[aktorque]

In which of the following clinical scenarios involving patients with lung disease would you expect pulmonary function studies to exhibit decreased compliance, increase elasticity, and an increased FEV/FVC ratio?

A. 6 y/o child with recurrent respiratory infections and steatorrhea.
B. 28 y/o non-smoking male with bilateral lower lobe emphysema.
C. 56 y/o smoker with productive cough, dyspnea, and cyanosis.
D. 10 y/o girl with bronchial asthma requiring systemic steroids.
E. 39 y/o dyspneic African American with bilateral hilar nodes.

have fun...

 

[Hope2Pass]

D

Increased elasticity and lack of compliance = Lack of surfactant
Increased FEV/FVC Ratio = It is an Obstructive disease

I narrowed it down to 2 options ( as always )

B or D ... emphysema or asthma

but since I have to choose one I would go with option D. 10 y/o girl with bronchial asthma requiring systemic steroids.

Let me know if Im wrong! (I still have to read respiratory)

 

[ms.med]

Would it be E- Sarcoidosis: restrictive lung disease
Restrictive lung disease unlike emphysema/asthma (obstructive) has a problem with compliance and getting air in.
Also the FEV1/FVC can be increased in restrictive diseases (unlike obstructive) because FVC decreases by more in comparison to FEV1.
Choices B and D should have very similar decreased FEV1/FVC and compliance will increase with a decrease in elastic recoil.

 

[Mondoshawan]

A

Ha ha! I was stuck between two as well, Hope2Pass - E and A for me. I think in the end I would choose A, but I wish I knew enough to be a little more confident about it...

My interpretation and reasoning:

A. sounds like possible cystic fibrosis - this could be the answer; it's restrictive, as suggested by the PFT's in the stem; the FEV and FVC would both go down, but I don't know which more quickly and thus I don't know how it would affect the ratio. hmmm, we'll keep that one on the back burner
B. emphysema is obstructive rather than constrictive, so we can cross that one off
C. sounds like a COPD "blue bloater" - obstructive rather than constrictive
D. asthma is obstructive too
E. sounds like possible sarcoidosis - can be an obstructive and a restrictive process. I think that FVC and FEV would both go down, but again not sure about the ratio.

Hmmm... :notsure: okay, A or E. uh........... :flips coin: ... A

 

[Amenah]

E. Sarcadosis

 

[Hope2Pass]

Increased elasticity and lack of compliance = Lack of surfactant
Increased FEV/FVC Ratio = It is an Obstructive disease

I narrowed it down to 2 options ( as always )

B or D ... emphysema or asthma

but since I have to choose one I would go with option D. 10 y/o girl with bronchial asthma requiring systemic steroids.

Let me know if Im wrong! (I still have to read respiratory)

haha wow! i was way off! ok so after doing my research and consulting my pathology brs, the FEV/FVC Ratio is decreased in Obstructive disease because there is a marked decreased in the forced expiratory volume (due to obstruction) and the forced vital capacity remains normal or increases .. .this results in a decreased FEV/FVC ratio. That concludes that the options B and D are ruled out since emphysema and asthma are both forms of Obstructive disease. But now im confused coz i cant figure out when this ratio will be higher than normal ... in restrictive it doesnt change much because both FEV and FVC decreased proportionately. The only way this ratio will increase is when FEV is bigger than FVC ...so .. ok now im confused lol I guess ill wait for an aswer

 

[aktorque]

E) 39 y/o dyspneic African American with bilateral hilar nodes.

Hey guys... I know you all confused by this qn. Let me tell you what really that qn is asking about.... This qn is simply asking you to recognize a scenario that could explain the changes on the pulmonary function test provided in the qn stem.

The pulmonary function test described on the qn stem is a restrictive lung disorder. Choice E) 39 y/o dyspneic African American with bilateral hilar nodes, is a typical presentation for Sarcoidosis. Sarcoidosis is a chronic granulomatous inflammatory disease that can affect the pulmonary parenchyma and also progress to pulmonary fibrosis and death.

Restrictive lung disease can exhibit decreased compliance, increase elasticity, and an increased FEV/FVC ratio (>80%).

As Mondoshawan mentioned above:

Choice A) describes Cystic fibrosis, B) describes alpha 1-antitrypsin deficiency, C) describes COPD and D) describes Bronchial asthma.

Thanks to everyone who had tried your best. Congrats to ms.med and Amenah.

 

[Mondoshawan]

Great question!

 

[geof1]

But why Cystic Fibrosis is wrong??
it s constrictive right?

 

[conspicous]

aaaww i can t claim the rigth answer cuz i just login...late as usual...brilliant question i loved it.

 

[aktorque]

But why Cystic Fibrosis is wrong??
it s constrictive right?

Cystic fibrosis is sometimes included in Obstructive lung disease category. But it definitely isn't a restrictive one.

 

[amresh kumar]

actualy cystic fibrosis causes bronchiectasis so it is included in obstructive disease