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Cardiopulmonary > Chronic Pulmonary > Flashcards

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
Q

What tests show reduced functional capacity in someone with COPD?

A

6 MWD

CPET

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26
Q

What is a common impairment in someone with COPD?

A

Back pain and chronic pain

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27
Q

What is true about breathing in COPD?

A

You can breath out the same amount of air it just takes more time (low FEV1)

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28
Q

Why do people with COPD get Dyspnea during exertion?

A

Lungs get too full because they cannot get air out

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29
Q

What often happens to the diaphragm in patients with COPD?

A

They cannot get all of their air out so the lungs get hyper inflated and compress the diaphram

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30
Q

When do hypoxemia develop in COPD?

A

When FEV1 is less than 50%

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31
Q

What does DLCO measure?

A

Diffusing capacity of CO through the alveolar membrane to hemoglobin

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32
Q

What will reduce DLCO?

A

Damage to alveolar capillary membrane or vasculature

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33
Q

What diseases in DLCO reduced in?

A

Obstructive and restrictive lung disease (normal in asthma)

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34
Q

What is a mild case of COPD?

A

FEV1 >80%

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35
Q

What is a moderate case of COPD?

A

FEV1 50-80%

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36
Q

What is a severe case of COPD?

A

FEV1 30-50%

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37
Q

What is a very severe case of COPD?

A

FEV1 < 30%

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38
Q

What is the prognosis used to assess COPD?

A

Severity based on FEV1

Distance on 6MWT

Score on MMRC Dyspnea scale

BMI

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39
Q

What are symptoms of asthma?

A

Wheezing

Dyspnea

Chest pain

Facial distress

Non productive cough

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40
Q

When does asthma happen in life?

A

Earlier on (childhood exposure to smoking and obesity)

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41
Q

What is asthmaticus?

A

Severe asthma attack

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42
Q

What are types of septic obstructive diseases?

A

Bronchiectasis

Cystic fibrosis

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43
Q

What is bronchiectasis?

A

Irreversible airway dilation due to destruction of the muscular and elastic properties of the lung

44
Q

What is the percentages that go on to cause bronchiectasis?

A

70% associated from underlying disease (COPD)

30% due to idiopathic causes

45
Q

What is an extrinsic cause in bronchiectasis?

A

Compression by adjacent lymphadenopathy or parenchymal tumor mass

46
Q

What is an intrinsic cause in bronchiectasis?

A

Airway tumor or aspiration (scarred airway)

47
Q

What is focal bronchiectasis?

A

Extrinsic and intrinsic causes localized area of the lung

48
Q

What is diffuse bronchiectasis?

A

Widespread, often arises from an underlying systemic disease

49
Q

What are symptoms of bronchiectasis?

A

Persistent productive cough with thick sputnum

Crackles and wheezing on lung auscultation

Obstructive pattern on PFT

50
Q

What type of disease is cystic fibrosis?

A

Multi system disease

51
Q

What is the defect in cystic fibrosis?

A

Na+/Cl- channels resulting in excessive salty mucous formation

52
Q

Why are children with cystic fibrosis physically underdeveloped?

A

Malabsorption

53
Q

What has high prevalence in cystic fibrosis?

A

Pulmonary arterial hypertension and type 1 diabetes

54
Q

What percent of patients are diagnosed with cystic fibrosis before 2 years old?

A

75% (assessed at birth with sweat chloride test)

55
Q

What do the majority of patients with cystic fibrosis die from?

A

Lung infection (high risk of infection)

56
Q

What is required to treat cystic fibrosis?

A

Consistent airway clearance

Exercise

Nutritional supplementation

(Possible lung transplant)

57
Q

What is the problem with restrictive lung disease?

A

Getting air in the lungs

58
Q

Why are FEV1 and FEV reduced in restrictive lung disease but the ratio is still normal?

A

Because the lungs got smaller

59
Q

What is prevented in restrictive lung disease?

A

The lungs from fully expanding

60
Q

What is an intrinsic problem in restrictive lung disease?

A

Reduced airway compliance due to thickening and scarring

61
Q

What is an extrinsic/mechanical problem in restrictive lung disease?

A

Reduced chest wall compliance (obesity, chest wall deformities, chest wall trauma, burns, neuromuscular disease)

62
Q

What are idiopathic causes of intrinsic restrictive lung disease?

A

Idiopathic pulmonary fibrosis

Sarcoidosis

63
Q

What are occupational causes of intrinsic restrictive lung disease?

A

Asbestosis

Silicosis

Coal workers pneumoconiosis

64
Q

What are autoimmune causes of intrinsic restrictive lung disease?

A

Systemic lupus erythematosus (SLE)

Wegener granulomatosis

Rheumatoid arthritis

65
Q

What’s the resultant appearance of fibrotic lung parenchyma?

A

Honeycomb lung

66
Q

What are symptoms of intrinsic restrictive lung disease?

A

Insidious onset of Dyspnea on exertion

Frequent dry nonproductive cough

Difficulty eating

67
Q

What are signs of intrinsic restrictive lung disease?

A

Fine bibasilar end inspiratory crackles

Clubbing of fingers

Right sides heart failure

68
Q

How do you diagnose intrinsic restrictive lung disease?

A

Lung biopsy

69
Q

Idiopathic pulmonary fibrosis

A

Chronic restrictive lung disease occurring with no identifiable etiology (destruction of alveoli and surrounding capillary network)

70
Q

What reduced lung compliance in idiopathic pulmonary fibrosis?

A

Progressive scar tissue formation (loss of alveolar capillary density, impaired gas exchange, and hypoxemia)

71
Q

Sarcoidosis

A

Multi system disease (possibly autoimmune) (younger than 40 years, higher rate in African Americans)

72
Q

What do most cases of sarcoidosis lead to?

A

Diffuse interstitial fibrosis and pulmonary arterial hypertension

73
Q

Asbestosis

A

Restrictive lung disease due to exposure to asbestos (plaque formation in pleura)

74
Q

What is at an increased risk for development if you have asbestosis?

A

Bronchogenic carcinoma

75
Q

Silicosis

A

Restrictive lung disease due to exposure of crystalline silica

76
Q

What is involved in silicosis?

A

Upper lobe with nodules and eggshell like calcification of hilar nodules

77
Q

What does silicosis lead to?

A

Infection with mycobacteria

78
Q

Hypersensitivity pneumonitis

A

Hypersensitive to certain allergens (affects alveolar septae)

79
Q

What is true about hypersensitivity pneumonitis?

A

Extremely aggressive progression (need lung transplant)

80
Q

What is at an increased risk for development from burns?

A

Interstitial fibrosis

81
Q

How does neuromuscular complications affect the lungs?

A

Damage to the brainstem results in abnormal breathing (apneic periods)

82
Q

What is paradoxical chest wall movements?

A

Abdomen rises and chest wall sinks (quadriplegics and paraplegics)

83
Q

What happens to breathing post polio?

A

Chest wall rises and abdomen sinks

84
Q

How does obesity increase the work of breathing?

A

Due to reductions in both chest wall compliance and respiratory muscle strength

85
Q

How much can obesity increase the work of breathing?

A

More than 3 folds

86
Q

What is there an imbalance between in obesity?

A

Demand on respiratory muscle and their capacity to generate force (leads to perception of increased breathing effort)

87
Q

How much does respiratory system compliance reduce in obesity?

A

30-50% (due to reductions in outward pull of chest wall at end of expiration from fat)

88
Q

What is also common in obesity?

A

Expiratory flow limitation

89
Q

Why are the lung volumes smaller in obesity?

A

Diaphragm cannot contract down as much due to excess fat so lungs cannot expand as much

90
Q

What are common pulmonary disorders that arise from obesity?

A

Obesity hypoventilation syndrome (pickwickian syndrome)

Pneumonia

91
Q

Obstructive sleep apnea

A

Upper airway obstruction due to increased cervical fat (association to obesity)

92
Q

What do the pharyngeal muscles not do during obstructive sleep apnea?

A

Does not maintain upper airway patency resulting in temporary cessation of ventilation during sleep

93
Q

What are symptoms of obstructive sleep apnea?

A

Snoring, sleep disturbance, lathargy

94
Q

What is treatment for obstructive sleep apnea?

A

cPAP, biPAP, or weight reduction

95
Q

Pulmonary hypertension

A

Elevation in pulmonary arterial pressures

96
Q

How is pulmonary hypertension diagnosed?

A

Right heart catherization

97
Q

What are the values to look for in pulmonary hypertension?

A

> 25 mmHg at rest

> 30 mmHg during exercise

98
Q

How can pulmonary hypertension lead to right heart failure?

A

Causes the heart to work harder

99
Q

What are the groups of pulmonary hypertension?

A

Pulmonary arterial hypertension

PH due to left ventricular dysfunction (back flow of fluid)

PH due to lung disease (retaining a lot of CO2)

100
Q

What are symptoms of pulmonary hypertension?

A

Progressive Dyspnea with exertion (at rest in later stages)

Exertional syncope

Normal spirometry with reduced DLCO

101
Q

What does pulmonary arterial hypertension lead to?

A

Right heart failure

102
Q

What is used to treat pulmonary arterial hypertension?

A

Phosphodiesterase-5 inhibitors (viagra)

103
Q

What is the majority of lung cancers related to?

A

Smoking

104
Q

What is small cell lung cancer?

A

Tumor cells are smaller than mature lymphocytes

105
Q

What percentage of patients are metastatic during time of small cell lung cancer diagnosis?

A

70% (considered inoperable)

106
Q

What is non small cell lung cancer?

A

80-85% of lung cancers and leading cause of death

107
Q

What are the two most common lung cancers in smokers?

A

Squamous cell and adenocarcinoma

Cardiopulmonary (20 decks)

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