Disorders of the Chest Wall

Question 1

Three causes of anterior horn cell disease

Answer 1

ALS (no good treatment)

Poliomyelitis

Spinal muscle atrophy

Question 2

Treatment for postoperative diaphragmatic dysfunction

Answer 2

Incentive spirometry

Question 3

Is orthopnea more common with bilateral or unilateral diaphragmatic paralysis?

Answer 3

Bilateral diaphragmatic paralysis

Hypoxemia when supine

Question 4

How would kypho/scoliosis affect PFTs

Answer 4

Restrictive pattern, reduced TLC, reduced FVC

Question 5

Patients with kyphoscoliosis are susceptible to respiratory failure due to these three factors

Answer 5

Infections
Narcotics
Sedatives

Question 6

Which syndrome causes an ascending paralysis and can require temporary mechanical ventilation?

Answer 6

Guillain-Barre syndrome

Question 7

Patients with myasthenia gravis should have these two things monitored

Answer 7

MIP and MEP

(max insp and exp pressures)

Question 8

Which condition is described as a “bamboo spine” and involves arthritis of costovertebral articulations?

Answer 8

Ankylosing spondylitis

Question 9

Kids with huge calf muscles and problems breathing might have this disorder

Answer 9

Muscular dystrophy (late)

Question 10

Describe the condition of flail chest

Answer 10

Multiple rib fractures in a vertical plane resulting in paradoxical movement (diaphragm moves down but chest wall sucks in)

Question 11

Which pulmonary neuromuscular disorder might be diagnosed with a sniff test (diaphragm fluoroscopy)?

Answer 11

Unilateral phrenic nerve injury

(look for paradoxical excursion of the paralyzed hemidiaphragm)

Question 12

Treatment for pectus excavatum/carinatum

Answer 12

Surgical (u-bar), best done during childhood

Question 13

Scoliotic angle >100 degrees is associated with these (5) pulmonary conditions

Answer 13

TLC reduced to 50%
Alveolar hypoventilation
Hypoxemia
Pulmonary hypertension
Cor pulmonale

Question 14

Respiratory treatment options (3) for patients with spinal cord transections causing paralysis of the diaphragm (full or partial)

Answer 14

Mech. ventilation (tracheostomy) if lesion at C3 or above

Abdominal binding

LABA inhalers

Question 15

Diaphragmatic plication is a treatment used in which pulmonary condition

Answer 15

Unilateral diaphragmatic paralysis

Question 16

Most common cause of unilateral diaphragmatic paralysis

Answer 16

Unilateral phrenic nerve injury caused by lung masses (bronchogenic cancer)

Question 17

Five things that can result from restrictive lung disease

Answer 17

Chronic hypercapnia, especially during sleep

Atelectasis

Ineffective cough

Recurrent infections

Pulm vasoconstriction > Pulm hypertension > Cor pulmonale

Question 18

This neuromuscular disorder can cause respiratory problems and causes cardiac and neurotoxicity

Answer 18

Diphtheria

Question 19

Treatments of kyphoscoliosis

Answer 19

Bracing (childhood)
Flu and pneumococcal vaccines very important

Question 20

Which substances can cause a descending paralysis?

Answer 20

Succinylcholine

Botulism toxin

Medications (clindamycin, propranolol, chloroquine, gentamicin)

Question 21

How would the following be affected by obesity:
Tidal volume:
Respiratory rate:
Work of breathing:
Intrathoracic pressure:
Airway resistance:
Functional residual capacity:

Answer 21

Tidal volume: DOWN
Respiratory rate: UP (can eventually lead to OHS though)
Work of breathing: UP
Intrathoracic pressure: UP
Airway resistance: UP
Functional residual capacity: DOWN

Question 22

Treatments for neuromuscular induced respiratory compromise

Answer 22

Bronchopulmonary hygiene
Treat infections
Mechanical/positive pressure ventilation

Question 23

Describe efficiency, strength, and impendance in relation to ventilation

Answer 23

Efficiency: ability to maintain consistent respiratory effort

Strength: ability of respiratory muscles to overcome impedance

Impedance: compliance of the respiratory system to move air

Question 24

Treatment for flail chest

Answer 24

Surgical fixation or mechanical/positive pressure ventilation

Question 25

Ways to diagnose OSA (obstructive sleep apnea) and OHS (obesity hypoventilation syndrome)

Answer 25

Check ABGs, PFTs, sleep study

Question 26

True or false. Eaton-Lambert syndrome is associated with cancer

Answer 26

True. Usually cancer is far along by the time cerebellar symptoms are present.

Question 27

This neuromuscular disorder is an episodic disease that can lead to respiratory failure. It’s triggered by antibiotics, B-blockers, and infection

Answer 27

Myasthenia gravis

Question 28

Which type of functional transection would require lifelong mechanical ventilation?

Answer 28

Transection = spinal cord damage

Damage above C3 paralyzes entire diaphragm and requires lifelong mechanical ventilation

Question 29

Symptoms for patients with Eaton-Lambert syndrome

Answer 29

Ataxia and neuropathy

Question 30

A patient who develops respiratory problems after eating poorly prepared puffer fish may have this disorder

Answer 30

Toxin-induced neural dysfunction

Irreversible neuromuscular blockade from blue-green algae toxins