Restrictive lung diseases

Question 1

What are the restrictive lung diseases?

Answer 1

1. Paranchymal diseases
2. Pleural diseases
3. Chest wall diseases
4. Neuromuscular disorders

Question 2

What are restrictive lung diseases?

Answer 2

1. diseases that prevent the lung from expanding fully
2. decreased compliance and decreased air pressure results in decreased air entry
3. decrease ventilation

Question 3

Does the work of breathing increase for restrictive lung diseases?

Answer 3

Yes, increased RR, increased accessory muscle use, increased pressure to maintain lung expansion, increased fatigue

Question 4

What is interstitial pulmonary fibrosis?

Answer 4

thickening of the alveolar walls which progresses to scarring or fibrosis

Question 5

Interstitial pulmonary fibrosis characteristics?

Answer 5

1. decreased lung compliance
2. increased elastic recoil
3. decreased diffusion capacity

Question 6

Clinical presentation of interstitial pulmonary fibrosis?

Answer 6

1. Inspection = increased RR + shallow breathing, clubbing, cyanosis, dry unproductive cough, decreased chest expansion
2. Palpation = increased tactile fremitus (because wall is thicker)
3. Percussion = dull
4. Auscultation = late fine insp crackles
5. ABGs = decrease O2, decrease CO2
6. Chest XR = small contracted lungs, raised diaphragm, bilateral lung disease

Question 7

What is Sarcoidosis?

Answer 7

Granuloma development in the lungs, skin and lymph nodes

Question 8

What is Atelectasis?

Answer 8

Collapse of alveoli or lung tissue

Question 9

Atelectasis and VQ matching?

Answer 9

Good perfusion but poor ventilation (shunting)

Question 10

Pathophysiology of Atelectasis?

Answer 10

Obstruction = mucus plug, tumour, foreign body

Question 11

What does nitrogen do for lungs?

Answer 11

Keeps them from collapsing

Question 12

Atelactasis and tracheal deviation?

Answer 12

There is ipsilateral tracheal deviation because the trachea moves towards the site of negative pressure/blocked lung

Question 13

Clinical presentation for atelectasis?

Answer 13

1. Inspection = IPSILATERAL TRACHEA DEVIATION, increased RR, shallow breathing, cyanosis, dyspnea
2. Palpation = decreased tactile fremitus, decreased chest wall expansion on side of atelectasis
3. Percussion = dull directly over compressed tissue
4. Auscultation = decreased BS or absent, fine inspiratry crackles
5. Chest XR = ipsilateral deviation of mediastinum

Question 14

Acute respiratory distress syndrome (ARDs)?

Answer 14

Acute lung injury characterised by resp distress, severe hypoxemia, and increased permeability of alveolar capillary membrane

Question 15

Explain pathophysiology of ARDs?

Answer 15

Increased permeability of capillaries due to injury leads to edema into the interstitial space and then the alveoli. Edema in the alveoli results in decreased oxygenation and shunting

Question 16

Clinical presentation of ARDs

Answer 16

1. Inspection = severe dyspnea (often requires mechanical ventilation at high PEEP), cyanosis, increased RR
2. Palpation = increased tactile fremitus
3. Percusion = dull
4. Auscultation = insp crackles, wheezing
5. ABGs = severe low O2, decrease CO2

Question 17

What are the pleural diseases?

Answer 17

Pneumothroax and Pleural effusion

Question 18

Describe a pneumothorax?

Answer 18

An abnormal collection of air in the pleural space. Loss of negative pressure in pleural cavity causes expanded rib cage and/or collapsed lung.

Question 19

Is a chest tube needed for a large pneumothorax?

Answer 19

Yes, used to release the air from the pleural space

Question 20

What are the three types of pneumothorax?

Answer 20

1. Spontaneous = due to rupture in air containing structure + common in young tall men
2. Traumatic = penetrating or non-penetrating injury to chest wall
3. Tension = tear in pleura that acts as a ONE WAY valve, air enters into pleural space but doesn’t leave during exhalation (life threatening)

Question 21

Clinical presentation of pneumothorax?

Answer 21

1. Inspection = chest pain, signs of resp distress (especially in tension), dyspnea, increased RR, dry cough
2. Palpation = decreased tactile fremitus
3. Percussion = hyper-resonant
4. Auscultation = decreased or absent breath sounds
5. ABGs = decreased O2

Question 22

What is a pleural effusion?

Answer 22

Fluid moving into the pleural space from increased permeability of pleural surface (increased fluid, WBCs, proteins) or increased hydrostatic pressure in pleural capillaries (CHF), fluid is clear with few proteins

Question 23

What is the difference between pulmonary edema and pleural effusion?

Answer 23

Pulmonary edema is fluid trapped in the LUNGS, and Pleural effusion is fluid trapped in the PLEURAL SPACE

Question 24

Is a pleural effusion a secondary disease?

Answer 24

Yes, it is secondary tp infection, cancer or disease (CHF, pneumonia, trauma)

Question 25

Clinical presentation of pleural effusion?

Answer 25

1. Inspection = increased RR, dry cough, may have chest pain 2. Palpation = decreased tactile fremitus, chest wall excursion decreased on side of effusion 3. Percussion = dull 4. Auscultation = pleural friction rub, decreased or absent sounds directly over effusion 5. ABGs = decreased O2, decreased CO2

Question 26

Chest wall deformities?

Answer 26

Bony deformities (Kyphosis, ankylosing spondylitis, pectus carinatum, pectus excavatum, scoliosis, kyphoscoliosis

Question 27

Chest wall deformity clinical presentation?

Answer 27

1. Inspection = dyspnea, SOBOE, abnormal thorax shape 2. Palpation = depends 3. Percussion = depends 4. Auscultation = depends 5. ABGs = decreased O2

Question 28

What nerves innervate the intercostals?

Answer 28

T1-T12

Question 29

What nerves innervate the phrenic nerve and what is its function

Answer 29

C3, C4, C5 and the diaphragm

Question 30

What nerves innervate the abdominals?

Answer 30

T6-L1

Question 31

What are accessory muscles of ventilation?

Answer 31

Trapezius, QL, Lats, Erector spinae, Pec minor and major, SCM, Scalenes