Chest Wall and Respiratory Muscle disorders Flashcards

1
Q

in newborns, FRC is maintained by

A

increase RR

decreased duration of inspiratory contraction

decreased time for lung deflation

glottal closure

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2
Q

ventilator induced diaphragm dysfunction can occur as quickly as how many hrs

A

18 hrs on vent

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3
Q

chest wall dysfuntion

A

reduced: lung volume
absolute flow rates
strength of respi muscles

RV and FEV1/FVC ratio normal
*RV can be augmented

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4
Q

hypercapnia is present during wakefulness with respi muscle strength less than how many %

A

less than 25% predicted

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5
Q

decrease in VC greater than expected if muscle strength is

A

less than 50% predicted

(atelectasis -decreased compliance)
joint ankylosis

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6
Q

can be the 1st symptom of chronic respi pump impairment

A

General fatigue and dyspnea on exertion

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7
Q

clinical signs of impending respi failure

A
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8
Q

to meet muscle work requirement

A

increase respi drive and phrenic nerve output

increase recruitment of FAST twitch muscle fiber

recruitment of Accessory respi muscles of chest and neck

change in respi pattern (reduce itime)

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9
Q

Upper motor neuron d/o causing chest wall dysfunction

A

CP
hemi and quadrilegia

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10
Q

Critical periods at risk of vent failure

A

neonatal
respi infection
GA
last tri preg

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11
Q

Frequent cause of diaphragmatic paralysis in newborn

A

stretching of c3 to c5 root during breech delivery (Erbs palsy)

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12
Q

most common side affected in diaphragmatic paralysis

A

right side

(more than 2 rib spaces higher than the left)

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13
Q

bilateral diaphragmatic paralysis, TLC is often less than how many percent

A

50%

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14
Q

confirmatory test for diaphragmatic paralysis

A

EMG with percutaneous stimulation of phrenic nerve

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15
Q

Ultrasound in spont breathing patient witg diaphragmatic paralysis

A

paradoxical INspiratory UPward motion of the PARaLYZED diaphragm

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16
Q

onset or age of 3 SMA types

A

0-6 months (type 1)
after 6 months (type 2)
after 10 months (type 3)

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17
Q

SMA type which has poor prognosis
and usually die by 18 months from respi failure

intact sensory
lack of motor

A

SMA type 1

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18
Q

Closing parasol

good quality of life

A

SMa type II

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19
Q

proximal limb weakness

walks 25 meters

frequent fall

normal lifespan

A

sma type 3

20
Q

diagnosis of sma

A

gene testing

21
Q

atrophy of type 1 and 2 muscle fiber

A

biopsy fx of sma

22
Q

chromosome involve in SMA vs DMD

A

SMA chromosome 5
DMD short arm of chromosome Xp21

23
Q

Difference between DMD and Becker Md

A

DMD absence of dystrophin
Becker Mutant dystrophin

24
Q

Difference of MG subtypes

A
25
Q

In DMd, age onset

A

2-4 yo
boys
proximal muscle weakness

26
Q

by what age does dmd px reach maximum plateau in vital capacity and progressive decrease thereafter

A

10 to 12 yo

27
Q

1st sign of chronic respi failure in dmd px

A

Nocturnal hypoventilation

28
Q

Presents in a young boy
with speech and muscle function delay

what to request if suspecting DMD

A

serum CK
50 to 100 times

genetic testing

29
Q

When to do surgery in dmd px with scoliosis

A

progressing cob angle 20 degrees
VC of atleast 40% of predicted

30
Q

pharma tx for dmd

A

pred 0.75mg/kg/day
Deflazacort 0.9 (cataract)

31
Q

chromosome 19

A

Myotonic dystrophy

32
Q

type of MD not presenting with myotonia

A

CONGENITAL

33
Q

what raises susp in px to have congenital md

A

mother has mild weakness of eyelid closure

overt grip myotonia

34
Q

Steinheart dx (autosomal dominant)

Or type 1 Myotonic dystrophy has mutation on

A

Chromosome 19

expansion of CTG trinucleotide in DMPK gene

35
Q

what can be seen in cxr of congenital myotonic dystrophy

A

thin ribs
right diaphragm elevation

36
Q

type of myotonic dystrophy presenting with aspiration pneumonia and post anesth failure

A

JUVEnile myotonic dystrophy

37
Q

system involved in Md

A

eyes
cns
endo
heart

skeletal
smooth muscles

38
Q

60% of pectus excavatum has shallow chest in ap described as

A

pectus gracilis

39
Q

it is polygenetic, common in white males, more than 90% of all congenital chest wall abnormalities

A

Pectus excavatum

40
Q

pectus excavatum is associated with what syndrome

A

Marfan

41
Q

spine and chest wall disorder impairing lung growth

A

Thoracic insufficiency syndrome

42
Q

Syndrome with small thoraces leading to secondary respi failure

A

Hypoplastic thorax syndrome

43
Q

Hypoplastic thorax syndrome occurs due to

A

reduced circumference
reduced thoracic vertebral height

44
Q

most common hypoplastic thoracic syndrome

A

Asphyxiating Thoracic Dystrophy

45
Q

Also known as Jeune Syndrome
auto recessive
ciliary chondroplasia

A

Asphyxiating TD
Thoracic pelvic phalangeal dystrophy
Shwachman syndrome