

A

CXR and PFT every 6-12 months

Annual slit lamp eye exam

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27
Q

Specific form of chronic, progressive interstitial scarring of unknown cause

A

Idiopathic pulmonary fibrosis

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28
Q

Prognosis of IPF

A

Poor, 2-5 year survival from time of dx

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29
Q

Epithelial-fibroblastic dz that causes diffuse epithelial cell disorganization

A

IPF pathophys

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30
Q

88% of IPF pts have this

A

Obstructive sleep apnea (OSA)

31
Q

How does IPF present?

A

DOE, non-productive cough, weight loss, low grade fevers, fatigue, arthralgias

32
Q

IPF PE

A

Inspiratory crackles
PH
Digital clubbing

33
Q

Symptoms of PH

A

RV heave
Increasd JVP
Pedal edema
Tricuspid regurgitation

34
Q

IPF CXR findings

A

Reticular opacities, predominantly at lung bases (honeycombing)
HIgh-res CT shows patchy reticular opacities

35
Q

IPF treatment

A 
Treat comorbidities
Smoking cessation
Oxygen therapy
Vaccination (flu and pneumococcal)
Lung transplant?
36
Q

Specific form of chronic, progressive interstitial scarring of known cause

A

Interstitial Lung Disease

37
Q

Asbestosis, silicosis, pneumoconiosis cause what type of lung dz?

A

ILD

38
Q

Medication, drug, radiation caused scarring is what type of disease?

A

ILD

39
Q

Hypersensitivity pneumonitis is a cause for what type of disease?

A

ILD

40
Q

Collagen vascular diseases like rheumatoid arthritis, lupus, and scleroderma cause what type of scarring lung disease?

A

ILD

41
Q

Result of ILD where increased interstitial tissue replaces normal capillaries and alveoli?

A

Decreased perfusion

42
Q

What are the four leading coal producing states?

A

Wyoming
West Virginia
Kentucky
Pennsylvania

43
Q

Coal mining can give you what disease?

A

pneumoconiosis

44
Q

What medications can cause ILD?

A 
Nitrofurantoin
ASA
Methotrexate
Amiodarone
Propanolol
45
Q

What drugs can cause ILD?

A

Heroin
Methadone
Cocaine
Propoxyphene

46
Q

What is cause of hypersensitivity pneumonitis that can cause ILD?

A

Bird-breeder’s lungs (bird dropping)
Farmer’s lungs (moldy hay)
Humidifier lungs (hot tubs, air conditioners)
Chemical worker’s lungs (resins, plastics, paints)

47
Q

Connective tissue diseases that cause ILD

A

scleroderma, rheumatoid arthritis, SLE, Sjogren’s syndrome, polymyositis

48
Q

S/Sx of ILD

A 
DOE 
non-productive cough
Decreased DLCO
Diffuse inspiratory rales/wheezing
Fever, chills, malaise
49
Q

ILD CXR findings

A

Interstitial opacities (GROUND GLASS)

50
Q

ILD Treatment

A 
Corticosteroids
Immunosuppressive (cyclosporine)
Oxygen therapy
Pulmonary rehab
Transplant?
Vaccines:  pneumococcal, influenza
51
Q

Characterized by bilateral pulmonary infiltrates and severe hypoxemia with diffuse alveolar injury leading to respiratory failure

A

ARDS

52
Q

What are the two types of ARDS?

A

Direct (toxic inhalation)

Indirect (sepsis)

53
Q

What is the mortality rate of ARDS if 3 organ systems fail?

A

99%

54
Q

Pathophys of ARDS

A

Increased permeability of alveolar-capillary barrier, Main sites of injury are vascular endothelium (sepsis) or alveolar epithelium (aspiration). promotes pulmonary edema

55
Q

What % of ARDS pts have no identifiable risk factor?

A

20

56
Q

Aspiration of gastric contents, sepsis, pancreatitis, multiple long bone fx, burns, transfusions, CABG sx, and drug OD are risk factors for what?

A

ARDS

57
Q

ARDS presentation

A

Critically ill, multi-system organ failure

Illness develops 12-28 hrs after event

58
Q

PEEP and CPAP acronyms

A

PEEP: Positive end expiratory pressure
CPAP: Continuous positive airway pressure

59
Q

ABG in ARDS

A

initially resp. alkalosis with progression to acidosis

60
Q

CXR in ARDS

A

bilateral pulmonary infiltrates (evolve rapidly, most severe in first 3 days)

61
Q

ARDS treatment

A

No drugs proven beneficial.
Ventilator support
PEEP, VTE, stress ulcer prophylaxis

62
Q

Hyaline membrane disease

A

IRDS

63
Q

Impaired surfactant synthesis, leading to atelectasis, hypoventilation and hypoxemia

A

IRDS

64
Q

True or False: IRDS is related to prematurity (26-32 weeks) of infants

A

True

65
Q

IRDS risk factors

A 
prematurity
maternal diabetes
C section delivery
Perinatal asphyxia
FH of IRDS
66
Q

S/Sx of IRDS

A

Cyanosis, apnea, rapid breathing, grunting, nasal flaring, decreased urine output

67
Q

Diagnosis of IRDS

A

ABGs, CXR, lab tests (r/o infx)

68
Q

IRDS treatment

A

CPAP
Surfactant
Warm, moist oxygen
Maintain ideal body temp, calm setting, carefully manage nutrition and fluids, treat infx right away

69
Q

Rare autoimmune disorder where antibodies form against acetylcholine receptors at neuromuscular junction of skeletal muscles

A

Myasthenia gravis

70
Q

How does myasthenia gravis cause restrictive lung dz?

A

Respiratory muscle weakness (extrinsic)

71
Q

Autoimmune d/o when immune system attacks myelin sheath that surrounds peripheral nerves causing weakness

A

Guillain Barre syndrome–

Respiratory muscle weakness causes extrinsic restrictive lung dz

72
Q

Pickwickian syndrome

A

Obesity hypoventilation syndrome

73
Q

Obesity effects on breathing

A

Daytime hypercapnia
Extrinsic restrictive lung dz
High diaphragm

Clin Med, Path, Pharm (12 decks)

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