01b: COPD Flashcards
Emphysema is pathologically characterized by (increase/decrease) in (X) and an abnormal (increase/decrease) in size of (Y).
Decrease;
X = total gas-exchanging airspaces
Increase;
Y = remaining airspaces
Which portion of respiratory airspaces are destroyed in emphysema?
Resp bronchioles and beyond (alv duct, alv sac, or alveolus)
T/F: Breath sounds are diminished in emphysema.
True - diaphragm doesn’t move with respiration
(X) is an alteration in structure/function of (R/L) (atrium/ventricle) caused by primary disorder of the respiratory symptom. This can occur in advanced emphysema.
X = cor pulmonale
RV
Dyspnea of extreme severity occurring with normal ADLs is typically seen at FEV1 less than:
750 mL
Emphysema patients usually die as a result of which diseases/complications?
- HF
- PE
- Infection
- Resp insufficiency
What’s a downside to utilization of inhaled corticosteroids in COPD patients?
Increased risk of pneumonia
T/F: If emphysema patient doesn’t exhibit improvement in flow rate after bronchodilator use in pulmonary lab, a bronchodilator should not be prescribed; patient may rely on it too heavily.
False - should be tried in those patients
Chronic bronchitis and (emphysema/bronchiectasis/asthma) patients always produce sputum.
Bronchiectasis
(Bronchitis/bronchiectasis) directly involves destruction of the gas exchanging structures in lung.
Neither! Destruction is of the airway wall components
List some etiologies of bronchiectasis.
- CF
- Kartagener’s syndrome (“immotile ciliary syndrome”)
- Post-infectious (rare)
- Allergic aspergillosis
T/F: Chronic bronchitis/bronchiectasis patients will have diminished breath sounds and hyper-aeration (like emphysema)
False - no hyper-aeration
Secondary erythrocytosis aka polycythemia is an (increase/decrease) in (X). It’s seen in (emphysema/bronchitis) and occurs in response to (Y).
Increase;
X = RBCs
Bronchitis/bronchiectasis
Y = Chronic hypoxia (leads to increased EPO production)
T/F: Diffusing capacity is usually within normal limits in chronic bronchitis/bronchiectasis patients.
True
Why might diuretics be important in medical therapy for (emphysema/bronchitic) patients?
Bronchitic;
Help mobilize fluid and improve cardiac performance
Normally, (X)% of forced vital capacity is exhaled in the first second.
X = over 70%
Hence: FEV1/FVC ratio should be over 70%
T/F: Seeing low FEV1 and FVC, but normal ratio is diagnostic of restrictive lung disease.
False! Can’t diagnose based on spirometry alone - ALWAYS need lung volumes!
Which lung volume would confirm restrictive lung disease?
Low TLC
You suspect restrictive lung disease, based on spirometry. But TLC is normal. Which value do you check next? If reduced, this indicates (X).
RV;
X = air-trapping
FEF25-75 is said to represent (X) and is measured with which units?
X = airflow through small airways
L/s
FV Loop: early portion characterized by (high/low) flows from (small/large) airways. And latter portion?
High; large airways
Low; small airways
“Hamburger” sign in FV Loop is indicative of:
Fixed Upper Airway destruction (ex: tracheal stenosis or goiter)
FV Loop: a truncated expiratory limb (with inspiratory loop preserved) is indicative of (X) condition.
X = variable intra-thoracic upper airways obstruction
FV Loop: a truncated inspiratory limb (with expiratory loop preserved) is indicative of (X) condition.
X = variable extra-thoracic upper airways obstruction
Vocal cord abnormalities would likely result in which FV Loop?
Truncated inspiratory limb (variable extra-thoracic upper airway obstruction)
Tracheal mass (above/below) vocal cords would likely result in FV Loop with truncated expiratory limb.
Below (variable intra-thoracic upper airway obstruction)
Helium dilution technique is used to measure (X) volume.
X = FRC
Measuring diffusion capacity involves inhalation and measurement of (X) gas
X = CO
Most important variables that affect diffusion capacity:
- Area
- Thickness
- Oxygen-carrying capacity of blood
How might smoking affect oxygen-carrying capacity of blood?
Increased (abnormal) CO levels bind Hb
Pulmonary edema decreases diffusion capacity of lungs by:
Increasing membrane thickness
Interstitial lung disease decreases diffusion capacity of lungs by:
Decreasing area for diffusion
T/F: Pulmonary hemorrhage increases diffusion capacity.
True - increase blood volume
T/F: Pulmonary hypertension increases diffusion capacity.
False - decreases it (probably due to abnormal structure of vasculature)
Asthma (increases/decreases) diffusion capacity of lungs, likely as a result of:
Increases;
more uniform distribution of blood flow (increase V/Q matching)
MIP, aka (X) pressure, is measured to assess strength of (Y) muscles.
X = Max inspiratory; Y = diaphragm (mainly) and other inspiratory muscles
MEP, aka (X) pressure, is measured to assess strength of (Y) muscles.
X = Max expiratory; Y = abdominals (mainly) and other expiratory muscles
Which equation represents the lung’s “stretchiness” or (X).
X = compliance;
deltaV/deltaP
change in volume per change in distending P
At (X) volume, the alveolar pressure is 0. This means that which forces are balanced?
X = FRC
Outward recoil of chest wall balances inward recoil of lungs
In emphysema, the lung compliance is (increased/decreased), so a (small/large) change in P produces (small/large) change in V.
Increased (loss of elastic recoil);
small; large
In restrictive lung disease, the lung compliance is (increased/decreased).
Decreased
(Increased/decreased/normal) chest resonance seen in Emphysema.
Increased (due to hyperinflation)
