Cardiovascular/Pulmonary: Case 4

Course Information Year 2 Courses: Cardiovascular & Pulmonary

Path Labs

Harvi

Foundation

Guidelines

Auscultation

G. Miller and R. Conrad

Week 3

• Weekly Objectives - Week 3

Boards and Beyond - Required

List of Boards and Beyond Videos along with length

Note: If you are logged into Board and Beyond, these links should go directly to the video.

This Week: 15 minutes

• Restrictive Lung Diseases - Boards and Beyond

  • Video

  15 minutes

Required

Textbook Assignments

• Interstitial Lung Disease - Ch 9 Pulmonary Disorders IN Current Medical Diagnosis and Treatment

• Acute Respiratory Failure - Ch 9 Pulmonary Disorders IN Current Medical Diagnosis and Treatment

• Environmental and Occupational Lung Disorders - Ch 9 Pulmonary Disorders IN Current Medical Diagnosis and Treatment

Article Assignments

• Therapeutic Approach to Adult Fibrotic Lung Diseases.

  Detailed review that covers the essentials as well as the studies that have established treatment options.
  --Read abstract, introduction, section on IPF pg 1372.
  --First paragraph in sections on Pirfenidone and Nintedanib
  --First paragraph of recommended approach to IPF, Chronic Hypersensitivity Pneumonitis
  --Section on Comorbidities in Fibrotic Lung Disease.
  Rest of article is for reference.

  more… less…

  Adegunsoye A, Strek ME. Therapeutic Approach to Adult Fibrotic Lung Diseases. Chest. 2016 Dec;150(6):1371-1386. doi: 10.1016/j.chest.2016.07.027.

• Respiratory Failure in Amyotrophic Lateral Sclerosis.

  Good review of pathophysiology treatment options and clinical course of ALS – all pertinent to case.

  more… less…

  Niedermeyer S, Murn M, Choi PJ. Respiratory Failure in Amyotrophic Lateral Sclerosis. Chest. 2019 Feb;155(2):401-408. doi: 10.1016/j.chest.2018.06.035.

• Amyotrophic Lateral Sclerosis

  Also listed on Guidelines
  For basic understanding of condition read the following sections:
  Introduction
  Pathologic Characteristics
  Therapeutics & beyond

  more… less…

  Brown RH, Al-Chalabi A. Amyotrophic Lateral Sclerosis. N Engl J Med. 2017 Jul 13;377(2):162-172. doi: 10.1056/NEJMra1603471

• Idiopathic Pulmonary Fibrosis

  Understand the basic mechanisms and especially differential diagnosis. EX. Table 2

  more… less…

  Lederer DJ, Martinez FJ. Idiopathic Pulmonary Fibrosis. N Engl J Med. 2018 May 10;378(19):1811-1823. doi: 10.1056/NEJMra1705751.

Enrichment

• The diagnosis and management of neuromuscular diseases causing respiratory failure.

  Old article, but good review of pathophysiology. Not necessary to review treatments.

  more… less…

  Kelly BJ, Luce JM. The diagnosis and management of neuromuscular diseases causing respiratory failure. Chest. 1991 Jun;99(6):1485-94.

• Obliterative Bronchiolitis

  more… less…

  Barker AF, Bergeron A, Rom WN, Hertz MI. Obliterative bronchiolitis. N Engl J Med. 2014 May 8;370(19):1820-8. doi: 10.1056/NEJMra1204664.

Weekly Objectives

Restrictive Lung Diseases (RLD): Neuromuscular Disease, Amyotrophic Lateral Sclerosis (ALS) and Interstitial Lung Disease (ILD)

Approach to Restrictive Lung Diseases

1. Describe the mechanisms by which restrictive lung disease can occur.
2. List the pathophysiologic consequences of restrictive lung diseases.
3. Identify common physical examination findings in restrictive lung disease, differentiating by etiology.
4. Identify the principal pathophysiologic processes that lead to restrictive lung physiology: neuromuscular
5. isease, interstitial disease, skeletal anomalies, and pleural filling.
6. Explain the interventions that may improve restrictive lung disorders.
7. Compare and contrast clinical diseases associated with restrictive physiology. 

Interstitial Lung Disease (ILD)

1. Describe how interstitial lung diseases affect gas exchange at rest and with exercise.
2. Compare pleural pressure excursions in restrictive interstitial lung disease compared to health and neuromuscular diseases.
3. Distinguish among inflammatory interstitial lung disease by etiology, pathology, treatment options, and prognosis.
4. List pharmacologic interventions used in ILD and explain mechanism of action and biological effects.

Neuromuscular Diseases

1. Explain the effects of neuromuscular weakness on airflow, gas exchange, and cardiovascular physiology.
2. Differentiate the physiologic consequences of neuromuscular disease from those associated with interstitial lung disease, skeletal anomalies, and pleural space filling.
3. Compare treatment options for a range of NMDs and discuss mechanism of actions, side effects and drug interactions.

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Source:
https://guides.utmb.edu/cvp/case4
Captured on May 5, 2021