Restrictive Lung Diseases – USMLE Step 2 CK exam

by / Tuesday, 29 June 2010 / Published in Internal Medicine

Restrictive Lung Diseases

  1. Interstitial Fibrosis
  2. Parenchymal disease
  3. Extrapulmonary disease
  4. Pleural effusion


Interstitial Fibrosis

  • Due to chronic insult to the lung tissue by things such as asbestos, chronic infections, organic dusts
  • Diagnosis made by a CXR, which shows a “honeycomb” pattern of the lung


  • 02, PEEP, steroids if there is collagen vascular disease

Parenchymal Disease

  • Parenchymal diseases are caused by things such as infections (TB), inflammation (sarcoidosis), drugs, toxic/chronic inhalation of offending agents (asbestos), and it may be idiopathic
  • Patient presents with a dry cough, SOB, and chronic hypoxia

Signs and Symptoms:

  • “Velcro” rales
  • Clubbing


  • CXR or high-resolution CT
  • Lung biopsy
  • PFT (all measurements are decreased proportionately)


  • If inflammatory, steroids can help
  • There are no definitive cures for other forms of parenchymal disease

Extrapulmonary Disease

  • Anything that affects the musculature responsible for aiding in breathing can cause problems
  • Multiple sclerosis, ALS, Guillain-Barre, spinal cord trauma
  • Anything that presses on the diaphragm can also cause trouble, such as pregnancy and obesity
  • Management/treatment is supportive only

Pleural Effusion

  • Fluid in the pleural space

Signs and Symptoms:

  • Decreased breath sounds
  • Dullness to percussion
  • Decreased tactile fremitus


  • The best initial diagnostic test is a CXR (lateral decubidus shows free flowing fluids)
  • Most accurate test is thoracentesis (can show which type of fluid it is)


  • Small effusions usually resorb spontaneously
  • Diuretics can be used if causing respiratory problems

If effusion is large, insert a chest tube for draining

6 Responses to “Restrictive Lung Diseases – USMLE Step 2 CK exam”

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