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DPT 528 > Quiz #3 > Flashcards

Quiz #3 Flashcards

1
Q

does restrictive lung disease involve difficulty getting air in or out?

A

difficulty getting air in

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2
Q

does obstructive lung disease involve difficulty getting air in or out?

A

difficulty getting air out

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3
Q

what is ventilation?

A

air in and out

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4
Q

what is respiration?

A

gas exchange

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5
Q

what is RLD?

A

abnormal reduction in pulmonary ventilation due to restriction of chest wall or lung expansion

decreased air moving in and out

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6
Q

what is the pathogenesis of RLD?

A

decreased chest wall compliance (stiff and difficult to expand)

decreased lung volumes and capacities

increased work of breathing (need greater transpulmonary pressure)

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7
Q

what anatomy is affected by restrictive lung disease?

A

lung parenchyma

thoracic pump

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8
Q

what breathing difficulty is associated with restrictive lung disease?

A

inspiration

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9
Q

how is tidal volume maintained with restrictive disease?

A

increased respiratory rate

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10
Q

what inspiratory muscles need to work harder due to decreased compliance?

A

diaphragm, external intercostals, accessory muscles

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11
Q

what are the 6 classic signs of RLD?

A

1) tachypnea
2) hypoxemia
3) decreased breath sounds w/dry inspiratory crackles heard at the base of the lungs caused by ateletactic alveoli
4) decreased lung volumes and capacities
5) decreased DLCO
6) cor pulmonale

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12
Q

what is diffusing capacity of the lungs for carbon monoxide (DLCO)?

A

measures of integrity of the functional unit

measure CO bc Hgb has a higher affinity for it than O2

gas perfusion measurement

dysfunction of alveoli membrane

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13
Q

what is cor pulmonale?

A

R sided HF

fibrotic pulmonary capillary beds –> pulm HTN –> hypoxemia (low O2 in blood)

caused by pulmonary disease

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14
Q

t/f: <50% DLCO is predictive of restrictive lung disorder

A

true

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15
Q

what are the 3 symptoms of RLD?

A

1) dyspnea/SOB
2) dry, non-productive cough
3) muscle wasting (cachexia)

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16
Q

what is the treatment for RLD if the etiology is permanent?

A

supportive measures

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17
Q

what are supportive measures?

A

supplemental oxygen

antibiotic therapy for secondary infection

interventions to promote adequate ventilation

interventions to prevent accumulation of secretions

good nutritional support

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18
Q

what is the treatment for RLD if the etiology is reversible?

A

corrective (chest tube) and supportive (temporary mechanical ventilation)

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19
Q

what is the role of surfactant?

A

keeps the alveoli open and prevents them from collapsing in on itself

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20
Q

what is respiratory distress syndrome (RDS)?

A

hyaline membrane disease

lack of complete lung maturation

inadequate surfactant production in alveoli

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21
Q

how is RDS diagnosed?

A

chest radiograph will show diffuse hazy appear with low lung volumes

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22
Q

how is RDS treated?

A

CPAP

PEEP

ECMO

surfactant replacement therapy

corticosteroids to mother b4 brith

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23
Q

what should the lungs look like on a chest x-ray?

A

black

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24
Q

when does normal aging begin?

A

in 20s

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25
Q

what is the treatment for maturational cuases of restrictive lung dysfunction?

A

keep aerobically exercising (walk 10 min, 3x/day)

strength training

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26
Q

what are some causes of RLD?

A

interstitial, infectious, neoplastic, pleural, cardiovascular, neuromuscular, connective tissues, maturational, immunologic, pregnancy, nutrition/metabolic, traumatic, therapeutic, pharmaceudical, radiologic

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27
Q

what are the 3 interstitial causes of RLD?

A

1) idiopathic pulmonary fibrosis
2) sarcoidosis
3) broncholitis obliterans

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28
Q

what is idiopathic pulmonary fibrosis?

A

chronic and irreversible

respiratory dysfunction due to fibrotic repsonse driven by abnormally activated alveolar epithelial cells

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29
Q

what is the pathophysiology of idiopathic pulmonary fibrosis?

A

atypical reparative process after lung epithelium injury (excessive fibroblast activity)

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30
Q

what is the worst environmental factor affecting idiopathic pulmonary fibrosis?

A

smoking

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31
Q

what is seen on a chest x-ray or CAT scan of idiopathic pulmonary fibrosis?

A

patchy focal lesions scattered

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32
Q

what is the disease progression in idiopathic pulmonary fibrosis?

A

steady decline in fxn

epithelial cells become more fibrotic

inflammation followed by repair process followed by fibroblastic phase

acute exacerbations characterized by rapid deterioration in lung fxn

survival rate: 2-3 years after dx

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33
Q

what are the diagnostic tests for idiopathic pulmonary fibrosis?

A

hx (exclusion of other causes of interstitial lung disease)

high res CT(patchy, peripheral, bibasilar reticular opacities)

chest radiography (opacities/infiltrates)

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34
Q

t/f: chest radiography lacks diagnostic specificity for idiopathic pulmonary fibrosis

A

true

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35
Q

what is the characteristic appearance of variably sized cysts in a background of densely scarred lung tissue in idiopathic pulmonary fibrosis?

A

honeycomb

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36
Q

what are the symptoms of idiopathic pulmonary fibrosis?

A

dyspnea on exertion

nonproductive cough

weight loss

fatigue

sleep disturbances

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37
Q

what are the signs of idiopathic pulmonary fibrosis?

A

decreased lung capacities

abnormal markings on chest x-ray

inspiratory dry rales

distal clubbing

pulm HTN

pedal edema

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38
Q

what is the treatment of idiopathic pulmonary fibrosis?

A

antifibrotic drugs

supportive care (supplemental O2)

pulm rehab (exercise)

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39
Q

what is sarcoidosis?

A

idiopathic multisystems granulomatous inflammatory disorder

primarily affecting black women

unknown etiology

20-40 y/o

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40
Q

what is the hilum?

A

the entrance of the major arteries and blood vessels from the heart and lungs

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41
Q

what are the 3 distinctive features of sarcoidosis?

A

1) inflammation: flu-like symptoms, night sweats, jt pain, fatigue
2) granulomas: masses of inflammed tissue
3) pulmonary sarcoidosis: scar tissue in lungs

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42
Q

what are the pulmonary causes of restrictive lung dysfunction?

A

bronchopulmonary dysplagia

bronchiolitis obliternas

necrosis of BRONCHIOLES

fibrotic lung disease that affects small airways

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43
Q

what is bronchopulmonary dysplagia?

A

chronic pulmonary syndrome in neonates who’ve been ventilated and receiving high concentrations of O2

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44
Q

what is bronchiolitis obliternas?

A

infection causing restrictive and obstructive lung dysfunction

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45
Q

what causes bronchiolitis obliterans in children?

A

viral infection

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46
Q

what causes bronchiolitis obliterans in adults?

A

toxic fume inhalation, viral, basterial, RA, graft vs host rxn

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47
Q

what lung structure is affected by bronchiolitis obliterans?

A

bronchioles

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48
Q

what is pneumonia?

A

inflammation of lung parenchyma beginning in lower respiratory tract

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49
Q

what are the 2 categories of pneumonia?

A

community acquired

hospital acquired (healthcare or ventilator associated)

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50
Q

what are the 4 types of pneumonia?

A

bacterial

viral

fungal

chlamydial

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51
Q

what is community acquired pneumonia most often caused by?

A

staph aureus (bacterial pneumonia)

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52
Q

what are bacterial pneumonias?

A

streptococcus pneumoniae

pseudomonas aeruginosa

staphylococcus aureus

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53
Q

what bacterial pneumonia has a vaccine?

A

staph aureus

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54
Q

what bacterial pneumonia is the msot often occuring nosocomial infection?

A

pseudomonas aeruginosa

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55
Q

what is the most common pneumonia in young children?

A

viral pneumonia

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56
Q

what is mycoplasma pneumonia?

A

atypical bacterial pneumonia

walking pneumonia

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57
Q

what pneumonia can emenate from air-conditioning equipment?

A

legionella pneumophila

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58
Q

what pneumonia is associated with AIDS?

A

fungal pneumonia

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59
Q

what are the symptoms of bacterial pneumonia?

A

high fever, chills, dyspnea, tachypnea, nonproductive cough, pleuritic pain

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60
Q

what are the symptoms of viral pneumonia?

A

moderate fever, dyspnea, tachypnea, nonproductive cough, myalgias

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61
Q

how is pneumonia treated?

A

antibiotic therapy

O2 (supplemental of vent) may be necessary with refractory hypoxemia (PaO2<60)

postural drainage, percussion, vibration, and assisted coughing

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62
Q

what is refractory hypoxemia?

A

O2 levels stay the same despite use of supplemental O2

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63
Q

what are neoplastic causes of RLD?

A

bronchiogenic carcinoma

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64
Q

what is bronchiogenic carcinoma?

A

malignant growth of abnormal epithelial cells in the tracheobronchial tree

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65
Q

is the risk of lung cancer more closely related to when someone starts smoking or how much someone smokes?

A

when someone starts smoking

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66
Q

what are the 2 main types of bronchogenic carcinomas?

A

1) small cell
2) non-small cell

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67
Q

what are the 3 types of non-small cell cancers?

A

1) adenocarcinoma
2) squamous cell carcinoma
3) large cell carcinoma

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68
Q

what is the most common type of lung cancer?

A

adenocarcinoma

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69
Q

what lung cancer starts in the bronchi and could present like obstructive lung disease?

A

squamous cell carcinoma

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70
Q

what lung cancer is rare, but rapidly growing and often not known until it is widespread?

A

large cell carcinoma

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71
Q

what is the most common lung cancer type in smokers?

A

small cell cancer

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72
Q

what type of lung cancer metastasizes very quickly to lymph nodes and vascular channels and is already metastatic at diagnosis?

A

small cell cancer

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73
Q

t/f: 75% of small cell cancers metastasize to the CNS

A

true

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74
Q

where is small cell cancer located?

A

bronchial epithelium near the hilar region

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75
Q

where is squamous cell carcinoma located?

A

bronchial epithelium near the hilar and projects to the bronchi

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76
Q

where is adenocarcinoma located?

A

mucous glands

tracheobronchial tree

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77
Q

where is large cell carcinoma located?

A

central or peripheral but often in trachea/large airways

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78
Q

what is the growth rate of small cell cancer?

A

very rapid

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79
Q

what is the growth rate of adenocarcinoma?

A

moderate

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80
Q

what is the growth rate of squamous cell carcinoma?

A

slow

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81
Q

what is the growth rate of large cell carcinoma?

A

rapid

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82
Q

what are the diagnoistic tests for bronchiogenic carcinoma?

A

chest x-ray and PET scans

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83
Q

what are the treatment options for bronchiogenic carcinoma?

A

surgery, radiation, chemo, immunotherapy

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84
Q

what is the most radiosensitive bronchiogenic carcinoma?

A

small cell followed by squamous

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85
Q

what is the treatment of choice for small cell cancer?

A

chemo

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86
Q

chemo has a low effect on what type of bronchiogenic carcinoma?

A

non-small cell

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87
Q

what is pleural effusion?

A

abnormal amount of pleural fluid in the pleural space

88
Q

what are the 3 main etiologies of pleural effusion?

A

cardiac failure, pneuomnia, and malignant neoplasms

89
Q

what is transudative effusion?

A

associated with HYDROSTATIC PRESSURE in pleural capillaries

LOW protein content

CARDIOGENIC

increased pulmonary capillary pressures–> fluid in pulmonary interstitium

fluid enters the pleural space, exceeding the drainage capacity of the lymphatics

90
Q

what is exudative effusion?

A

INFLAMMATORY PROCESSES produce increased PERMEABILITY of pleural surfaces, allowing proteins and excessive fluid to move into pleural space

HIGH protein content

NON-CARDIOGENIC

91
Q

what is the most common cardiogenic origin of transudative effusions?

A

CHF

92
Q

what is the purpose of the pleural cavity?

A

lubrication for movement

93
Q

what is the fluid in the pleural cavity made of?

A

filtrate from capillaries and lymphatics

94
Q

what is the difference b/w pleural effusion and pulmonary edema?

A

pulmonary edema involved fluid int he alveoli

pleural effusion involved fluid in the pleural space

95
Q

is the parietal pleura high or low pressure?

A

high pressure

96
Q

is the visceral pleura high or low pressure?

A

low pressure

97
Q

fluid moves from the ___ pleura capillaries into the pleural space and is then reabsorbed into the ___ pleural capillaries

A

parietal, visceral

98
Q

t/f: more blood flows from the parietal pleura towards the lungs

A

true

99
Q

what is oncotic pressure?

A

pressure from amount of protein

fluid into capillaries

100
Q

what is hydrostatic pressure?

A

fluid out of capillaries

101
Q

what pleural diseases can cause pleural effusion?

A

pleuritis

fibrothorax

pneumothorax

emphysema

hemothorax

102
Q

what is pleuritis?

A

inflammation of pleura (visceral or parietal)

103
Q

what is fibrothorax?

A

visceral pleura becomes fibrotic and destroys pleural cavity

pleural cavity becomes connective tissue

104
Q

what is pneumothorax?

A

air in the lungs

105
Q

what is emphysema?

A

pus in the lungs

106
Q

what is hemothorax?

A

blood in the lungs

107
Q

what are the 3 types of pneumothorax?

A

1) closed
2) open
3) tension

108
Q

what is a closed pneuomothorax?

A

the amount of air entering the pleural cavity doesn’t increase

collapsed lung

lung or bronchus rupture

109
Q

what is an open pneumothorax?

A

air goes in and out

chest wound

110
Q

what is a tension pneumothorax?

A

air continually going into the pleural space

wound

air accumulates in the pleural cavity

111
Q

how is a pleural effusion diagnosed?

A

hx/exam

chest radiography (white fluid)

thoracoscopy (thoracentesis-analysis of fluid-exudate)

opacity of atelectactic segment/lobe (large hematogenous opacity of fluid)

elevation of hemidiaphragm on affected side

blunting of costophrenic angle

shift of mediastenum toward the affected side

112
Q

what is the costophrenic angle?

A

where the diaphragm meets the ribs

113
Q

what lung sound is indicative of pleural inflammation?

A

pleural rub

114
Q

where are bronchial breath sounds normally heard?

A

normally heard b/w 1st and 2nd rib; anywhere else is abnormal

115
Q

what is egophany?

A

e sounds like ah

116
Q

when is abnormal bronchial breath sounds, pleural rub, and/or egophany heard?

A

in pleural effusions/inflammation

117
Q

how is pleural effusion treated?

A

based off the underlying cause

thoracentesis (needle extracts fluid)

thoracoscopy (scope explores hemithorax)

pleural space chest tube

118
Q

what are chest drains?

A

one-way mechanism that lets air/fluid out of the pleural space and prevents outside air/fluid from entering

119
Q

___ pressure during inspiration causes the water level in the chest tube to rise slightly

A

negative

120
Q

____ pressure during expiration pushes air and fluid out of the pleural space and into the chest tube and collection bottle

A

positive

121
Q

what helps with fluid drainage in chest tubes?

A

gravity

122
Q

t/f: pleural effusion is an indication for bronchopulmonary hygiene techniques

A

false

123
Q

why don’t drainage positions work to treat pleural effusions?

A

bc the fluid is in the pleural space, not the alveoli

124
Q

what is atelectasis?

A

incomplete expansion of the lungs or loss of volume

collapsed, nonaerated lung parenchyma

125
Q

what are the 6 types of atelectasis?

A

1) obstruction (resorptive)
2) passive
3) adhesive
4) compressive
5) cicatrization
6) congestive

126
Q

what 2 types of atelectasis can best be treated by pT

A

obstructive and passive

127
Q

what types fo atelectasis are most associated with bedrest and surgery?

A

obstructive and passive

128
Q

what is obstruction atelectesis?

A

the most common

due to a tumor, mucus plug, or foreign body

129
Q

what is passive atelectasis?

A

simple pneumothorax

associated with bedrest, sedation, anesthesia, and not taking deep breaths

130
Q

what is adhesive atelectasis?

A

surfactant deficiency

131
Q

what is compressive atelectasis?

A

space occupying lesion

pleural effusion

132
Q

what is cicatrization atelectasis?

A

fibrosis

133
Q

what is congestive atelectasis?

A

edema and hemorrhage into lung parenchyma from PE

134
Q

how is atelectasis diagnosed?

A

chest radiograph

135
Q

what is the treatment for atelectesis?

A

manage the underlying cause

deep breathing or incentive spirometry, coughing

136
Q

what does incentive spirometry measure?

A

max inspiration with a single breath

137
Q

what is ARDS?

A

inflammation causing an increase in pulmonary vascular permeability, lung weight, and loss of aerated tissue

a form of non-cardiogenic pulmonary edema, due to alveolar injury secondary to an inflammatory process, that can be either pulmonary or systemic (extra pulmonary) in origin

138
Q

what syndrome is described as a”leaky bucket” where excessive fluid is leaking out of endothelial capillary and alveolar membrane?

A

ARDS

139
Q

what is a milder case of ARDS?

A

ALI

140
Q

what are the pulmonary origins of ARDS?

A

pneumonia

inhalation injury

aspiration or gastric contents

chest trauma/pulmonary contusion

near drowning

141
Q

what are the non-cardiogeneic causes of ARDS?

A

sepsis

major trauma

burns

pancreatitis

fat embolism

hypovolemia

transfusion-related acute lung injury

cardiopulmonary bypass

142
Q

what is the 3 stage process of ARDS?

A

1) exudative
2) proliferative
3) fibrotic

143
Q

what is the exudative stage of ARDS?

A

inflammatory phase with release of inflammatory mediators causing edema in the lungs

ventilation-perfusion mismatch

reduced compliance

thrombus formation w/in pulmonary capillaries

144
Q

what is the proliferative stage of ARDS?

A

synthesis of scarring

145
Q

what is the fibrotic stage of ARDS?

A

scars mature into fibrotic tissue

146
Q

what are the signs of ARDS?

A

decreased pulmonary capacities and compliance

decreased DLCO

chest x ray shows bilateral opacities (DEFINING CRITERIA)

decreased ABGs

decreased breath sounds over fluid filled areas, wet rales, wheezing, rhonci

tachycardia and maybe arryhthmias due to hypoxemia

147
Q

what are the symptoms of ARDS?

A

appearn acutely ill

dyspnic at rest and w/activity

fast, labored breathing

cyanotic

may have impaired mental status, restlessness, headache, anxiety

148
Q

what are the treatments for ARDS?

A

treat precipitating cause

mechanical ventilation (lung protective vent, PEEP, and proning)

supportive

prevent/treat complications

149
Q

what is the goal of lung protective ventilation?

A

adequate gas exchange and low TV

150
Q

what is positive end expiratory pressure (PEEP)?

A

keeps the alveoli open

PREVENTS alveolar collapse

5-15 cm H2O

higher cm H2O=worse condition

151
Q

what is proning?

A

delivery of mechanical ventilation with pt in prone to IMPROVE OXYGENATION and IMPROVE LUNG PERFUSION

152
Q

what are the cardiovascular causes of RLD?

A

pulmonary edema

pulmonary emboli

153
Q

what is pulmonary edema?

A

increased fluid int eh lungs from pulmonary vascular systems starting int he interstitial space and progressing to alveolar space

154
Q

what are the 2 main categories of pulmonary edema?

A

cardiogenic and noncardiogenic

155
Q

what is the primary cause of cardiogenic pulmonary edema?

A

left ventricular failure

156
Q

what are causes of cardiogenic pulmonary edema?

A

LEFT VENTRICULAR FAILURE

ARDS

renal failure

high altitude pulmonary edema

heart disease

157
Q

how does L ventricular failure result in cardiogenic pulmonary edema?

A

increased L atrial pressure –> pressure back on pulmonary circulation–> increased microcirculation (hydrostatic pressure)–>fluid spills into interstitial space

158
Q

the lymphatics don’t work when the pulmonary vascular hydrostatic pressure is >___mmHg

A

30

159
Q

pulmonary edema of cardiac origin has ___ protein content

A

low (transudative)

160
Q

what are Kerly B lines and what are they indicative of?

A

short, thin horizontal lines extedning inward from pleural space

indicative of cardiogenic pulmonary edema

161
Q

what breath sounds are heard in cardiogenic pulmonary edema?

A

wet rales with decreased breath sounds

bronchospasms and wheezing

162
Q

are arrythmias common in cardiogenic pulmonary edema?

A

yes

163
Q

what are the symptoms of cardiogenic pulmonary edema?

A

appear in respiratory distress

report sense of suffication

SOB

orthopnea

cough with pink frothy sputum

cynaptic

increased RR

labored breathing

pallor

diaphoresis

164
Q

how is cardiogenic pulmonary edema managed?

A

decrease cardiac prelaod (GET FLUID OUR OF HEART) with diuretics, vasodialtors, decreased sodium, and physical activity

maintain oxygenation of tissues with supplemental O2 and mechanical vent as needed

165
Q

what is a pulmonary emboli?

A

complication of venous thrombosis that travels from systemic vein (mostly from the legs) to pulmonary circulation

166
Q

t/f: 1/3 of pulmonary emboli end with death w/in an hour

A

true

167
Q

what fraction of ppl with a DVT/PE will have another one within 10 years?

A

1/3

168
Q

t/f: PE are clinically silent

A

true

169
Q

what are the classical traid of symptoms with PE?

A

pleuritic chest pain, hemoptosis, and DVT

170
Q

what % of orthopeadic pts will have a PE w/o blood thinners

A

80%

171
Q

what are the pathophysiologic changes associated with PE?

A

occlusion of pulmonary artery branch leads to edema and hemorrhage

lack of blood flow–>necrosis of alveolar walls–> inflammatory response

a portion of the lung is ventilated but no longer perfused

172
Q

what is the clinical presentation of PE?

A

dyspnea

chest pain

hemoptysis

173
Q

what are the risk factors for DVT?

A

immobilization

injuries to leg

increased age

inherited clotting disorders

infectious and inflammatory diseases

pregnancy/contraceptives

cancer

smoking

obesity

burns

thrombocytosis

sickle cell anemia

orthopedic pts

174
Q

how is a PE diagnosed?

A

CT pulmonary angiography

175
Q

what 4 things should be involved in DVT risk assessment?

A

1) advocate for a culture of mobility
2) assess for risk during hx and exam
3) when pts present with conditions that increase their risk, we should be highly suspicious of DVT
4) promote preventative measures for those with high risk

176
Q

what is the medical intervention for PE?

A

prevention

anticoagulants

some kind of filtration device

177
Q

what are the neuromuscular causes of RLD?

A

SCI

ALS

GBS

myasthenia gravis

duchenne’s muscular dystrophy

178
Q

what muscles are involved in inspiration?

A

external intercostals

179
Q

what muscles are involved in expiration?

A

internal intercostals

180
Q

what can cervical SCI cause?

A

decreased VC and MVV

weak/paralyzed expiratory muscles

weak/absent diaphragm

181
Q

what can weak/paralyzed expiratory muscles and weak/absent diaphragm lead to?

A

inability to cough

pulmonary infection

alveolar hypoventilation, hypoxemia, and hypercapnia

182
Q

what can alveolar hypoventilation, hypoxemia, and hypercapnia lead to?

A

atelectasis

183
Q

what is paradoxical breathing?

A

diaphragm goes up and chest wall goes in with inspiration; diaphragm goes down and chest wall flares with expiration

chest expands and abdomen draws in with inspiration; abdomen pushes out with expiration

184
Q

how is cervical SCI treated?

A

strengthen and increase the endurance of any remaining ventilatory muscles
- inspiratory muscle training
- resistance exercise training
- incentive spirometry

secretion clearance techniques
- postural drainage, percussion, vibration, assisted cough, suctioning

185
Q

what is ALS?

A

progressive degenerating NS disease involving demyelinated UMNs and LMNs

186
Q

what are the phases of respiratory involvement in ALS?

A

phase 1: minimal complications

phase 2: risk for complications

phase 3: respiratory failure with signs of disease progression

phase 4: continuous non-invasive ventilation (NIV)

phase 5: trach, QOL

187
Q

what lung fxn tests are used in ALS phase 2?

A

forced vital capacity

max inspiratory pressure

188
Q

what NIF/MIP is indicative of impaired diaphragm fxn?

A

above 60

189
Q

what FVC is indicative of impaired diaphragm fxn?

A

less than 50%

190
Q

what is BiPAP?

A

bilevel positive assisted airway pressure

opens up alveoli and prevents them from collapsing

191
Q

what is the difference b/w BiPAP and PEEP?

A

PEEP just keeps the alveoli from collapsing, BiPAP also opens them up

many different mask options

192
Q

what are these examples of:

mechanical insufflation-exsufflation device

suction devices

A

cough assist devices

193
Q

what is GBS?

A

demyelination of peripheral motor neurons

idiopathic polyneuritis linked to the immune system

194
Q

what is the treatment for GBS?

A

heat for pain, PROM, active exercise including breathing

195
Q

what is myasthenia gravis?

A

chronic neuromuscular disease characterized by progressive muscular weakness on exertion

autoimmune attack on acetylcholine receptors at the postsynaptic neuromuscular junction

weakness and fatigue of voluntary muscles, SOB, weak and ineffective cough

196
Q

what is Duchenne’s muscular dystrophy?

A

genetically determined progressive degenerative myopathy

involvement of diaphragm late in disease

197
Q

what is the treatment of DMD?

A

supportive, preserving mobility, and prevention of respiratory infection

198
Q

what are the s/s of the neuromuscular causes of RLD?

A

respiratory muscle weakness

decreased breath sounds

SOB/dyspnea at rest

inability to cough

ineffective clearning of secretions

poor voice volume

decrease in life activities

199
Q

what are connective tissue causes of RLD?

A

rheumatoid arthritis

systemic lupus erythematosus

scleraderma

polymyositis

200
Q

what is rheumatoid arthritis?

A

chronic inflammation of peripheral jts resulting in progressive destruction of articular and periarticular structures

strong correlation with smoking

lung PARENCHYMA changes

decreased chest wall compliance and decreased inspiratory power

pain from pleurisy

201
Q

how is RA treated?

A

corticosteroids and immunosuppressant drugs

202
Q

what is systemic lupus erythematosus (SLE)?

A

chronic inflammatory connective tissue disorder

most in black women

antigen-antibody reactions

pleurisy

diaphragmatic weakness

BUTTERFLY RASH

203
Q

how is SLE treated?

A

reverse autoimmune and inflammatory changes

prevent complications

204
Q

what is scleroderma?

A

progressive fibrosing disorder that causes degenerative changes in skin, small blood vessels, esophagus, intestinal tract, lung, heart, kidney, and articular structures

FIBROSIS

idiopathic

more common in women

205
Q

how is scleroderma treated?

A

treat specific symptoms

supportive

206
Q

what are musculoskeletal causes of RLD?

A

kyphoscoliosis

ankylizing spondylitis

pectus excavatum

pectus carinatum

pregnancy

obesity

207
Q

what is kyphoscoliosis?

A

combo of excessive AP and lat curvature of thoracic spine

only 3% have lung dysfxn

208
Q

how is hyphoscoliosis treated?

A

orthotic devices

exercise

surgery

pulmonary compromise (immunizations, good hydration, aggressive treatment of pulm infections, avoidance of sedatives, supplemental O2, and resp musc training)

209
Q

what is ankylosing spondylitis?

A

chronic inflammatory disease of the spine characterzied by immobility of SI and vertebral jts and ossification of paravertebral ligs

low chest compliance

210
Q

how is ankylosing spondylitis treated?

A

maintain good body alignment, thoracic mobility

211
Q

what is pectus excavatum?

A

funnel chest

sternal depression and decreased AP diameter

decreased TLC, VC, and max voluntary ventilation

212
Q

what is pectus carinatum?

A

pigeon breast

sternum protruding anteriorly

associated with prolonged childhood asthma

213
Q

how does pregnancy lead to RLD?

A

decreased chest wall compliance due to downward excursion of diaphragm

closing small airways

ventilation-perfusion mismatch

increased work of breathing

214
Q

how does obesity lead to RLD?

A

decreased lung capacities, lung volumes, and respiratory musc strength

increased airway resistance pulmonary diffusion

heterogeneity of ventilation distribution

hypercapnic resp failure

215
Q

what are traumatic causes of RLD?

A

crush injuries

penetrating wounds

216
Q

how does surgical therapy lead to RLD?

A

pulm dysfxn due to anesthetic agent, surgical incision, pain post-op

DPT 528 (9 decks)

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