Exam #3: Obstructive & Restrictive Disorders Flashcards Preview

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Flashcards in Exam #3: Obstructive & Restrictive Disorders Deck (38):
1

What are the three classifications of obstructive pulmonary disorders?

1) Obstructions from conditions in the wall of the lumen
2) Obstruction related to loss of lung parenchyma
3) Obstruction of the airway lumen

2

List examples of obstructions from conditions in the wall of the lumen.

Asthma
Acute bronchitis
Chronic bronchitis

3

List examples of obstruction related to loss of lung parenchyma.

Emphysema

4

List examples of obstruction of the airway lumen.

Bronchiectasis
Bronchiolitis
Cystic Fibrosis
Acute tracheobronchial obstruction
Epiglottitis
Croup Syndrome

5

Comparing the three major obstructive lung diseases: asthma, chronic bronchitis, & emphysema how are the three distinguished from each other?

- Asthma is the most reversible of obstructive lung diseases
- Chronic bronchitis is hallmarked by increased sputum production
- Emphysema involves the most damage to the alveolar wall

6

What are the classic features of asthma.

- Diffuse airway inflammation
- Increased airway responsiveness
- Partially or completely reversible bronchoconstirction

7

What are the two main types of asthma?

Allergic vs. non-allergic asthma

8

What are the characteristics of allergic asthma?

Extrinsic
Pediatric onset

9

What are the characteristics of Non-allergic asthma?

- Intrinsic
- Adult-onset
- Allergen- specific immunotherapy & environmental control measures NOT helpful

10

Outline the pathophysiology of allergic asthma.

In response to an allergen, a myraid of inflammatory cells release inflammatory mediators that result in:
1) Bronchoconstriction
2) Plasma exudation
3) Edema
4) Vasodilation
5) Mucus hypersecretion
6) Activation of sensory nerves

Chronic inflammation leads to structural changes including:
1) Thickening of the basement membrane
2) Smooth muscle hypertrophy & hyperplasia
3) Angiogenesis
4) Hyperplasia of mucus-secreting cells

11

What are the clinical manifestations of asthma?

Dyspnea accompanied by:
- Cough
- Wheezing
- Anxiety

12

What are common triggers of allergic asthma?

- Exercise
- Aspirin
- Extrinsic factors i.e. allergens
- Intrinsic factors i.e. no identifiable
- *rapid changes in temperature & humidity*

13

What is seen on physical examination of an asthmatic patient?

*****Wheezing*****

- Rapid breathing
- Tachycardia
- Pulsus Paradoxus
- Accessory muscle use
- Active & prolonged expiratory phase
- Hyperresonance to percussion

14

Why is there tachycardia in acute asthma?

Increased work of breathing requires increased HR

15

What is pulsus paradoxus?

- Decrease in blood pressure with inspiration, which is the opposite of normal
- Alveolar hyperinflation constricts pulmonary capillaries & causes an increase in afterload on RV-->pushes the ventricular septum into the LV & decreases the SV ejected

16

How is asthma manifested on PTF?

Decreased airflow rates throughout the vital capacity
- Decreased PEFR
- Decreased FEV1
- Decreased MMEFR

17

Draw the schematics of flow-volume curves in acute asthma, early resolution, and late-resolution.

N/A

18

What are the four therapeutic goals in asthma?

1) Allow patient the pursue ADLs
2) Allow the patient to sleep without awakening b/c of symptoms
3) Minimize bronchodilator use
4) Prevent unscheduled medical care

19

What are the therapeutic options in asthma?

Acute reliever
Controller

20

What are the receptors for rescue treatments?

- B-2 adrenergic (bronchodilation)
- Anticholinergics (M3)

21

List the controller treatments used for asthma.

Inhaled corticosteroids
Antileukotrienes
Long-acting B-agonists
Theophylline
Systemic corticosteroids
Anti-IgE

22

What are the classifications of the restrictive lung disorders?

Lung parencymal
Pleural
Neuromuscular
Infection

23

What are the two subclasses of lung parenchymal disorders?

Fibrotic Interstitial Lung Disease
Atelectatic Disorder

24

List examples of Fibrotic Interstitial Lung Diseases.

1) Diffuse interstitial lung disease
2) Sarcoidosis
3) Hypersensitivity pneumonitis
4) Occupational lung disease

25

List examples of Atelectatic Disorders.

ARDS
Infant RDS

26

List examples of pleural space disorders.

Pneumothorax
Pleural Effusion

27

What are the two classes of neuromuscular, chest wall, and obesity disorders?

Neuromuscular Disorders
Chest Wall Deformities

28

List examples of neuromuscular disorders.

Poliomyelitis
ALS
Muscular Dystrophy
Guillain Barre Syndrome
Myasthenia Gravis

29

List examples of chest wall deformities.

Kyphoscoliosis
Ankylosing Spondylitis
Flail Chest
Obesity

30

List the examples of inflammation of the lung.

Pneumonia
Severe ARDS
Pulmonary Tuberculosis

31

What is ARDS?

Adult Respiratory Distress Syndrome

32

What is ARDS characterized by?

- Damage to the alveolar-capillary membrane
- Widespread alveolar infiltrates & dyspnea

33

What is ARDS accoiated with?

Trauma
Sepsis
Aspiration of gastric acid
Fat emboli sydrome
Shock

34

How is ARDS diagnosed?

Decreased Pa)2 that is refractory to supplemental to O2 therapy

35

What are the three key pathological features of ARDS?

1) Noncardiogenic pulmonary edema= damage to the capillary membrane increases permeability
2) Atelectasis associated with lack of surfactant
3) Fibrosis associated with inflammatory deposition of proteins

36

What are the common findings in ARDS?

1) Severe hypoexmia
2) Decreased compliance from deposition of plasma protein & fluid
3) Decreased FRC
4) White out CXR
5) Non-cardiogenic pulmonary edema (not following the distribution of the vascular tree)

37

How is ARDS treated?

- Mostly supportive
- Identify & correct underlying cause
- Maintain fluid & electrolyte balance
- Block system inflammatory cells
- Adequate oxygenation
- High-frequency jet ventilation
- Inhaled nitric oxide

38

What is absorption atelectasis?

100% oxygen= no Nitrogen

- Body uses O2
- In ARDS that O2 in residual volume is used
- Causes atelectasis

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