Restrictive Lung Disease (Exam IV)

Question 1

TLC is ________ % of normal in mild restrictive lung disease.

Answer 1

65 - 80%

Question 2

TLC is ________ % of normal in moderate restrictive lung disease.

Answer 2

50 - 65 %

Question 3

TLC is ________ % of normal in severe restrictive lung disease.

Answer 3

< 50 %

Question 4

The two chest x-rays below would likely be indicative of what?

Answer 4

Pulmonary Edema

Bilateral symmetrical butterfly appearing opacities.

Question 5

What occurs at the cellular level with pulmonary aspiration?

Answer 5

• Surfactant producing cells are destroyed
• Capillary endothelium is destroyed

Question 6

Where is aspiration most often seen on a CXR?

Answer 6

Superior Segment of the RLL

Question 7

How would acute respiratory failure be defined?

Answer 7

• Inability to provide O₂ and eliminate CO₂
• PaO₂ < 60 mmHg despite O₂ administration
• Uncompensated metabolic alkalosis w/ PaCO₂ > 50 mmHg

Question 8

Differentiate acute vs chronic respiratory failure.

Answer 8

Acute: ↑ PaCO₂ and ↓ pH
Chronic: ↑ PaCO₂ and compensated pH (from renal HCO₃⁻)

Question 9

How is ARDS classified?

Answer 9

By its PaO₂ / FiO₂ ratio

P/F Ratio

Question 10

What would be classified as mild ARDS?

Answer 10

PaO₂ / FiO₂ = 201 - 300 mmHg

Question 11

What would be classified as moderate ARDS?

Answer 11

PaO₂ / FiO₂ of 101 - 200 mmHg

Question 12

What would be classified as severe ARDS?

Answer 12

PaO₂ / FiO₂ of ≤ 100 mmHg

Question 13

How could ARDS be diagnosed via CXR?

Answer 13

Bilateral findings in at least 3 lung quadrants not explained by pleural effusion or atelectasis.

Question 14

Why might neuromuscular blockers be useful for ARDs?

Answer 14

• Less ventilator barotrauma
• Less inflammatory mediators

Question 15

Why might prone positioning be useful for ARDS?

Answer 15

• Recruits Alveoli
• Improves V/Q mismatch

Question 16

What is Sarcoidosis?

Answer 16

Systemic granulomatous disorder primarily involving lymph nodes and the lungs

Question 17

What signs and symptoms might initially be seen with sarcoidosis?

Answer 17

Usually no symptoms at time of presentation

Question 18

What signs and symptoms might be seen later in sarcoidosis?

Answer 18

• Wheezing, dyspnea, cough
• Cor pulmonale
• Hypercalcemia

Question 19

What places can sarcoidosis affect other than the lungs and lymph nodes?

Answer 19

• Ocular (uveitis)
• Myocardial (conduction problems)
• Laryngeal

Question 20

How is sarcoidosis diagnosed?

Answer 20

• Mediastinoscopy
• ↑ACE activity

Question 21

What drug class is used to treat sarcoidosis?

Answer 21

Corticosteroids

Question 22

What is kyphosis?

Answer 22

Anterior flexion of the spinal vertebral column

Question 23

What is the most serious spinal abnormality affecting the pulmonary system?

Answer 23

Kyphoscoliosis

Question 24

Kyphoscoliosis exhibits a raised hemidiaphragm on the ______ side of the concavity.

Answer 24

same

Question 25

How is the severity of kyphoscoliosis measured?

Answer 25

Cobb Angle

Question 26

What Cobb angle would indicated mild-moderate kyphoscoliosis severity?

Answer 26

< 60°

Question 27

What Cobb angle would indicated severe kyphoscoliosis?

Answer 27

> 100°

Question 28

At what Cobb angle would you expect to see an increased risk of respiratory dysfunction?

Answer 28

> 70°

Question 29

What would occur with a Cobb Angle of > 100° ?

Answer 29

- Chronic hypoventilation - pHTN - Hypoxemia - Erythrocytosis - Cor Pulmonale

Question 30

What vital capacity would be expected of someone with a Cobb Angle of > 100° ?

Answer 30

VC < 45% of normal

Question 31

What CXR signs are seen with pleural effusion?

Answer 31

- Costophrenic angle blunting - Homogenous opacity - Concave meniscus of the chest wall

Question 32

What test has a better sensitivity and specificity for pleural effusion than chest x-rays?

Answer 32

Ultrasound

Question 33

What characterizes secondary pneumothorax?

Answer 33

Known parenchymal lung pathology

Question 34

What characterizes spontaneous pneumothorax?

Answer 34

Gas originating from the lung

Question 35

What characterizes idiopathic spontaneous pneumothorax?

Answer 35

Rupture of apical subpleural blebs

Question 36

With tension pneumothoraces the trachea is deviated _____ the pneumothorax.

Answer 36

away from

Question 37

Where is a needle decompression of a tension pneumothorax performed?

Answer 37

Second anterior intercostal space

Question 38

What pathology is depicted below?

Answer 38

Tension Pneumothorax

Question 39

What types of masses are seen in the anterior mediastinum?

Answer 39

- Thymomas - Germ Cell tumors - Lymphomas - Thyroid and Parathyroid masses

Question 40

What types of masses are seen in the middle mediastinum?

Answer 40

- Tracheal masses - Bronchogenic - Pericardial cysts - Enlarged lymph nodes - Proximal aortic disease

Question 41

What types of masses are seen in the posterior mediastinum?

Answer 41

- Neurogenic cysts and tumors - Meningocele - Lymphoma - Descending aortic problems - Esophageal disorders

Question 42

How would mediastinal masses be evaluated pre-operatively?

Answer 42

- Flow-volume loop studies - Imaging studies - Check for tracheobronchial compression

Question 43

What lung volumes are decreased with obese patients?

Answer 43

FEV₁ FVC FRC ERV *RV and TLC as well if BMI > 40 kg/m²*

Question 44

Is V_T or respiratory rate generally elevated in obese patients?

Answer 44

respiratory rate

Question 45

Central obesity is associated with ______ lung function.

Answer 45

worse

Question 46

How does pregnancy affect the subcostal angle?

Answer 46

Pregnancy will **widen** the subcostal angle from 63° to 103°

Question 47

What happens to the circumference of the lower chest wall in pregnancy?

Answer 47

Chest wall circumference increases

Question 48

Increased levels of what hormone are responsible for a lot of the musculoskeletal changes seen in pregnancy?

Answer 48

Relaxin

Question 49

How long does it take for chest wall configuration to normalize post-pregnancy?

Answer 49

6 months *Subcostal angle will remain 20° wider*.

Question 50

What Cobb angle would indicated mild-moderate kyphoscoliosis severity?

Answer 50

< 60°