Week 5 - Restrictive and Obstructive Lung Disease Flashcards

1
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A

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5
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6
Q

What does TLCO measure?

A

Measures how well oxygen and carbon dioxide are transferred between the alveoli (air sacs) and the blood in the pulmonary capillaries

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7
Q

How does KCO differ from TLCO?

A

KCO is TLCO that is adjusted for alveolar volume - i.e. measures the transfer of CO in alveoli that are ventilated.

Both are reduced by V/Q mismatch conditions.
KCO is not diminished by extra thoracic restrictive conditions -whereas TLCO is - therefore helps you distinguish the cause.

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8
Q

Why does the FEV1:FVC ratio increase in restrictive lung disease?

A

Restrictive lung disease - lungs are smaller - therefore FVC decreases, but less than FEV1 - therefore ration increases.

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9
Q

What can cause restriction to the lungs?

A

Damage to the parenchyma (inflammation and fibrosis) - e.g. pulmonary fibrosis, sarcoidosis, pneumoconiosis

Pleural disease (P Eff, pneumo/haemothorax, calcification, mesothelioma)
Obesity
Chest wall disease (NMD, palsy, kyphosis/scoliosis)

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10
Q

In lung fibrosis - where is the primary site of injury?

A

The interstitium - between the cells and basement membrane - thickens and stiffens = reduced transfer of O2

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11
Q

What are the RF for lung fibrosis?

A
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12
Q

How can Sx for lung fibrosis present?

A

SOB - worsening progressively
Cough
Fatigue
Weight loss
Crackles

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13
Q

How can you differentiate an AI cause for lung fibrosis?

A

AI / Collagen vascular - can also have difficulty swallowing, cold hands, joint pains, weight loss, skin rash

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14
Q

What are the clinical signs of lung fibrosis?

A

Clinical signs à ↑ RR, Tachypnoea, Dyspnoea, Clubbing, CVS - ↑ JVP, perip oedema, loud P2 heat (signs of cor pulmonale). Low O2 sats – desats on exertion.

If AI can have – RA, skin changes (telangiectasia, Raynaud’s), joint signs, eye signs

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15
Q

What is it called when we dont know what is causing fibrosis of the lungs?

A

Idiopathic pulmonary fibrosis (IPF)

M>F

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16
Q

What is the average length of surivival from diagnosis of IPF?

A

2.5-3.5 years

Often sudden exacerbation (infection) & decline – dramatic decrease in LF à death

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17
Q

What does honeycombing and bronchial dilation on CT suggest?

A

IPF

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18
Q

What does spirometry show in IPF?

A
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19
Q

What Rx is given for IPF?

A

Symptomatic
Antifibrotic
Palliative (if young poss transplant)

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20
Q

What investigations can you do to investigate whether a P has pulmonary fibrosis or not?

A

Bloods - FBCs, U&Es, AI screen
CXR
HRCT
Spirometry
TLCO and KCO

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21
Q

What type of respiratory failure is caused by pulmonary fibrosis?

A

T1

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22
Q

Which type of pulmonary fibrosis is associated with AI or collagen vascular disease?

A

Non-Specific Interstitial Pneumonia

(is actually pneumonitis not a pneumonia)

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23
Q

How does NSIP differ from IPF in terms of Ps?

A

Younger Ps affected
Not associated with smoking
M = F (whereas in IPF - M>F)

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24
Q

Extensive ground glass changes, small lungs and reticule-nodular changes on imaging suggests?

A

NSIP

25
Q

Which collagen-vascular diseases can cause NSIP?

A

Scleroderma
RA
SLE

26
Q

Why is it important to distinguish IPF from NSIP?

A

NSIP has a better prognosis and responds to anti-inflammatories whereas IPF won’t.

27
Q

How is NSIP managed?

A
28
Q

Which drugs can cause pulmonary fibrosis?

A

Amiodarone
Nitrofurantoin
Bleomycin
+ more

29
Q
A

Erythema nodosum
Bilateral hilar lymphadenopathy

30
Q

A P with
SOB
Cough
Fever
Night sweats
Weight Loss
Arthralgia
Reduced appetite
Myalgia
Anterior uveitis
Lymphadenopathy
Erythema Nodosum
Bilateral hilar lymphadenopathy

Could have?

A

Pulmonary sarcoidosis

DDs = TB, Vasculitic conditions, lymphoma

31
Q

What is sarcoidosis?

A

Multisystem granulomatous disease – unknown aetiology (thought poss infection, dusts, minerals, beryllium, congenital – may be immune response to inhaled antigen)
Creates non-caseating granulomas – often in multiple organs. Primarily affects the lungs

May resolve spontaneously
OR may progress to pulmonary fibrosis

32
Q

What is the average of age of sarcoidosis?

A

20-50

33
Q

What types of sarcoidosis can you have?

A

Acute (Loefgren’s), chronic and asymptomatic

34
Q
A
35
Q

What finding in the bloods that can suggest sarcoidosis?

A

Hypercalcaemia
Abnormal LFTs

36
Q

Which other organ systems can be affected by sarcoidosis?

A

Pretty much any

37
Q

How is sarcoidosis diagnosed?

A

Clinical + radiological + histological features

38
Q

How is pulmonary sarcoidosis staged by CXR?

A

0-IV

0 = normal lungs
IV = bad lungs

39
Q

Non-caseating epithelioid-cell granulomas + multi-nucleated cells with asteroid bodies, Schumann bodies and bifringent crystalline particles + minimal necrosis - suggests what?

A

Sarcoidosis

40
Q

Why do you get hypercalcaemia and hypercalciuria in sarcoidosis?

A

Vit D is increased by macrophages in the granulomas => inc Ca

41
Q

What is the outcome of sarcoidosis?

A
42
Q

How is sarcoidosis managed?

A
43
Q
A

Pleural effusion

44
Q

How much pleural fluid is produced and cycled through the pleura each day?

A

1L

45
Q

What types of fluid can you get in the pleural space?

A

Transudate
Exudate

46
Q

How can you differentiate between transudate and exudate?

A

Exudate =

Fluid protein : serum protein > 0.5
Fluid LDH : serum LDH >0.6
Fluid LDH - >2/3rds ULN of normal serum LDH

Therefore - exudate is high in protein and LDH

Transudate =

Fluid protein : serum protein <0.5
Fluid LDH : serum LDH <0.6
Fluid LDH < 2/3rds ULN of normal serum LDH

47
Q

What causes exudate in the pleura?

A

Malignancy
Infection
AI disease
Chylothorax (blocked lymphatics)

48
Q

What causes transudate in the pleura?

A

Congestive cardiac failure
Low albumin - often caused by nephrotic syndrome or liver failure

49
Q

What are the clinical signs of pleural effusion?

A
50
Q
A
51
Q

What are the RF for spontaneous pneumothorax (i.e. primary pneumothorax)?

A

Tall and thin
Asthma
Collagen vascular disease

52
Q

What can cause secondary pneumothorax?

A

COPD
Pulmonary fibrosis
Cystic fibrosis

53
Q

How is pleural effusion managed?

A
54
Q

What can cause chest wall disease?

A
55
Q

What can cause mixed obstructive and restrictive lung disease?

A

Smoking = emphysema and pulmonary fibrosis

Pulmonary sarcoidosis

Obesity in smokers

56
Q

When is TLC reduced and when is it increased?

A

TLC = reduced in restrictive disorders

Increased in obstructive disorders (air trapping)

57
Q

What do the following all do to TLCO?
- V/Q mismatch
- PE
- Emphysema
- Interstitial lung disease
- External lung restriction

A

Decrease TLCO

58
Q

What does inc pul capillary BV (e.g. high cardiac output, polycythaemia, pulmonary haemorrhage) do to TLCO?

A

Increases it

59
Q

What is KCO used to differentiate?

A

Can differentiate whether restriction is intra or extrathoracic. If extra-thoracic restriction, KCO is not reduced (but TLCO will be).