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CardioPulm > Exam 3: Wk 11: Obstructive/Restructive Lung Dysfunction > Flashcards

Exam 3: Wk 11: Obstructive/Restructive Lung Dysfunction Flashcards

1
Q

How does the brain control ventilation?

A

Feedforward - estimates how much ventilation should be required
Output - motor activity to mm of inspiration

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2
Q

Causes of Dyspnea

A

Ventilatory pump failure = hypoxia hypoxic (hypoxemia)
Cardiac pump/supply lines- ischemic hypoxia (ischemia) (HA/Strokes)
Bloods oxygen carrying capacity - anemic hypoxia (anemia)

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3
Q

Leading cause of morbidity and mortality in adults in western civilization

A

Ischemic hypoxia

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4
Q

3 main causes of breathing disorders

A
  • damage to the brain stem
  • difficulty inhaling (restrictive)
  • difficulty exhaling (obstructive)
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5
Q

Restrictive disease

A

Breathing impaired AS IF movement of chest is restricted
- normal strength, but chest too stiff
- normal stiffness, but too weak muscles

  • all spirometry volumes are reduced
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6
Q

Obstructive Disease

A

Breathing impaired AS IF airways obstructive
- SOB due to difficulty exhaling
- increased FRC
- increased diameter of chest (barrel chest)

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7
Q

Tip to help people w obstructive disease breathe better

A

Long and slow breaths

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8
Q

Two basic causes of obstructive disease

A
  1. Increased airway resistance (asthma)
  2. Decreased elastic recoil
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9
Q

Emphysema

A

Loss of elastic recoil so you can’t get all the air out of lungs
Can have some airway obstruction

Pressure builds up in alveoli and its walls become damaged

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10
Q

CF can result in obstructive diseases like _____ or ______

A

Bronchiectasis or chronic bronchitis

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11
Q

Obstructive disease : equal pressure point

A

Point in airway anatomy where outside compressive pressure equals inside elastic pressure

  • should occur in larger airways with cartilaginous rings

W obstructive disease, there’s loss of pressure moving air through obstruction moves the equal pressure point distally so when they cough, its less effective

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12
Q

T or F: COPD is a category of disease, not a specific disease

A

True

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13
Q

4 diseases that make up COPD

A

ABCE

Asthma
Bronchietasis
Chronic bronchitis
Emphysema

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14
Q

Describe the type of hypoxemia:

SOB w normal sP02 and PO2,
normal blood flow
Inadequate O2 carrying capacity

A

Anemic hypoxemia

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15
Q

Describe the type of hypoxemia:

SOB w normal sP02 and PO2,
inadequate blood flow
Normal O2 carrying capacity

A

Ischemic hypoxemia

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16
Q

Describe the type of hypoxemia:

SOB w decreased sP02 and PO2,
normal blood flow
Normal O2 carrying capacity

A

Hypoxic hypoxemia

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17
Q

Pathophysiology of emphysema (how it develops)

A

Smoking —> respiratory bronchiolitis

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18
Q

Signs and symptoms of emphysema

A
  • barrel chest
  • emaciated
  • hypertrophy SCM and scalenes
  • tripod position
  • prolonged emphysema
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19
Q

Medical and surgical management of emphysema

A

Bronchodilators
Lung volume reduction surgery : restores biomechanics of breathing by removing poorly functioning lung tissue

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20
Q

Chronic Bronchitis

A

Excessive sputum production on most days for at least 3 months of the year for at least 2 consecutive years
- impaired mucus clearance

Airway gets smaller

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21
Q

Blue bloater

A

Chronic bronchitis - overweight and cyanotic

  • cant get CO2 out
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22
Q

Pink puffer

A

Emphysema

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23
Q

Bronchiectasis

A

Chronic and permanent dilation of bronchi due to inflammation or infection
- copious amounts of foul smelling sputum
- dilated or obliterated bronchi in dependent airways

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24
Q

S & S Bronchiectasis

A
  • chronic cough
  • coughing blood and a lot of mucus
  • abnormal wheezing
  • SOB
  • chest pain
  • fatigue
  • bad breath odor
  • BLUE
  • weight loss
  • thickening of skin under nails or toes
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25
Q

Medical management of Bronchiectasis

A

Antibiotics, airway clearance, surgical removal of nonfunctioning tissue

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26
Q

What is described as inflammation of bronchial walls without an increase or change in bronchial wall diameter?

A

Bronchitis - no change in wall diameter, the inflammation narrows the airways

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27
Q

What happens to the walls in Bronchiectasis

A

The walls are dilated and eventually destroyed

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28
Q

Is co2 acid or base

A

ACID (volatile acid)

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29
Q

Normal mechanism of ventilation drive

A

Negative feedback loop between pH and CSF and ventilation

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30
Q

Response of ventilation to decreased pH

A

Ventilation increases and if chronic, kidneys respond to eliminate fixed acid

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31
Q

Ventilation response to increased pH

A

Ventilation is slowed
- CO2 accumulates
- pH is normalized
- if chronic, kidneys and buffering systems respond

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32
Q

Effect of CO2 on the brain

A
  • high CO2 will depress cerebral function
    *giddy to somnolent to unconscious to DEAD
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33
Q

How much O2 does normal air have? How about FIO2?

A

Normal air has 21% oxygen

FIO2 = .21

34
Q

How is FIO2 increased?

A

Increasing flow rate or % O2

35
Q

Higher ventilation = ______ PO2 and ____ PCO2

Is this good or bad

A

Higher PO2
Lower PCO2

This is good :)

36
Q

High ventilation has ____ PO2 and _____ PCO2

A

Low PO2
High pco2

37
Q

Atmosphere has ___ PO2 and ____ PCO2

A

High PO2
Low PCO2

38
Q

High ventilation makes alveoli like atmosphere or venous blood? Hb low ventilation?

A

High - atmosphere - freshhhh
Low - venous blood - stale

39
Q

what is the primary determinant of oxygenation of the blood ?

A

V/Q
Vq ratio

40
Q

Increasing V/Q does what it PaO2 and PaCO2

A

Increases PaO2 and lowers PaCO2

41
Q

Decreasing V/Q does what to PaO2 and PaCO2

A

Decreases PaO2 and increases PaCO2

42
Q

What’s the optimal V/Q

A

.8

43
Q

What is carried w ventilation? What is carried with perfusion? And to where?

A

Ventilation - O2 into alveoli
Perfusion - O2 away from alveoli to be used by the body

44
Q

Low V/Q analogy

A

bus leaves half empty - hypoxic hypoxia

  • low ventilation results in low PaO2 and unloaded Hb leaving capillaries
45
Q

High V/Q analogy

A

One bus and 1000 ppl wanting to board

*high ventilation causes PO2 to rise and PCO2 to fall

46
Q

V/Q at resting conditions slow ventilation and slow pulmonary blood flow unit

A

Slow ventilation 4L/min
Slow pulmonary blood flow 5L/min

47
Q

V/Q during exercise

A

Pulmonary blood flow increase 4-5x resting blood flow

48
Q

Too much V/Q - why is it bad

A

Waisting energy on breathing - wasted ventilation so there’s less O2 for the rest of the body and arterial CO2 falls and respiratory alkalosis can occur

49
Q

Slower blood flow ___ PaO2

A

Increases

50
Q

If cardiac output is low and V/Q is normal what happens to PaO2 and what type of hypoxia is it?

A

May have high PaO2 and would result at a tissue level of ISCHEMIC HYPOXIA and cellular injury

51
Q

If cardiac output is normal and V/Q is low, what happens to PaO2 and what type of hypoxia is it

A

PaO2 becomes low and results in hypoxic hypoxia

52
Q

What do pulmonary functional tests look at?

A

TV , IRV, ERV, VC, some wash out helium or nitrogen

53
Q

Gas Flow Rate

A

Looks at the volume of flow to see if there’s early airway closure or collapse as is typical with COPD (decreased flow rate)

54
Q

Flow volume loop interpretation

A

Low volume - restrictive disease
Peaked slope = restrictive
Scooped out = obstructive

55
Q

DLCO - diffusion capacity of lung

A

Ability of lungs to transfer gas from inhaled air to the RBC in the pulmonary capilalries

56
Q

Factors that decrease diffusion

A

Anemia
Increased diffusion distance
Decreased exchange area
Poor perfusion

57
Q

Norm for FEV1/FVC

A

> .8 or 80%

58
Q

Restrictive lung disease definition

A

Difficulty breathing O2 in due to decreased lung compliance or impaired ability of thorax to expand

59
Q

Main characteristics of RDL

A

Decreased pulmonary compliance
Increased work of breathing
On PFT all lung volumes and capacities are decreased

60
Q

What type of cancer is leading cause of death in US

A

Lung cancer :(

61
Q

Pulmonary Fibrosis

A

Inflammatory process of alveolar wall
- patchy focal infiltrates thought the lung, may become fibrotic or scarred

62
Q

Pulmonary Fibrosis

A
  • ABGs: pO2 decreased/ pCO2 normal
  • decreased breath sounds
  • cor pulmonary, clubbing, cyanosis
  • nonproductive cough
  • weight loss
63
Q

Tx for pulmonary fibrosis

A

Corticosteroids only in inflammatory stage, O2, nutrition, pulmonary rehab

64
Q

Pneumonia is inflammation of

A

Parenchyma

65
Q

Signs and symptoms of Pneumonia

A

Crackles over consolidation
Infiltrate on CXR
Hyporesonance on percussion
SOB
Tachypnea

66
Q

Pressure change of obstructive vs restrictive

A

Obstructive: greater pressure change REQUIRED
Restrictive: greater EFFORT to achieve pressure change

67
Q

Obstructive vs restrictive lung volumes

A

Obstructive: increased FRC
Restrictive: all volumes decreased

68
Q

Causes of Obstructive vs Restrictive

A

Obstructive: physical obstruction, lack of elastic recoil
Restrictive: stiffness, weakness, edema

69
Q

Restrictive Disease Viscous Cycle

A

Disease —> dyspnea —> poor posture & chest wall mobility —> disuse —> disease

70
Q

Upper Respiratory Infection

A

Cold, influenza

  • can lead to LRI
71
Q

Lower Respiratory Infection

A

Pneumonia - inflammation and consolidation of lung tissue
Abscesses
Bronchitis/Bronchioltis

72
Q

Pneumonia

A

Bacterial divided into lobar and bronchopneumonia

73
Q

Atypical Pneumonia

A

Caused by micro plasma, viruses, chlamydia

74
Q

Walking Pneumonia

A

Infection by mycoplasma pneumonia
- watery sputum and substernal burning with coughing
- pt does not feel ill and can function to a large degree
- requires antibiotics that does not act on cell walls as mycoplasma do not have cell walls

75
Q

Viral Pneumonia

A

Fever, headache, muscle ache, dry cough, dry hacking, no sputum

76
Q

Lobar Pneumonia

A

When pneumonia is limited to a lobe or segment of the lung

  • lower lobe mostly affected DUH
77
Q

Bronchopneumonia

A

Widespread inflammation of distal airways

78
Q

Lung Abscesses

A

Aspiration of infected material due to dysphagia

79
Q

Epiglottitis

A

Life threatening infection of young children

*vaccine now so its less common

80
Q

Croup

A

Upper airway infection that blocks breathing and has a barking cough
- inspirations strider, cough

81
Q

Respiratory Synctial Virus RSV

A

Cause of Viral pneumonia in children under 2

  • passed due to lack of handwashing
82
Q

Walking speeds for ADLs and crossing street and such

A

Look in the last lecture idk but pretty fast ig

CardioPulm (17 decks)

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