Clinical Concepts/Integration Flashcards
1
Q
Hyaline Membrane Disease
A
- Premature infants have a lack of mature surfactant
- Alveoli are destabilized and collapse
- Increased elastance and recoil damage the alveoli and endothelium
- Protein leaks into the alveolus (noncardiogenic edema)
- Proteinaceous material creates ‘hyaline’ membranes on pathology
2
Q
A
Hyaline Membrane Disease
3
Q
Hyaline Membraen Disease Lung Volume
A
•decreases
4
Q
restrictive lung disease = […] elastance
A
increased
5
Q
HMD Treatment
A
- Surfactant replacement
- Oxygen
- Low pressure mechanical ventilation
- Low tidal volume
- High respiratory rate
- Nutrition
6
Q
Bronchopulmonary Dysplasia
A
Chronic lung disease due to
- Volutrauma/Barotrauma from ventilator
- Oxygen toxicity
- Inflammation
7
Q
Three Ways to Block an Airway
A
- in th elumen
- in the wall
- outside the wall
8
Q
BPD Physiology
A
- Mixed restrictive/obstructive disease
- Damaged airways
- No new airways after early second trimester
- Remodel airways to heal
- Damaged alveoli
- Millions of new alveoli and pulmonary capillaries heal gas exchange
9
Q
A
10
Q
Bronchioles depend on alveoli…
A
…to inflate, therfore pulling airways open.
11
Q
BPD Treatment
A
- Oxygen
- Nutrition
- Avoid Infection
- Avoid pulmonary hypertension
- Avoid aspiration
- Time
12
Q
Clues for CF
A
- Failure to thrive or ‘stunting’
- Chronic bronchiolitis’ and/or recurrent pneumonia
- Paroxysmal cough with cyanosis
- Abnormal stool history
- Hypochloremic alkalosis with dehydration
13
Q
CF Pathophysiology
A
- CFTR is a chloride channel
- CFTR regulates other channels; e.g. ENAC
- Reduced mucociliary clearance
- Chronic infection, especially P. aeruginosa
- Progressive damage to airway structure
- Bronchiectasis
- Thick sputum with high levels of DNA
- Progressive obstructive airway disease
14
Q
FEV1/FVC ratio is […] in obstructive airway disease.
A
decreased
15
Q
A
Endstage Bronchiectasis
16
Q
Cough
A
- Deep inspiration to load lung with gas
- Compression phase against closed vocal cords
- Rapid decompression phase
- Shake, rattle and roll
- Squeeze airways with dynamic compression
17
Q
Cough and CF
A
- Bronchiectasis commonly peripheral to equal pressure point at high lung volumes
- Mucus trapped behind airway compression
18
Q
Foreign Body Clues
A
- Age > 6-10 months and male
- ‘Helpful toddler sibling’ in home
- Sunflower seeds, peanuts, pinon nuts, etc….
- Coarse wheeze with monophonic component
- Heterophony (Differential air entry) with local hyperinflation or collapse
- 20-30% have a delayed diagnosis
19
Q
Intrathoracic Obstruction
A
•Intrathoracic airways
- ncrease diameter with inspiration
- decrease diameter with expiration
- Intrathoracic obstruction causes expiratory wheeze
- Foreign body can be a ball-valve obstruction
20
Q
Croup
A
- subglottic narrowing
- Viral infection (parainfluenza, RSV)
- Onset with cold symptoms
- Development of sub-glottic (below the vocal cords) obstruction due to inflammation
- Barking cough and increased resistive work of breathing
21
Q
Extrathoracic Obstruction
A
Extrathoracic airways (pharynx, larynx, upper trachea)
- Increase diameter with expiration
- Decrease diameter with inspiration
- Extrathoracic airway obstruction causes inspiratory stridor
- Croup is a classic extrathoracic airway obstruction
22
Q
Croup and Helium
A
Sub-glottic space narrowest part of airway
- High velocities
- High Turbulence
- P = K2 x Flow2
- Helium is low density and reduces turbulence and work of breathing
23
Q
Intra - vs. Extrathoracic Obstruction
A
Inspiration:
- Pressure outside extrathoracic airway greater than in airway lumen
- Collapse on inspiration = inspiratory stridor
Expiration
- Pressure outside intrathoracic airway greater than in airway lumen
- Collapse on expiration = expiratory wheeze
