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Respiratory 3 > Obstructive Lung Diseases > Flashcards

Obstructive Lung Diseases Flashcards

1
Q

deficiency in what disease is responsible for the genetic cause of COPD (emphysema)?

A

alpha-1 antitrypsin (inhibits elastase from degrading elastin)

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2
Q

What immune responses are involved in the pathogenesis of COPD?

A

Both innate and adaptive immunity

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3
Q

Histopathologic lesions of emphysema are characterized by

A

dilation and merging of alveolar spaces

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4
Q

FEV1/FVC naturally decreases with

A

age

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5
Q

Predicted % values of FEV1, FVC, and FEV1/FVC are based on

A
  1. age
  2. height
  3. sex
  4. race at times
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6
Q

The point where chest wall forces is equal to the lung elastic recoil forces is called

A

FRC (functional residual capacity)

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7
Q

What three lung volume measurements can’t be measured by spirometry?

A

RV
FRC
TLC

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8
Q

What is the best way to measure lung volumes?

A

Body Box

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9
Q

What test is used if patient is claustrophobic and can’t use body box?

A

Helium dilution

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10
Q

Why is helium dilution bad for COPD?

A

It underestimates the degree of abnormality of COPD

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11
Q

Hyperinflation and air trapping develop over many years. ______ hyperinflation refers to the findings of COPD at rest.

A

static

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12
Q

______ hyperinflation is and when air trapping and hyperinflation become more profound as respiratory rate increase with exercise

A

dynamic

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13
Q

Dyspnea in COPD patients is due to reduced

A

IC (inspiratory capacity)

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14
Q

people with pure chronic bronchitis; LE edema, and tends to retain CO2 making them appear blue

A

blue bloater

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15
Q

people with pure emphysema; decreased O2 level makes them tachypneic and pink

A

pink puffer

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16
Q

True or False: Quit smoking at any age increases longevity

A

true

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17
Q

Acute inflammation of the airways; sudden onset cough greater than 5 days; NO fever, tachycardia or tachypnea; number one cause of antibiotic abuse

A

Acute bronchitis

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18
Q

Why is acute bronchitis the number one cause of antibiotic abuse in US?

A

90% is caused by virus

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19
Q

What is required to distinguish acute bronchitis from pneumonia, chronic bronchitis, asthma, GERD, etc.?

A

a good HISTORY

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20
Q

Why might asthmatic lungs become hyperinflated?

A

Mucous plugs prevent air from escaping

21
Q

Asthma is more prevalent in

A

developed countries

22
Q

Asthma “phenotypes” are divided into what 2 large categories?

A
  1. T2 high (secrete type 2 cytokines –> IL-4, IL-5 and IL-13)
  2. Non-Th2 or T2 low (not driven by T2 cytokines)
23
Q

Eosinophils cause mild, moderate, and severe asthma and is recruited by Th2 cells or ILCs. Eosinophils are steroid

A

responsive

24
Q

Neutrophils cause severe asthma and is recruited by Th17 cells. Neutrophils are steroid

A

resistant

25
Q

Why do asthmatics have a “scooped out appearance” on flow-volume curves and a a low FEV-1 value?

A

reduced airway luminal diameter, flow through asthmatic airways is slower than normal resulting in less air being exhaled per second

26
Q

Test that can be used to clinically differentiate between asthma from COPD

A

DLCO (Diffusion of Lung Carbon Monoxide)

27
Q

airway contrition after exposure to various stimuli (cold air, perfume, smoke) that do not affect the caliber of airways in normal individuals

A

Airway hyperresponsiveness

28
Q

test that is used clinically to diagnose asthma in patients suspected of having mild-asthma hyperresponsiveness whose baseline spirometry is normal

A

Methacholine challenge test

29
Q

Why might intubation of an asthmatic patient with a high RR (to blow off CO2) be detrimental?

A

Appropriate for a patient WITHOUT airflow obstruction

Can lead to hypotension in a patient with obstructive asthma (or COPD) because air SLOWLY leaves the lungs, so a high RR can prevent complete expiration and lead to gradual hyperinflation and compression of thoracic vasculature

30
Q

How might you set the ventilation settings on an intubated asthmatic patient with possible airway obstruction to avoid hyperinflation and cardiac arrest

A

Low RR and slightly low tidal volume (~400) (allow for complete expiration with each breath)

AVOID AUTO-PEEP (will compress pulmonary veins and decrease overall CO)

31
Q

breath stacking caused by mechanical ventillation which results in a progressive increase in lung volume

A

dynamic hyperinflation

32
Q

Auto-peep can cause

A

cariogenic shock

33
Q

when you have a cardiac rhythm that is not V tach or V fib but have no pulse or blood pressure indicating that blood is not circulating

A

Pulseless Electrical Activity

34
Q

The layer that lines the inside of the thoracic cavity, ribcage, diaphragmatic surface

A

parietal pleura

35
Q

The layer that lines the lungs and separates the different lobes of the lung from each other; thicker than parietal pleura;

A

visceral pleura

36
Q

Both parietal and visceral pleura are lines by

A

mesothelial cells

37
Q

Which pleura has stoma (openings) between mesothelial cells that lead to lymphatic channels (drains pleural fluid)?

A

Parietal pleura only

38
Q

Which pleura has sensory (pain) nerves and can possibly cause pleuritic chest pain?

A

Parietal pleura only

  • there is no pain nerves in parenchyma
39
Q

Which pleura is supplied by intercostal arteries and drains into venous system?

A

Parietal

40
Q

Which pleura is supplied by bronchial arteries and drains into pulmonary venous system?

A

Visceral

41
Q

______ is generated in the pleural space by the opposing elastic forces of the chest wall (outward pull) and lung (inward pull) at FRC

A

negative pressure

42
Q

How much fluid is normally present in the pleural space?

A

10 ml

43
Q

Hydrostatic pressure gradient favors net

A

influx of fluid into pleural space

44
Q

Oncotic pressure gradient favors net

A

efflux of fluid out of pleural space and into capillaries

45
Q

Normally, hydrostatic pressure is ______ than the oncotic pressure gradient, creating a net influx of fluid into the pleural space

A

greater

46
Q

Normally, there is no effusion (abnormal collection of fluid) in the pleural space because lymphatic clearance is ___ times higher than the normal rate of pleural fluid formation

A

28

47
Q

(True vs. False) Normal pleural fluid has about 75% macrophages and 25% lymphocytes and 2% mesothelial cells/neutrophils/eosinophils

A

True

48
Q

(True vs. False) Normal pleural fluid has pH >7.5 and is low in protein

A

True

Respiratory 3 (4 decks)

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