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T2 - Phase 2 - Systems Modules (II) > Pulm - PFTs; Chronic Obstructive Disease > Flashcards

Pulm - PFTs; Chronic Obstructive Disease Flashcards

1
Q

____________ (obstructive/restrictive) lung diseases cause individuals to breathe at high lung volumes.

A

Obstructive lung diseases cause individuals to breathe at high lung volumes.

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2
Q

____________ (obstructive/restrictive) lung diseases cause individuals to breathe at low lung volumes.

A

Restrictive lung diseases cause individuals to breathe at low lung volumes.

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3
Q

Physiological dead space = __________ dead space + __________ dead space

A

Physiological dead space = anatomical dead space + alveolar dead space

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4
Q

Shunt is _______ that flows through the lungs but does not participate in gas exchange.

A

Shunt is blood that flows through the lungs but does not participate in gas exchange.

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5
Q

How are alveolar (VA) and dead space ventilation (VD) related to total ventilation (VE)?

A

VE = VA + VD

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6
Q

There is higher perfusion at which portion of the lung?

There is higher ventilation at which portion of the lung?

A

Bottom;

bottom

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7
Q

Normal alveolar O2 and CO2 are ____ mmHg and ____ mmHg, respectively.

A

Normal alveolar O2 and CO2 are 100 mmHg and 40 mmHg, respectively.

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8
Q

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.

A

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.

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9
Q

In cases of increased shunting due to blocked airways, alveolar O2 and CO2 are ____ mmHg and ____ mmHg, respectively, in the alveoli that are blocked.

A

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).

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10
Q

Normal airways show V/Q ________.

A

Normal airways show V/Q matching.

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11
Q

Increased shunting is due to _________ blockage.

Increased dead space is due to _________ blockage.

A

Increased shunting is due to airway blockage.

Increased dead space is due to vessel blockage.

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12
Q

The oxygen-hemoglobin dissociation curve shifts right in response to increases in what factors?

A

pCO2

H+

2,3-DPG

Temperature

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13
Q

Physiological causes of hypoxemia:

  1. _______________
  2. _______________
  3. Shunt (V/Q = 0)
  4. V/Q mismatch
  5. Diffusion abnormality
A

Physiological causes of hypoxemia:

  1. Reduced fraction of oxygen (e.g. altitude)
  2. Hypoventilation
  3. Shunt (V/Q = 0)
  4. V/Q mismatch
  5. Diffusion abnormality
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14
Q

Physiological causes of hypoxemia:

  1. Reduced fraction of oxygen (e.g. altitude)
  2. Hypoventilation
  3. ______________
  4. ______________
  5. Diffusion abnormality (e.g. fibrosis)
A

Physiological causes of hypoxemia:

  1. Reduced fraction of oxygen (e.g. altitude)
  2. Hypoventilation
  3. Shunt (V/Q = 0)
  4. V/Q mismatch
  5. Diffusion abnormality (e.g. fibrosis)
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15
Q

Physiological causes of hypoxemia:

  1. Reduced fraction of oxygen (e.g. altitude)
  2. Hypoventilation
  3. ______________
  4. V/Q mismatch
  5. ______________
A

Physiological causes of hypoxemia:

  1. Reduced fraction of oxygen (e.g. altitude)
  2. Hypoventilation
  3. Shunt (V/Q = 0)
  4. V/Q mismatch
  5. Diffusion abnormality (e.g. fibrosis)
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16
Q

What is the equation for calculating alveolar-arterial gradient?

A

A-a gradient ≤ age/3

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17
Q

What is the alveolar gas equation?

A

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)

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18
Q

Name three small airway respiratory diseases.

(RBC)

A
  1. Respiratory bronchiolitis (of cigarette smokers)
  2. Polypoid bronchiolitis obliterans
  3. Constrictive bronchiolitis
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19
Q

Emphesyma is associated with what cardiac pathology?

A

Cor pulmonale

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20
Q

Which of the following is most responsible for the emphysematous lung damage seen in alpha1-antitrypsin deficiency?

Macrophages

Neutrophils

T cells

B cells

Eosinophils

A

Neutrophils

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21
Q

Where is alpha1-antitrypsin produced?

A

The liver

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22
Q

Alpha1-antitrypsin deficiency most affects what two organ systems?

A

Lungs (emphysema);

liver (cirrhosis)

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23
Q

Alpha1-antitrypsin is normally found on chromosome _____ (MM is normal; zz is pathological).

A

Alpha1-antitrypsin is normally found on chromosome 14 (MM is normal; zz is pathological).

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24
Q

Alpha1-antitrypsin is normally found on chromosome 14 (_____ is normal; _____ is pathological).

A

Alpha1-antitrypsin is normally found on chromosome 14 (MM is normal; zz is pathological).

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25
Q

In cases of alpha1-antitrypsin deficiency, a lysine residue is exchanged for glutamic acid. What is the result in the liver?

A

Misfolded protein aggregates –> cirrhosis

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26
Q

Emphysema associated with smoking is _______lobular.

Emphysema associated with alpha1-antitrypsin deficiency is _______lobular.

A

Emphysema associated with smoking is centrilobular.

Emphysema associated with alpha1-antitrypsin deficiency is panlobular.

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27
Q

How does the diaphragm appear in patients with emphysema?

A

Flattened

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28
Q

Does emphysema affect CO diffusion rates?

A

Yes

(decreased due to decreased surface area)

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29
Q

Patients with ____________ are known as ‘pink puffers.’

Patients with ____________ are known as ‘blue bloaters.’

A

Patients with emphysema are known as ‘pink puffers.’

Patients with chronic bronchitis are known as ‘blue bloaters.’

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30
Q

Describe the difference between centrilobular and panlobular emphysema.

A
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31
Q

A spontaneous pneumothorax is most likely to be seen in what patient population?

A

Tall, athletic, young men

32
Q

A spontaneous pneumothorax is most likely to arise in what portion of the lung?

A

The apex

33
Q

What is here described?

A chronic condition where the walls of the bronchi are thickened irreversibly dilated from inflammation and infection.

A

Bronchiectasis

34
Q

How can bronchiectasis lead to life-threatening hemorrhage?

A

Erosion into bronchial arteries

35
Q

Name some of the S/Sy of bronchiectasis.

A

Hemoptysis

Morning productive cough

Clubbing

Cor pulmonale

Secondary amyloidosis

36
Q

Upper lobe bronchiectasis is most associated with what disorder?

A

Cystic fibrosis

37
Q

Which of the following is associated with bronchiectasis?

Obstruction

Cystic fibrosis

Necrotizing infections

Congenital deficiency of bronchial cartilage

Kartagener’s

Immunodeficiencies (especially IgA-related)

A

All of them

38
Q

Chronic bronchitis is defined as what?

A

Chronic productive cough (on most days) for ≥ 3 months for 2 successive years (with no other known cause)

39
Q

How does chronic bronchitis present on auscultation?

A

Coarse ronchi and wheezes

40
Q

How is chronic bronchitis associated with V/Q mismatch?

A

Secretions block inhaled air from contacting pulmonary blood flow

41
Q

What effects might hypoxia have on an individual with chronic bronchitis?

A

Pulmonary hypertension;

cor pulmonale;

increased hematocrit (EPO secretion)

visible cyanosis

42
Q

When FEV1 falls below 50%, the 5-year survival drops to ____%.

A

When FEV1 falls below 50%, the 5-year survival drops to 50%.

43
Q

Chronic bronchitis has a reid index of above ____%.

A

Chronic bronchitis has a reid index of above 50%.

44
Q

The Reid index is the ratio of the thickness of the _________ to the thickness of the _________.

A

The Reid index is the ratio of the thickness of the mucosal glands to the thickness of the wall.

45
Q

Bronchioles are the airways < _____ in diameter.

A

Bronchioles are the airways < 2 mm in diameter.

46
Q

What percentage of smokers develop COPD?

A

15 - 20%

47
Q

What is the most common cause of COPD?

A

Smoking

48
Q

What cells are the main drivers of lung damage in smokers that develop COPD?

A

CD8+ T cells

49
Q

Name two medications (an adrenergic antagonist and an antidepressant) that can be used in aiding smoking cessation.

A

Varenicline;

bupropion

50
Q

Name a few pharmacological methods of approaching treatment for patients with COPD.

A

Smoking cessation tools (varenicline; bupropion; nicotene patches);

beta agonists;

immunosuppressants (stop T cell and neutrophil damage);

protease inhibitors;

mucoregulators

51
Q

Which type of COPD patient will most resemble a patient with heart failure?

A

Chronic bronchitis

52
Q

How do emphysematous patients’ hearts present on X-ray?

A

Very small hearts found in the center of the chest

53
Q

True/False.

Clubbing is often seen in patients with COPD.

A

False.

Clubbing is associated with bronchiectasis, cystic fibrosis, bronchogenic carcinoma, intrapulmonary vascular malformations, and congenital heart disease.

54
Q

A COPD patient with clubbing is most likely to have what condition?

A

Lung cancer

55
Q

What is the gold standard for the diagnosis and assessment of COPD?

A

Spirometry

56
Q

For diagnoses of COPD, FEV1/FVC is ______%.

A normal FEV1/FVC is ______%.

A

For diagnoses of COPD, FEV1/FVC is < 70%.

A normal FEV1/FVC is > 80%.

57
Q

Besides spirometry, ______ can be used to differentiate between various obstructive lung diseases.

A

Besides spirometry, DLCO can be used to differentiate between various obstructive lung diseases.

58
Q

DLCO is low in which cause of COPD?

A

Emphysema

(reduced surface area)

59
Q

What will occur if a patient continues to smoke after their FEV1 has decreased to less than 30%?

A

Rapid decline in FEV1

60
Q

What is the only therapy for COPD that has shown improved survival benefit?

A

Oxygen therapy

61
Q

The major exacerbation of COPD is __________.

A

The major exacerbation of COPD is infection.

62
Q

If a patient’s FEV1 increases by ____% after administration of bronchodilators, then a patient likely has asthma rather than COPD.

A

If a patient’s FEV1 increases by 12% after administration of bronchodilators, then a patient likely has asthma rather than COPD.

63
Q

Patients that are heterozygous for the abnormal alpha1-antitrypsin gene are most at risk for emphysema under what condition(s)?

A

If smoking is initiated

(otherwise asymptomatic)

64
Q

True/False.

Both chronic bronchitis and emphysema increase a patient’s risk of cor pulmonale.

A

True.

65
Q

Besides cor pulmonale, chronic bronchitis also increases a patient’s risk of i__________.

A

Besides cor pulmonale, chronic bronchitis also increases a patient’s risk of infection.

66
Q

Bronchiectasis is associated with a(n) ____________ in bronchial tone.

A

Bronchiectasis is associated with a decrease in bronchial tone.

67
Q

Name two causes of localized bronchiectasis.

A
  1. Tumor or foreign body
  2. Necrotizing infection
68
Q

Bronchiectasis is associated with what mycotic infection?

A

Allergic bronchopulmonary aspergillosis

69
Q

What two congenital disorders are associated with bronchiectasis?

A

Cystic fibrosis;

Kartagener’s syndrome

70
Q

What are the clinical features of bronchiectasis?

A

Cough;

dyspnea;

foul-smelling sputum

71
Q

How is bronchiectasis diagnosed?

A

High-resolution CT

72
Q

What is the most common diease leading to bronchiectasis?

A

Cystic fibrosis

73
Q

True/False.

Bronchiectasis is irreversible.

A

True.

74
Q

Which is not a common cause of bronchiectasis?

a) Cystic fibrosis
b) Hypogammaglobulinemia
c) Lung cancer
d) Non-tuberculosis mycobacterium

A

Which is not a common cause of bronchiectasis?

a) Cystic fibrosis
b) Hypogammaglobulinemia

c) Lung cancer

d) Non-tuberculosis mycobacterium

75
Q

What is the gold standard for diagnosis of cystic fibrosis?

A

Sweat chloride test

76
Q

Cystic fibrosis is the most common lethal genetic disease affecting what race?

A

Caucasians

77
Q

What is the inheritance pattern of cystic fibrosis?

A

Autosomal recessive

T2 - Phase 2 - Systems Modules (II) (22 decks)

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