Disorders of the Chest Wall Flashcards
Three causes of anterior horn cell disease
ALS (no good treatment)
Poliomyelitis
Spinal muscle atrophy
Treatment for postoperative diaphragmatic dysfunction
Incentive spirometry
Is orthopnea more common with bilateral or unilateral diaphragmatic paralysis?
Bilateral diaphragmatic paralysis
Hypoxemia when supine
How would kypho/scoliosis affect PFTs
Restrictive pattern, reduced TLC, reduced FVC
Patients with kyphoscoliosis are susceptible to respiratory failure due to these three factors
Infections
Narcotics
Sedatives
Which syndrome causes an ascending paralysis and can require temporary mechanical ventilation?
Guillain-Barre syndrome
Patients with myasthenia gravis should have these two things monitored
MIP and MEP
(max insp and exp pressures)
Which condition is described as a “bamboo spine” and involves arthritis of costovertebral articulations?
Ankylosing spondylitis
Kids with huge calf muscles and problems breathing might have this disorder
Muscular dystrophy (late)
Describe the condition of flail chest
Multiple rib fractures in a vertical plane resulting in paradoxical movement (diaphragm moves down but chest wall sucks in)
Which pulmonary neuromuscular disorder might be diagnosed with a sniff test (diaphragm fluoroscopy)?
Unilateral phrenic nerve injury
(look for paradoxical excursion of the paralyzed hemidiaphragm)
Treatment for pectus excavatum/carinatum
Surgical (u-bar), best done during childhood
Scoliotic angle >100 degrees is associated with these (5) pulmonary conditions
TLC reduced to 50%
Alveolar hypoventilation
Hypoxemia
Pulmonary hypertension
Cor pulmonale
Respiratory treatment options (3) for patients with spinal cord transections causing paralysis of the diaphragm (full or partial)
Mech. ventilation (tracheostomy) if lesion at C3 or above
Abdominal binding
LABA inhalers
Diaphragmatic plication is a treatment used in which pulmonary condition
Unilateral diaphragmatic paralysis
Most common cause of unilateral diaphragmatic paralysis
Unilateral phrenic nerve injury caused by lung masses (bronchogenic cancer)
Five things that can result from restrictive lung disease
Chronic hypercapnia, especially during sleep
Atelectasis
Ineffective cough
Recurrent infections
Pulm vasoconstriction > Pulm hypertension > Cor pulmonale
This neuromuscular disorder can cause respiratory problems and causes cardiac and neurotoxicity
Diphtheria
Treatments of kyphoscoliosis
Bracing (childhood)
Flu and pneumococcal vaccines very important
Which substances can cause a descending paralysis?
Succinylcholine
Botulism toxin
Medications (clindamycin, propranolol, chloroquine, gentamicin)
How would the following be affected by obesity:
Tidal volume:
Respiratory rate:
Work of breathing:
Intrathoracic pressure:
Airway resistance:
Functional residual capacity:
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
Treatments for neuromuscular induced respiratory compromise
Bronchopulmonary hygiene
Treat infections
Mechanical/positive pressure ventilation
Describe efficiency, strength, and impendance in relation to ventilation
Efficiency: ability to maintain consistent respiratory effort
Strength: ability of respiratory muscles to overcome impedance
Impedance: compliance of the respiratory system to move air
Treatment for flail chest
Surgical fixation or mechanical/positive pressure ventilation
Ways to diagnose OSA (obstructive sleep apnea) and OHS (obesity hypoventilation syndrome)
Check ABGs, PFTs, sleep study
True or false. Eaton-Lambert syndrome is associated with cancer
True. Usually cancer is far along by the time cerebellar symptoms are present.
This neuromuscular disorder is an episodic disease that can lead to respiratory failure. It’s triggered by antibiotics, B-blockers, and infection
Myasthenia gravis
Which type of functional transection would require lifelong mechanical ventilation?
Transection = spinal cord damage
Damage above C3 paralyzes entire diaphragm and requires lifelong mechanical ventilation
Symptoms for patients with Eaton-Lambert syndrome
Ataxia and neuropathy
A patient who develops respiratory problems after eating poorly prepared puffer fish may have this disorder
Toxin-induced neural dysfunction
Irreversible neuromuscular blockade from blue-green algae toxins
