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Chronic Pulmonary Flashcards

1
Q

What makes breathing more challenging?

A

Elastic recoil forces and airway resistance

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2
Q

What is static lung compliance?

A

Change in volume for any given applied pressure

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3
Q

What does compliance increase with?

A

Age and COPD

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4
Q

What does compliance decrease with?

A

Restrictive lung disease

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5
Q

What are some common secondary complications of chronic lung disease?

A

Pulmonary hypertension

Right heart failure

Atrial fibrillation (especially COPD)

Obstructive sleep apnea (especially COPD)

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6
Q

What is the most common cause of digital clubbing?

A

Lung cancer

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7
Q

What are types of COPD?

A

Chronic bronchitis

Emphysema (alpha 1 antitrypsin deficiency)

Asthma

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8
Q

What are types of septic obstructive diseases?

A

Bronchiectasis

Cystic fibrosis (both have high incidence of infection)

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9
Q

What is the problem with obstructive pulmonary diseases?

A

Getting air out of the lungs (FEV1 is the main problem)

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10
Q

What is the FEV1/FVC ratio in someone with COPD?

A

Less than .7

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11
Q

What is FEV1 in someone with COPD?

A

Less than 80% of predicted

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12
Q

What is the most common risk factor for COPD?

A

Tabacco smoking

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13
Q

Asthma

A

Reversible bronchospasm with wheezing (short lived episodes and often occurs in kids)

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14
Q

Emphysema

A

Damage to structures distal to terminal bronchiole and loss of alveolar airways

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15
Q

Chronic bronchitis

A

Cough and sputnum production especially during winter (present on most days for at least 3 months per year for 2 years)

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16
Q

What increase in emphysema?

A

Airway compliance (air trapping and hyperinflation)

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17
Q

What decreases in emphysema?

A

Surface area of alveoli for gaseous exchange

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18
Q

What obstructs the airways in chronic bronchitis?

A

Mucus which can lead to bronchiectasis or atelectasis

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19
Q

What is alpha-1 antitrypsin deficiency?

A

Lack of enzyme in the blood produced by the liver that is designed to protect the lungs

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20
Q

What occurs when someone has Alpha-1 antitrypsin deficiency?

A

Neutrophil protease are unopposed causing an imbalance and so degradation occurs faster than repair (genetic)

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21
Q

What do patients with Alpha-1 antitrypsin deficiency usually develop?

A

Pan-acinar emphysematic COPD (accelerated by smoking, have Dyspnea and chronic cough)

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22
Q

What are patients who have Alpha-1 antitrypsin deficiency usually initially diagnosed with?

A

Asthma or nongenetic emphysema

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23
Q

What are the muscle pathophysiological changes in COPD?

A

Metabolic insufficiency (fiber shift from type 1 to 2)

Reduced fat free mass (especially in quads)

Increased resting energy expenditure

Impaired mitochondrial function

Disuse atrophy

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24
Q

What percentage of normal max diaphragmatic pressure do patients with severe COPD generate?

A

60%

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25
What tests show reduced functional capacity in someone with COPD?
6 MWD CPET
26
What is a common impairment in someone with COPD?
Back pain and chronic pain
27
What is true about breathing in COPD?
You can breath out the same amount of air it just takes more time (low FEV1)
28
Why do people with COPD get Dyspnea during exertion?
Lungs get too full because they cannot get air out
29
What often happens to the diaphragm in patients with COPD?
They cannot get all of their air out so the lungs get hyper inflated and compress the diaphram
30
When do hypoxemia develop in COPD?
When FEV1 is less than 50%
31
What does DLCO measure?
Diffusing capacity of CO through the alveolar membrane to hemoglobin
32
What will reduce DLCO?
Damage to alveolar capillary membrane or vasculature
33
What diseases in DLCO reduced in?
Obstructive and restrictive lung disease (normal in asthma)
34
What is a mild case of COPD?
FEV1 >80%
35
What is a moderate case of COPD?
FEV1 50-80%
36
What is a severe case of COPD?
FEV1 30-50%
37
What is a very severe case of COPD?
FEV1 < 30%
38
What is the prognosis used to assess COPD?
Severity based on FEV1 Distance on 6MWT Score on MMRC Dyspnea scale BMI
39
What are symptoms of asthma?
Wheezing Dyspnea Chest pain Facial distress Non productive cough
40
When does asthma happen in life?
Earlier on (childhood exposure to smoking and obesity)
41
What is asthmaticus?
Severe asthma attack
42
What are types of septic obstructive diseases?
Bronchiectasis Cystic fibrosis
43
What is bronchiectasis?
Irreversible airway dilation due to destruction of the muscular and elastic properties of the lung
44
What is the percentages that go on to cause bronchiectasis?
70% associated from underlying disease (COPD) 30% due to idiopathic causes
45
What is an extrinsic cause in bronchiectasis?
Compression by adjacent lymphadenopathy or parenchymal tumor mass
46
What is an intrinsic cause in bronchiectasis?
Airway tumor or aspiration (scarred airway)
47
What is focal bronchiectasis?
Extrinsic and intrinsic causes localized area of the lung
48
What is diffuse bronchiectasis?
Widespread, often arises from an underlying systemic disease
49
What are symptoms of bronchiectasis?
Persistent productive cough with thick sputnum Crackles and wheezing on lung auscultation Obstructive pattern on PFT
50
What type of disease is cystic fibrosis?
Multi system disease
51
What is the defect in cystic fibrosis?
Na+/Cl- channels resulting in excessive salty mucous formation
52
Why are children with cystic fibrosis physically underdeveloped?
Malabsorption
53
What has high prevalence in cystic fibrosis?
Pulmonary arterial hypertension and type 1 diabetes
54
What percent of patients are diagnosed with cystic fibrosis before 2 years old?
75% (assessed at birth with sweat chloride test)
55
What do the majority of patients with cystic fibrosis die from?
Lung infection (high risk of infection)
56
What is required to treat cystic fibrosis?
Consistent airway clearance Exercise Nutritional supplementation (Possible lung transplant)
57
What is the problem with restrictive lung disease?
Getting air in the lungs
58
Why are FEV1 and FEV reduced in restrictive lung disease but the ratio is still normal?
Because the lungs got smaller
59
What is prevented in restrictive lung disease?
The lungs from fully expanding
60
What is an intrinsic problem in restrictive lung disease?
Reduced airway compliance due to thickening and scarring
61
What is an extrinsic/mechanical problem in restrictive lung disease?
Reduced chest wall compliance (obesity, chest wall deformities, chest wall trauma, burns, neuromuscular disease)
62
What are idiopathic causes of intrinsic restrictive lung disease?
Idiopathic pulmonary fibrosis Sarcoidosis
63
What are occupational causes of intrinsic restrictive lung disease?
Asbestosis Silicosis Coal workers pneumoconiosis
64
What are autoimmune causes of intrinsic restrictive lung disease?
Systemic lupus erythematosus (SLE) Wegener granulomatosis Rheumatoid arthritis
65
What’s the resultant appearance of fibrotic lung parenchyma?
Honeycomb lung
66
What are symptoms of intrinsic restrictive lung disease?
Insidious onset of Dyspnea on exertion Frequent dry nonproductive cough Difficulty eating
67
What are signs of intrinsic restrictive lung disease?
Fine bibasilar end inspiratory crackles Clubbing of fingers Right sides heart failure
68
How do you diagnose intrinsic restrictive lung disease?
Lung biopsy
69
Idiopathic pulmonary fibrosis
Chronic restrictive lung disease occurring with no identifiable etiology (destruction of alveoli and surrounding capillary network)
70
What reduced lung compliance in idiopathic pulmonary fibrosis?
Progressive scar tissue formation (loss of alveolar capillary density, impaired gas exchange, and hypoxemia)
71
Sarcoidosis
Multi system disease (possibly autoimmune) (younger than 40 years, higher rate in African Americans)
72
What do most cases of sarcoidosis lead to?
Diffuse interstitial fibrosis and pulmonary arterial hypertension
73
Asbestosis
Restrictive lung disease due to exposure to asbestos (plaque formation in pleura)
74
What is at an increased risk for development if you have asbestosis?
Bronchogenic carcinoma
75
Silicosis
Restrictive lung disease due to exposure of crystalline silica
76
What is involved in silicosis?
Upper lobe with nodules and eggshell like calcification of hilar nodules
77
What does silicosis lead to?
Infection with mycobacteria
78
Hypersensitivity pneumonitis
Hypersensitive to certain allergens (affects alveolar septae)
79
What is true about hypersensitivity pneumonitis?
Extremely aggressive progression (need lung transplant)
80
What is at an increased risk for development from burns?
Interstitial fibrosis
81
How does neuromuscular complications affect the lungs?
Damage to the brainstem results in abnormal breathing (apneic periods)
82
What is paradoxical chest wall movements?
Abdomen rises and chest wall sinks (quadriplegics and paraplegics)
83
What happens to breathing post polio?
Chest wall rises and abdomen sinks
84
How does obesity increase the work of breathing?
Due to reductions in both chest wall compliance and respiratory muscle strength
85
How much can obesity increase the work of breathing?
More than 3 folds
86
What is there an imbalance between in obesity?
Demand on respiratory muscle and their capacity to generate force (leads to perception of increased breathing effort)
87
How much does respiratory system compliance reduce in obesity?
30-50% (due to reductions in outward pull of chest wall at end of expiration from fat)
88
What is also common in obesity?
Expiratory flow limitation
89
Why are the lung volumes smaller in obesity?
Diaphragm cannot contract down as much due to excess fat so lungs cannot expand as much
90
What are common pulmonary disorders that arise from obesity?
Obesity hypoventilation syndrome (pickwickian syndrome) Pneumonia
91
Obstructive sleep apnea
Upper airway obstruction due to increased cervical fat (association to obesity)
92
What do the pharyngeal muscles not do during obstructive sleep apnea?
Does not maintain upper airway patency resulting in temporary cessation of ventilation during sleep
93
What are symptoms of obstructive sleep apnea?
Snoring, sleep disturbance, lathargy
94
What is treatment for obstructive sleep apnea?
cPAP, biPAP, or weight reduction
95
Pulmonary hypertension
Elevation in pulmonary arterial pressures
96
How is pulmonary hypertension diagnosed?
Right heart catherization
97
What are the values to look for in pulmonary hypertension?
>25 mmHg at rest >30 mmHg during exercise
98
How can pulmonary hypertension lead to right heart failure?
Causes the heart to work harder
99
What are the groups of pulmonary hypertension?
Pulmonary arterial hypertension PH due to left ventricular dysfunction (back flow of fluid) PH due to lung disease (retaining a lot of CO2)
100
What are symptoms of pulmonary hypertension?
Progressive Dyspnea with exertion (at rest in later stages) Exertional syncope Normal spirometry with reduced DLCO
101
What does pulmonary arterial hypertension lead to?
Right heart failure
102
What is used to treat pulmonary arterial hypertension?
Phosphodiesterase-5 inhibitors (viagra)
103
What is the majority of lung cancers related to?
Smoking
104
What is small cell lung cancer?
Tumor cells are smaller than mature lymphocytes
105
What percentage of patients are metastatic during time of small cell lung cancer diagnosis?
70% (considered inoperable)
106
What is non small cell lung cancer?
80-85% of lung cancers and leading cause of death
107
What are the two most common lung cancers in smokers?
Squamous cell and adenocarcinoma

Cardiopulmonary (20 decks)

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