Pulm - PFTs; Chronic Obstructive Disease Flashcards
____________ (obstructive/restrictive) lung diseases cause individuals to breathe at high lung volumes.
Obstructive lung diseases cause individuals to breathe at high lung volumes.
____________ (obstructive/restrictive) lung diseases cause individuals to breathe at low lung volumes.
Restrictive lung diseases cause individuals to breathe at low lung volumes.
Physiological dead space = __________ dead space + __________ dead space
Physiological dead space = anatomical dead space + alveolar dead space
Shunt is _______ that flows through the lungs but does not participate in gas exchange.
Shunt is blood that flows through the lungs but does not participate in gas exchange.
How are alveolar (VA) and dead space ventilation (VD) related to total ventilation (VE)?
VE = VA + VD
There is higher perfusion at which portion of the lung?
There is higher ventilation at which portion of the lung?
Bottom;
bottom
Normal alveolar O2 and CO2 are ____ mmHg and ____ mmHg, respectively.
Normal alveolar O2 and CO2 are 100 mmHg and 40 mmHg, respectively.
In cases of increased dead space due to blocked perfusion, alveolar O2 and CO2 are ____ mmHg and ____ mmHg, respectively, in the alveoli that aren’t perfused.
In cases of increased dead space due to blocked perfusion, alveolar O2 and CO2 are 150 mmHg and 0 mmHg, respectively, in the alveoli that aren’t perfused.
In cases of increased shunting due to blocked airways, alveolar O2 and CO2 are ____ mmHg and ____ mmHg, respectively, in the alveoli that are blocked.
In cases of increased shunting due to blocked airways, alveolar O2 and CO2 are 40 mmHg and 45 mmHg, respectively, in the alveoli that are blocked (same O2 and CO2 values found in mixed venous blood).
Normal airways show V/Q ________.
Normal airways show V/Q matching.
Increased shunting is due to _________ blockage.
Increased dead space is due to _________ blockage.
Increased shunting is due to airway blockage.
Increased dead space is due to vessel blockage.
The oxygen-hemoglobin dissociation curve shifts right in response to increases in what factors?
pCO2
H+
2,3-DPG
Temperature
Physiological causes of hypoxemia:
- _______________
- _______________
- Shunt (V/Q = 0)
- V/Q mismatch
- Diffusion abnormality
Physiological causes of hypoxemia:
- Reduced fraction of oxygen (e.g. altitude)
- Hypoventilation
- Shunt (V/Q = 0)
- V/Q mismatch
- Diffusion abnormality
Physiological causes of hypoxemia:
- Reduced fraction of oxygen (e.g. altitude)
- Hypoventilation
- ______________
- ______________
- Diffusion abnormality (e.g. fibrosis)
Physiological causes of hypoxemia:
- Reduced fraction of oxygen (e.g. altitude)
- Hypoventilation
- Shunt (V/Q = 0)
- V/Q mismatch
- Diffusion abnormality (e.g. fibrosis)
Physiological causes of hypoxemia:
- Reduced fraction of oxygen (e.g. altitude)
- Hypoventilation
- ______________
- V/Q mismatch
- ______________
Physiological causes of hypoxemia:
- Reduced fraction of oxygen (e.g. altitude)
- Hypoventilation
- Shunt (V/Q = 0)
- V/Q mismatch
- Diffusion abnormality (e.g. fibrosis)
What is the equation for calculating alveolar-arterial gradient?
A-a gradient ≤ age/3
What is the alveolar gas equation?
PAO2 = (FiO2 (PAtmo - PH<span>2</span>O)) - (PaCO2 / R)
PAO2 = (0.21 (760 - 47)) - (PaCO2 / 0.8)
(i.e. PAO2 = 150 - PaCO2 / 0.8)
Name three small airway respiratory diseases.
(RBC)
- Respiratory bronchiolitis (of cigarette smokers)
- Polypoid bronchiolitis obliterans
- Constrictive bronchiolitis
Emphesyma is associated with what cardiac pathology?
Cor pulmonale
Which of the following is most responsible for the emphysematous lung damage seen in alpha1-antitrypsin deficiency?
Macrophages
Neutrophils
T cells
B cells
Eosinophils
Neutrophils
Where is alpha1-antitrypsin produced?
The liver
Alpha1-antitrypsin deficiency most affects what two organ systems?
Lungs (emphysema);
liver (cirrhosis)
Alpha1-antitrypsin is normally found on chromosome _____ (MM is normal; zz is pathological).
Alpha1-antitrypsin is normally found on chromosome 14 (MM is normal; zz is pathological).
Alpha1-antitrypsin is normally found on chromosome 14 (_____ is normal; _____ is pathological).
Alpha1-antitrypsin is normally found on chromosome 14 (MM is normal; zz is pathological).
In cases of alpha1-antitrypsin deficiency, a lysine residue is exchanged for glutamic acid. What is the result in the liver?
Misfolded protein aggregates –> cirrhosis
Emphysema associated with smoking is _______lobular.
Emphysema associated with alpha1-antitrypsin deficiency is _______lobular.
Emphysema associated with smoking is centrilobular.
Emphysema associated with alpha1-antitrypsin deficiency is panlobular.
How does the diaphragm appear in patients with emphysema?
Flattened
Does emphysema affect CO diffusion rates?
Yes
(decreased due to decreased surface area)
Patients with ____________ are known as ‘pink puffers.’
Patients with ____________ are known as ‘blue bloaters.’
Patients with emphysema are known as ‘pink puffers.’
Patients with chronic bronchitis are known as ‘blue bloaters.’
Describe the difference between centrilobular and panlobular emphysema.
A spontaneous pneumothorax is most likely to be seen in what patient population?
Tall, athletic, young men
A spontaneous pneumothorax is most likely to arise in what portion of the lung?
The apex
What is here described?
A chronic condition where the walls of the bronchi are thickened irreversibly dilated from inflammation and infection.
Bronchiectasis
How can bronchiectasis lead to life-threatening hemorrhage?
Erosion into bronchial arteries
Name some of the S/Sy of bronchiectasis.
Hemoptysis
Morning productive cough
Clubbing
Cor pulmonale
Secondary amyloidosis
Upper lobe bronchiectasis is most associated with what disorder?
Cystic fibrosis
Which of the following is associated with bronchiectasis?
Obstruction
Cystic fibrosis
Necrotizing infections
Congenital deficiency of bronchial cartilage
Kartagener’s
Immunodeficiencies (especially IgA-related)
All of them
Chronic bronchitis is defined as what?
Chronic productive cough (on most days) for ≥ 3 months for 2 successive years (with no other known cause)
How does chronic bronchitis present on auscultation?
Coarse ronchi and wheezes
How is chronic bronchitis associated with V/Q mismatch?
Secretions block inhaled air from contacting pulmonary blood flow
What effects might hypoxia have on an individual with chronic bronchitis?
Pulmonary hypertension;
cor pulmonale;
increased hematocrit (EPO secretion)
visible cyanosis
When FEV1 falls below 50%, the 5-year survival drops to ____%.
When FEV1 falls below 50%, the 5-year survival drops to 50%.
Chronic bronchitis has a reid index of above ____%.
Chronic bronchitis has a reid index of above 50%.
The Reid index is the ratio of the thickness of the _________ to the thickness of the _________.
The Reid index is the ratio of the thickness of the mucosal glands to the thickness of the wall.
Bronchioles are the airways < _____ in diameter.
Bronchioles are the airways < 2 mm in diameter.
What percentage of smokers develop COPD?
15 - 20%
What is the most common cause of COPD?
Smoking
What cells are the main drivers of lung damage in smokers that develop COPD?
CD8+ T cells
Name two medications (an adrenergic antagonist and an antidepressant) that can be used in aiding smoking cessation.
Varenicline;
bupropion
Name a few pharmacological methods of approaching treatment for patients with COPD.
Smoking cessation tools (varenicline; bupropion; nicotene patches);
beta agonists;
immunosuppressants (stop T cell and neutrophil damage);
protease inhibitors;
mucoregulators
Which type of COPD patient will most resemble a patient with heart failure?
Chronic bronchitis
How do emphysematous patients’ hearts present on X-ray?
Very small hearts found in the center of the chest
True/False.
Clubbing is often seen in patients with COPD.
False.
Clubbing is associated with bronchiectasis, cystic fibrosis, bronchogenic carcinoma, intrapulmonary vascular malformations, and congenital heart disease.
A COPD patient with clubbing is most likely to have what condition?
Lung cancer
What is the gold standard for the diagnosis and assessment of COPD?
Spirometry
For diagnoses of COPD, FEV1/FVC is ______%.
A normal FEV1/FVC is ______%.
For diagnoses of COPD, FEV1/FVC is < 70%.
A normal FEV1/FVC is > 80%.
Besides spirometry, ______ can be used to differentiate between various obstructive lung diseases.
Besides spirometry, DLCO can be used to differentiate between various obstructive lung diseases.
DLCO is low in which cause of COPD?
Emphysema
(reduced surface area)
What will occur if a patient continues to smoke after their FEV1 has decreased to less than 30%?
Rapid decline in FEV1
What is the only therapy for COPD that has shown improved survival benefit?
Oxygen therapy
The major exacerbation of COPD is __________.
The major exacerbation of COPD is infection.
If a patient’s FEV1 increases by ____% after administration of bronchodilators, then a patient likely has asthma rather than COPD.
If a patient’s FEV1 increases by 12% after administration of bronchodilators, then a patient likely has asthma rather than COPD.
Patients that are heterozygous for the abnormal alpha1-antitrypsin gene are most at risk for emphysema under what condition(s)?
If smoking is initiated
(otherwise asymptomatic)
True/False.
Both chronic bronchitis and emphysema increase a patient’s risk of cor pulmonale.
True.
Besides cor pulmonale, chronic bronchitis also increases a patient’s risk of i__________.
Besides cor pulmonale, chronic bronchitis also increases a patient’s risk of infection.
Bronchiectasis is associated with a(n) ____________ in bronchial tone.
Bronchiectasis is associated with a decrease in bronchial tone.
Name two causes of localized bronchiectasis.
- Tumor or foreign body
- Necrotizing infection
Bronchiectasis is associated with what mycotic infection?
Allergic bronchopulmonary aspergillosis
What two congenital disorders are associated with bronchiectasis?
Cystic fibrosis;
Kartagener’s syndrome
What are the clinical features of bronchiectasis?
Cough;
dyspnea;
foul-smelling sputum
How is bronchiectasis diagnosed?
High-resolution CT
What is the most common diease leading to bronchiectasis?
Cystic fibrosis
True/False.
Bronchiectasis is irreversible.
True.
Which is not a common cause of bronchiectasis?
a) Cystic fibrosis
b) Hypogammaglobulinemia
c) Lung cancer
d) Non-tuberculosis mycobacterium
Which is not a common cause of bronchiectasis?
a) Cystic fibrosis
b) Hypogammaglobulinemia
c) Lung cancer
d) Non-tuberculosis mycobacterium
What is the gold standard for diagnosis of cystic fibrosis?
Sweat chloride test
Cystic fibrosis is the most common lethal genetic disease affecting what race?
Caucasians
What is the inheritance pattern of cystic fibrosis?
Autosomal recessive
