Restrictive Pulmonary Pathophysiology

Question 1

Where is EEV relative to vital capacity?

Answer 1

At the end of Tidal Volume – where the lungs don’t need any energy to remove air

Question 2

The elastic recoil of the lungs creates what type of pull?

Answer 2

Inward

Question 3

The elastic recoil of the chest wall connective tissue what type of pull?

Answer 3

Outward

Question 4

How do changes in capillary oncotic and hydrostatic contribute to pulmonary edema?

Answer 4

Primarily an increase in hydrostatic pressure causes fluid to move into the interstitial space

Question 5

Do changes in capillary oncotic and hydrostatic pressures predominantly affect ET, TT, or both?

Answer 5

Predominately Equilibrium Time

Question 6

What is ARDS?

Answer 6

Pulmonary edema due to inflammation – “Adult Respiratory Distress Syndrome”

Question 7

How does inflammation in the lungs interfere with gas exchange?

Answer 7

Leads to pulmonary edema and vasodilation

Question 8

Does inflammation in the lungs alter ET, TT, or both?

Answer 8

Both

Question 9

What measures can sometimes help to prevent pulmonary fibrosis?

Answer 9

Take precautions with particles; promote deep breaths

Question 10

What are the mechanisms by which a thoracotomy causes pulmonary restriction?

Answer 10

Pain, Incision scars (disuse atrophy)

Question 11

How can a thoracotomy impair pulmonary gas exchange?

Answer 11

Less deep breaths = decrease alveoli filling

Question 12

What are the mechanisms by which obesity causes pulmonary restriction? How can this impair pulmonary gas exchange?

Answer 12

Increase WOB due to external load & diaphragm pushed upward which decreases lung volume.

Question 13

What are some other MSK disorders that could reduce chest wall

Answer 13

Costochondritis, fractured rib, muscle weakness, ankylosis, rheumatoid arthritis

Question 14

What measures can help to prevent loss of chest wall compliance?

Answer 14

Work on taking deep breaths; weight management; etc.

Question 15

What are the accessory inspiratory muscles?

Answer 15

SCM, Scalenes, Pec Minor

Question 16

What steps are necessary for a productive cough?

Answer 16

Step 1: Take deep breath
Step 2: Close Glottis
Step 3: Contract abdominals to increase intra-abdominal/thoracic pressure
(Step 4: open glottis)

Question 17

Wich ventilatory (inspiratory and expiratory) muscles would have innervation in a patient with a complete SCI at: C6? T8? L2?

Answer 17

C6 Diaphragm only (maybe SCM?)

T8 Diaphragm and some Intercostals

L2 Diaphragm, Intercostals, Abdominals, Accessory Muscles

Question 18

How would impaired ventilatory muscle function present in patients with progressive neuromuscular disorders?

Answer 18

Deterioration over time – won’t happen all at once. Pattern depends on condition

Question 19

What is the type and location of the following space occupying disorder?

Hemothorax

Answer 19

Blood between pleural layers

Question 20

What is the type and location of the following space occupying disorder?

Pleural effusion

Answer 20

Fluid between pleural layers

Question 21

What is the type and location of the following space occupying disorder?

Pneuomothorax

Answer 21

Air between lung and pleural membranes

Question 22

What is the type and location of the following space occupying disorder?

Adenocarcinoma tumor

Answer 22

Abnormal tissue in the lungs

Question 23

What is the type and location of the following space occupying disorder?

Pulmonary edema

Answer 23

Fluid within the alveoli

Question 24

What predisposes a patient to developing atelectasis?

Answer 24

Any condition that causes hypoventilation

Question 25

How does surfactant act to prevent atelectasis?

Answer 25

Lines the alveoli to lower surface tension – makes it less likely to have alveoli collapse

Question 26

↓ lung volume, ↓ CW compliance, ↓lung compliance, or ↓ muscle function: Lobectomy

Answer 26

↓ lung volume: The removal of a lobe of the lung decreases the total lung capacity and the functional residual capacity, resulting in reduced lung volume.

Question 27

↓ lung volume, ↓ CW compliance, ↓lung compliance, or ↓ muscle function: Heart transplantation

Answer 27

↓ chest wall (CW) compliance: Following heart transplantation, especially if a sternotomy (opening of the chest) was performed, the thoracic cavity may experience stiffness due to surgical changes, healing processes, or alterations in the mechanics of the chest wall.

Question 28

↓ lung volume, ↓ CW compliance, ↓lung compliance, or ↓ muscle function: Phrenic nerve injury

Answer 28

↓ muscle function

Question 29

↓ lung volume, ↓ CW compliance, ↓lung compliance, or ↓ muscle function: 3rd-4th degree thorax burns

Answer 29

↓ chest wall (CW) compliance: Severe burns on the thorax can cause scarring and stiffness of the chest wall, limiting its ability to expand and contract during breathing.

Question 30

↓ lung volume, ↓ CW compliance, ↓lung compliance, or ↓ muscle function: >90 degree scoliotic curves

Answer 30

↓ chest wall compliance

Question 31

↓ lung volume, ↓ CW compliance, ↓lung compliance, or ↓ muscle function: Spinal muscle atrophy

Answer 31

↓ muscle function: This condition is characterized by the degeneration of motor neurons in the spinal cord, resulting in weakness and atrophy of the muscles, including those involved in breathing.

Question 32

↓ lung volume, ↓ CW compliance, ↓lung compliance, or ↓ muscle function: Idiopathic lung fibrosis

Answer 32

↓ lung compliance: This condition is characterized by the thickening and stiffening of lung tissue due to fibrosis, which significantly reduces the lungs' ability to expand, resulting in decreased lung compliance.

Question 33

↓ lung volume, ↓ CW compliance, ↓lung compliance, or ↓ muscle function: Pulmonary edema

Answer 33

↓ lung compliance/volume: The accumulation of fluid in the alveoli and interstitial spaces of the lungs increases the stiffness of the lung tissue, reducing its ability to expand and thus leading to decreased lung compliance.

Question 34

↓ lung volume, ↓ CW compliance, ↓lung compliance, or ↓ muscle function: Pulmonary emboli

Answer 34

↓ lung volume: The obstruction of blood flow in the pulmonary arteries due to a blood clot can cause areas of the lung to become non-ventilated or poorly ventilated, leading to decreased lung volumes.

Question 35

What do diminished / absent breath sounds indicate?

Answer 35

Pneumothorax

Question 36

Why is a cough often nonproductive in patients with restricted lung disease?

Answer 36

There are no secretions in the lung that needs to be removed – the things causing restrictive disease aren’t causing mucus production or are able to be coughed up

Question 37

What causes a low tidal volume in patients with restricted lung disease?

Answer 37

Something is restricting movement of the lungs  patients compensate by taking smaller breaths because it is more efficient for them

Question 38

Why do many patients with restricted lung disease have low BMI?

Answer 38

It’s more difficult to eat with dyspnea – also WOB is harder so the metabolic demand is up