Exam 2 - Respiratory packet Flashcards
Does cough have much Dx value?
Limited, however may be only indicator
Characteristics of cough d/t asthma?
Nonproductive, non-paroxysmal
What other disorder should be considered when dealing with chronic cough, esp. in cases of nocturnal asthma?
Gastroesophageal reflux dz (GERD)
What is aspiration pneumonitis (in relation to GERD)?
acid reflux from stomach is aspirated into lungs
What is an acute cough?
Cough lasting <3 wks
What is acute cough most often d/t?
viral tracheobronchitis/URTI
What is a chronic cough?
Cough lasting >3 wks
Common causes of chronic cough?
asthma, airway hyper-reactivity, smoking
What happens with the tongue with a disorder of CN XII?
Inability to generate “tongue sounds” “L”, “D”, “T”, “N”
What happens with the larynx with a disorder of CN IX & X?
trouble generating sound - dysphonia. (Can’t say aaaaah)
General rule regarding airways and determining if epithelium is ciliated?
The harder the surrounding tissue, the greater the likelihood that the underlying epithelium is ciliated
Is the trachea pain sensitive?
NO unless significantly irritated
Are the primary bronchi pain sensitive?
NO unless significantly irritated
What is a pancoast tumor?
lung cancer near superior sulcus of lung
Classic presentation of pancoast tumor?
Middle aged male smoker w/ sudden onset of neck/shoulder/arm pain
Why do sound and vibration generated in the larynx normally reach the chest wall?
airways are patent, pleural surfaces have to be intact and functional
What is an extra-mural obstruction of the airway?
Outside the wall of the airway; bronchogenic carcinoma or enlarged mediastinal lymph nodes
What is an intra-mural obstruction of the airway?
In the wall of the airway; bronchogenic carcinoma
What is an intra-luminal obstruction more likely to lead to?
Complete obstruction
What happens to sound/vibration with a partial obstruction?
Will be transmitted to chest wall
What happens to sound/vibrations with a complete obstruction?
no airflow = no sound or vibration to chest wall
What is atelectasis?
collapse of previously-inflated lung tissue
What is the rate of lung collapse?
gradual
What happens to air movement during atelectasis?
no air movement to/from affected area of lung
What happens to chest wall movement during atelectasis?
No movement of chest wall
What happens to breath/voice sounds during atelectasis?
No breath sounds or transmitted voice sounds over affected area
What does it mean if noisy breathing goes away after a productive cough?
Implies that noise was d/t serous fluid or mucus accumulation
What are wheezes/rhonchi?
continuous sounds, more likely heard during expiration
What are crackles/rales?
non-continuous sounds, more likely heard during inspiration
What do wheezes imply?
airways narrowing
What do crackles imply?
fluid accumulation in airways
What is the usual origin of the “chest cold”?
almost always viral in origin
When does a chest cold occur?
3-4 days after a viral URI
general rule regarding airways and determining if epithelium is ciliated?
cough and possible sputum production lasting <3 wks, sometimes coarse wheezes
Is dyspnea usually an issue in acute bronchitis?
No
What are the differences b/t acute bronchitis and pneumonia?
High fever, shaking chills, SOB present in pneumonia but NOT acute bronchitis
What is chronic bronchitis almost always d/t?
Long-term active cigarette smoking
How is “uncomplicated” chronic bronchitis usually diagnosed?
Long-term active cigarette smoking & mucus-producing cough th/ occurs on most days and lasts at least 3 mos/year
What can cause excessive mucus production in chronic bronchitis?
possible metaplasia of goblet cells
What can cause decreased mucus clearance in chronic bronchitis?
dysfunctional/damaged cilia
What does partial obstruction of the larger airways in chronic bronchitis cause?
“coarse” wheezes and crackles
Can a pt with chronic bronchitis cough forcefully enough to clear mucus from larger airways?
Yes - “smoker’s hack”
Do all smokers get chronic bronchitis?
No
What is the subjective way to grade dyspnea?
Grades I-V
What is Grade V dyspnea?
begins almost as soon as pt lies down
Which grades are considered DOE?
Grades I & II
Which grades are considered SOB?
Grades III - V
Characteristics of dyspnea d/t lung dz?
very gradual in onset, worsens over several years
Characteristics of dyspnea d/t heart failure?
gradual in onset, worsens over period of few months to a few years
What is dyspnea of heart failure more likely to be provoked by?
lying down flat
What is the “hallmark” of small airways dz?
Dyspnea
What happens to mucociliary escalator in small airways dz d/t basic irritation?
likely still intact
What happens to serous mucus production in small airways dz d/t irritation?
possible increase => productive cough
What happens to mucociliary escalator in small airways dz d/t acute inflammation?
decreased activity
What happens to mucus production in small airways dz d/t acute inflammation?
increased production of both serous AND viscous mucus
What is considered the “real problem” concerning small airways dz?
chronic inflammation
Why is chronic inflammation a problem in small airways dz?
it is a positive feedback loop - swollen inflamed endothelium cannot distribute the NO it produces
What does dyspnea and a non-productive cough tend to indicate?
small airways dz
When would productive cough be seen in small airways dz?
After airways patency restored
Is severity of asthma attack based on intensity of wheeze?
NO
What is hyper-reactive airways dz?
reversible bronchoconstriction
What is bronchial asthma?
both bronchoconstriction and inflammation
What is asthmatic bronchitis?
inflammation first, followed by reversible bronchoconstriction
What is a mucus plug?
dried secretions in the already-narrowed airways
What happens to smaller airways that have been chronically inflamed/infected?
distortion, expansion, extension of a distortion => permanent symptoms and potential bronchiectasis
What is allergic alveolitis/hypersensitivity pneumonitis?
Type III or IV hypersensitivity rxn in response to antigens (usually FUNGAL)
What is an acute response in allergic alveolitis?
dyspnea, fever, DRY cough and shivering 4-6 hrs after exposure
What is a chronic response in allergic alveolitis?
progressive dyspnea over several years d/t progressive fibrosis of alveolar septae
Common causes of allergic alveolitis?
Stachybotrys chartarum and other molds (Aspergillus, etc)
What is bronchopneumonia?
foci (“patches”) of acute inflammation of tertiary bronchi
What can bronchopneumonia result in?
LOBULAR pneumonia
Significant risk factor of bronchopneumonia?
cigarette smoking
What is lung parenchyma?
“functional” tissue of lung - involved in respiration
What does lobar pneumonia usually follow?
viral respiratory tract infection
Characteristics of lobar pneumonia?
ABRUPT ONSET, fever >101.3 F, productive cough, decreased intensity of normal breath sounds, abnormal bronchial sounds
What is COPD?
chronic obstructive pulmonary dz
What is chronic bronchitis?
long-term cough w/ mucus production
What is emphysema?
destruction of alveolar septal tissue over time
What happens to oxygenation in really complicated chronic bronchitis?
decreased oxygenation d/t obstructed bronchioles
What happens d/t prei-bronchiolar inflammation and edema in COPD?
compresses arterioles and venules => larger workload on R ventricle => cor pulmonale
What is cor pulmonale?
Heart failure d/t lung dz
What is “the Blue Bloater”?
late-stage obstructive chronic bronchitis involving smaller airways w/ associated cor pulmonale
Classic presentation of blue bloater?
can’t catch breath, cough all the time, pursed lip respiration
What are blebs in the lung?
distended alveoli with no elastic properties
What are bullae in the lung?
distened air-filled space >1 cm
What can ruptured blebs/bullae lead to?
pneumothorax
What does lung inflammation do to lytic enzymes?
Increased activity
What does serous fluid that bathes lung tissue contain?
Serum protein = alpha-1 antitrypsin
What does alpha-1 antitrypsin do?
protects lungs from lytic agents
What does cigarette smoke do to alpha-1 antitrypsin?
“deactivates” it
What happens when alpha-1 antitrypsin is deactivated?
decrease in elastic recoil, decreased surface area for gaseous exchange
What is “the Pink Puffer”?
persistent non-productive cough, labored expiration, “air hunger” on inspiration, hypertrophy of clinical mm. of respiration, systemic vasodilation from increased resp. effort
What is the common form of pulmonary edema?
Passive
What causes passive pulmonary edema?
left heart failure (cardiogenic)
What is interstitial pulmonary edema?
fluid accumulation around alveoli
What is the cough like in interstitial pulmonary edema?
non-productive
What is alveolar pulmonary edema?
fluid accumulation in the alveoli
What is the cough like in alveolar pulmonary edema?
productive - serous fluid th/ may be blood tinged
What happens in passive pulmonary edema if accumulated fluid compresses the alveoli?
orthopnea, basilar rales/crackles, NON-PRODUCTIVE cough
What happens in passive pulmonary edema if accumulated fluid enters the alveoli?
orthopnea, worseing basilar rales/crackles, PRODUCTIVE cough
What is non-cardiogenic ARDS?
acute respiratory distress syndrome
What is pneumoconioses?
“lung dust” - d/t asbestos, coal dust, crystalline silica, SMOKING
What is the onset of pneumoconiosis usually like?
insidious and work-related
Risk factors for pneumoconiosis?
intensity/duration of exposure, size of inhaled particles, nature of inhaled material, and whether pt smokes cigarettes
What is the most common pneumoconiosis in the US?
silicosis (“sand-blasters lung”)
Important co-factor for silicosis?
SMOKING
What is silicosis?
inhalation of crystalline silica
What is “black lung”?
coal worker’s pneumonconiosis
important co-factor for coal workers pneumoconiosis?
smoking
What is asbestosis?
diffuse pulmonary fibrosis d/t inhalation of asbestos dusts
important co-factor for asbestosis?
SMOKING
Onset of asbestosis?
10-40 yrs after the start of exposure
When might you get benign pleural plaques?
following “trivial” exposure to asbestos
What are 2 additional risks for pts with asbestosis?
increased risk of lung cx and mesothelioma
Is visceral pleura pain-sensitive?
no
Is intra-pleural space pain-sensitive?
no
is parietal pleura pain-sensitive?
Yes
What does inflammation of lung tissue close to parietal pleura cause?
Vague chest wall pain
What does direct inflammation of the parietal pleura lead to?
sharp, stabbing chest wall pain
What happens to vibration and breath sounds with accumulation of large amts of air and fluid?
can block transmission to chest wall
Which nerve contacts the parietal pleura (making it pain-sensitive)?
intercostal nerve
What causes fine crackles that are heard on inspiration?
accumulation of excess serous fluid in intrapleural space
What is spontaneous primary pneumothorax?
blebs/bullae rupture, usually during aerobic exercise, allow small amt of air into intrapleural space
what is spontaneous secondary pneumothorax?
In emphysema pt - small amt of air in intrapleural space cause “respiratory embarassment”
What is tension pneumothorax/”relaxation” atelectasis?
large amts of air enter intrapleural space, separate visceral pleura from chest wall. ER referral
What is serous pleural effusion/”compressive” atelectasis?
large amts of fluid enter intrapleural space
How does discomfort of the central tendon of the diaphragm present?
vague pain referral to ipsilateral shoulder via phrenic n.
Will vague shoulder discomfort d/t diaphragm be made worse by palpation?
No
How does irritation of the peripheral diaphragm present?
localized pain d/t parietal pleura
Will pain d/t inflammation of parietal pleura be made worse by palpation?
no
