Restrictive lung overview

Question 1

What are the clinical classifications of DPLD? (5 based on frequency, cause)

Answer 1

1. Acute DPLD
2. Episodic DPLD, may present acutely
3. Chronic DPLD due to occupational/ environmental agent/drugs
4. Chronic DPLD without systemic disease
5. Chronic DPLD with systemic disease

Question 2

What is restrictive lung disease?

Answer 2

Diseases that are extrinsic or intrinsic to the lungs that impairs alveolar gas exchange, leading to poor ventilation

Question 3

Steps involved in the pathophysiology of Restrictive lung disease?

Answer 3

1. Alveolar wall damage
2. Impaired gas exchange
3. C02 exchange unimpaired as it is v soluble
4. Final effect–> Low PO2 (SO2) normal PCO2

Result- Poor ventilation

Question 4

What happens to normal lung tissue in restrictive lung disease?

Answer 4

Pulmonary fibrosis- Normal lung tissue replaced by scar tissue, which have pockets of air in them
Honeycomb structure

Question 5

What is pulmonary oedema?

Answer 5

Fluid in alveolar air spaces

Question 6

What are the causes of cardiac PE?

Answer 6

Raised pulmonary venous pressure, due to LVF

Question 7

What are non cardiac causes of PE?

Answer 7

Leaky pulmonary capillaries due to sepsis or trauma

Question 8

What 3 things can cause consolidation of the air spaces leading to restrictive lung disease?

Answer 8

1. Infective pneumonia
2. Pulmonary emboli/infarct
3. Other causes- e.g. rheumatoid

Question 9

What kind of pathogens can cause pneumonia led consolidation?

Answer 9

Viruses- influenza,measles
Bacteria- TB, pneumococcus
Parasites- filaria

Question 10

What is alveolitis?

Answer 10

Inflammatory infiltrate of the alveolar walls

Question 11

What can cause alveolitis?

Answer 11

1. Extrinsic allergic alevolitis

2. Sarcoidosis

Question 12

What is sarcoidosis?

Answer 12

Inflammatory process characterised by granuloma formation in the lungs.

Question 13

Two multi system effects of sarcoidosis?

Answer 13

1. Lymphadenopathy

2. Erythema nodosum- red nodules appearing on leg shins

Question 14

Give two examples of drugs that can cause Alveolitis?

Answer 14

1. Bleomycin

2. Methatrexate

Question 15

Which toxic gas can cause alveolitis?

Answer 15

Chlorine

Question 16

What type of alveolitis can rheumatoid disease cause?

Answer 16

Fibrosing

Question 17

Two examples of autoimmune disorders causing alveolitis?

Answer 17

Wegeners

Bechets

Question 18

What is Pneumoconiosis?

Answer 18

Occupational restrictive disease caused by dust inhalation

Can be fibrinogenic as in asbestosis or non like in baritones

Question 19

Clinical signs and symptoms of DPLD? (6)

Answer 19

1. Breathless on exertion
2 Cough but no wheeze
3. Finger clubbing
4. Inspiratory lung crackles
5. Central cyanosis
6. Pulmonary fibrosis- end stage response to chronic inflammation

Question 20

What things are important in patient history to confirm DPLD? (4)

Answer 20

1. Occupational
2. Pets
3. Drugs
4. Arthritis (rheumatoid)

Question 21

What are the lung volume findings that can confirm the diagnosis?

Answer 21

Reduced lung volumes

• Low FVC & FEV1
• FEV1/FVC normal
• Peak flow normal

Question 22

What changes in saturation levels can confirm the diagnosis?

Answer 22

Low PO2 (SaO2), Normal PCO2
At rest or during exercise