Clinical discussion: back and thorax

Question 1

COPD on xray

Answer 1

Pink puffer: flattening of diaphragm, hyperinflation of chest, larger costophrenic angle

Blue bloater: sternum out, ribs lifted up as if to take a huge breath

Question 2

Head forward posture

Answer 2

narrows posterior oropharynx, COPD pts, increases risk of sleep apnea, neck collapsing into chest –> limited ability to generative negative intrathoracic pressure to pump lymphatics …fluid backup

Question 3

INhalation ribs

Answer 3

caused by coughing and air trapping, limit ability to generate negative intrathoracic pressure, fixed with rib raising

Question 4

Flattened diaphragm

Answer 4

caused by coughing, air trapping, limit ability to generative negative intrathoracic pressure, diaphragm redoming, fixed with pedal pump

Question 5

Tiotroprium

Answer 5

anticholinergic, good drug for COPD

Question 6

Kerley B lines

Answer 6

lymphatic vessels between lung lobule segments, appear as white lines throughout lungs on cxr, appear as 1-2 cm long lines perpendicular to the pleura in the costophrenic angle, where easiest to see

Question 7

CXR of lymphedema pt

Answer 7

Kerley B lines, fluid collects in costophrenic angle, hazing around lung root where lymph builds up, hylar nodes are in the hilum (aka bronchopulmonary nodes)

Question 8

Frank-Starling’s Law

Answer 8

• ability to pump more is decreased in heart failure
• graph showing curves: blue curve (bottom) is “Sleeping,” purple is “walking,” etc.
• ionotropy = pumping strength
• downward right side slope i due to heart attempting to pump for more than its ionotropy allows –> decreased pumping ability –> fluid backup

Question 9

CHF on capillary system

Answer 9

• increased hydrostatic pressure (increased pressure in capillary beds –> blood not flowing away quickly)
• possibly decreased osmotic pressure (low protein - albumin)