Restrictive Lung Disease Flashcards
(141 cards)
1
Q
- TLC volume is used to classify RLD as mild, moderate, or severe:
- Mild disease: TLC _______% of the predicted value
- Moderate disease: TLC _______% of the predicted value
- Severe disease: TLC <____% of the predicted value
A
65-80
50-65
50
2
Q
Causes of Restrictive Lung disease:
A
3
Q
- Acute pulmonary edema can be c/b increased capillary pressure or by increased capillary permeability.
Both of these lead to:
A
Capillary stress failure
4
Q
Pulmonary edema typically appears as __________________ on CXR
A
bilateral, symmetric perihilar opacities
- Diffuse alveolar damage is typically present with the increased-permeability pulmonary edema associated with ARDS
5
Q
____________ has emerged as a newer means to dx pulmonary edema
A
Bedside lung ultrasound
6
Q
Cardiogenic Pulmonary Edema (seen in acute decompensated HF) is characterized by:
A
Dyspnea
tachypnea
elevated cardiac pressures
SNS activation (more than regular increased permeability Pulm edema)
7
Q
risk increased w/conditions that acutely increase preload s/a _________ and __________
A
acute aortic regurgitation and acute mitral valve regurgitation
8
Q
risk are also increased w/conditions that increase ________ and _______ such as left ventricular outflow tract (LVOT) obstruction, _________ and ________-
A
afterload & SVR
mitral stenosis, and renovascular HTN
9
Q
Negative pressure pulmonary edema is also called:
A
post-obstructive pulmonary edema
10
Q
causes of Negative Pressure pulmonary Edema
A
laryngospasm, epiglottitis, tumors, or OSA
11
Q
Negative intrapleural pressure decreases the interstitial hydrostatic pressure, increases venous return, and increases left ventricular ______
A
afterload
12
Q
onset of pulmonary edema ranges from a __________ to ____________after relief of the obstruction (time range)
A
few minutes to 2-3 hrs
13
Q
Additionally, negative pressure leads to intense _________, _________, and __________
A
SNS activation, HTN, and central displacement of blood volume
14
Q
- Sx of negative pressure pulmonary edema:
A
tachypnea, cough, and desaturation
15
Q
Tx of Neg Pressure Pulmonary edema:
A
- supplemental 02 and maintaining a patent airway is usually sufficient, as NPPE typically self-limited
- mechanical ventilation is occasionally needed for a brief period
- radiographic evidence of NPPE resolves within 12-24 hours
16
Q
Neurogenic Pulmonary Edema (develops in a small fraction of acute brain injury pts) occurs ____________ after CNS injury and may manifest during _______ period
A
minutes-hrs
peri-op
17
Q
- A massive outpouring of _____ impulses from the injured CNS causes generalized vasoconstriction and blood volume shifting _______ the pulmonary circulation
A
SNS
into
18
Q
_________ and _________can also injure blood vessels in the lungs
A
Pulmonary HTN & hypervolemia
19
Q
Re-expansion Pulmonary edema is caused by:
A
- The rapid expansion of a collapsed lung may lead to REPE
20
Q
The risk of REPE aOer relief of pneumothorax or pleural effusion is related to
A
- amount of air/liquid that was in the pleural space (>1 L increases the risk)
- the duration of collapse (>24 hours increases the risk)
- speed of re-expansion
21
Q
The high protein content of pulmonary edema fluid suggests that enhanced capillary membrane ___________is a factor in its development
A
permeability
Treatment is supportive care
22
Q
What drugs are notorius for causing Drug induced Pulmonary Edema:
A
Opioids (heroin)
and Cocaine
- the high protein concentration in the pulmonary edema fluid suggests it is a highpermeability pulmonary edema
23
Q
- cocaine causes ____________, _____________, and ______________
A
pulmonary vasoconstriction
acute myocardial ischemia
myocardial infarction
24
Q
Does Naloxone reverse opioid induced pulmonary edema?
A
Nah!
Does reverse the sedation, tho!
- treatment of drug-induced pulmonary edema is supportive (Intubate and mechanically ventilate them)
25
If pulmonary edema does not respond to diuretics, what is the likely cause?
DAH (diffuse alveolar hemorrhage)
26
High-Altitude Pulmonary Edema (HAPE) may occur at heights ranging from ________-______m.
Depends on the ______ of the ascent.
2500-5000m
rate
27
Onset of HAPE is gradual but typically occurs within _____- ____ hours at high altitude
48-72
28
less severe symptoms of ___________may precede pulmonary edema
"mountain sickness"
29
the cause of this high-permeability pulmonary edema is presumed to be________________, which increases pulmonary vascular pressure
hypoxic pulmonary vasoconstriction
30
Anesthesia Implications for pulmonary Edema
31
treatment of HAPE includes 02 administration and _______________
quick descent from the high altitude
* inhalation of nitric oxide may improve oxygenation
32
Chemical Pneumonitis (Aspiration Pneumonia) sx:
abrupt onset dyspnea, tachycardia, and desaturation
* Elevating the HOB during intubation & extubation decrease aspiration risk
33
* When gastric fluid is aspirated, it distributes throughout the lungs and destroys ________ and _________
surfactant-producing cells and pulmonary capillary endothelium
* As a result, there is atelectasis and leakage of intravascular fluid into the lungs, producing capillary-permeable pulmonary edema
34
* This acute lung injury might present with:
tachypnea,
bronchospasm,
acute pulmonary HTN,
and arterial hypoxemia
35
* CXR may not demonstrate evidence of aspiration pneumonitis for ____ hrs
6-12
36
if the pt aspirated in supine position, radiographic evidence of aspiration is most likely in the superior segment of the ______
RLL
37
If aspiration noted, what two things do you do?
the oropharynx should be suctioned and the pt turned to the side
38
T/F: Trendelenburg position will not stop reflux, but can prevent aspiration once gastric contents are in the pharynx
True
39
The aspirated gastric fluid is rapidly redistributed to peripheral lung regions, so lavage for pH testing is _______
not useful
40
* Aspiration pneumonitis is best treated w/ _________ and ________
supplemental 02 & PEEP
41
T/F: There is evidence that abx decrease the incidence of pulmonary infection or alter outcomes
When may antibiotics be considered?
False! no evidence
Abx may be considered if a pt symptomatic after 48 hrs and + culture results
42
E-Cigarette Vaping Associated Lung Injury (EVALI) is associated w/:
pneumonia,
diffuse alveolar damage,
acute fibrinous pneumonitis,
bronchiolitis,
and interstitial lung disease (ILD)
43
What additives have associated with EVALI?
tetrahydrocannabinol (THC),
vitamin E acetate,
nicotine,
cannabinoids (CBD),
and other oils
44
Sx of EVALI:
dyspnea,
cough,
N/V/D,
abd pain,
and chest pain
* Pt may be febrile, tachycardia, tachypnea, and hypoxic
45
Radiologic findings for EVALI are similar to the diffuse alveolar damage seen in -_________
ARDS
46
EVALI Tx:
Antibiotics,
systemic steroids,
and supportive care
47
COVID -19 SLide
48
ARF is present when the Pa02 is <________despite 02 supplementation and in the absence of a _________
60 mmHg
right-to-left intracardiac shunt
49
In ARF, * PaC02 can be __________, __________, or ___________ d/o the relationship of alveolar ventilation to C02 production
Increased, unchanged, or decreased
50
A PaC02 >______ in the absence of respiratory-compensated metabolic alkalosis is consistent with the diagnosis of ARF
50 mmHg
* ARF is characterized by abrupt increased PaC02 and decreased pH
51
* In chronic respiratory failure, the PaC02 is ___________, but the pH is normal
increased
This normal pH reflects renal compensation for respiratory acidosis.
52
3 tx goals of ARF:
1) a patent airway
2) hypoxemia correction
3) removal of excess C02
53
Maintaining Oxygen
54
Volume Cycled Ventilation
55
Vent Modes
56
COmplications of mechanical ventilation
57
* Infection increases the risk of barotrauma, by :
weakening the pulmonary tissue
58
_______ is a common cause of hypoxemia during mechanical ventilation
Atelectasis
* In acute desaturation: check for ETT migration, kinks, or mucous plugs
59
T/F: Hypoxemia d/t atelectasis is responsive to an increase in Fi02
False!
60
Other causes of sudden hypoxemia include ________ and __________, which are usually accompanied by _____
tension PTX and PE
HoTN
61
___________may be necessary to remove mucous plugs
Bronchoscopy
62
Atelectasis may be identified on _________ by presence of static air bronchograms
bedside lung ultrasound (LUS)
63
* The efficacy of gas exchange through the ____________is measured by the difference btw the alveolar Pa02 and the measured arterial Pa02
ALveolar-capillary membranes
64
Mechanisms of hypoxia
65
* Significant desaturation of arterial blood occurs only when the Pa02 is <______mmHg
60
66
* 3 main causes of arterial hypoxemia:
V/Q mismatch, right-to-left pulmonary shunting, and hypoventilation
* Increasing the Fi02 improves the Pa02 in all of these conditions, except for a significant right-to-left pulmonary shunting
67
* Compensatory responses are stimulated by an acute decrease in Pa02 <_____mmHg
60
68
In chronic hypoxemia, these responses are occur when Pa02 is <50mmHg These responses include:
1. Carotid body–induced increase in alveolar ventilation
2. Hypoxic pulmonary vasoconstriction to divert pulmonary blood flow away from hypoxic alveoli
3. Increased SNS activity to increase COP and enhance tissue oxygen delivery
69
* Acute increases in PaC02 are associated with: increased:
CBF and ICP
* Extreme increases in PaC02 to >80 mmHg result in CNS depression
70
* Arterial hypoxemia is associated w/:
metabolic acidosis
71
* Acidemia caused by respiratory or metabolic compromise may lead to:
dysrhythmias and pulmonary hypertension
72
________ is often assoc w/ mechanical hyperventilation and diuretic use, which leads to loss of chloride & potassium ions
* Alkalemia
* Dysrhythmias may be increased by respiratory alkalosis
* Alkalemia in pts recovering from ARF can delay successful weaning from ventilator d/t the compensatory hypoventilation that occurs to correct alkalosis
73
* Right-to-left pulmonary shunting means:
perfusion of nonventilated alveoli
* The net effect is a decrease in Pa02, reflecting the dilution of oxygenated blood with hypo-oxygenated blood coming from unventilated alveoli
74
A physiologic shunt is ______ of COP
2-5%
75
* This degree of right-to-left pulmonary shunting reflects the passage of pulmonary arterial blood directly to the left side of the circulation through the bronchial and ___________ veins
thebesian
* Determination of the shunt fraction in pts breathing ˂100% 02 reflects the contribution of V/Q mismatching as well as right-to-left intrapulmonary shunting
76
* Guidelines for discontinuing mechanical ventilation include:
* Vital capacity of >15 mL/kg
* Alveolar-arterial oxygen difference of <350 cmH2O while breathing 100% 02
* Pa02 of >60 mm Hg with an Fi02 of <0.5
* Negative inspiratory pressure of more than −20 cmH2O
* Normal pHa
* RR <20
* VD:VT of < 0.6
77
Is Breathing at rapid rates with low tidal volumes usually a sign that pt will tolerate extubation
No. signifies an inability to tolerate extubation
78
When a pt is ready for a trial of vent withdrawal, what 3 options are considered:
1. SIMV, which allows progressively fewer mandatory breaths until pt breathing on their own
2. Intermittent trials of total removal of mechanical support and breathing through a T-piece
3. Use of decreasing levels of pressure support ventilation
79
Vent weaning criteria:
* The Pa02 should remain >60 mmHg with Fi02 <0.5
* PaC02 should remain <50 mmHg, and the pHa >7.30
* Additional criteria include PEEP <5 cmH2O, RR <20, and VC >15 mL/kg
* Pts should be alert, with active laryngeal reflexes and the ability to generate an effective cough and clear secretions
* Supplemental 02 is often needed after extubation d/t V/Q mismatching
80
What is associated with the highest risk of ARDS
Sepsis
81
* Hallmarks of ARDS:
Rapid-onset respiratory failure,
arterial hypoxemia,
and CXR findings similar to cardiogenic pulmonary edema
82
__________ cause increased alveolar capillary membrane permeability and alveolar edema
Proinflammatory cytokines
83
Acute ARDS usually resolves completely, but may progress to ___________with persistent arterial _____________ and ___________
fibrosing alveolitis
hypoxemia and decreased pulmonary compliance
84
ARDS Supportive care consists of:
ventilation,
antibiotics,
stress ulcer prophylaxis,
DVT prophylaxis,
and early enteral feeding
Prone and ECMO are clutch!
85
* Additional supportive therapies:
Optimal fluid mgmt,
NMB,
inhaled nitric oxide,
prostacyclins (PGI2),
recruitment maneuvers,
surfactant replacement,
glucocorticoids,
and ketoconazole
86
Chronic intrinsic restrictive lung disease
(interstitial lung disease)
term used for a group of diseases with similar presentation and radiographic findings, leading to restrictive physiology d/t diffuse parenchymal disease
87
* ILD examples:
* Sarcoidosis
* Hypersensitivity Pneumonia
* Pulmonary Langerhans Cell Histiocytosis
* Pulmonary Alveolar Proteinosis
* Lymphangioleiomyomatosis
88
ILD Pts usually present with:
dyspnea & nonproductive cough,
ultimately leading to chronic restrictive lung disease
89
Sarcoidosis is:
Systemic granulomatous disorder that involves many tissues, most commonly the lungs and intrathoracic lymph node
* Often asymptomatic, and identified incidentally on CXR
90
Progressive pulmonary fibrosis causes loss of pulmonary vasculature, leading to pulmonary _______ or _________
hypertension & cor pulmonale
91
Wheezing in sarcoidosis may be present if there is involvement of the __________
bronchioles
* Some pts have dyspnea & cough
92
* Myocardial sarcoidosis may cause___________ and __________
conduction abnormalities and dysrhythmias
93
* Neurologic sarcoidosis often displays a _________________
unilateral facial nerve palsy
* Endobronchial sarcoid is common
94
Laryngeal sarcoidosis occurs in up to 5% of pts and may interfere with intubation
yup!
And Cor pulmonale may develop
95
__________ is a classic manifestation of sarcoidosis
Hypercalcemia
96
__________ enzyme activity is increased w/sarcoidosis, bc it is produced by granuloma cells
Angiotensin-converting
97
Other markers include:
serum amyloid A,
adenosine deaminase,
and serum soluble IL2 receptor
98
__________ skin test is used to detect sarcoidosis, which is similar to a TB test
Kveim
99
Procedures such as _________, _________ and __________ may be necessary to provide tissue or lavage fluid for dx
mediastinoscopy,
endobronchial ultrasound,
and bronchoscopy
100
_____________ are used to suppress sx of sarcoidosis and treat hypercalcemia
Corticosteroids
101
* Advanced pulmonary fibrosis may lead to:
pulmonary hypertension
102
Hypersensitivity Pneumonitis is characterized by:
by diffuse interstitial granulomatous inflammation in the lungs after inhalation of dust containing fungi, spores, or animal or plant material
* may present as acute, subacute, or chronic
103
Hypersensitivity pneumonitis Sx: dyspnea & cough lasts______ hrs after inhalation of the antigen, followed by ____________, ___________, and ___________
4-6
leukocytosis, eosinophilia, and arterial hypoxemia
104
In Hypersensitivity Pneumonitis CT shows :
ground-glass opacities in the mid to upper lung zones
105
Hypersensitivity Pneumonitis Diagnostic procedures include:
bronchoscopy,
trans-tracheal or bronchial biopsy,
and cryobiopsy
106
Repeated episodes of hypersensitivity pneumonitis may lead to:
pulmonary fibrosis
107
Hypersensitivity Pneumonitis Tx:
antigen avoidance,
glucocorticoids,
and lung transplant
108
Pulmonary Langerhans Cell Histiocytosis involves:
When you hear this, think:
inflammation is usually around smaller bronchioles, causing destruction of the bronchiolar wall and surrounding parenchyma
Smoking
109
Pulmonary Langerhans Cell Histiocytosis affects:
the upper and middle zones of the lung
110
Pulmonary Langerhans Cell Histiocytosis Has strong association with:
smoking tobacco
111
CT can be diagnostic, _________ or _________ in upper zones with __________ sparing
showing cysts or honeycombing
costophrenic
112
Lung biopsy shows inflammatory lesions around the bronchioles containing __________, ___________, ___________ and ________
Langerhans cells,
eosinophils,
lymphocytes,
and neutrophils
113
Pulmonary Langerhans Cell Histiocytosis treatment:
Treatment consists of smoking cessation, systemic glucocorticoids, and symptomatic support
114
Pulmonary Alveolar Proteinosis (PAP) is a disease characterized by:
lipid-rich proteinaceous material in the alveoli
115
Pulmonary Alveolar Proteinosis (PAP) usually presents in the _______ w/sx of _________ and __________
40s-50s
dyspnea and hypoxemia
116
Pulmonary Alveolar Proteinosis (PAP) May occur independently or assoc w/ ________, __________ or __________
chemotherapy,
AIDS,
or inhaled mineral dust
117
In Pulmonary Alveolar Proteinosis (PAP), CXR shows ____________ in ______________
batwing distribution of alveolar opacities
middle and lower lung zones
118
Pulmonary Alveolar Proteinosis (PAP) Tx:
Tx of severe cases requires whole-lung lavage under GA to remove the alveolar material and improve macrophage function
* Lung lavage in pts with hypoxemia may temporarily decrease oxygenation
119
Airway management during anesthesia for _________ includes Double Lumen Tube to lavage each lung separately and optimizing oxygenation during the procedure
lung lavage
120
Lymphangioleiomyomatosis is a:
Rare multisystem disease causing proliferation of smooth muscle of the airways, lymphatics, and blood vessels
121
Lymphangioleiomyomatosis occurs mostly in:
occurs mostly in women of reproductive age
122
In Lymphangioleiomyomatosis, PFTs show:
restrictive & obstructive disease with decreased diffusing capacity
123
Lymphangioleiomyomatosis sx:
progressive dyspnea,
hemoptysis,
recurrent pneumothorax,
pleural effusions
124
Lymphangioleiomyomatosis treatment of symptomatic patients:
Treatment with Sirolimus (immunosuppressive) is indicated in symptomatic pts w/progressive disease
125
Age Related Restrictive physiology:
126
Chronic extrinsic restrictive lung diseases are
disorders of the thoracic cage that interfere with lung expansion
127
Deformities of the sternum, ribs, vertebrae, & costovertebral structures include:
ankylosing spondylitis,
flail chest,
scoliosis,
and kyphosis
* Work of breathing is increased d/t abnormal mechanics and increased airway resistance that results from decreased lung volumes
128
Chronic extrinsic restrictive lung diseases
129
"no need to know the exact location of the masses: anterior, posterior and middle"
130
Mediastinal mass
131
* Asphyxiating thoracic dystrophy AKA:________ is a ________
Jeune syndrome
autosomal recessive disorder with skeletal dysplasia and multiorgan dysfunction
132
Jeune syndrome is associated with:
* associated with cysts in kidney, pancreas, and liver
retinal abnormality with short ribs, short limbs, narrow thorax, and polydactyly
133
* Fibrodysplasia ossificans is a:
hereditary disorder c/b a genetic variation in bone morphogenetic protein (BMP) type 1
134
* Poland syndrome:
partial or complete absence of pectoral muscles, commonly affecting one side. Pts may also have paradoxical respiratory motion due to the absence of multiple ribs
135
Extrathoracic causes of RLD
136
RLD- Neuromuscular Disorders
137
Spinal Cord Injuries
138
Obesity
139
Pregnancy
140
RLD Anesthetic Management
141
RLD- Diagnostic Procedures
