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Medical Physiology > Exam #3: Obstructive & Restrictive Disorders > Flashcards

Exam #3: Obstructive & Restrictive Disorders Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the three classifications of obstructive pulmonary disorders?

A

1) Obstructions from conditions in the wall of the lumen
2) Obstruction related to loss of lung parenchyma
3) Obstruction of the airway lumen

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2
Q

List examples of obstructions from conditions in the wall of the lumen.

A

Asthma
Acute bronchitis
Chronic bronchitis

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3
Q

List examples of obstruction related to loss of lung parenchyma.

A

Emphysema

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4
Q

List examples of obstruction of the airway lumen.

A 
Bronchiectasis 
Bronchiolitis 
Cystic Fibrosis
Acute tracheobronchial obstruction 
Epiglottitis 
Croup Syndrome
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5
Q

Comparing the three major obstructive lung diseases: asthma, chronic bronchitis, & emphysema how are the three distinguished from each other?

A
  • Asthma is the most reversible of obstructive lung diseases
  • Chronic bronchitis is hallmarked by increased sputum production
  • Emphysema involves the most damage to the alveolar wall
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6
Q

What are the classic features of asthma.

A
  • Diffuse airway inflammation
  • Increased airway responsiveness
  • Partially or completely reversible bronchoconstirction
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7
Q

What are the two main types of asthma?

A

Allergic vs. non-allergic asthma

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8
Q

What are the characteristics of allergic asthma?

A

Extrinsic

Pediatric onset

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9
Q

What are the characteristics of Non-allergic asthma?

A
  • Intrinsic
  • Adult-onset
  • Allergen- specific immunotherapy & environmental control measures NOT helpful
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10
Q

Outline the pathophysiology of allergic asthma.

A

In response to an allergen, a myraid of inflammatory cells release inflammatory mediators that result in:

1) Bronchoconstriction
2) Plasma exudation
3) Edema
4) Vasodilation
5) Mucus hypersecretion
6) Activation of sensory nerves

Chronic inflammation leads to structural changes including:

1) Thickening of the basement membrane
2) Smooth muscle hypertrophy & hyperplasia
3) Angiogenesis
4) Hyperplasia of mucus-secreting cells

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11
Q

What are the clinical manifestations of asthma?

A

Dyspnea accompanied by:

  • Cough
  • Wheezing
  • Anxiety
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12
Q

What are common triggers of allergic asthma?

A
  • Exercise
  • Aspirin
  • Extrinsic factors i.e. allergens
  • Intrinsic factors i.e. no identifiable
  • rapid changes in temperature & humidity
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13
Q

What is seen on physical examination of an asthmatic patient?

A

Wheezing

  • Rapid breathing
  • Tachycardia
  • Pulsus Paradoxus
  • Accessory muscle use
  • Active & prolonged expiratory phase
  • Hyperresonance to percussion
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14
Q

Why is there tachycardia in acute asthma?

A

Increased work of breathing requires increased HR

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15
Q

What is pulsus paradoxus?

A
  • Decrease in blood pressure with inspiration, which is the opposite of normal
  • Alveolar hyperinflation constricts pulmonary capillaries & causes an increase in afterload on RV–>pushes the ventricular septum into the LV & decreases the SV ejected
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16
Q

How is asthma manifested on PTF?

A

Decreased airflow rates throughout the vital capacity

  • Decreased PEFR
  • Decreased FEV1
  • Decreased MMEFR
17
Q

Draw the schematics of flow-volume curves in acute asthma, early resolution, and late-resolution.

A

N/A

18
Q

What are the four therapeutic goals in asthma?

A

1) Allow patient the pursue ADLs
2) Allow the patient to sleep without awakening b/c of symptoms
3) Minimize bronchodilator use
4) Prevent unscheduled medical care

19
Q

What are the therapeutic options in asthma?

A

Acute reliever

Controller

20
Q

What are the receptors for rescue treatments?

A
  • B-2 adrenergic (bronchodilation)

- Anticholinergics (M3)

21
Q

List the controller treatments used for asthma.

A 
Inhaled corticosteroids
Antileukotrienes 
Long-acting B-agonists
Theophylline
Systemic corticosteroids
Anti-IgE
22
Q

What are the classifications of the restrictive lung disorders?

A

Lung parencymal
Pleural
Neuromuscular
Infection

23
Q

What are the two subclasses of lung parenchymal disorders?

A

Fibrotic Interstitial Lung Disease

Atelectatic Disorder

24
Q

List examples of Fibrotic Interstitial Lung Diseases.

A

1) Diffuse interstitial lung disease
2) Sarcoidosis
3) Hypersensitivity pneumonitis
4) Occupational lung disease

25
Q

List examples of Atelectatic Disorders.

A

ARDS

Infant RDS

26
Q

List examples of pleural space disorders.

A

Pneumothorax

Pleural Effusion

27
Q

What are the two classes of neuromuscular, chest wall, and obesity disorders?

A

Neuromuscular Disorders

Chest Wall Deformities

28
Q

List examples of neuromuscular disorders.

A 
Poliomyelitis 
ALS 
Muscular Dystrophy 
Guillain Barre Syndrome 
Myasthenia Gravis
29
Q

List examples of chest wall deformities.

A

Kyphoscoliosis
Ankylosing Spondylitis
Flail Chest
Obesity

30
Q

List the examples of inflammation of the lung.

A

Pneumonia
Severe ARDS
Pulmonary Tuberculosis

31
Q

What is ARDS?

A

Adult Respiratory Distress Syndrome

32
Q

What is ARDS characterized by?

A
  • Damage to the alveolar-capillary membrane

- Widespread alveolar infiltrates & dyspnea

33
Q

What is ARDS accoiated with?

A 
Trauma 
Sepsis 
Aspiration of gastric acid
Fat emboli sydrome
Shock
34
Q

How is ARDS diagnosed?

A

Decreased Pa)2 that is refractory to supplemental to O2 therapy

35
Q

What are the three key pathological features of ARDS?

A

1) Noncardiogenic pulmonary edema= damage to the capillary membrane increases permeability
2) Atelectasis associated with lack of surfactant
3) Fibrosis associated with inflammatory deposition of proteins

36
Q

What are the common findings in ARDS?

A

1) Severe hypoexmia
2) Decreased compliance from deposition of plasma protein & fluid
3) Decreased FRC
4) White out CXR
5) Non-cardiogenic pulmonary edema (not following the distribution of the vascular tree)

37
Q

How is ARDS treated?

A
  • Mostly supportive
  • Identify & correct underlying cause
  • Maintain fluid & electrolyte balance
  • Block system inflammatory cells
  • Adequate oxygenation
  • High-frequency jet ventilation
  • Inhaled nitric oxide
38
Q

What is absorption atelectasis?

A

100% oxygen= no Nitrogen

  • Body uses O2
  • In ARDS that O2 in residual volume is used
  • Causes atelectasis

Medical Physiology (74 decks)

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