Topic 7 - Pulmonary Disease 1

Question 1

Obstructive

Answer 1

Characterised by an increase in resistance to airflow owing to complete or partial obstruction at any level, due to early airway closure
Issue getting air out of their lungs - occurs at a slow rate
Can occur at any level from trachea to bronchiole

Question 2

Obstructive Spirometry

Answer 2

low FEV1
↓ FEV1/FCV (normal = 80%)
relative preservation of FVC
RV ↑ as lots of air still in lungs = high CO2

Question 3

Restrictive

Answer 3

Characterised by decreased expansion of lung parenchyma with decrease total lung capacity
Issue with getting air into lung - breath is initiated by lung unable to expand
Problems with chest wall being unable to move also contributes as well as ↓ expansion of lung parenchyma
- pleural conditions - pleural effusion or pneumothorax
- obesity - excess adipose tissue
- RA

Question 4

Restrictive Spirometry

Answer 4

low FEV1
↓ FVC
Therefore FEV1/FVC normal or slightly increased

Question 5

Obstructive ABG

Answer 5

pH = ↓ due to CO2 dissolving and forming carbonic acid
CO2 = ↑ = can't get air out due to floppy airways and early airway closure 
O2 = ↓ = impaired gas exchange due to ↓ SA at alveoli 
Bicarbonate = ↑ buffer acid, kidneys produce more HCO3- to bring pH back to normal range

Question 6

Respiratory Failure

Answer 6

Type 1 = low O2

Type 2 = low O2 and high CO2

Question 7

Functions of Pulmonary System

Answer 7

1. Respiration - inhaling and exhaling
2. Gas exchange - CO2 diffuses from capillaries to alveoli and O2 reverse (exchange b/w cells and capillaries - carried by haemoglobin and bicarbonate ions)
3. Olfaction
4. Voice production

Question 8

Normal ABG

Answer 8

pH = 7.35-7.45
CO2 = 35-45mmHg
O2 = 85-100mmHg

Question 9

Right lung

Answer 9

3 lobes: U,M,L

2 fissures: oblique and horizontal - form margins of lungs

Question 10

Left Lung

Answer 10

2 lobes: U,L
lingular “lobe” part of upper lobe
1 fissure: oblique
Cardiac + aortic arch impression

Question 11

Right bronchopulmonary segments

Answer 11

Upper
- apical, anterior, posterior
Middle
- lateral, medial
Lower
- apical, M,A,L,P basal

Question 12

Left bronchopulmonary segments

Answer 12

Upper
- apical, anterior, posterior
Lower
- apical, A,L,P basal
Lingular 
- superior, inferior

Question 13

Respiratory Anatomy

Answer 13

Pleural sac encases each lung
Parietal and visceral pleura
Pleural cavity
- closed potential space
- small amount of pleural fluid - lubrication
- intrapleural pressure lower than atmospheric
- pressure gradient exists from apex to base of the lungs
Bronchopulmonary segments are triangular in shape, apex towards root of lung and base towards pleural surface

Question 14

Fissures

Answer 14

Horizontal fissure = divides m+u lobe

Oblique fissure = divides upper and lower lobe

Question 15

COPD

Answer 15

Disease state characterised by presence of airflow obstruction that is not fully reversible
Irreversible is effects of inflam, fibrosis and remodelling of airways
Triad including asthma, emphysema and chronic bronchitis
Aetiology: commonly cigarette smoking
Pathophysiology: limitation to expiratory airflow

Question 16

COPD Pathophysiology

Answer 16

Permanent dilation of bronchi and bronchioles due to smooth muscle destruction
Loss of elastic recoil due to inflammation (cigarette smoking+permanent) = floppy airways
↓ gas exchange due to ↓ SA of alveoli or thickened membranes —> ↓O2 and ↑CO2
Fibrosis in airways = restriction
- progressive disabling disease with serious complications and exacerbations
systemic effects =

Question 17

S+S of COPD

Answer 17

• Dyspnoea
• Sputum
• educed exercise tolerance

Question 18

Asthma

Answer 18

Chronic inflam disorder of airways in which many cells play a role. Episodes are associated with airflow obstruction that is reversible with medication or spontaneously. Inflammation causes an associated ↑ hyper responsiveness to a variety of stimuli

Question 19

Asthma S+S

Answer 19

recurrent episodes of
- wheezing 
- breathlessness
- chest tightness 
- coughing - especially at night or early in morning - sputum
asymptomatic in between attacks

Question 20

Asthma Pathophysiology

Answer 20

Anatomic narrowing of airways
- smooth muscle hypertrophy and hyperplasia - thicken airway
- inflammatory cells will infiltrate and makes everything more swollen
- oedema in airways
- goblet cells and mucus gland hyper-secretion - further narrowing the lumen
- remodelling of airways protein deposition including collagen - airways stiffer and more rigid
- epithelial desquamation - shedding of epithelial cells
ventolin works on bronchospasm

Question 21

Asthma Classification

Answer 21

Atopic
- most common
- specific allergens - pollen, dust
- fam history
- ↑IgE levels
Non-atopic
Intermittent
Persistent - brittle asthmatics - symptoms most day of year