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ExPhys > RCQ ch. 6 - RLD > Flashcards

RCQ ch. 6 - RLD Flashcards

1
Q

cardinal presentation of IPF

A

decreased compliance

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2
Q

cardinal presentation of lung cancer

A

decreased lung vol

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3
Q

cardinal presentation of pulmonary edema

A

decreased diffusion capacity

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4
Q

cardinal presentation of sarcoidosis

A

tachypnea

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5
Q

cardinal presentation of pneumonia

A

hypoxemia

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6
Q

cardinal presentation of connective tissue caused RLD

A

decreased breath sounds

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7
Q

cardinal presentation of traumatic caused RLD

A

dyspnea

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8
Q

cardinal presentation of obesity/DM caused RLD

A

cough
cor pulmonale
weight loss

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9
Q

typical anatomy affected in RLD

A

lung parenchyma

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10
Q

breathing phase difficulty associated with RLD

A

inspiration

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11
Q

pathophysiology related to RLD

A

decreased lung/thoracic compliance

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12
Q

useful measurements in RLD

A

volumes and capacities

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13
Q

primary difference between restrictive and obstructive

A

Obstructive = flow of air is impeded
Restrictive = volume of air or gas is reduced

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14
Q

Cardinal Presentations of RLD

A

tachypnea
hypoxemia
decreased breathing sounds
decreased lung vol and capacity
decreased DLCO
cor pulmonale

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15
Q

tachypnea occurs because

A

increased respiratory rate and decrease volumes in order to maintain minute ventilation

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16
Q

hypoxemia occurs because

A

V/Q mismatch due to:
changes in framework of lung scarring in capillary channels distortion of small airways compression from tumors
bony abnormalities

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17
Q

what breathing sounds are found in RLD

A

dry inspiratory crackles caused by atelectatic alveoli opening at end inspiration, found at base of lungs

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18
Q

what is used to measure lung volume and capacities

A

pulmonary function testing

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19
Q

why is DLCO decreased

A

consequence of widening the interstitial spaces due to scar tissue, fibrosis of capillaries and V/Q mismatch

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20
Q

what is DLCO

A

diffusing capacity of carbon monoxide

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21
Q

what is the value significant to DLCO

A

<50% of predicted value

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22
Q

cor pulmonale is _______, which is caused by ______, and it leads to ________

A

right-sided HF due to
pulmonary HTN and increasing RAtrium work

leads to
hypoxemia, fibrosis, compression of pulmonary capillaries

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23
Q

what clinically may be seen as a result of cor pulmonale

A

hypoxemia / cyanosis
decreased chest wall
clubbing

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24
Q

symptoms of RLD

A

dyspnea
irritating, dry, nonproductive cough
cachectic appearence

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25
Q

what symptom typically brings pts into the doctors office

A

irritating, dry, nonproductive cough

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26
Q

compliance definition

A

relationship between pressure exerted by the chest wall and the volume of air that can be contained within the lungs

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27
Q

in RLD, decreased compliance leads to pressure changes. explain

A

increased transpulmonary pressure to expand lungs

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28
Q

what volumes are most affected in RLD

A

IRV
ERV

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29
Q

how are IRV and ERV affected by RLD

A

decreased distensibility leads to less air coming in and less air able to be expelled

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30
Q

connection between transpulmonary pressure and tidal volume

A

greater transpulmonary pressure is needed to achieve normal TV

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31
Q

Physiological Changes that lead to increased work of breathing

A

decreased TV and increased RR

increased airway resistance leads to increased RR due to decreased lung and chest wall compliance

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32
Q

when RR increases, what muscles are affected? how so?

A

diaphragm must work harder
SCM and Scalenes are recruited

–> more oxygen needed in muscles to maintain RR, therefore a larger percent of the inhaled air is used by muscles

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33
Q

what is the % increase of oxygen inhaled used in muscles to facilitate breathing

A

5 to 25%
of the oxygen inhaled consumed by muscles

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34
Q

treatment option for permanent/progressive RLD

A

supplemental O2
antibiotic therapy
promotion of adequate ventilation
pulmonary clearance
nutritional support

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35
Q

general pulmonary system changes associated with aging

A

control of ventilation changes
thorax changes
lung tissue changes
cardiac changes

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36
Q

how is control of ventilation affected throughout aging

A

o Ventilatory response mediated by CNS diminishes
o Peripheral chemoreceptors desensitize to hypoxia
o Central chemoreceptors desensitize to acute hypercapnia

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37
Q

how is the thorax changed due to aging

A

o Decalcification of ribs
o Calcification of costal cartilages
o Arthritic changes in rib joints, vertebrae
o Increased dorsal thoracic kyphosis
o Increased anteroposterior diameter (barrel chest)

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38
Q

how is the lung tissue affected during aging

A

Enlargement of air spaces due to enlargement of alveolar ducts and terminal bronchioles

Alveolar surface area decrease

Alveolar parenchymal volume decrease

Alveolar walls become thinner

Capillary beds affected severely due to V/Q mismatching

elastic recoil decrease

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39
Q

how are capillary beds affected via age

A

diffusing capacity decreases
physiologic dead space increases

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40
Q

how does elastic recoil change due to aging

A

alveolar compliance increases
RV increases as IRV/ERV decrease

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41
Q

atelectasis definition

A

Describes a state where a region of the lung parenchyma is collapsed and non-aerated

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42
Q

5 types of atelectasis

A

resorptive/obstructive
passive
adhesive
compressive
cicartization

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43
Q

passive atelectasis
- characterized by
- who can have it / why?

A

Loss of volume in the lung caused by simple pneumothorax or diaphragmatic dysfunction

both resorptive and passive are associated with bedridden patient

Can occur with the use of sedatives or if patient has been in general anesthesia

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44
Q

resorptive atelectasis

A

Obstruction causing resorption of alveolar air distal to the obstruction

Most common
– large airway vs smaller airway types

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45
Q

adhesive atelectasis

A

surfactant deficiency

Greater tendency for alveoli to collapse, may adhere

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46
Q

what may cause adhesive atelectasis

A

ARDS, pulmonary embolism, pneumonia, cardiac bypass

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47
Q

compressive atelectasis

A

Compression of the lung from space-occupying lesion

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48
Q

what may cause compressive atelectasis

A

pleural effusion
pleural tumor
empyema

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49
Q

Cicatrization atelectasis

A

Volume loss due to decreased pulmonary compliance via fibrosis

50
Q

pneumonia definition

A

Inflammatory process of the lung parenchyma that begins with an infection in lower respiratory tract

51
Q

categories of pneumonia

A

Community acquired
hospital-acquired
healthcare associated
ventilator associated

52
Q

symptoms of bacterial pneumonia

A

high fever, chills, dyspnea, tachypnea, productive cough, pleuritic pain, leukocytosis

53
Q

what bacterial pneumonia is most common?
symptoms?
treatment?

A

streptococcus pneumonia

Rusty sputum, hemoptysis, bronchial breath sounds, pleuritic pain, pleural effusion (1/4 of patients), liver dysfunction

Penicillin G, ampicillin, tetracyclines

54
Q

how do viral pneumonias work? what do they affect?

A

localizes in respiratory epithelial cells in those that are immunocompromised

Destruction of the cilia /mucosal surface

Loss of mucociliary function / predisposition to bacterial pneumonia

55
Q

if viral pneumonia gets to the alveoli, what can be seen

A

edema
hemorrhage
hyaline membrane
possibly ARDS

56
Q

who are most commonly affected by viral pneumonia

A

infants
children
women late in pregnancy

57
Q

what fungal pneumonia is associated with AIDS

A

pneumocystis carinii

58
Q

pneumonia will present with these PFT decreases

A

lung volumes
lung compliance
gas exchange
oxygen uptake

59
Q

pneumonia will result in increased

A

respiratory rate
inspiratory pressure
work of breathing

60
Q

explain difference between bacterial and viral pneumonia radiographs

A

bacteria = lobular consolidation in one or more lobes

viral = bilateral bronchopneumonia
–> diffuse fluffy shadows, patchy alveolar infiltrates

61
Q

how does pneumonia affected ABG

A

decreased PaO2 and PaCO2

62
Q

pneumonia effect on breath sounds

A

absent breath sounds over pneumonia w/ dull-mediate percussion

63
Q

symptoms of viral pneumonia

A

moderate fever
dyspnea
tachypnea
nonproductive cough
myalgias

64
Q

ARDS is a result of ____ that leads to

A

a disease that causes inflammation

increased pulmonary vascular permeability
increased lung weight
loss of aerated tissue

65
Q

triggers of ARDS

A

pulmonary and extrapulmonary

66
Q

pulmonary triggers of ARDS

A

Pneumonia
inhalation injury
aspiration
chest trauma
near drowning

67
Q

extra pulmonary triggers of ARDS

A

sepsis
major trauma
burns, pancreatitis
fat embolism
hypovolemia
cardiopulmonary bypass

68
Q

Three Stages of ARDS

A

exudative
proliferative
fibrotic

69
Q

exudative ARDS characterized by

A

capillary leak
alveoli to fill with neutrophilic infiltrate and protein rich edema

–> will be worsened by inflammatory mediators

70
Q

proliferative/fibrotic ARDS described as? what is the result of this?

A

chronic inflammation will lead to scar formation

V/Q mismatch, reduced compliance

71
Q

diagnosis of ARDS is done by

A

bilateral opacities consistent with pulmonary edema

ABG - decreased PaO2/CO2

72
Q

signs of ARDS in PFT

A

decreased
functional reserve capacity
vital capacity
lung compliance with or without increased work of breathing and respiratory rate
DLCO

Flow rates normal or decreased slightly

73
Q

sign of ARDS in breathing sounds

A

decreased sounds over fluid filled area

wet rales
wheezing
rhonchi

74
Q

symptoms of ARDS

A

ill appearance
dyspneic at rest or activity
Breathing pattern fast / labored
Cyanotic

Impaired mental status, restlessness, headache, and +/- anxiety

Will experience muscle wasting/weakness

75
Q

treatment of ARDS

A

Precipitating cause
Mechanical ventilation
Prone positioning
Nutritional status and fluid balance
Preventing treatment complications of condition
early mobility

76
Q

what is interstitial lung disease

A

Large group of disorders that cause issues with diffusion of oxygen into the blood stream

77
Q

what causes ILD

A

Resultant of progressive scarring and subsequently fibrosis of the lung tissue

Autoimmune disorders, exposures in environment, medication effects, genetics, idiopathic

78
Q

what is ILD characterized by on PFTs

A

decreased
- lung volumes
- FVC (normal FEV1/FVC)
- DLCO

increased RR

79
Q

symptoms of ILD

A

dyspnea
dyspnea on exertion
dry cough
fatigue
decreased exercise tolerance crackles in auscultation

80
Q

treatment of ILD

A

steroids
removal environmental exposure
supplemental oxygen

81
Q

pulmonary fibrosis is characterized by

A

Chronic, progressive, irreversible lung disease characterized by progressive worsening of dyspnea and lung function

82
Q

what portion of the lung does pulmonary fibrosis affect

A

all components of the alveolar wall (epi and endo cells)
the components of the interstitium capillary network.

83
Q

pathophys of pulmonary fibrosis

A

marked by proliferation and accumulation of fibroblasts and myofibroblasts / deposition of extracellular matrix

84
Q

sarcoidosis characterized by

A

idiopathic granulomatous inflammatory disorder that affects the lung, heart, skin, CNS, and eyes

85
Q

3 features of sarcoidosis

A

alveolitis
round/oval granulomas
pulmonary fibrosis

86
Q

explain alveolitis

A

inflammatory cells entering alveolar walls

87
Q

bronchiolitis obliterans is

A

fibrotic lung disease that affects smaller airways

can produce restrictive and obstructive dysfunction

88
Q

bronchiolitis obliterans characterized by

A

necrosis of respiratory epithelium in affected bronchioles

pulmonary edema and obstruction of small airways

if progressed significantly, inflammatory response occurs

89
Q

differences in pediatric and adult bronchiolitis obliterans onset and treatment

A

ped = result of viral infection
- hydration/supplemental o2

adult = toxic fume inhalation, viral, bacterial or mycobacterial infections
- corticosteroids, antibiotics, bronchodilators

90
Q

RA affects the lungs in 7 ways

A

Pleural involvement
Pneumonitis
Interstitial fibrosis
Pulmonary nodules
Pulmonary vasculitis
Obliterative bronchiolitis
Bronchogenic cancer

91
Q

prevalence of RA

A

50-60 years of age
2-3x more in women
men typically have more lung involvement

92
Q

breathing pattern seen in cervical SCI

A

paradoxical breathing

93
Q

explain paradoxical breathing

A

Diaphragm is descended, abdomen rises and paralyzed thoracic wall is pulled inward

Relaxation causes abdomen to wall and chest wall to move outward

94
Q

paradoxical breathing leads to _____ volume decreases

A

Vital Capacity
Max Voluntary ventilation

95
Q

when expiratory muscles are paralyzed via SCI, the likelihood of _____ increases

A

pulmonary infection via loss of coughing mechanism

96
Q

circulation of parietal vs visceral pleura

A

parietal = systemic arterial
visceral = pulmonary

97
Q

explain pleural effusion

A

fluid moves from parietal pleural capillaries into the pleural space and reabsorbed into visceral pleural capillaries

when damaged, fluid accumulates in pleural space and limits lung expansion

98
Q

transudative pleural effusion is caused by

A

elevation in hydrostatic pressure in pleural capillaries

left sided heart failure, right sided or both

99
Q

exudative pleural effusion is caused by

A

Increase in permeability of pleural surfaces

Allows protein and excess fluid to move into pleural space

100
Q

pulmonary edema is described as ______, this is caused by

A

increase in fluid within the lung

excessive fluid movement from the pulmonary vascular to the extravascular system

101
Q

pulmonary edema results in decreased _____ and increased ______ on PFTs

A

decreased
gas exchange

increased
V/Q mismatching
work of breathing

102
Q

forms of pulmonary edema

A

cardiogenic
noncardiogenic

103
Q

cardiogenic pulmonary edema is caused by

A

arrythmias and low CO
congenital heart defects
left ventricular failure
MI
pulmonary embolus
renal failure
heart disease
systemic hypertension

104
Q

what causes noncardiogenic pulmonary edema

A

increased capillary permeability
decreased oncotic pressure
decreased intrapleural pressure lymphatic insufficiency

105
Q

what is the significant value related to pulmonary vascular hydrostatic pressure? what does that cause?

A

> 25-30 mmHg

oncotic pressure loses its holding force and spills into interstitial space

106
Q

what does pulmonary edema disrupt

A

tight alveolar epithelium
floods alveolar spaces
moves through visceral pleura and causes pleural effusion

107
Q

treatment of pulmonary edema

A

Decreasing cardiac preload / maintaining oxygenation to tissues

venous return is decreased  decreased left ventricle filling pressure

Venodilators / diuretics

Angiotensin converting enzyme inhibitors

Positive inotropes

Supplemental oxygen

Albumin to increase osmotic pressure

108
Q

symptoms of pulmonary emboli

A

dyspnea
hemoptysis
pleuritic chest pain

109
Q

pathophys of pulmonary emboli

A

Occlusion of one or more pulmonary arterial branches
coagulative necrosis of alveolar walls
pneumoconstriction
surfactant production decrease
V/Q mismatch

110
Q

treatment/prevention of pulmonary emboli

A

Ankle pumping
Early ambulation
graded compression
estim of calf muscles
Medicines that decrease coagulation

111
Q

characteristics of systemic lupus erythematosus

A

chronic inflammatory connective tissue disorder

112
Q

what is caused by systemic lupus erythematosus

A

fibrous pleuritis
hypoxemia
shortness of breath
cyanosis
tachypnea
tachycardia
diaphragmatic weakness

113
Q

scleroderma is categorized as

A

fibrosing disorder that causes degenerative changes

114
Q

explain how scleroderma occurs

A

collagen replaces normal connective tissue framework of the lung

fibrotic replacement of connective tissue in alveolar walls

115
Q

polymyositis is described as

A

connective tissue disease leading to proximal muscle weakness and pain

116
Q

coal worker’s pneumoconiosis is caused by

A

accumulation of coal dust in the lungs

117
Q

explain types of coal workers’ pneumoconiosis

A

simple = <1cm opacities
complicated = >1 cm opacities

118
Q

excavatum vs carinatum

A

excavatum - sternal depression and decreased ant-post diameter

carinatum - sternum protrusion anteriorly

119
Q

what is flail chest? what causes it?

A

thoracic cage disconnected from thoracic wall

free floating segment of ribs due to multiple rib fractures because

120
Q

flail chest is similar to

A

paradoxical breathing

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