Emphysema Overview Quiz

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Questions and Answers

Emphysema is characterized by the destruction of ___. that leads to loss of _ _, _ recoil, and _____ support to maintain airway patency.

parenchyma, surface area, elastic, structural

Bronchitis is characterized by ___ of airways by _ and ___ production.

narrowing, small, inflammation, mucous

COPD is observed most often in individuals with an extensive history of

smoking (correct)

exposure to pollutants

coal mining

tuberculosis

COPD takes ___ years or longer to mainfest.

30 Signup and view all the answers

Chronic bronchitis is refers to chronic or recurrent excess mucous secretion occurring on most days for at least _ months of the year for at least _ consecutive years.

3, 2 Signup and view all the answers

Centrilobular emphysema dilation predominantly affects the ___ bronchioles in the _ lung lobes.

respiratory, upper Signup and view all the answers

Panlobular emphysema tissue destruction is _________.

widespread Signup and view all the answers

Emphysema leads to four primary alterations:

increase in the size of the

loss of alveolar

mismatch of -

increase in _____ workload due to decreased amount of pulmonary capillaries

acini, surface area, ventilation perfusion, right ventricular Signup and view all the answers

COPD is the __ leading cause of death and affects more than _ % of adult Americans.

3rd, 5% Signup and view all the answers

In COPD, lung compliance __ with the tissue damage and the airways' narrowing and collapsibility impede te ability of ventilatory muscles to the lung completely.

increases, empty Signup and view all the answers

In COPD, chronic CO2 retention and hypercapnia, the normal central ventilatory response relies on a ____ in Pa to increase ventilation.

decrease, O2 Signup and view all the answers

Minute ventilation in COPD is generally

normal to above normal Signup and view all the answers

Emphysema is caused by damage to elastic fibers because of an imbalance between and in the lung.

elastase, a1-antitrypsin Signup and view all the answers

Chronic lung hyperinflation results in diaphragmatic _, and a __ in contractile force.

flattening, reduction Signup and view all the answers

_ intrathoracic pressure is generated during expiration in COPD, which leads to a __ in systemic venous return.

Positive, decrease Signup and view all the answers

Exaggeration of respiratory variation in arterial blood pressure is called _ ____

pulsus paradoxus Signup and view all the answers

Chronic pressure overload causes right ventricular _, whereas acute pressure changes causes right ventricular .

hypertrophy, dilation Signup and view all the answers

Air-containing spaces greater than 1cm in diameter that result from destruction and dilation of air spaces distal to terminal bronchioles.

Bullae Signup and view all the answers

Hallmarks of COPD are

chronic productive cough and progressive exercise limitation Signup and view all the answers

Explain the findings of COPD spirometry: include FEV1, FEV1/FRC, FRC, RV, TLC

FEV1 decreased, FEV1/FRC decreased, FRC increases, RV increased, TLC increased Signup and view all the answers

Match the spirometry to the severity of COPD

FEV1 >/= 80% = MILD FEV1 50-79% = MODERATE FEV1 30-49% = SEVERE FEV1 < 30% = VERY SEVERE Signup and view all the answers

COPD can manifest with impaired gas exchange of oxygen and co2 - PaO2 < mmHg, PaCo2 > _ mmHg

60, 45 Signup and view all the answers

In chronic bronchitis, _ in the airways impede gas flow.

excess mucus Signup and view all the answers

In COPD, chronic hypoxia causes _ _ _ to rise and increase work on the ____.

pulmonary vascular resistance, right ventricle Signup and view all the answers

Current guidelines note that a smoking history of greater than _____ pack-years is the single best variable for predicting airway obstruction.

40 Signup and view all the answers

a1-antitrypsin is produced by the _ and helps to protect lung tissue from damage by _____.

liver, neutrophil elastase Signup and view all the answers

Smoking can cause an immune-related release of _ ___. This results in degradation of pulmonary connective tissue.

neutrophil elastase Signup and view all the answers

COPD anesthetic considerations:

Pre-op: assessment (1) of airflow limitation (2) History of _(3) _

Anesthetic plan: ____ or GA with _ (to promote bronchodilation)

Ventilator management: avoid , , _; _ I:E ratio (careful because this can increase PIP)

Maintain and eliminate _

COPD anesthetic considerations: <ol> <li>Pre-op: assessment (1) severity of airflow limitation (2) History of exacerbations (3) comorbidities</li> <li>Anesthetic plan: regional anesthesia or GA with volatile anesthetics (to promote bronchdilation)</li> <li>Ventilator management: avoid barotrauma, volutrauma, atelectasis; lower I:E ratio (careful because this can increase PIP)</li> <li>Maintain oxygenation and eliminate PaCO2</li> </ol> Signup and view all the answers

Which of the following is a hallmark sign of COPD?

Chronic productive cough Signup and view all the answers

A decrease in FEV1 is a dominant feature of COPD.

True Signup and view all the answers

What condition can lead to increased PVR and increased work on the RV in COPD patients?

Chronic hypoxia Signup and view all the answers

The main treatment for COPD includes __________ cessation and bronchodilator therapy.

smoking Signup and view all the answers

Match the following treatments for COPD with their purpose:

Inhaled B2-agonists = Promote bronchodilation Corticosteroids = Reduce inflammation Flu vaccine = Prevent respiratory infections Oxygen therapy = Maintain adequate oxygen levels Signup and view all the answers

Which gas levels indicate a diagnosis of chronic respiratory failure in COPD?

PaO2 < 60 mmHg and PaCO2 > 45 mmHg Signup and view all the answers

Pulmonary rehabilitation is recommended for patients with FEV1 < 50%.

True Signup and view all the answers

What intervention is suggested to maintain a PaO2 greater than 60 mmHg in COPD patients?

Oxygen therapy Signup and view all the answers

What is the primary cause of emphysema related to COPD?

Imbalance between protease and antiprotease activities Signup and view all the answers

Chronic obstruction in COPD leads to the normal central ventilatory response relying on decreases in PaO2 to increase __________.

ventilation Signup and view all the answers

What is the primary risk factor for developing COPD?

Cigarette smoking Signup and view all the answers

Chronic bronchitis is characterized by the permanent destruction of alveolar walls.

False Signup and view all the answers

What does FEV1 measure?

The volume of air exhaled in one second from maximal inspiration. Signup and view all the answers

In COPD, a smoking history of greater than _____ pack-years is the best predictor of airway obstruction.

40 Signup and view all the answers

Match the following changes in lung function with their effects on COPD:

Decreased FEV1 = Obstructive disease Decreased elastic recoil = Airway collapse V/Q mismatch = Impaired gas exchange Increased right ventricular workload = Cor pulmonale Signup and view all the answers

Which of the following statements is true regarding emphysema?

It results in the destruction of air spaces distal to terminal bronchioles. Signup and view all the answers

In COPD patients, the FEV1/FVC ratio is typically greater than 70%.

False Signup and view all the answers

What is the impact of chronic bronchitis on airway dimensions?

Narrowing of airways due to thickened walls and mucus production. Signup and view all the answers

COPD is characterized by an inflammatory response in the lungs leading to ________ airflow obstruction.

progressive Signup and view all the answers

What is one of the clinical consequences of emphysema?

Increased airflow resistance Signup and view all the answers

What does the BODE assessment in COPD stand for?

Body mass index, Obstructive airflow, Dyspnea, Exercise capacity Signup and view all the answers

Regional anesthesia is recommended for COPD patients to avoid airway management.

True Signup and view all the answers

What is the effect of avoiding N2O in patients with COPD?

Avoiding N2O prevents the enlargement and potential rupture of bullae. Signup and view all the answers

In patients with COPD, a lower ______ ratio allows more time for expiration but can increase peak pressure.

I:E Signup and view all the answers

Match the following anesthetic considerations with their corresponding details:

Maintain adequate oxygenation = can result in absorptive atelectasis with high FiO2 Use of volatile anesthetic = Facilitates bronchodilation Avoid drastic reductions in PaCo2 = an unintended alkalemia can result and may make ventilator weaning difficult Post-operative pulmonary toileting = mobilize secretions Signup and view all the answers

What physiological change is primarily caused by chronic microbial colonization in patients with COPD?

Increased influx of neutrophils Signup and view all the answers

How does excess mucus production affect patients with COPD?

It disrupts the mucociliary transport system. Signup and view all the answers

What is one consequence of the paralysis of the mucociliary transport system in COPD patients?

Increased microbial colonization Signup and view all the answers

What impact does chronic neutrophil influx have on lung tissue in COPD?

It causes fibrosis in the lung tissue. Signup and view all the answers

What role does increased mucus production play in the progression of COPD?

It exacerbates lung obstruction. Signup and view all the answers

Study Notes

COPD Anesthetic Considerations

COPD severity and treatments:
- Identify severity.
- Implement treatments to reduce inflammation, improve secretion clearance, treat underlying infections, and increase airway caliber.

BODE Index

A tool for assessing COPD severity.
It includes Body Mass Index (BMI), Obstruction of airflow, Dyspnea, and Exercise capacity

Anesthetic Assessment

Includes symptoms, severity of airflow limitation, history of exacerbations, and co-morbidities

COPD Anesthesia Considerations

Avoid drastic reductions in PaCO2:
- Rapid decreases in PaCO2 can lead to respiratory distress and worsen symptoms.
Regional anesthesia is recommended:
- Avoids airway management and mechanical ventilation, especially in patients with severe COPD.
- However, neuraxial anesthesia above T6 is not recommended
  - Decreases expiratory reserve volume.
  - Impairs coughing effort.
  - May create anxiety-provoking weakness.
General anesthesia:
- Use volatile anesthetics to facilitate bronchodilation.
- Humidification is essential to maintain airway moisture.
Opioids:
- Can be used with caution.
- Cause less V/Q mismatch compared to other sedatives
- Respiratory depressant effects need to be considered, especially in the elderly.
N2O should be avoided:
- Can enlarge and rupture bullae (air pockets in the lung).
Ventilator Management:
- Maintain adequate oxygenation.
- ** Eliminate CO2.**
- Avoid barotrauma (high peak inspiratory pressures).
- Avoid alveolar injury (atelectasis).
- Avoid volutrauma from excessive tidal volume (Vt) or auto-PEEP.
Lower I:E ratio (inspiratory: expiratory time ratio):
- Allows more time for expiration.
- Increases peak pressure.
Postoperative Care:
- Pulmonary toilet (techniques to clear airways)
- Incentive spirometry (deep breathing exercises)

COPD Defense System Disruption

Excess mucus production and mucociliary transport system paralysis in COPD patients create an environment for microbial colonization.
Chronic colonization leads to a vicious cycle, increasing mucus production, reducing ciliary motility, and causing an influx of neutrophils.
This influx of neutrophils contributes to fibrosis, further impairing the respiratory system.

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Test your knowledge on emphysema, a chronic lung condition. This quiz covers its characteristics, effects on lung function, and implications for airway support. Discover the intricate details of this disease and assess your understanding.

Emphysema Overview Quiz

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Questions and Answers

Emphysema is characterized by the destruction of _____. that leads to loss of _____ _____, _____ recoil, and _______ support to maintain airway patency.

Bronchitis is characterized by _______ of ______ airways by _______ and _______ production.

COPD is observed most often in individuals with an extensive history of

COPD takes ___ years or longer to mainfest.

Chronic bronchitis is refers to chronic or recurrent excess mucous secretion occurring on most days for at least ___ months of the year for at least ___ consecutive years.

Centrilobular emphysema dilation predominantly affects the _______ bronchioles in the _____ lung lobes.

Panlobular emphysema tissue destruction is _________.

Emphysema leads to four primary alterations: increase in the size of the ____ loss of alveolar ______ ______ mismatch of -__ increase in ______ _________ workload due to decreased amount of pulmonary capillaries

COPD is the ____ leading cause of death and affects more than ___ % of adult Americans.

In COPD, lung compliance ______ with the tissue damage and the airways' narrowing and collapsibility impede te ability of ventilatory muscles to ____ the lung completely.

In COPD, chronic CO2 retention and hypercapnia, the normal central ventilatory response relies on a ______ in Pa__ to increase ventilation.

Minute ventilation in COPD is generally

Emphysema is caused by damage to elastic fibers because of an imbalance between ______ and ______ in the lung.

Chronic lung hyperinflation results in diaphragmatic _____, and a ______ in contractile force.

_____ intrathoracic pressure is generated during expiration in COPD, which leads to a ______ in systemic venous return.

Exaggeration of respiratory variation in arterial blood pressure is called _____ ________

Chronic pressure overload causes right ventricular _______, whereas acute pressure changes causes right ventricular ______.

Air-containing spaces greater than 1cm in diameter that result from destruction and dilation of air spaces distal to terminal bronchioles.

Hallmarks of COPD are

Explain the findings of COPD spirometry: include FEV1, FEV1/FRC, FRC, RV, TLC

Match the spirometry to the severity of COPD

COPD can manifest with impaired gas exchange of oxygen and co2 - PaO2 < __ mmHg, PaCo2 > ___ mmHg

In chronic bronchitis, ____ _____ in the airways impede gas flow.

In COPD, chronic hypoxia causes _____ _______ _________ to rise and increase work on the ______ ________.

Current guidelines note that a smoking history of greater than _____ pack-years is the single best variable for predicting airway obstruction.

a1-antitrypsin is produced by the _____ and helps to protect lung tissue from damage by ______ _______.

Smoking can cause an immune-related release of _____ _______. This results in degradation of pulmonary connective tissue.

Which of the following is a hallmark sign of COPD?

A decrease in FEV1 is a dominant feature of COPD.

What condition can lead to increased PVR and increased work on the RV in COPD patients?

The main treatment for COPD includes __________ cessation and bronchodilator therapy.

Match the following treatments for COPD with their purpose:

Which gas levels indicate a diagnosis of chronic respiratory failure in COPD?

Pulmonary rehabilitation is recommended for patients with FEV1 < 50%.

What intervention is suggested to maintain a PaO2 greater than 60 mmHg in COPD patients?

What is the primary cause of emphysema related to COPD?

Chronic obstruction in COPD leads to the normal central ventilatory response relying on decreases in PaO2 to increase __________.

What is the primary risk factor for developing COPD?

Chronic bronchitis is characterized by the permanent destruction of alveolar walls.

What does FEV1 measure?

In COPD, a smoking history of greater than _____ pack-years is the best predictor of airway obstruction.

Match the following changes in lung function with their effects on COPD:

Which of the following statements is true regarding emphysema?

In COPD patients, the FEV1/FVC ratio is typically greater than 70%.

What is the impact of chronic bronchitis on airway dimensions?

COPD is characterized by an inflammatory response in the lungs leading to ________ airflow obstruction.

What is one of the clinical consequences of emphysema?

What does the BODE assessment in COPD stand for?

Regional anesthesia is recommended for COPD patients to avoid airway management.

What is the effect of avoiding N2O in patients with COPD?

In patients with COPD, a lower ______ ratio allows more time for expiration but can increase peak pressure.

Match the following anesthetic considerations with their corresponding details:

What physiological change is primarily caused by chronic microbial colonization in patients with COPD?

How does excess mucus production affect patients with COPD?

What is one consequence of the paralysis of the mucociliary transport system in COPD patients?

What impact does chronic neutrophil influx have on lung tissue in COPD?

What role does increased mucus production play in the progression of COPD?

Study Notes

COPD Anesthetic Considerations

BODE Index

Anesthetic Assessment

COPD Anesthesia Considerations

COPD Defense System Disruption

Studying That Suits You

Description

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Emphysema is characterized by the destruction of ___. that leads to loss of _ _, _ recoil, and _____ support to maintain airway patency.

Bronchitis is characterized by ___ of airways by _ and ___ production.

Chronic bronchitis is refers to chronic or recurrent excess mucous secretion occurring on most days for at least _ months of the year for at least _ consecutive years.

Centrilobular emphysema dilation predominantly affects the ___ bronchioles in the _ lung lobes.

Emphysema leads to four primary alterations:

increase in the size of the

loss of alveolar

mismatch of -

increase in _____ workload due to decreased amount of pulmonary capillaries

COPD is the __ leading cause of death and affects more than _ % of adult Americans.

In COPD, lung compliance __ with the tissue damage and the airways' narrowing and collapsibility impede te ability of ventilatory muscles to the lung completely.

In COPD, chronic CO2 retention and hypercapnia, the normal central ventilatory response relies on a ____ in Pa to increase ventilation.

Emphysema is caused by damage to elastic fibers because of an imbalance between and in the lung.

Chronic lung hyperinflation results in diaphragmatic _, and a __ in contractile force.

_ intrathoracic pressure is generated during expiration in COPD, which leads to a __ in systemic venous return.

Exaggeration of respiratory variation in arterial blood pressure is called _ ____

Chronic pressure overload causes right ventricular _, whereas acute pressure changes causes right ventricular .

COPD can manifest with impaired gas exchange of oxygen and co2 - PaO2 < mmHg, PaCo2 > _ mmHg

In chronic bronchitis, _ in the airways impede gas flow.

In COPD, chronic hypoxia causes _ _ _ to rise and increase work on the ____.

a1-antitrypsin is produced by the _ and helps to protect lung tissue from damage by _____.

Smoking can cause an immune-related release of _ ___. This results in degradation of pulmonary connective tissue.