Restrictive Lung Disease (Exam IV) Flashcards
TLC is ________ % of normal in mild restrictive lung disease.
65 - 80%
TLC is ________ % of normal in moderate restrictive lung disease.
50 - 65 %
TLC is ________ % of normal in severe restrictive lung disease.
< 50 %
The two chest x-rays below would likely be indicative of what?
Pulmonary Edema
Bilateral symmetrical butterfly appearing opacities.
What occurs at the cellular level with pulmonary aspiration?
- Surfactant producing cells are destroyed
- Capillary endothelium is destroyed
Where is aspiration most often seen on a CXR?
Superior Segment of the RLL
How would acute respiratory failure be defined?
- Inability to provide O₂ and eliminate CO₂
- PaO₂ < 60 mmHg despite O₂ administration
- Uncompensated metabolic alkalosis w/ PaCO₂ > 50 mmHg
Differentiate acute vs chronic respiratory failure.
Acute: ↑ PaCO₂ and ↓ pH
Chronic: ↑ PaCO₂ and compensated pH (from renal HCO₃⁻)
How is ARDS classified?
By its PaO₂ / FiO₂ ratio
P/F Ratio
What would be classified as mild ARDS?
PaO₂ / FiO₂ = 201 - 300 mmHg
What would be classified as moderate ARDS?
PaO₂ / FiO₂ of 101 - 200 mmHg
What would be classified as severe ARDS?
PaO₂ / FiO₂ of ≤ 100 mmHg
How could ARDS be diagnosed via CXR?
Bilateral findings in at least 3 lung quadrants not explained by pleural effusion or atelectasis.
Why might neuromuscular blockers be useful for ARDs?
- Less ventilator barotrauma
- Less inflammatory mediators
Why might prone positioning be useful for ARDS?
- Recruits Alveoli
- Improves V/Q mismatch
What is Sarcoidosis?
Systemic granulomatous disorder primarily involving lymph nodes and the lungs
What signs and symptoms might initially be seen with sarcoidosis?
Usually no symptoms at time of presentation
What signs and symptoms might be seen later in sarcoidosis?
- Wheezing, dyspnea, cough
- Cor pulmonale
- Hypercalcemia
What places can sarcoidosis affect other than the lungs and lymph nodes?
- Ocular (uveitis)
- Myocardial (conduction problems)
- Laryngeal
How is sarcoidosis diagnosed?
- Mediastinoscopy
- ↑ACE activity
What drug class is used to treat sarcoidosis?
Corticosteroids
What is kyphosis?
Anterior flexion of the spinal vertebral column
What is the most serious spinal abnormality affecting the pulmonary system?
Kyphoscoliosis
Kyphoscoliosis exhibits a raised hemidiaphragm on the ______ side of the concavity.
same
How is the severity of kyphoscoliosis measured?
Cobb Angle
What Cobb angle would indicated mild-moderate kyphoscoliosis severity?
< 60°
What Cobb angle would indicated severe kyphoscoliosis?
> 100°
At what Cobb angle would you expect to see an increased risk of respiratory dysfunction?
> 70°
What would occur with a Cobb Angle of > 100° ?
- Chronic hypoventilation
- pHTN
- Hypoxemia
- Erythrocytosis
- Cor Pulmonale
What vital capacity would be expected of someone with a Cobb Angle of > 100° ?
VC < 45% of normal
What CXR signs are seen with pleural effusion?
- Costophrenic angle blunting
- Homogenous opacity
- Concave meniscus of the chest wall
What test has a better sensitivity and specificity for pleural effusion than chest x-rays?
Ultrasound
What characterizes secondary pneumothorax?
Known parenchymal lung pathology
What characterizes spontaneous pneumothorax?
Gas originating from the lung
What characterizes idiopathic spontaneous pneumothorax?
Rupture of apical subpleural blebs
With tension pneumothoraces the trachea is deviated _____ the pneumothorax.
away from
Where is a needle decompression of a tension pneumothorax performed?
Second anterior intercostal space
What pathology is depicted below?
Tension Pneumothorax
What types of masses are seen in the anterior mediastinum?
- Thymomas
- Germ Cell tumors
- Lymphomas
- Thyroid and Parathyroid masses
What types of masses are seen in the middle mediastinum?
- Tracheal masses
- Bronchogenic
- Pericardial cysts
- Enlarged lymph nodes
- Proximal aortic disease
What types of masses are seen in the posterior mediastinum?
- Neurogenic cysts and tumors
- Meningocele
- Lymphoma
- Descending aortic problems
- Esophageal disorders
How would mediastinal masses be evaluated pre-operatively?
- Flow-volume loop studies
- Imaging studies
- Check for tracheobronchial compression
What lung volumes are decreased with obese patients?
FEV₁
FVC
FRC
ERV
RV and TLC as well if BMI > 40 kg/m²
Is VT or respiratory rate generally elevated in obese patients?
respiratory rate
Central obesity is associated with ______ lung function.
worse
How does pregnancy affect the subcostal angle?
Pregnancy will widen the subcostal angle from 63° to 103°
What happens to the circumference of the lower chest wall in pregnancy?
Chest wall circumference increases
Increased levels of what hormone are responsible for a lot of the musculoskeletal changes seen in pregnancy?
Relaxin
How long does it take for chest wall configuration to normalize post-pregnancy?
6 months
Subcostal angle will remain 20° wider.
What Cobb angle would indicated mild-moderate kyphoscoliosis severity?
< 60°
