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Health Assessment > **in progress** Restrictive Lung Disease (FINAL EXAM) > Flashcards

**in progress** Restrictive Lung Disease (FINAL EXAM) Flashcards

1
Q

What is restrictive lung disease?

A
  • Decreased lung compliance and lung expansion
  • Inability to increase lung volume in proportion to an increase in alveoli pressure
  • Reduction in surface area for gas diffusion
  • All lung volumes are decreased
  • Preservation of expiratory flow rates
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2
Q

__________ will result from the inability to clear lung secretions, and hypoventilation

A
  • Hypoxia
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3
Q

Restrictive Lung Disease Dx
* Mild:
* Moderate:
* Severe

Dr. E pretty much told us this will be a test question.

A
  • Mild - TLC 65%–80% of the predicted value
  • Moderate- TLC 50%–65% of the predicted value
  • Severe - TLC < 50% of the predicted value
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4
Q

Acute Pulmonary Edema is caused by

A
  • Increased capillary pressureOR
  • Increased capillary permeability
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5
Q

What will you see on a CXR for someone with acute pulmonary edema?

A
  • Bilateral symmetrical perihilar opacities on CXR
  • Butterfly appearance d/t increasedcapillary pressure
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6
Q

Cardiogenic pulmonary edema signs and symptoms

A
  • Dyspnea
  • Tachypnea
  • SNS activation
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7
Q

What valvular disorder can cause cardiogenic pulmonary edema?

A
  • Acute aortic regurgitation
  • Mitral regurgitation
  • Mitral valve stenosis
  • Left ventricular outflow tract. obstruction
  • Renovascular HTN (renal artery stenosis)
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8
Q

What is the are possible results of aspiration of gastric fluids?

A
  • Destruction of surfactant-producing cells
  • Damages pulmonary capillary endothelium
  • Atelectasis and leakage of intravascular fluid
  • Capillary permeability pulmonary edema
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9
Q

What do patients present with during aspiration?
What will the CXR show with aspiration?

A
  • Arterial hypoxemia
  • Tachypnea, bronchospasm, and acute pulmonary HTN
  • CXR will show aspiration pneumonitis usually in the superior segment of the RLL (right bronchi is a straight shot)
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10
Q

Aspiration Treatment

A
  • Supplemental oxygen and PEEP
  • Bronchodilation
  • Antibiotics (controversial- hit or miss)
  • Steroids (controversial- hit or miss)
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11
Q

Pulmonary EdemaAnesthesia Considerations

A
  • Optimize patient before Elective surgery
  • Make sure large pleural effusions are drained
  • Persistent hypoxemia biggest problem consider post op ventilation and PEEP
  • Post-op vent management
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12
Q

What is Acute Respiratory Failure

A
  • Inability to provide adequate arterial oxygenation and/or elimination of CO2
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13
Q

With ARF, PaO2< _______ mm Hg despite oxygen supplementation and in the absence of a right-to-left intracardiac shunt.

A

*< 60 mmHg

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14
Q

PaCO2 during Acute Respiratory Failure

A

PaCO2- increased, unchanged, or decreased

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15
Q

A PaCO2 above 50 mm Hg in the absence of respiratory compensation for __________is consistent with the diagnosis of acute respiratory failure.

A
  • metabolic alkalosis
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16
Q

Acute RF will result in:
_________ PaCO2
_________ Arterial pH

A
  • ↑ PaCO2
  • ↓ Arterial pH
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17
Q

Chronic RF
_______ pH
What organ will compensate for Chronic Renal Failure?

A
  • Arterial pH between 7.35 and 7.45, despite an increased PaCO2
  • Renal compensation: ↑ HCO3-
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18
Q

Acute Respiratory Failure
________ FRC and lung compliance
________ PVR and pulmonary HTN

A
  • Decreased FRC and lung compliance
  • Increased PVR and pulmonary HTN
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19
Q

Acute Respiratory Failure Treatment

A
  • Establish patent and open upper airway
  • Correction of hypoxemia
  • Removal of excess CO2
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20
Q

Acute Respiratory Distress Syndrome (ARDS)

A
  • Inflammatory injury to the lung manifested an acute hypoxemic respiratory failure
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21
Q

Acute Respiratory Distress Syndrome (ARDS) Causes

A
  • Direct or indirect lung injury causes
  • Sepsis
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22
Q

Acute Respiratory Distress Syndrome (ARDS) Signs/Sx

ARDS Chest CXR is indistinguishable from what condition?

A
  • Rapid-onset respiratory failure
  • Refractory arterial hypoxemia
  • CXR - indistinguishable from cardiogenic pulmonary edema

Proinflammatory cytokines released in ARDS will lead to capillary membrane permeability in alveoli.

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23
Q

What are direct and indirect lung injuries for ARDS?
What is the biggest indirect lung injury?

A
  • Sepsis
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24
Q

Classification (PaO2/FIO2ratio) for ARDS
Mild-
Moderate -
Severe-

A

Mild- 201 mm Hg - 300 mm Hg
Moderate - 101 mm Hg - 200 mm Hg
Severe- ≤ 100 mm Hg

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25
Q

To diagnose ARD, what needs to be present in the patient’s CXR?

A
  • Bilateral findings in at least 3 lung quadrants not explained by pleural effusion or atelectasis
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26
Q

What does an ECHO rule out for ARDS?

A

R/O cardiogenic cause of pulmonary edema

An ECHO is used bc a CXR can distinguish between ARDS and Cardiogenic Pulmonary Edema.

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27
Q

What causes pulmonary HTN?

A
  • Pulmonary artery vasoconstriction and pulmonary capillary bed destruction
  • Acute right-sided HF
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28
Q

ARDS Treatment

A

Prone positioning
* Lung recruitment
* Improves ventilation/perfusion matching

ECMO
* Severe hypoxemic
* Hypercapnic respiratory failure

Conservative fluid therapy

Neuromuscular blockers
* Less barotrauma
* Less secretion of both pulmonary and systemic proinflammatory mediators

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29
Q

Sarcoidosis

A

Systemic granulomatous disorder primarily involving intrathoracic lymph nodes and the lungs

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30
Q

What are the different types of sarcoidosis

A
  • Ocular sarcoidosis - uveitis (eye redness)
  • Myocardial sarcoidosis - conduction defects and dysrhythmias
  • Endobronchial sarcoid- c/o chest tightness
  • Laryngeal sarcoidosis - occurs in 5% of pts
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31
Q

Sarcoidosis signs, symptoms, and manifestations?

A
  • No symptoms at the time of presentation
  • CXR - abnormal findings
  • Wheezing, dyspnea, and cough
  • Cor pulmonale
  • Hypercalcemia (classic manifestation) ↑Ca2+
  • Increase ACE activity
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32
Q

How is Sarcoidosis diagnosed?

A

Mediastinoscopy

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33
Q

ACE activity is ____________ with sarcoidosis

A

increased

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34
Q

What do steroids treat in sarcoidosis

A

Corticosteroids
Suppress the manifestations of sarcoidosis
Treat the hypercalcemia

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35
Q

Anesthesia Considerations for Sarcoidosis

A
  • Avoid prolonged apneic periods -Small FRC and low oxygen stores
  • Decreased FRC
  • GA- supine position and controlled ventilation
  • Faster Uptake of inhaled anesthetics
  • ↑ Risk of hypoxia (biggest consideration)
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36
Q

What is the cause of Chronic Restrictive Lung Disease?

A
  • Often due to disorders of the thoracic cage that interfere with lung expansion
  • Deformities of the sternum, ribs, vertebrae, and costovertebral structures
  • Ankylosing spondylitis, flail chest, scoliosis, and kyphosis
  • Compressed lungs and reduced lung volumes
  • ↑ WOB
  • Compression of the pulmonary vasculature
  • Recurrent pulmonary infection
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37
Q

Define Scoliosis

A

lateral curvature with rotation of the vertebral column

38
Q

Define Kyphosis

A

anterior flexion of the vertebral column

39
Q

Kyphoscoliosis leads to severe restrictive impairment of lung function. What are the causes of Kyphoscoliosis?

A
  • Idiopathic (80%)
  • Neuromuscular disorder
  • Associated with congenital vertebral malformations
40
Q

Kyphoscoliosis will result in:
_______ventilatory capacity of the lung
________ work of breathing
________ hemidiaphragm on the side of the concavity

A
  • Decreased ventilatory capacity of the lung
  • Increased work of breathing
  • Raised hemidiaphragm on the side of the concavity
41
Q

How is the severity of kyphoscoliosis measured?

A

Severity - measured by the degree of spinal curvature (Cobb angle)

42
Q
  • Mild to moderate kyphoscoliosis
A
  • (scoliotic angle < 60 degrees)
  • > 70 degrees - increased risk of respiratory dysfunction
43
Q

What are the results of Severe Kyphoscoliosis deformities (scoliotic angle > 100 degrees)?

A
  • Chronic alveolar hypoventilation
  • Hypoxemia
  • Secondary erythrocytosis
  • Pulmonary HTN
  • Cor pulmonale
  • Respiratory failure
  • Vital capacity < 45% of the predicted value
44
Q

What is Pleural Effusion?
What are the possible causes of Pleural Effusion?

A
  • Accumulation of fluid in the pleural space
  • Hemothorax (blood)
  • Empyema (pus)
  • Chylothorax (lipids)
  • Hydrothorax (serous liquid)
45
Q

How is a pleural effusion diagnosed?

A
  • CXR
  • CT scan of the chest
  • Bedside US
46
Q

What will you see with pleural effusion on a CXR?

A
  • Blunting of the costophrenic angle
  • Homogeneous opacity
  • Concave meniscus with the chest wall
  • CXR has decreased sensitivity
47
Q

How many mL needs to be considered for pleural effusion to be diagnosed on a CXR?

A
  • 250 cc

Ultrasound has increased sensitivity and is better at diagnosing pleural effusion.

48
Q

Where is the pleural effusion

A

Notice the blunting on the patient’s right lung. That is the pleural effusion.

49
Q

What is a Pneumothorax?
Differentiate a parietal and visceral pleura pneumothorax.

A
  • Presence of gas in the pleural space with disruption of the Parietal pleura or Visceral pleura
  • There will be pleural separation where air can be seen between the visceral pleural lining and rib cage
  • Parietal pleura is from an external penetrating injury
  • Visceral pleura from a tear or rupture in the parenchyma
50
Q

Spontaneous pneumothorax

A

Gas originates from the lung

51
Q

Secondary pneumothorax

A

Known parenchymal lung pathology

COPD, Lung CA, CF - something that is known and diagnosed that is causing the pathology.

52
Q

Idiopathicspontaneous pneumothorax

A

Rupture of apical subpleural blebs

This usually occurs with tall thin men b/w the ages of 20 to 40. Think basketball players.

53
Q

The prevalence of pneumothorax increases with this risk factor.

A lot of times, when does spontaneous pneumothorax occur?

A
  • Smoking
  • Spontaneous pneumothorax occurs at rest
54
Q

What is a Tension Pneumothorax?

A
  • Gas enters the pleural space during inspiration and can’t escape during exhalation.
  • The trapped gas will expand and increase in tension over time.
  • Medical Emergency
55
Q

30% of the time, a tension pneumothorax will occur during ________.

A
  • Mechanical Ventilation
56
Q

Tension Pneumothorax Signs and Symptoms

A
  • Respiratory distress
  • Trachea deviated to the side, away fromthe pneumothorax
  • Decreased/absent breath sounds on the side of the pneumothorax
  • Hyperresonance on percussion
  • Tachycardia and hypotension
57
Q

Tension Pneumothorax Treatment

A
  • Evacuation of gas through a needle or a small-bore catheter
  • Second anterior intercostal space
  • Placement of a chest tube

Needle decompression is for small to moderate-size spontaneous pneumothorax.

58
Q

Tension Pneumothorax Anesthesia Consideration

A
  • D/C nitrous oxide IMMEDIATELY
  • 100% O2
  • Needle/catheter decompression
  • Chest tube placement
59
Q

Pneumothorax less than _____% and no symptoms. What do you do?

This will be a test question.

A
  • 15%
  • Observation
60
Q

What is a pneumomediastinum?

A
  • Tear in the esophagus or tracheobronchial tree, or * Alveolar rupture
61
Q

Pneumomediastinum cause

A

No known cause

62
Q

Pneumomediastinum signs and symptoms

A
  • Retrosternal chest pain and dyspnea
  • Subcutaneous emphysema
  • Pneumothorax
  • Pneumomediastimum occurs after cocaine use.
63
Q

What is used to diagnose a Pneumomediastinum

A
  • CXR
64
Q

Pneumomediastinum Treatment

A
  • Spontaneous pneumomediastinum self-resolving
  • Surgery (VATS)
65
Q

What were some common Mediastinal Masses listed in class?

A
  • Tracheal Mass
  • Descending aortic aneurysm
  • Esophageal disorder
  • Thyroid
66
Q

Mediastinal Mass – Evaluation

A
  • CT w/ contrast to assess vascular structures, soft tissues, calcifications, and Size
  • Evaluate Airway obstruction (fiber optics)
  • Evaluate Loss of lung volumes
  • Evaluate Pulmonary artery compression
    Cardiac compression
    Superior vena cava obstruction
67
Q

Mediastinal Mass – Treatment

A

Treatment of a mediastinal mass depends on the underlying pathology

68
Q

Mediastinal Mass – Anesthetic Considerations Preop

A
  • Consider Flow-volume loop
  • Imaging studies
  • Tracheobronchial compression
  • Fiberoptic bronchoscopy
  • Local anesthetic vs GA - (LA need to maintain spontaneous vent)
  • External edema - mouth and hypopharynx
    Arterial line - BP
69
Q

The induction and intubation in the presence of mediastinal tumors depend on the preoperative airway assessment. Visible external edema associated with superior vena cava syndrome is likely accompanied by similar edema inside the ______ and __________.

A
  • Mouth
  • Hypopharynx
70
Q

Where will you see external edema with mediastinal mass?

A

Sitting vs supine
Fiberoptic laryngoscopy
Severe airway obstruction
Spontaneous ventilation

71
Q

Obesity
FEV1:
FVC:
FRC:
ERV:

A

FEV1: ↓
FVC: ↓
FRC: ↓
ERV: ↓

72
Q

Obesity
Chest wall compliance:

A

Chest wall compliance: ↓

73
Q

Central obesity

A
  • Worse lung function and respiratory symptoms
  • Increased resting respiratory rate w/ normal Vt
74
Q

Anterior abdominal wall and visceraadipose tissue:
________Diaphragmatic movement
________Basal lung expansion during inspiration
________Closure of peripheral lung units

A

Decrease Diaphragmatic movement
Decrease Basal lung expansion during inspiration
Increase Closure of peripheral lung units

75
Q

Anterior abdominal wall and visceraadipose tissue will lead to

A

Ventilation/perfusion abnormalities
Arterial hypoxemia
Respiratory compromise

76
Q

Pregnancy Thorax structural changes

A
  • Increased subcostal angle of the rib cage
  • Circumference of the lower chest wall
  • Diaphragm moves cephalad
77
Q

Pregnancy:
Increase in ____ level contributes to structural changes in pregnancy

A
  • Relaxin
78
Q

The subcostal angle widens, _____ to _____ degrees

A
  • 68 to 103
79
Q
  • Anteroposterior diameter and transverse diameter of the chest wall _________
  • Uterus moves diaphragm
A
80
Q

37th week of pregnancy

A
81
Q

37th week of pregnancy

A
82
Q

37th week of pregnancy

A
83
Q

37th week of pregnancy

A
84
Q

37th week of pregnancy

A
85
Q

Chest wall configuration normalizes about 6 months postpartum
Subcostal angle - remains wider by about 20%

A
86
Q

Pregnancy
_____FRC, ERV, and RV

A

Decrease

87
Q

Pregnancy
_____FRC, ERV, and RV

A

Decrease

88
Q

FRC
Elevation of the diaphragm, downward pull of the abdomen, and changes in chest wall compliance
Decreases by 15%–20% or 200–300 mL
Supine vs sitting position

A
89
Q

FRC
Elevation of the diaphragm, downward pull of the abdomen, and changes in chest wall compliance
Decreases by 15%–20% or 200–300 mL
Supine vs sitting position

A
90
Q

Intrinsic lung compliance is unaffected by pregnancy

A
91
Q

The induction and intubation in the presence of mediastinal tumors depend on the preoperative airway assessment. Visible external edema associated with superior vena cava syndrome is likely accompanied by similar edema inside the ______ and __________.

A
  • Mouth
  • Hypopharynx

Health Assessment (7 decks)

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