Dust to Dust: The Lung’s Revenge
This defense mechanism normally clears inhaled particles from the respiratory tract but fails in chronic exposure to coal dust.
What is the mucociliary escalator?
This mechanism of hypoxemia occurs when alveolar oxygen levels are low, often due to high altitude or hypoventilation.
What is decreased inspired oxygen (low PiO₂)?
In restrictive lung disease, what vascular complication can increase the workload on the right side of the heart?
What is pulmonary hypertension?
In pneumoconiosis, fibrosis causes an increase in this lung property, resulting in reduced lung compliance and difficulty with lung expansion.
What is elastic recoil?
When a patient shows anger, this is the best initial approach a physician should take to de-escalate the situation.
What is to remain calm and listen actively?
In silicosis, this cell type is activated to secrete fibrogenic cytokines after ingesting silica particles.
What are alveolar macrophages?
This is the most common mechanism of hypoxemia in interstitial lung diseases, caused by fibrosis disrupting the alveolar-capillary membrane.
What is impaired diffusion?
In chronic interstitial lung disease, which physiological reflex (typically protective) paradoxically contributes to pulmonary hypertension by increasing pulmonary vascular resistance?
What is hypoxic pulmonary vasoconstriction?
In pneumoconiosis, this lung function parameter (think lung volumes and capacities) is typically reduced, reflecting stiff lungs and decreased lung compliance.
What is total lung capacity (TLC)? (other values acceptable too)
This ethical principle supports the right of a competent, angry patient to refuse treatment—even if it’s life-saving.
What is autonomy?
This structural change in the lungs leads to the “eggshell” calcification seen in chronic silicosis on imaging.
What is hilar lymph node fibrosis?
This type of hypoxemia improves with supplemental oxygen and occurs when some alveoli are ventilated but not perfused — or vice versa.
What is V/Q mismatch?
In patients with advanced restrictive lung disease, which echocardiographic finding—indicative of right ventricular strain—supports the diagnosis of cor pulmonale?
What is right ventricular hypertrophy with septal flattening during systole aka D-sign on echo?
According to Ohm’s law, this equation relates pressure, flow, and resistance in the airways.
What is Flow = Pressure difference / Resistance?
Q=(change) P/ R
According to communication guidelines, when a patient is angry, this technique involves acknowledging their feelings without necessarily agreeing with their accusations.
What is reflective listening or validation?
This progressive condition results when inhaled asbestos fibers trigger fibroblast proliferation and collagen deposition.
What is interstitial pulmonary fibrosis?
This type of hypoxemia is caused by alveoli that are perfused but not ventilated, often seen in ARDS or pneumonia, and it doesn’t improve significantly with 100% oxygen.
What is an intrapulmonary right-to-left shunt?
In the setting of chronic pulmonary hypertension due to restrictive lung disease, which molecular and cellular mechanisms primarily drive heart remodeling?
What is myocyte hypertrophy and increased collagen deposition mediated by neurohormonal activation and mechanical stress casing Right ventricular hypertrophy?
Poiseuille’s law explains how airflow resistance is affected by this airway characteristic, which has the greatest impact on resistance when changed.
What is the radius of the airway?
R= 8nL/ pi (r^4)
In cases where a patient’s anger escalates to verbal threats or aggression, the physician’s next best step is to ensure this for everyone’s safety.
What is maintaining personal safety and request assistance if needed?
(sa-KURity sa-KURity please)
A 67-year-old man with a 40-pack-year smoking history and prior employment in shipbuilding presents with chronic exertional dyspnea and dry cough. Physical exam reveals digital clubbing and fine bibasilar crackles. PFTs show a restrictive pattern with reduced DLCO. HRCT reveals bilateral subpleural reticulations and calcified pleural plaques. Bronchoalveolar lavage reveals ferruginous bodies. He is at greatest risk for developing what pulmonary malignancy?
What is bronchogenic carcinoma?
A 58-year-old woman with known systemic sclerosis presents with worsening exertional dyspnea. ABG on room air shows PaO₂ of 58 mmHg and a widened A-a gradient. DLCO is significantly reduced. She improves with 4L nasal cannula. What is the primary cause of her hypoxemia, and why does oxygen help?
What is impaired diffusion due to interstitial fibrosis; oxygen increases the gradient to compensate for reduced transfer efficiency?
A 62-year-old man with advanced idiopathic pulmonary fibrosis presents with worsening lower extremity edema, fatigue, and decreased urine output. Exam shows elevated jugular venous pressure and hepatomegaly. Labs reveal rising creatinine and hyponatremia. Which complication of cor pulmonale is most likely causing his kidney dysfunction?
What is cardiorenal syndrome?
A 60-year-old man with a history of asbestos exposure presents with progressive shortness of breath. Pulmonary function tests show decreased total lung capacity and normal airway resistance. According to Poiseuille’s law, why does this patient’s airway resistance remain normal despite his restrictive lung disease?
What is fibrosis affects lung parenchyma and elastic tissue and not the airway radius. (Poiseuille’s law states resistance depends mainly on airway radius)
A 29-year-old woman storms into your clinic convinced that her boyfriend cheated on her after getting a vaccine for a virus (HPV) which was actually developed by Big Pharma in order to alter men's behavior. She states that he has radically changed his behavior since he was given the vaccine. She accuses you, his physician, of being part of the conspiracy because you “always push vaccines” and gave him the HPV vaccine two months ago and says he hasn't been the same since. She refuses to undergo pulmonary function testing for her restrictive lung disease unless you first prove you are not a government agent. She is well-groomed, well-nourised, and provides a lengthy journal of evidence and quotes from both the CDC and Consipiracy websites that doctors are in cahoots with big pharma. What is the most ethical course of action?
What is evaluate her decision-making capacity, and if intact, respect her autonomy while using motivational interviewing to guide her toward necessary care?