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Opt 637 Pulmonary Exam 2
Dr. Lingel Lecture 2
57
Medical
Graduate
10/20/2011

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Term
How do chest x-rays differ from CT scans for dx'ing lungs?
Definition
CT scan is more detailed, more anatomical detail
Term
Why are x-rays preferred to CT scans?
Definition
Less radiation received by the pt
Term
What is pulmonary angiography used to dx?
Definition
pulmonary emboli and arteriovenous malformations; general ischemia
Term
What is spirometry?
Definition
measures pt lung volume and velocity of respiration
Term
What is on the y axis of spirometry graphs?
Definition
Flow rate
Term
What is on the x axis of spirometry graphs?
Definition
instantaneous lung volume
Term
What does TV stand for?
Definition
tidal volume = normal, at rest breathing volume
Term
What does IRV stand for?
Definition
Inspiratory reserve volume = extra are volume which can be brought into the lungs with effort BEYOND tidal volume
Term
What does ERV stand for?
Definition
Expiratory reserve volume = extra air that can be expired forcefully
Term
What does VC stand for?
Definition
Vital capacity = total air volume that can be changed
Term
What does FRC stand for?
Definition
Functional Residual Capacity = amt of air remaing in lungs at end of normal expiration
Term
What does RV stand for?
Definition
Residual volume = volume of air in lungs that remains after most forced expiration (minimum possible volume in lungs)
Term
What does TLC stand for?
Definition
Total lung capacity = maximum volume of lungs
Term
How is residual volume measured?
Definition
have pt inspire helium, it mixes with the residual volume and upon expiration the change in helium concentration is measured
Term
What are blood gases that are measured in arterial blood to measure lung and kidney fxn?
Definition
O2, CO2, H+, HCO3-
Term
What blood ion is regulated by the kidneys?
Definition
HCO3-
Term
What blood concentration is controlled by the lungs?
Definition
CO2
Term
What does decreased blood pH indicate?
Definition
acidosis
Term
What can cause respiratory induced blood acidosis?
Definition
hypoventilation

head injuries

meds

brain tumors
Term
In blood acidosis, what level will be high, what level will be normal or slightly increased?
Definition
CO2 is high, but HCO3- may be normal or just slightly elevated
Term
What causes metabolic acidosis?
Definition
Inability of kidneys to excrete acidic ions

kidney dysfxn

shock

DM!! (most commonly seen by OD's)

Cardiac arrest
Term
What is higher in blood acidosis?
Definition
CO2 concentration

therefore breathing rate increases to expel the excess CO2
Term
What are the two major categories of lung dz?
Definition
Obstructive pulmonary dz

Restrictive pulmonary dz
Term
What are hallmarks of obstructive pulmonary dz?
Definition
limitation of airflow, especially on exhalation

makes breathing harder

e.g. asthma, emphysema
Term
What are hallmarks of restrictive pulmonary dz?
Definition
reduced expansion of lung parenchyma

decreased lung capacity

minimizes or prevents gas exchange

e.g. collagen vascular dz, sarcoidosis
Term
What pulmonary dz's will also have ocular SE?
Definition
TB

sarcoidosis

histoplasmosis

Collagen vascular disorders
Term
What are ocular SE of pulmonary dz meds?
Definition
optic atrophy

glaucoma

cataract

blurred vision

tear effects
Term
What ocular dz's can present more often with pulmonary dz?
Definition
glaucoma

ARMD

Retinal vascular changes

optic nerve head changes

This is probably all related to decreased O2 in blood due to pulmonary dysfunction!
Term
Can pulmonary dz CI ocular meds?
Definition
yes
Term
What anatomical changes are seen in obstructive pulmonary dz?
Definition
change in lumen size

thickening of airway wall

changes in supporting structure around airway

altered secretions --> decreased lumen size
Term
What changes in spirometry results with obstructive pulmonary dz's?
Definition
VC goes down

RV goes up

FRC goes up
Term
What happens to the diaphragm in obstructive pulmonary dz?
Definition
High RV --> diaphragm is flatter after expiration --> decreased ability to change lung volume
Term
Do obstrutive pulmonary dz's cause increased effort to breathing?
Definition
Yes, this causes fatigue in and of itself, let alone the poor O2 exchange
Term
What happens to the flow volume loop in obstructive pulmonary dz?
Definition
Overall volume goes down, rest tidal volume is much closer to the exercising tidal volume
Term
What are 4 common obstructive pulmonary dz's?
Definition
Asthma

Cystic Fibrosis

Emphysema

Chronic Bronchitis
Term
Is asthma considered a form of COPD?
Definition
No, that term is for emphysema, chronic bronchitis, etc
Term
What is the prevalence of asthma?
Definition
10% in kids

5% of adults
Term
What type of hypersensitivity is asthma?
Definition
Type 1 hypersensitivity
Term
What predisposes a pt to asthma?
Definition
genetic predisposition to type 1 hypersensitivities
Term
What can aggravate asthma?
Definition
heat

stress

cold

exercise

dust

tobacco

dander
Term
Is asthma considered a progressive dz leading to tissue damage over time?
Definition
no
Term
How many people are killed by asthma every year?
Definition
3k, generally due to poor control
Term
What are s/sx of asthma?
Definition
chronic cough

wheezing

chronic episodic dyspnea

sympathetic discharge

tachypnea
Term
Are astham pt's normal between attacks?
Definition
yes, they will be asymptomatic if not in an active attack
Term
What is acute severe asthma also called?
Definition
fatal asthma
Term
What peculiar childhood behavior can reduce the likelihood of asthma?
Definition
eating dirt (immune system conditioning)
Term
What are the hallmarks of acute severe asthma?
Definition
severe attack that does not respond to routine therapy
Term
What are s/sx of acute severe asthma?
Definition
difficulty talking

diaphoresis

pulsus paradoxus

orthopnea

diaphoresis

decreasted mental status

use of accessory respiratory muscles
Term
What must be done for someone having an acute severea asthma attack?
Definition
trip to ER/dial 911. Needs emergency tx.
Term
What is the main pathophysiology of asthma?
Definition
inflammation due to hypersensitivity
Term
What Ab is associated with asthma?
Definition
IgE
Term
What does IgE initiate in asthma pts?
Definition
mast cell activity
Term
What do activated mast cells release?
Definition
histamines

prostaglandins

tryptase

leukotrienes
Term
What are tissue responses to asthma induced inflammation?
Definition
smooth muscle constriction (bronchospasm)

mucosal edema

hypersecretion of mucus
Term
What is diaphoresis?
Definition
excessive sweating
Term
Does asthma actively remodel the tissues of the lungs?
Definition
Yes, asthmatics have 10x more cells
Term
What is pulsus paradoxus?
Definition
decreased systolic BP by >20 mmHg upon inspiration of lungs
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