Pulmonary Changes with Age Exam 3

Question 1

Mechanical Changes: thoracic cage

Answer 1

Increased collagen leading to increased stiffness of costovertebral joints

loss of disc height leading to increase thoracic kyphosis and increased A-P diameter of the cage

Question 2

Lung Parenchyma Changes with age

Answer 2

Decreased compliance in small airways

● More difficult to fill with air

⦿Increased size & production of mucous glands

⦿Decreased elastic recoil of lungs

● gas trapping…what is this similar to? COPD

Question 3

Alevoli change with age

Answer 3

• decreased available surface area of gas exchange
• decreased diffusion capacity

decreased number of pulmonary capillaries

Question 4

Change in respiratory muscle with age?

Answer 4

⦿Decreased size of Type I and II
⦿Decreased number of motor units
⦿Slowing at the neuromuscular junction
⦿Lose optimal L-T due to anatomical changes

• muscles must work harder to create negative pressure

Question 5

Lung volume and capacities with age

Answer 5

⦿Decreased FVC ⦿Decreased FEV1 ⦿Increased RV

⦿No change in TLC

Question 6

If you exercise with elders what changes will be seen with a greater ventilation:

Answer 6

• increased oxygen consumption
• decreased strength of respiratory muscle
• increased resistance to airflow
• changes in bony thorax

Question 7

In elders who exercise less oxygen is available for myocardium and muscles during exercise leading to what?

Answer 7

● Decreased compliance of chest wall
● Decreased respiratory muscle strength 
● Lungs are more compliant (air trapping)
 ● Increased small airway resistance
● Decreased ability to diffuse gasses
● Able to maintain respiration at rest

Question 8

Normal inspiratory reserve volume

Answer 8

3100 ml

Question 9

Normal tidal volume

Answer 9

500 ml

Question 10

Normal expiratory reserve volume

Answer 10

1200 ml

Question 11

Normal residual volume

Answer 11

1200 ml

Question 12

Normal Inspiratory capacity

Answer 12

3600 ml

Question 13

Normal residual capacity

Answer 13

2400 ml

Question 14

Normal Vital capacity

Answer 14

4800 ml

Question 15

Normal Total lung capacity

Answer 15

6000 ml

6 liters in men
5 liters in women

Question 16

FEV1 ranges

Answer 16

● Little Obstruction FEV1 > 2 L

● Mild to Moderate FEV1 1-2L ● Severe FEV1 <1L

Question 17

Gold Classification system gold 1:

Answer 17

mild

FEV 1 > 80% predicted

greater than or equal to 80

Question 18

Gold Classification system gold 2:

Answer 18

Moderate

50 < FEV1 < 80% predicted

equal to 50

Question 19

Gold Classification system gold 3:

Answer 19

Severe

30 < FEV1 < 50%

Equal to 50

Question 20

Gold Classification system gold 4:

Answer 20

Very severe

FEV1 < 30%

Question 21

Goals for medical assessment

Answer 21

Determine level of airflow limitation

Determine impact on health status

Determine risk of future events

Question 22

Chronic obstructive pulmonary disease (COPD)

Answer 22

a common, preventable, and treatable disease, is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.

Question 23

Goals of treating COPD

Answer 23

“Concomitant diseases are common; heart disease, muscle wasting, metabolic syndrome, anxiety, depression, lung cancer. These should be evaluated and treated as they have an independent correlation to hospitalizations and mortality.”

Question 24

compared to usual care PR provides moderately large and clinically significant improvements in:

Answer 24

● Dyspnea
● Fatigue
● Emotional functioning 
● Health-related QOL
● Exercise capacity

Question 25

PR Goals:

Answer 25

``` ⦿Modification of Risk Factors ⦿Increase strength ⦿Increase endurance ⦿Reduce economic burden of pulmonary disease ⦿Return to work ⦿Improve quality of life ```

Question 26

Candidates of PR:

Answer 26

Dx of chronic, stable respiratory condition with symptoms that impair FUNCTION

Question 27

Terminating exercise in PR

Answer 27

``` ⦿ Breathlessness, fatigue, weakness beyond normal levels that doesn’t improve with rest or management with oxygen, medications, tripod positioning ⦿ Chest pain or tightness ⦿ Muscle pain that doesn’t improve ⦿ Feeling Dizzy or faint ⦿ Leg pain, weakness, cramping ⦿ Sweating more than usual with exercise ```

Question 28

MMRC dyspnea scale grade 0

Answer 28

only get breathless with strenuous exercise

Question 29

MMRC dyspnea scale grade 1

Answer 29

short of breath when hurrying on level ground or walking up a hill

Question 30

MMRC dyspnea scale grade 2

Answer 30

walk slower than people of same age b/c of breathlessness or have to stop for breath when walking at my own pace

Question 31

MMRC dyspnea scale grade 3

Answer 31

Stop for breath after walking 100 yards or a few minutes on level ground

Question 32

MMRC dyspnea scale grade 4

Answer 32

too breathless to leave house or i am breathless when dressing

Question 33

St. george is validated in:

Answer 33

COPD, bronchiectasis and sarcoidosis

Question 34

Transtheoretical model: precontemplation

Answer 34

No intention to take action in next 6 months

Question 35

Transtheoretical model: contemplation

Answer 35

Intention to take action in next 6 months

Question 36

Transtheoretical model: preparation

Answer 36

Intention to take action in next 30d and has taken | behavioral steps to initiate change

Question 37

Transtheoretical model: action

Answer 37

Behavior has changed for <6 months

Question 38

Transtheoretical model: maintenance

Answer 38

Behavior has changed for > 6 months