Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathophysiology > Exam 2 - Cardiac and Pulmonary Pathophysiology > Flashcards

Exam 2 - Cardiac and Pulmonary Pathophysiology Flashcards

0
Q

Signs and symptoms of PAD?

A

Pain/ache with walking (intermittent claudication)
Pain related to increased speed, incline, workload
Pain/parathesia (tingling or numbness) when limb is elevated
Diminished pulses
Cool limb
Pallor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

What is a LVAD (Left Ventricular Assistive Device)?

A

It is a mechanical pump that bridges the left ventricle to the aorta. Has an external component (a battery).
Orthotopic Heart Transplantation (OHT) is a procedure done by opening the sternum to perform a transplant using a donor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pathology and risk factors for PAD are similar to what cardiovascular disease? What are the risk factors?

A

Coronary Artery Disease and CerebroVascular Accident.
Non-Modifiable RF for PAD: age, gender, race, hormonal status, family history
Modifiable RF for PAD: physical activity, weight, BP, diet/cholesterol, stress, glucose tolerance, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What changes occur with chronic occlusive diseases?

A 
Thickening of nail beds
Drying of skin
Loss of hair on feet/toes
Temperature difference
Muscle atrophy
Diminished sensation and strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Severe occlusive disease (critical limb ischemia) complications?

A

Ulcerations
Gangrene
Pain
Diminished functional capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is clinically used to Dx PAD?

A

Ankle brachial index. Is measured by the systolic BP in the ankle divided by systolic BP in the arm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Rx for PAD?

A

Risk factor modification
Cardiovascular risk reduction (cholesterol, weight)
Progressive exercise
Foot care

Severe PAD Rx:
Angioplasty
Bypass surgery
Amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is an aneurysm? What are the types of aneurysms?

A

Localized dilation or out pocketing of the arterial wall.
True aneurysm: deterioration of media
False aneurysm: accumulation of blood and disruption of three layers of vessel wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sx of aneurysm?

A

Usually asymptomatic
Palpable turbulent outpocketings in LEs
Severe abdominal back pain

aneurysm that ruptures has a poor prognosis, can develop into thrombi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Rx of aneurysm?

A

Monitor size and location of aneurysm
Resection of aneurysm
Grafting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a DVT? What 3 situations put someone at a higher risk for getting a DVT?

A

A DVT is a blood clot in the venous system.
Virchows triad:
Stasis of blood flow (bed rest, immobility, paralysis. All these limit the use of the muscular pump)
Endothelia injury (i.e. fractures, soft tissue injury
Hypercoagulability of blood (oncologic diseases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RF for DVT?

A 
Dehydration
Malignancy
Surgery or trauma
Birth control pills
Pregnancy
Obesity
Transatlantic flights
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sx of DVT?

A 
May be asymptomatic
Unilateral swelling distal to occlusion
Pain
Erythema 
Warmth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rx for DVT?

A

Anticoagulation therapy
Filters
Prevention: mobility, compression stockings/pumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a pulmonary embolus? RF for PE?

A 
PE is a blood clot in the pulmonary artery that blocks blood supply. Commonly caused by DVT in deep veins of LEs.
RF:
Virchows triad
Age>60
Cigarettes
Obesity
Indwelling catheters

10% die within an hour. Prognosis is favorable depending on size of the clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sx of PE?

A

Chest wall tightness
Sh. Pain
Hemoptysis (expectoration of blood)
Dyspnea (difficult of labored breathing)

occur in <20% of population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Dx of PE?

A

Search for clot using Doppler ultrasound
V/Q scan (determine ventilation/perfusion ratio: V is the ability for air to reach all parts of the lungs. Q evaluates how well blood circulates within the lungs.)
CT chest scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Rx of PE?

A

Anticoagulation
Fibrinolytics (dissolves clots and restores blood flow to ischemic tissues)
Compression garments
Oxygen
Mobility: graded compression stockings, filters, compression pumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Congenital heart disease occurs in utero (1st trimester), what are the two types?

A

Cyanotic defects: blood flow to the lungs may be impaired and/or there is mixing of oxygenated blood and deoxygenated blood (transposition of great vessels, tetrology of fallot, tricuspid atresia)

Acyanotic defects: shunting of blood from the left side of heart to the right side of the heart (ventricular septal defect, atrial septal defect, coarctation of aorta, patent ductus arteriosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes congenital heart disease?

A 
10% is attributed to genetic defect
Maternal alcohol consumption
Maternal diabetes
Viruses
Hypoxemia (abnormally low level of oxygen in blood)
Prematurity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is coarctication of aorta?

A

Is a narrowing of the aorta where the ductus arteriosis inserts. It is a congenital defect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is tetralogy of fallot?

A 
It is a congenital heart disease with 4 characteristic abnormalities: 
Pulmonary infundibular stenosis
Overriding aorta
Ventricular septal defect
Right ventricular hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does cyanotic and acyanotic mean?

A

Cyanotic- a bluish discoloration of skin and mucous membranes. Mixing of oxygenated and deoxygenated blood.

Acyanotic- blood is shunted from the right side to the left side of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is patent ductus arteriosis? What is actually happening?

A

The ductus arteriosis connects the aorta to the pulmonary artery. In-utero is used to bypass the lungs since they are not used yet.
Blood travels from the high pressure aorta to the low pressure pulmonary artery creating a left to right shunt. Acyanotic because the blood being mixed is oxygenated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Sx of congenital heart defects?

A 
Respiratory distress
Cyanosis
Grunting/wheezing
Failure to thrive
Signs of heart failure
Shortness of breath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Dx of congenital heart defects?

A

Prenatal screening for genetic disorders
Ultrasound
Echocardiogram

PT needs to assess activity tolerance, breathing patterns, HR response, posturing, and developmental milestones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the 4 classifications of pulmonary disease?

A

Infectious/inflammatory disorders
Obstructive (flow of air is impeded)
Restrictive (volume of air is decreased)
Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What classification does pneumonia fall into? What are the RF for pneumonia?

A

Infectious/inflammatory classification

RF: increasing age, dysphagia (difficulty swallowing), immunosuppression, diabetes, malnutrition, dehydration, hospitalization, immobility (primary cause of pneumonia), altered consciousness, smoking history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pathogenesis of pneumonia?

A

A normal immune response does not eliminate bacteria/virus. Organism releases chemicals that stimulate an immune/inflammatory response.
The mucous membrane is damaged
The alveolar capillary membrane is damaged
The cellular debris impedes oxygen diffusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Bacterial vs viral pneumonia?

A

Bacterial: usually limited to 1-2 lobes of lungs
Viral: usually bilateral. Destroys epithelial and goblet cells, mucous glands. Impaired mucociliary escalator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What causes aspiration pneumonia?

A

Impaired protection of the airway due to seizures or a depressed gag reflex. Severity of pneumonia depends on the amount of material aspirated and the acidity of the material aspirated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Sx of pneumonia?

A 
Recent upper respiratory tract infection
Pleuritic pain
Productive cough
Dyspnea
Tachypnea/tachycardia
Fever
Fatigue
Generalized myalgias
Cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Aspiration pneumonia is more likely to affect what lung? Why?

A

The right lung because the main bronchus is more vertical than the left lung main bronchus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Sx of aspiration pneumonia?

A

Same as viral or bacterial pneumonia.
Coughing, shortness of breath with eating and shortly thereafter

PT implication: head/neck position and posture is important for swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is pneumocystis carinii pneumonia?

A

Pneumocytes attach onto the alveolar lining and feed on the cell. New pneumocytes form. The alveoli are filled with cellular debris and new pneumocytes and effect the ability of the alveoli to participate in gas exchange.

usually seen in immunosuppressed patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Rx for pneumonia?

A 
Usually lasts 1-2 weeks
Antibiotics for bacterial pneumonia
Hydration
Exercise for pulmonary hygiene
Alternative feeding
Positioning
Vaccine the high risk groups (> 65 y/o, chronic lung disease, diabetes, immunocompromised)
36
Q

Dx of pneumonia?

A

Hx of upper respiratory infection (URI)
Sputum culture
Chest x-ray
Urine antigen testing for streptococcus pneumonia
Auscultation- crackles, decreased lung sounds, wheezing

6th leading cause of death in US (mostly elderly)

37
Q

What is tuberculosis? Describe etiology?

A

TB is an infectious disease of the lungs. Inhaled droplets contracted from an infected person sneezing, coughing, laughing, talking too close to someone.
A proliferation of the epithelial cells in the alveoli occurs and TB particles are “walled off”. A latent infection is usually asymptomatic.

38
Q

Active TB facts?

A

Necrotic center
Fibrosis of tissues
Is spread through the bloodstream and lymphatic system

39
Q

Sx of TB?

A

Productive cough (>3 weeks)
Weight loss
Fever
Malaise (general discomfort or uneasiness)

40
Q

RF for TB?

A 
Age
HIV 
Homeless
Overcrowded living arrangements
Malnutrition
Prison inmates
ESRD (end state renal disease)
Immunocompromised 
Health care workers
41
Q

Dx of TB?

A

Hx
Chest x-ray
Sputum culture
Skin test

42
Q

Rx for TB?

A

Combination of medications for 6-9 months to prevent cell wall biosynthesis.

if untreated prognosis 50-80% fatal in 2.5 years

43
Q

PT implications for TB???

A 
2 step ppd test yearly
Cover nose/mouth when sneezing
Wear appropriate mask when working with client who has TB
Disinfect stethoscope after use
Hand washing
44
Q

RF for obstructive diseases (emphysema & chronic bronchitis)?

A 
Smoking (#1 RF for obstructive diseases)
Age
Men > women
Environmental allergens
Heredity
45
Q

List some defining characteristics of COPD?

A
  • Airway obstruction (causes more constriction during expiration than normal, walls flop down on each other)
  • Air trapping
  • Gas exchange abnormalities (if cannot get air out cannot get CO2 out either)
  • Mucus production (in addition to floppy airways increased mucus production further blocks airway)
  • Pulmonary HTN (referring to pulm. artery and the right side of the heart pumping against the increased resistance of the lungs)
  • Systemic effects
46
Q

What is chronic bronchitis? What is occurring in the lungs?

A

Chronic bronchitis is an inflammation of the bronchi with scarring of the bronchial lining. The airway is collapsed and results in air trapping. This decreases the amount of air that reaches the alveoli and thus causes decreased ventilation.

47
Q

What are some indicators a physician might see and suspect chronic bronchitis?

A

A productive cough that lasts for at least 3 months each year for two consecutive years.
A decreased expiratory flow (FEV1) because chronic bronchitis is an obstructive disease and obstructive diseases affect expiration mainly.
Frequent infections

48
Q

Sx of chronic bronchitis?

A 
Cough
Sputum production (worse in morning)
Shortness of breath
Activity intolerance
Enlarged A-P diameter of chest
Use of accessory muscles with activity
Wheezing (sign of constriction)
Cyanosis
Cor pulmonale
49
Q

Describe the pathophysiology for emphysema.

A

Impaired mucociliary elevator.
Destruction of the distal airways beyond the terminal bronchiole resulting in air trapping and insufficient gas exchange.
Destruction of elastic properties of the alveolar wall resulting in decreased elastic recoil and bronchi collapse during expiration.
Pockets of air (blebs) form between alveolar spaces which increases the dead space in the lungs (the dead space means not getting any air exchange).

50
Q

Sx of emphysema?

A

DOE progressing to SOB at rest
Cor pulmonale (systemic swelling / jugular vein distension)
Accessory muscle use to assist in respiration
Cachetic (increased work of breathing)
Barrel chest (puts the diaphragm at length tension disadvantage)

51
Q

What happens when someone with emphysema exercises?

A

Air trapping worsens which is known as dynamic hyperinflation.
Results in decreased amount of time in expiratory phase and doesn’t allow full expiration (tachypnea)
As the air trapping worsens it hinders the full excursion of diaphragm.
Will lead to dyspnea, early termination of activity, and deconditioning spiral

52
Q

What are the effects of COPD on peripheral muscles?

A

Systemic effects of COPD cause atrophy of the endurance muscles. Poor strength and endurance is related to higher rates of mortality

53
Q

Dx of obstructive diseases?

A

Pulmonary function tests (PFTs)
Purpose is to evaluate the function of the respiratory muscles, the health/function of the airways, and classify different types of pulmonary diseases

54
Q

What does a spirometer do? Is used for?

A

Measuring volume of air. Often used in PFTs

55
Q

Why is it important to measure gas flow rates when testing pulmonary function?

A

Gas flow rates measure the flow of gas in various parts of the lungs. Helps evaluate the function of the lungs, the magnitude of the impairment as well as the location of the impairment.

56
Q

What does FVC stand for? What does it measure?

A

Forced Vital Capacity measures the maximum volume of gas a patient can exhale forcefully and quickly

57
Q

How does an obstructive disorder effect FEV1 and FVC?

A

It reduces both.

58
Q

What is FEV1? Why is this useful?

A

FEV1 is the amount of air exhaled during the 1st second of a FVC.
Is useful because it gives one an idea about the patency of airways and how air flows during expiration

59
Q

How does one interpret the results of a PFT?

A

Values are based on pt. age, gender, height, weight and race.
Take actual value and divide by predicted value, the result must be < 80% before being considered abnormal
Results also effort dependent
Serial PFTs are useful for screening exposed populations of workers

60
Q

What is characteristic of COPD based on a PFT?

A

PFT will indicate airflow abnormalities
FEV1/FVC needs to be < .70 post bronchodilator to be COPD

> 80% mild COPD
50-79% moderate COPD
30-49% severe COPD

61
Q

Dx of COPD?

A 
Chest x-ray
Arterial blood gas
Sputum cultures
PFTs
Hx of smoking or environmental exposure
62
Q

Rx for COPD?

A 
Smoking cessation
Steroids to reduce inflammation
Bronchodilators (i.e. B-2 agonists and anticholinergics)
Mucolytics
Antibiotics
Oxygen
Exercise
Breathing retraining
Posture training
Lung volume reduction surgery
Lung transplant
63
Q

What is asthma?

A

It is a reversible obstructive lung disease. Characterized by increased lung reactivity when exposed to a stimulus.
Airway hyperresponsiveness, edema, mucous, bronchoconstriction

64
Q

RF for asthma?

A 
Premature birth
Urban/industrialized settings
Cold climates
Low socioeconomic status
African Americans
Overcrowded living areas
Obesity
65
Q

Protective factors of asthma?

A

Older sibling
Early exposure to pets
Large families
Attending daycare

66
Q

Extrinsic asthma vs intrinsic asthma

A

Extrinsic - food and environmental triggers. IgE antibodies and mast cells hyperrespond to allergen and release bronchoconstrictors.

Intrinsic - no known trigger, adult onset > 40 y/o, and chronic upper respiratory infection

67
Q

Describe the pathogenesis of asthma

A

The trigger causes IgE antibodies and mast cells to resond:

  • Narrowing airway due to edema and thickening of airway walls
  • Mucus plugging due to thickening of mucus and decreased function of the mucociliary elevator
  • Air trapping
  • V/Q mismatch
  • Increased WOB

airway inflammation is always present, symptoms abate after treatment or time, the pt will be asymptomatic between episodes and PFTs will return to normal

68
Q

How does a patient with asthma present?

A 
Sensation of airway narrowing (tickling, fear)
Nonproductive cough
Inspiratory and expiratory wheezing
Tachypnea, tachycardia
Fatigue
Nostril flaring
Accessory muscle use
Cyanosis
Restlessness
69
Q

Dx of asthma?

A 
Pulse ox (O2)
PFT with medications
Arterial blood gas tests
X-rays
Hx
70
Q

Prevention is asthma once it has been Dx?

A

Education about what asthma is to pt.
Compliance with medications
Aerobic fitness
Identify trigger (avoid it)

71
Q

Medications to control asthma? 2 classes

A

Controllers - medications taken daily for long term
Relievers - medications given as needed that act quickly to resolve an acute episode

inhalers preferred over oral med to reduces systemic effects of steroids

72
Q

What is an EIB? List some characteristics

A

Exercise induced bronchospasm. 5-15 minutes after exercise begins or once exercise is terminated. Breathing through the mouth and nose dehumidifies the airways. Can last 15-60 minutes after exercise and is most common in endurance sports/athletes

73
Q

Dx EIB?

A

10-15% or greater drop in FEV1 when they reach at least 80% of maximum heart rate for at least four minutes

Encourage hydration, adequate warm-
up, and MD often prescribes a SABA (inhaler )to be taken right before exercise

74
Q

What is a restrictive lung disease?

A

Characterized as a decreased amount of air you can get into your lungs. Decreased total lung capacity. Primary (pulmonary and cystic fibrosis)

75
Q

General restrictive lung disease Sx

A 
DOE (Decreased exercise tolerance)
 Increased work of breathing
Accessory muscle use 
Weight loss 
Hypoxemia (abnormally low conc. of O2 in blood)
76
Q

RF for pulmonary fibrosis?

A 
Idiopathic (majority of cases) 
TB (tuberculosis)
ARDS (acute respiratory distress syndrome)
Asbestos 
Lupus 
Chemotherapy 
Radiation
77
Q

Pathogenesis of pulmonary fibrosis?

A

Irreversible proliferation of fibroblasts (Decreased lung compliance, Resistance to expansion)
Alveolar and capillary injury
(Decreased ability to diffuse gasses, hypoxemia)

78
Q

Rx for pulmonary fibrosis?

A

Corticosteroids
Chronic, progressive disease
Median survival <4 years

79
Q

General Rx for restrictive lung diseases?

A 
Corticosteroids 
Maximize use of diaphragm
Maintain airway opening 
Maintain oxygenation 
Cough training
80
Q

What is cystic fibrosis?

A
  • Autosomal recessive disorder
  • Disorder of sodium and chloride channels in exocrine glands
  • Chromosome 7
  • -Abnormal CF transmembrane conductance regulator (CFTR)
  • -Chloride channel malfunctions
  • -Dehydrated and thick mucous gland secretions
  • -Increased concentration of NaCl
  • -Pancreatic enzyme insufficiency
81
Q

Pathogenesis of cystic fibrosis?

A
  • Obstruction by mucus (mucus gets thick, dry and dehydrated due to the channel abnormality)
  • Frequent infections (lungs are wet, dark, warm)
  • Hyperinflation (air trapping)
  • Bronchiolitis/bronchiectasis
82
Q

How does a patient with cystic fibrosis present?

A 
“salty” sweat 
Productive cough 
Wheezing 
Frequent infections 
Weight loss 
Exercise intolerance
Increased WOB 
Decreased FEV1
83
Q

Cystic fibrosis in the viscera

A
  • GI system
  • -Weight loss
  • -GERD
  • -Intestinal obstruction
  • Liver
  • -Cirrhosis
  • Pancreas
  • -Thick secretions block pancreatic ducts
  • -fibrosis Pancreatic enzymes are blocked
  • -Loose stools
  • -Vitamin deficiency
  • -Anemia
  • -DM
  • Genitourinary
  • -Sterility males
  • -Infertility in some females
84
Q

Musculoskeletal Sx of cystic fibrosis?

A 
Muscle atrophy 
Rheumatoid arthritis
Osteopenia 
 Nutrition 
 Steroids 
 Estrogen deficiency
85
Q

Lung Sx of cystic fibrosis?

A

Purulent sputum
Frequent infections
Hypoxia (Clubbing)
Barrel chest

86
Q

Dx of cystic fibrosis?

A 
Prenatal screening 70% detection rate 
Failure to thrive, respiratory infections in infancy 
Sweat test 
 (+) chloride concentration >60mEq/L; normal is 40 
Pancreatic elastase -1  
 Pancreatic insufficiency 
PFT’s 
 Obstructive pattern
87
Q

Rx of cystic fibrosis?

A 
Multidisciplinary Team 
 Pulmonologist, Endocrinologist, Physical 
Therapist, Gastroenterologist, RespiratoryTherapist 
Bronchodilators 
Mucolytics 
Corticosteroids 
Oxygen 
Antibiotics
88
Q

PT implications for cystic fibrosis?

A 
Chest physical therapy 
Postural drainage 
Exercise 
Positioning 
Theravest 
Autogenic drainage 
Adjunct airway clearance
 PEP 
 Stents airways 
Flutter 
 Provides vibratory force

Pathophysiology (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions