Disorders of the Chest Wall

Question 1

Five things that can result from restrictive lung disease

Answer 1

Chronic hypercapnia, especially during sleep

Atelectasis

Ineffective cough

Recurrent infections

Pulm vasoconstriction > Pulm hypertension > Cor pulmonale

Question 2

Describe efficiency, strength, and impendance in relation to ventilation

Answer 2

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 3

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

Answer 3

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 4

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

Answer 4

Check ABGs, PFTs, sleep study

Question 5

How would kypho/scoliosis affect PFTs

Answer 5

Restrictive pattern, reduced TLC, reduced FVC

Question 6

Scoliotic angle >100 degrees is associated with these pulmonary conditions

Answer 6

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

Question 7

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

Answer 7

Infections
Narcotics
Sedatives

Question 8

Treatments of kyphoscoliosis

Answer 8

Bracing (childhood)
Flu and pneumococcal vaccines very important

Question 9

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

Answer 9

Ankylosing spondylitis

Question 10

Treatment for pectus excavatum/carinatum

Answer 10

Surgical (u-bar), best done during childhood

Question 11

Describe the condition of flail chest

Answer 11

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

Question 12

Treatment for flail chest

Answer 12

Surgical fixation or mechanical/positive pressure ventilation

Question 13

Treatments for neuromuscular induced respiratory compromise

Answer 13

Bronchopulmonary hygiene
Treat infections
Mechanical/positive pressure ventilation

Question 14

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

Answer 14

Unilateral phrenic nerve injury

(look for paradoxical excursion of the paralyzed hemidiaphragm)

Question 15

Most common cause of unilateral diaphragmatic paralysis

Answer 15

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

Question 16

Is orthopnea more common with bilateral or unilateral diaphragmatic paralysis?

Answer 16

Bilateral diaphragmatic paralysis

Hypoxemia when supine

Question 17

Diaphragmatic plication is a treatment used in which pulmonary condition

Answer 17

Unilateral diaphragmatic paralysis

Question 18

Treatment for postoperative diaphragmatic dysfunction

Answer 18

Incentive spirometry

Question 19

Which type of functional transection would require lifelong mechanical ventilation?

Answer 19

Transection = spinal cord damage

Damage above C3 paralyzes entire diaphragm and requires lifelong mechanical ventilation

Question 20

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

Answer 20

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

Abdominal binding

LABA inhalers

Question 21

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

Answer 21

Guillain-Barre syndrome

Question 21

Three causes of anterior horn cell disease

Answer 21

ALS (no good treatment)

Poliomyelitis

Spinal muscle atrophy

Question 22

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

Answer 22

Toxin-induced neural dysfunction

Irreversible neuromuscular blockade from blue-green algae toxins

Question 23

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

Answer 23

Diphtheria

Question 24

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

Answer 24

Myasthenia gravis

Question 25

Patients with myasthenia gravis should have these two things monitored

Answer 25

MIP and MEP

(max insp and exp pressures)

Question 26

Symptoms for patients with Eaton-Lambert syndrome

Answer 26

Ataxia and neuropathy

Question 27

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

Answer 27

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

Question 28

Which substances can cause a descending paralysis?

Answer 28

Succinylcholine

Botulism toxin

Medications (clindamycin, propranolol, chloroquine, gentamicin)

Question 29

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

Answer 29

Muscular dystrophy (late)