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Cardiopulmonary > Pulmonary Pathophysiology: Restrictive Lung Dysfunction > Flashcards

Pulmonary Pathophysiology: Restrictive Lung Dysfunction Flashcards

1
Q

Define restrictive lung dysfunction (RLD)

A
  • Abnormal reduction in pulmonary ventilation caused by restricted expansion of the chest wall or the lungs
  • Decreased volume of air or gas moving in & out of the lungs
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2
Q

Pathophysiology of RLD is related to what 3 factors

A
  • Decreased compliance of both the lung & the chest wall
  • Decreased lung volumes & capacities
  • Increased work of breathing
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3
Q

What are some causes of increased work of breathing

A
  • Increased airway resistance
  • Increased flow rates
  • Decreased lung or chest wall compliance
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4
Q

Greater ___________ pressure is required to achieve a normal TV in RLD

A
  • Transpulonary
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5
Q

6 classic signs of RLD

A
  • Tachypnea (increased RR)
  • Hypoxemia (low blood O2 concentration)
  • Decreased breath sounds with dry inspiratory crackles
  • Decrease in lung volumes & capacities
  • Decreased diffusing capacity of lung for carbon monoxide (DLCO)
  • Cor pulmonale (R sided HF): due to pulmonary HTN or hypoxia
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6
Q

What are the 3 hallmark signs of RLD

A
  • Dyspnea
  • Irritating, dry, & nonproductive cough
  • Wasted, emaciated appearance as the disease progresses
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7
Q

If etiological factors of RLD are permanent or progressive, then treatment consists of supportive measures:

A
  • Supplemental O2 to support the PaO2
  • Antibiotic therapy to fight 2ndy pulmonary infection
  • Measures to promote adequate ventilation & prevent the accumulation of pulmonary secretions
  • Good nutritional support
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8
Q

If etiological factors are reversible, treatment is _____________ and ____________

A
  • Corrective and supportive
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9
Q

What does diffusing capacity of the lung for carbon monoxide (DLCO) measures

A
  • Measures how well the lungs transfer O2 from the air into the blood
  • Normal: 75-140% predicted
  • Mildly Reduced= 60-75% predicted
  • Severely Reduced= <40% predicted
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10
Q

Describe what low and high DLCO indicates are may be seen in

A
  • Low DLCO means the lungs aren’t getting O2 from the air to the blood efficiently
  • Low DLCO with restrictive pathology may indicate interstitial lung disease (ILD)
  • Reduced DLCO with obstructive pathology could suggest emphysema
  • High DLCO may be seen in asthma or obesity
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11
Q

Define atelectasis

A
  • Incomplete expansion
  • Clinical manifestation of several lung & chest disorders
  • Region of lung parenchyma is collapsed & non-aerated
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12
Q

What are the 5 types of atectasis

A
  • Resorptive/obstructive: most common, often caused by an obstruction
  • Passive: loss of volume in lungs caused by pneumothorax or diaphragmatic dysfunction; lack of deep breathing, under general anesthesia
  • Adhesive: surfactant deficiency (greater tendency for alveoli to collapse)
  • Compressive: caused by space occupying lesion, pleural effusion/tumor, or empyema
  • Cicatrization: volume loss caused by decreased pulmonary compliance bc of fibrosis
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13
Q

Define pneumonia

A
  • Inflammatory process of the lung parenchyma
  • Usually begins with an infection in the lower respiratory tract
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14
Q

Causative agents of pneumonia

A
  • Bacteria
  • Viruses
  • Fungi
  • Mycoplasmas
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15
Q

Symptoms of a bacterial pneumonia

A
  • High fever
  • Chills
  • Dyspnea
  • Tachypnea
  • Productive cough
  • Pleuritic pain
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16
Q

Symptoms of a viral pneumonia

A
  • Moderate fever
  • Dyspnea
  • Tachypnea
  • Non-productive cough
  • Myalgias (pain in muscle/muscle group)
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17
Q

What is adult respiratory distress syndrome (ARDS)/acute lung injury

A
  • Widespread inflammatory condition affecting pulmonary tissue
  • Leads to increased pulmonary vascular permeability/lung weight and loss of aerated tissue
  • All pts develop some muscle wasting/weakness that continues past 1yr post discharge
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18
Q

Pulmonary triggers of ARDS

A
  • Pneumonia
  • Inhalation injury
  • Aspiration of gastric contents
  • Chest trauma/pulmonary contusion
  • Near drowning
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19
Q

Extrapulmonary triggers of ARDS

A
  • Sepsis
  • Major trauma
  • Burns
  • Pancreatitis
  • Fat embolism
  • Hypovolemia
  • Transfusion related acute lung injury (TRALI)
  • Cardiopulmonary bypass
  • Drug induced
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20
Q

Symptoms of ARDS

A
  • Appear acutely ill
  • Dyspneic at rest & with any activity
  • Breathing pattern fast & labored
  • Cyanotic
  • May have impaired mental status, restlessness, HA, & increased anxiety
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21
Q

Causes of ARDS

A
  • Hyaline membrane damage
  • Ruptured alveolar walls
  • Intra-alveolar edema
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22
Q

What is interstitial lung disease

A
  • A group of lung disorders that cause problems with diffusion of O2 into the blood stream as a result of progressive scarring & fibrosis of the lung tissue
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23
Q

Common causes of interstitial lung disease (ILD)

A
  • Exposures in the environment
  • Autoimmune disease
  • Medication effects
  • Genetics
  • Idiopathic or unknown reasons
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24
Q

Describe idiopathic pulmonary fibrosis (IPF)

A
  • Most common idiopathic interstitial pneumonia
  • Worst prognosis of the ILDs
  • Bc of poor diffusion capacity individuals with ILD often require supplemental O2 as the disease progresses & especially with exercise
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25
Q

Symptoms of pulmonary fibrosis

A
  • SOB that gets worst over time
  • Dry cough that doesn’t improve
  • Achy joints & muscles
  • Feeling tired or weak
  • Losing weight slowly & without trying
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26
Q

Describe idiopathic pulmonary fibrosis (IPF)

A
  • Progressive, irreversible, & usually lethal lung disease
  • Progressive worsening of dyspnea & lung function
  • Most important environmental risk factors: cigarette smoking, exposure to metal & wood dust
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27
Q

What is sarcoidosis

A
  • Idiopathic granulomatous inflammatory disorder that affects many organ systems (lungs, heart, skin, CNS, & eyes)
  • Lungs are most involved organ
  • Typically affects young adults
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28
Q

What are the 3 distinct features of sarcoidosis

A
  • Alveolitis
  • Formation of well-defined round or oval granulomas
  • Pulmonary fibrosis
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29
Q

Fibrotic lung disease that affects the smaller airways; Produces restrictive and obstructive lung dysfunction describes

A
  • Bronchiolitis obliterans
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30
Q

Bronchiolitis obliterans is characterized by

A
  • Necrosis of the respiratory epithelium in the affected bronchioles
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31
Q

Causes/association of Bronchiolitis obliterans in children versus adults

A
  • Pediatrics: often caused by viral infection
  • Adults: associated with toxic fume inhalation or by viral, bacterial, or mycobacterial infectious agents, particularly M. pneumonia
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32
Q

What are the 7 ways RA can affect the lungs

A
  • Pleural involvement
  • Pneumonitis
  • Interstitial fibrosis
  • Development of pulmonary nodules
  • Pulmonary vasculitis
  • Obliterative bronchiolitis (OB)
  • Increased incidence of bronchogenic CA
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33
Q

Characterized by various antigen–antibody reactions; May involve the skin, joints, kidneys, lung, nervous tissue, and heart describes

A
  • Systemic lupus erythematosus (SLE)
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34
Q

What is the most common lung dysfunction with SLE

A
  • Pleurisy: pain with deep breathing
  • Diaphragmatic weakness is relatively common
35
Q

Progressive fibrosing disorder that causes degenerative changes in skin, small blood vessels, esophagus, intestinal tract, lungs, heart, kidney, and articular structures; In lung, appears as progressive diffuse interstitial fibrosis describes

A
  • Scleroderma
36
Q

Systemic connective tissue disease characterized by symmetric proximal muscle weakness and pain; May involve lung parenchyma; Aspiration pneumonia—most common abnormality describes

A
  • Polymyositis
37
Q

Systemic connective tissue disease characterized by inflammatory and degenerative changes in the skin; Pulmonary involvement mirrors that of polymyositis.

A
  • Dermatomyositis
38
Q

Characterized by Interstitial or intraalveolar hemorrhage, Glomerulonephritis, Anemia; Caused by antiglomerular basement membrane antibodies that react with vascular basement membranes of the alveolus and glomerulus describes

A
  • Goodpasture syndrome
  • Coughing up and peeing blood is a sign
39
Q

Treatment for good pasture syndrome

A
  • Plasmapheresis & immunosuppressive therapy to lower the levels of anti-GBM antibodies; cyclophosphamide with prednisone
40
Q

Multisystem disease characterized by granulomatous vasculitis of upper and lower respiratory tracts, glomerulonephritis, and small vessel vasculitis; Often starts in upper respiratory tract with necrotizing granulomas and ulceration in the nasopharynx and paranasal areas describes

A
  • Wegener granulomatosis
41
Q

Treatment of choice for Wegener granulomatosis

A
  • Cyclophosphamide
42
Q

Interstitial lung disease caused by accumulation of coal dust in the lungs and the subsequent reaction by the surrounding tissue; Caused by repeated inhalation of coal dust over a long period of time (10 to 12 years) describes

A
  • Coal workers’ pneumoconiosis (aka Black Lung)
43
Q

What is the pathologic hallmark of coal workers’ pneumonsoniosis

A
  • Coal macule
  • Focal collection of coal dust with little tissue reaction either in terms of cellular infiltration of fibrosis
44
Q

Fibrotic lung disease caused by the inhalation of free crystalline silicon dioxide or silica; Industries associated with exposure—mining, tunneling through rock, quarrying, grinding and polishing rock, sandblasting, ship building, foundry work, hydraulic fracturing (fracking) of oil and gas wells describes

A
  • Silicosis
  • Even after the pt is no longer exposed, lung function impairment worsens as the disease progresses
45
Q

Pneumoconiosis caused by the inhalation of asbestos; Plaques (localized fibrous thickenings of the parietal pleura) and pleural effusions may occur describes

A
  • Asbestosis
46
Q

Asbestosis often has a dormancy period after exposure of __________ years

A
  • 20 to 30 years
47
Q

Describe Radiation pneumonitis and fibrosis

A
  • Primary complication of irradiation to thorax
  • Usually occurs 2-6mo after tx
  • Pulmonary injury includes acute radiation pneumonitis & chronic radiation fibrosis
48
Q

Lung cancer is a growth of abnormal epithelial cells in the tracheobronchial tree.
Two main types: Small cell cancer and Nonsmall cell lung cancer describes

A
  • Bronchogenic carcinoma
49
Q

Primary causative factor of bronchogenic carcinoma

A
  • Tobacco use
50
Q

Common sites of metastasis for lung cancer

A
  • Liver
  • Kidney
  • Adrenal
  • Brain
  • Heart
  • Lymph
  • Pleura
  • Bone
51
Q

Pleural effusion is when there is an abnormal amount of fluid within the pleural space made up of transudate and exudate define these terms

A
  • Transudate: fluid with low protein content accumulates bc of changes in hydrostatic pressure within pleural capillaries
  • Exudate: fluid with high protein content accumulates bc changes in permeability of pleural surfaces
52
Q

Most common conditions leading to pleural effusion

A
  • Cardiac failure
  • Pneumonia
  • Malignant neoplasm
53
Q

How to diagnosis and remove fluid for pleural effusion

A
  • Thoracentesis procedure can diagnosis and remove excess pleural fluid
54
Q

_______________ is an increase in the pulmonary capillary hydrostatic pressure, often secondary to left ventricular failure.

A
  • Cardiogenic pulmonary edema
55
Q

Heavy clot burden may cause ______ ventricular dysfunction or acute cor pulmonale

A
  • Right
56
Q

Eight clinical variables significantly associated with an absence of PE

A
  • Age < 50 years
  • Pulse < 100 beats per minute;
  • SaO2 > 94%
  • No unilateral leg swelling
  • No hemoptysis
  • No recent trauma or surgery
  • No history of VTE
  • No oral hormone use
57
Q

Innervation of the inspiratory muscles

A
  • Diaphragm: C3-C5 (Phrenic nerve)
  • External intercostals: T1-T12
  • Sternocleidomastoid: Cranial nerve XI (Spinal accessory)
  • Scalenes: C1-C2
58
Q

Innervation of expiratory muscles

A
  • Internal intercostals: T1-T12
  • Abdominals: T7-L1
59
Q

Pacing the diaphragm muscle has decreased pulmonary complication and can also

A
  • decrease pulmonary complication
  • improve venous return
  • improve breathing, speech, and mobility
  • Improve quality of life
60
Q

Progressive degenerative disease of the nervous system that involves upper and lower motor neurons; Respiratory muscles may be severely affected describes

A
  • Amyotrophic lateral sclerosis (ALS)
61
Q

Virus is neurotropic and has a predilection for the motor cells of the anterior horn and the brainstem; Can result in muscular paralysis describes

A
  • Poliomyelitis
62
Q

Demyelinating disease of the motor neurons of the peripheral nerves; Idiopathic polyneuritis linked to the immune system; Characterized by rapid bilateral ascending flaccid motor paralysis and areflexia describes

A
  • Guillain-Barre Syndrome
63
Q

Chronic neuromuscular disease characterized by progressive muscular weakness on exertion; Caused by autoimmune attack on acetylcholine receptors at the postsynaptic neuromuscular junction; Crisis occurs if respiratory muscles are affected; requires mechanical ventilation with treatment in the ICU describes

A
  • Myasthenia Gravis
64
Q

Disease of the neuromuscular system caused by the neurotoxin produced by Clostridium tetani; Blocks release of inhibitory transmitter; Causes severe muscle spasticity with tonic convulsions; May cause chest wall immobilization, resulting in asphyxia and death describes

A
  • Tetanus
65
Q

Sex-linked (X chromosome) recessive disorder that occurs only in males; Causes progressive degenerative myopathy describes

A
  • Pseudohypertrophic (Duchenne) muscular dystrophy
66
Q

Common symptoms appearing before age 6 for Duchenne muscular dystrophy

A
  • Progressive muscle weakness & atrophy
  • Calf muscle hypertrophy
  • Fatigue
  • Toe walking
  • Difficulty climbing up stairs
  • Frequent falls
  • Developmental delay
  • Breathing problems
  • Learning differences
  • Delayed speech & language development
  • Scoliosis
  • Short stature (height)
67
Q

Describe the differences between supportive and respiratory treatment for Duchenne muscular dystrophy

A
  • Supportive treatment—preserving the patient’s mobility as long as possible; patient comfort
  • Respiratory treatment—prevention of infection with maintenance of good inspiratory effort and good airway clearance to mobilize any secretions
68
Q

Diaphragm paralysis or paresis is most commonly caused by

A
  • Invasion of the Phrenic nerve by bronchogenic carcinoma
  • Pathologic changes are heightened in the supine position
69
Q

Combination of excessive anteroposterior and lateral curvature of the thoracic spine describes

A
  • Kyphoscoliosis
70
Q
  • Describe the implications with difference severities of curvature angle
A
  • Angle <70º: no pulmonary dysfunction
  • Angle 70-120º: some pulmonary dysfunction
  • Angle >120º: severe RLD & respiratory failure
71
Q

Chronic inflammatory disease of the spine; Characterized by immobility of sacroiliac and vertebral joints and ossification of paravertebral ligaments; Pulmonary impairment results from markedly decreased compliance of the chest wall describes

A
  • Ankylosing spondylitis
72
Q

Describe the differences between pectus excavator and carinatum

A
  • Excavatum (funnel chest): Congenital abnormality characterized by sternal depression and decreased anteroposterior diameter; If deformity is severe, patients may have decreased TLC, VC, and maximum voluntary ventilation
  • Carinatum (pigeon breast): Structural abnormality characterized by the sternum protruding anteriorly; Associated with prolonged childhood asthma
73
Q

How does pregnancy cause RLD

A
  • Growth/position of fetus impairs ventilation to dependent regions
  • Decrease in chest wall compliance is caused by decreased downward excursion of the diaphragm
  • Work of breathing increases
  • Voluntary lung volumes decrease
74
Q

Describe when a Lung contusion would occur

A
  • Occurs when a lung strikes directly against the chest wall
75
Q

Describe the differences between pneumothorax and hemothorax

A
  • Pneumothorax: entry of free air into the pleural space
  • Hemothorax: presence of blood in the pleural space
76
Q

Describe a thermal trauma

A
  • Usually caused by inhalation injuries, direct burn injuries to the thorax, or a combination of both
  • Often caused by exposure to fire/smoke
77
Q

Describe a pulmonary laceration

A
  • Laceration directly into the lung parenchyma is usually caused by a penetrating wound
  • Results in air/blood escaping from the lung into pleural space & often into the environment
  • Most commonly appears in combination with a pneumothorax or hemothorax
78
Q

Pulmonary dysfunction is caused by three primary factors

A
  • The anesthetic agent
  • The surgical incision or procedure itself
  • The pain caused by the incision or procedure
79
Q

Postoperatively, hypoxia can be treated with methods that may include

A
  • Inflation-hold breathing techniques
  • PEEP
  • CPAP
  • Increased oxygen concentration
80
Q

Common methods to treat postoperative atelectasis

A
  • Deep breathing exercises
  • Early mobilization of the patient out of bed
  • Incentive spirometry
  • CPAP
81
Q

Most drug-induced ILD is ____________ if recognized early and the drug is discontinued

A
  • Reversible
82
Q

Drugs capable of inducing interstitial lung disease (ILD)

A
  • Oxygen
  • Antibiotics
  • Nitrofurantoin
  • Sulfasalazine
  • Antiinflammatory drugs
  • Cardiovascular drugs
  • Chemotherapeutic drugs
  • Poisons
  • Anesthetics
  • Muscle relaxants
  • Illicit drugs
83
Q

Drug-induced ILD probably results from a combination of mechanisms, including

A
  • Toxic effects of the drug or its metabolites
  • Interference with the oxidant–antioxidant system
  • An indirect inflammatory reaction
  • Altered immunologic processes

Cardiopulmonary (9 decks)

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