Exam #3: Obstructive & Restrictive Disorders 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.

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
List examples of Atelectatic Disorders.
ARDS | Infant RDS
26
List examples of pleural space disorders.
Pneumothorax | Pleural Effusion
27
What are the two classes of neuromuscular, chest wall, and obesity disorders?
Neuromuscular Disorders | Chest Wall Deformities
28
List examples of neuromuscular disorders.
``` Poliomyelitis ALS Muscular Dystrophy Guillain Barre Syndrome Myasthenia Gravis ```
29
List examples of chest wall deformities.
Kyphoscoliosis Ankylosing Spondylitis Flail Chest Obesity
30
List the examples of inflammation of the lung.
Pneumonia Severe ARDS Pulmonary Tuberculosis
31
What is ARDS?
Adult Respiratory Distress Syndrome
32
What is ARDS characterized by?
- Damage to the alveolar-capillary membrane | - Widespread alveolar infiltrates & dyspnea
33
What is ARDS accoiated with?
``` Trauma Sepsis Aspiration of gastric acid Fat emboli sydrome Shock ```
34
How is ARDS diagnosed?
Decreased Pa)2 that is refractory to supplemental to O2 therapy
35
What are the three key pathological features of ARDS?
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
What are the common findings in ARDS?
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
How is ARDS treated?
- Mostly supportive - Identify & correct underlying cause - Maintain fluid & electrolyte balance - Block system inflammatory cells - Adequate oxygenation - High-frequency jet ventilation - Inhaled nitric oxide
38
What is absorption atelectasis?
100% oxygen= no Nitrogen - Body uses O2 - In ARDS that O2 in residual volume is used - Causes atelectasis