Final Exam - Restrictive Disease Flashcards
(77 cards)
1
Q
How is RLD classified?
A
Mild: TLC 65-80% of predicted
Moderate: TLC 50-65% of predicted
Severe: TLC < 50% of predicted
2
Q
Pulmonary edema findings on CXR?
A
Symmetric perihilar opacities
3
Q
Dyspnea, tachypnea, elevated cardiac pressures, and SNS activation is more pronounced in ____ than in ____ .
A
cardiogenic pulmonary edema
increased-permeabilty pulmonary edema
4
Q
Things that increase cardiogenic pulmonary edema:
A
Acutely increased preload: aortic or mitral regurgitation
Increased afterload/SVR: LVOT obstruction, mitral stenosis, renovascular HTN
5
Q
Causes of negative pressure pulmonary edema?
A
- Laryngospasm
- Epiglottitis
- Tumors
- Hiccups
- OSA
6
Q
Patho of negative pressure pulmonary edema?
A
- Breathing against obstruction increases Pip, drawing in fluid from pulmonary alveolar capillaries
- This decreases Pis, increasing venous return and LV afterload
- All of these increase the transcapillary pressure gradient
- Onset can be a few minutes to hours after obstruction is removed
7
Q
Patho of neurogenic pulmonary edema?
A
Massive outpouring of SNS impulses from the injured CNS causesgeneralized vasoconstriction and blood volume shifting into the pulmonary circulation
8
Q
What three things increase the risk of re-expansion pulmonary edema after relief of a pneumo or pleural effusion?
A
- > 1 L of air/liquid that was in the pleural space
- the duration of collapse (>24 hours increases the risk)
- speed of re-expansion
9
Q
What drugs can lead to pulmonary edema?
What type of edema is it?
A
- Opioids (heroin) and cocaine
- High-permeability (pts have high protein in pulm fluid)
10
Q
How can you tell if a patient is expieriencing drug-induced pulm edema or diffuse alveolar hemorrhage (DAH)?
A
DAH will not respond to diuretics
11
Q
What causes high-altitude pulmonary edema (HAPE)?
A
- Ascending at heights of 2500-5000m
- Caused by HPV and increased pulm vascular pressure
12
Q
Ventilator considerations for patients with pulmonary edema?
A
- Low Vt
- RR 14-18
- End-inspiratory pressures < 30 cmH2O
- Titrate PEEP along with insp. pausing
13
Q
How to prevent aspiration pneumonitits?
A
Elevate the HOB during intubation and extubation
14
Q
If someone aspirates supine, which lobe is likely affected on CXR?
A
Superior RLL
15
Q
What position should you place the patient in if aspiration is suspected?
A
Trendelenburg
16
Q
What e-cigarette additives are associated with EVALI?
A
- THC
- CBD
- Vit E acetate
- Nicotine
17
Q
CXR findings in EVALI?
Treatments?
A
- Similar to the diffuse alveolar damage in ARDS
- Tx: Abx, systemic steroids, supportive care
18
Q
What disesases are associtated with EVALI?
A
- pneumonia
- diffuse alveolar damage
- acute fibrinous pneumonitis
- bronchiolitis
- interstitial lung disease (ILD)
19
Q
What is the most commonly reported finding in COVID-19 induced RLD?
A
Reduced diffusion capacity
20
Q
In COVID-19 induced RLD, what is the highest risk for long-term pulm complications?
A
Pts who require mechanical ventilation
21
Q
What PaO2 defines ARF?
A
- PaO2 < 60 mmHg despite O2 supplementation
- PaCO2 > 50 mmHg without respiratory compensated metabolic alkalosis
22
Q
3 treatment goals in ARF?
A
- Patent airway
- Correction of hypoxemia
- Removal of excess CO2
23
Q
Why are NC, venturi mask, non-rebreather and T-piece only helpful in mild-moderate V/Q mismatching?
A
They cannot provide O2 concentrations above 50%
24
Q
When should you initiate CPAP for a ARF patient?
A
- When PaO2 falls below 60 mmHg
- PaO2 > 60 mmHg should be adequate to keep SpO2 > 90%
25
What is volume-cycled ventilation?
- Fixed Vt with inflation pressure as a dependent variable
- Pressure limit can be set
26
An elevated AP may indicate:
- Pulmonary edema
- Pneumothorax
- Kinked ETT
- Mucous plug
27
Disadvantage of volume-cycled ventilation?
Inability to compensate for leaks in the delivery system
28
Advantages of SIMV over A/C?
* use of respiratory muscles
* lower mean airway pressures
* prevention respiratory alkalosis
* improved pt–ventilator coordination
29
What is pressure-cycled ventilation?
- Provides gas flow until a preset airway pressure is reached
- Vt varies with changes in compliance/resistance
30
What is the most important predisposing factor for developing nosocomial pneumonia?
Intubation
31
What causes barotrauma symptoms (SQ emphysema, tension pneumothorax)?
- Passage of air from ruptured alveoli
- Infection increases risk by weakening pulmonary tissue
32
Hypoxemia d/t atelectasis is not responsive to ____
Increased FiO2
33
Sx of PTX and PE?
Sudden hypoxemia and hypotension
34
How can atelectasis be identified on lung ultrasound?
Bronchogram shows static air
35
Why is PAO2-PaO2 useful?
- Evaluating gas exchange
- Lung function
- Distingusing the cause of arterial hypoxemia
36
Fill in this chart
- R-L shunt only one not responsive to O2
- Hypoventilation only one with increased pCO2
37
desaturation of arterial blood occurs when the Pa02 is ____
< 60 mmHg
38
3 main causes of arterial hypoxemia:
* V/Q mismatch
* right-to-left pulmonary shunting
* hypoventilation
39
What happens to the hypoxemic response to low PaO2 in chronic conditions?
Responses do not occur until PaO2 < 50 mmHg
40
What are the physiologic responses to hypoxemia?
1. Carotid body–induced increase in alveolar ventilation
2. Hypoxic pulmonary vasoconstriction to divert blood flow away from hypoxic alveoli
3. Increased SNS activity to increase COP and enhance tissue oxygen delivery
41
Chronic hypoxemia leads to an increase in ____ to improve 02 carrying capacity
RBC mass
42
What does VD:Vt reflect?
What is normal?
* Efficacy of CO2 transfer across alveolar capillaries
* < 0.3
43
In what 3 pathologies is VD:Vt increased?
- ARF
- ↓ CO
- PE
44
A physiologic shunt is ____ of COP
2-5%
45
General guidlines for extubation:
* Vital capacity of ____
* Alveolar-arterial oxygen difference ____ cmH2O on 100% 02
* Pa02 of >60 mm Hg on Fi02 of ____
* Negative inspiratory pressure of more than ____ cmH2O
* Normal pHa
* RR ____
* VD:VT of ____
* Vital capacity of **>15 mL/kg**
* Alveolar-arterial oxygen difference **< 350** cmH2O on 100% 02
* Pa02 of >60 mm Hg on Fi02 of **< 0.5**
* Negative inspiratory pressure of more than **−20** cmH2O
* Normal pHa
* RR **< 20**
* VD:VT of **< 0.6**
46
What usually signifies that a patient will not tolerate extubation?
Rapid RR with low Vt
| Trial pain medicine to see if that is the cause
47
3 options for vent weaning:
1. SIMV
2. Trial total removal of MV
3. Decrease level of PSV
48
____ is associated with the highest risk of ARDS
Sepsis
49
Sx of ARDS?
* Rapid-onset respiratory failure
* hypoxemia
* CXR findings similar to cardiogenic pulmonary edema
50
What are the interstitial lung diseases (ILD)?
* Sarcoidosis
* Hypersensitivity Pneumonia
* Pulmonary Langerhans Cell Histiocytosis
* Pulmonary Alveolar Proteinosis
* Lymphangioleiomyomatosis
51
____ is a classic manifestation of sarcoidosis?
Hypercalcemia
52
Where can sarcoids develop?
- Neurologic (facial nerve palsy)
- Myocardic (dysrhythmias)
- Endobronchial
- Laryngeal (difficult intubation)
53
What test is use to detect sarcoidosis?
Kveim skin test
54
What enzyme activity is increased in sarcoidosis?
ACE
55
What causes hypersensitivity pneumonia?
Inhalation of fungus/pore particles
56
Primary cause of pulmonary langerhans cell histiocytosis?
CT findings?
Tx?
- Smoking tobacco
- CT shows cysts or honeycombing in upper zones
- Tx: smoking cessation, systemic glucocorticoids, and symptom support
57
Cause of pulmonary alveolar proteinosis?
CXR findings?
Tx for severe cases?
- Lipid-rich protein material in the alveoli from chemo, AIDS, or inhaled dust
- CXR shows batwing alveolar opacitites
- Tx for severe cases includes lung lavage under GA
58
What in the hell is lympangioleiomyomatosis?
Tx:
- Rare multisystem disease causing proliferation of smooth muscle of the airways, lymphatics, and blood vessels
- Occurs in women of reproductive age normally
- Tx: Sirolimus, an immunosuppressive
59
Restrictive changes with aging includes:
- Decreased compliace and ER tissue
- Increased RV, VC, and FRC
- FEV1 and FVC decrease
60
List the diseases that cause thoracic extrapulmonary restrictive diseases:
* ankylosing spondylitis
* flail chest
* scoliosis
* kyphosis
61
What is pectus carinatum?
* “pigeon chest:” deformity of sternum characterized by the outward projection of the sternum & ribs
* Genetic
62
Idiopathic spontaneous ptx occurs most often in ____
Caused by ____
* Tall, thin men, age 20-40
* Rupture of apical subpleural blebs
63
Sx of tension pneumothorax?
Tx:
* trachea may be deviated **away** from ptx
* breath sounds are decreased/absent on the side of ptx
* if the pt is on vent, increased airway pressures and decreased TV
* Tx: Immediate evacuation through a needle or small-bore catheter placed into the second anterior intercostal space
64
Most common anterior mediastinal mass?
Thymoma
65
# thoracic nonpulmonary causes of RLD
What is asphyxiating thoracic dystrophy?
Another name for it?
* Disorder with skeletal dysplasia and multiorgan dysfunction leading to organ cysts, short limbs, and polydactyly
* "Jeune syndrome"
66
# thoracic nonpulmonary causes of RLD
What is Fibrodysplasia ossificans?
genetic variation in bone morphogenetic protein (BMP)
67
# thoracic nonpulmonary causes of RLD
What is poland syndrome?
Partial or complete absence of pectoral muscles, commonly affecting one side.
May also have paradoxical respiratory motion due to the absence of multiple ribs
68
Pts w/ severe neuromuscular disorders are dependent on ____ to maintain adequate ventilation
their state of wakefulness
69
What contributes to cor pulmonale in pts with NM diseases?
During sleep, they can develep hypoxemia and hypercapnia
70
What percent of GB patients require MV?
20-25%
71
At what level of SCI is diaphragmatic breathing maintained?
Injuries below T4
72
Why may SCI patients benefit from a anticholinergic bronchodilator?
Pts have mild bronchial constriction caused by the PNS tone that is unopposed by SNS activity from the spinal cord
73
A BMI > ____ leads to decreased RV and TLC
40
74
When do RLD changes peak in pregnancy?
37 weeks
75
What chest wall change does not return to normal after pregnancy?
Subcostal angle - remains wider by ~20%
76
The enlargin uterus pushes the diaphragm up by ____
4 cm
77
A mediastinoscopy must be performed under ____
General Anesthesia
