Obstructive and restrictive lung disorders

Question 1

What are features of allergic asthma?

Answer 1

1. Extrinsic2. Genetic predisposition 3. Family history 4. Allergen-specific immunotherapy and environmental control measures are helpful

Question 2

What is the cardinal finding during an asthma attack?

Answer 2

Wheezing

Question 3

Which spirometry parameters are decreased during an acute asthma attack?

Answer 3

PEFR, FEV1, maximal mid-expiratory flow rate / forced mid-expiratory flow rate (MMEFR / FEF)

Question 4

What are the two treatment modalities for people with asthma?

Answer 4

B2-adrenergic agents and anticholinergics

Question 5

What do B2 adrenergic agents do?

Answer 5

Stimulate B2 adrenergic receptors on bronchial smooth muscle - bronchodilation

Question 6

What do anticholinregic agents do?

Answer 6

Inhibit effect of Ach released from intrapulmonary motor nerves that run in vagus and innervate airway smooth muscle (M3 receptors)

Question 7

What type of lung damage characterizes ARDS?

Answer 7

Damage to alveolar-capillary membrane

Question 8

What is the diagnosis for ARDS?

Answer 8

Decrease in paCO2 that is refractory to supplemental O2 therapy

Question 9

What are the three key pathological findings of ARDS?

Answer 9

1. Noncardiogenic pulmonary edema 2. Atelectasis associated with lack of surfactant 3. Fibrosis (hyaline membranes) associated with inflammatory deposition of proteins

Question 10

What are the main clinical findings of ARDS?

Answer 10

Hypoxemia (shunting), white out, respiratory distress

Question 11

ARDS presents with what deficits in pulmonary findings?

Answer 11

1. Decreased VC 2. Decreased FRC 3. Decreased compliance 4. Decreased TV

Question 12

What does the V/Q distribution look like with ARDS?

Answer 12

1. Main peak at 1.0, but significant right to left shunt 2. A region with a very low V/Q and one with a very high V/Q

Question 13

What does the V/Q distribution look like with asthma?

Answer 13

1. Bimodal - a normal 1.0 V/Q and a low V/Q 2. No shunt

Question 14

What is the treatment for ARDS?

Answer 14

1. Supportive 2. Mechanical ventilation with positive end-expiratory pressure (PEEP) ventilation and supplemental oxygen 3. Inhaled NO 4. High frequency jet ventilation - reduces ventilator-induced injury

Question 15

What is the purpose of positive end-expiratory pressure (PEEP)?

Answer 15

1. Increase FRC and prevent alveolar collapse at end-expiration 2. Force edema out of alveoli