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PDX 1 > Exam 2 - Respiratory packet > Flashcards

Exam 2 - Respiratory packet Flashcards

1
Q

Does cough have much Dx value?

A

Limited, however may be only indicator

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2
Q

Characteristics of cough d/t asthma?

A

Nonproductive, non-paroxysmal

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3
Q

What other disorder should be considered when dealing with chronic cough, esp. in cases of nocturnal asthma?

A

Gastroesophageal reflux dz (GERD)

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4
Q

What is aspiration pneumonitis (in relation to GERD)?

A

acid reflux from stomach is aspirated into lungs

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5
Q

What is an acute cough?

A

Cough lasting <3 wks

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6
Q

What is acute cough most often d/t?

A

viral tracheobronchitis/URTI

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7
Q

What is a chronic cough?

A

Cough lasting >3 wks

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8
Q

Common causes of chronic cough?

A

asthma, airway hyper-reactivity, smoking

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9
Q

What happens with the tongue with a disorder of CN XII?

A

Inability to generate “tongue sounds” “L”, “D”, “T”, “N”

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10
Q

What happens with the larynx with a disorder of CN IX & X?

A

trouble generating sound - dysphonia. (Can’t say aaaaah)

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11
Q

General rule regarding airways and determining if epithelium is ciliated?

A

The harder the surrounding tissue, the greater the likelihood that the underlying epithelium is ciliated

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12
Q

Is the trachea pain sensitive?

A

NO unless significantly irritated

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13
Q

Are the primary bronchi pain sensitive?

A

NO unless significantly irritated

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14
Q

What is a pancoast tumor?

A

lung cancer near superior sulcus of lung

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15
Q

Classic presentation of pancoast tumor?

A

Middle aged male smoker w/ sudden onset of neck/shoulder/arm pain

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16
Q

Why do sound and vibration generated in the larynx normally reach the chest wall?

A

airways are patent, pleural surfaces have to be intact and functional

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17
Q

What is an extra-mural obstruction of the airway?

A

Outside the wall of the airway; bronchogenic carcinoma or enlarged mediastinal lymph nodes

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18
Q

What is an intra-mural obstruction of the airway?

A

In the wall of the airway; bronchogenic carcinoma

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19
Q

What is an intra-luminal obstruction more likely to lead to?

A

Complete obstruction

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20
Q

What happens to sound/vibration with a partial obstruction?

A

Will be transmitted to chest wall

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21
Q

What happens to sound/vibrations with a complete obstruction?

A

no airflow = no sound or vibration to chest wall

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22
Q

What is atelectasis?

A

collapse of previously-inflated lung tissue

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23
Q

What is the rate of lung collapse?

A

gradual

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24
Q

What happens to air movement during atelectasis?

A

no air movement to/from affected area of lung

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25
Q

What happens to chest wall movement during atelectasis?

A

No movement of chest wall

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26
Q

What happens to breath/voice sounds during atelectasis?

A

No breath sounds or transmitted voice sounds over affected area

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27
Q

What does it mean if noisy breathing goes away after a productive cough?

A

Implies that noise was d/t serous fluid or mucus accumulation

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28
Q

What are wheezes/rhonchi?

A

continuous sounds, more likely heard during expiration

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29
Q

What are crackles/rales?

A

non-continuous sounds, more likely heard during inspiration

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30
Q

What do wheezes imply?

A

airways narrowing

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31
Q

What do crackles imply?

A

fluid accumulation in airways

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32
Q

What is the usual origin of the “chest cold”?

A

almost always viral in origin

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33
Q

When does a chest cold occur?

A

3-4 days after a viral URI

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34
Q

general rule regarding airways and determining if epithelium is ciliated?

A

cough and possible sputum production lasting <3 wks, sometimes coarse wheezes

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35
Q

Is dyspnea usually an issue in acute bronchitis?

A

No

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36
Q

What are the differences b/t acute bronchitis and pneumonia?

A

High fever, shaking chills, SOB present in pneumonia but NOT acute bronchitis

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37
Q

What is chronic bronchitis almost always d/t?

A

Long-term active cigarette smoking

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38
Q

How is “uncomplicated” chronic bronchitis usually diagnosed?

A

Long-term active cigarette smoking & mucus-producing cough th/ occurs on most days and lasts at least 3 mos/year

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39
Q

What can cause excessive mucus production in chronic bronchitis?

A

possible metaplasia of goblet cells

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40
Q

What can cause decreased mucus clearance in chronic bronchitis?

A

dysfunctional/damaged cilia

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41
Q

What does partial obstruction of the larger airways in chronic bronchitis cause?

A

“coarse” wheezes and crackles

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42
Q

Can a pt with chronic bronchitis cough forcefully enough to clear mucus from larger airways?

A

Yes - “smoker’s hack”

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43
Q

Do all smokers get chronic bronchitis?

A

No

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44
Q

What is the subjective way to grade dyspnea?

A

Grades I-V

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45
Q

What is Grade V dyspnea?

A

begins almost as soon as pt lies down

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46
Q

Which grades are considered DOE?

A

Grades I & II

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47
Q

Which grades are considered SOB?

A

Grades III - V

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48
Q

Characteristics of dyspnea d/t lung dz?

A

very gradual in onset, worsens over several years

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49
Q

Characteristics of dyspnea d/t heart failure?

A

gradual in onset, worsens over period of few months to a few years

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50
Q

What is dyspnea of heart failure more likely to be provoked by?

A

lying down flat

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51
Q

What is the “hallmark” of small airways dz?

A

Dyspnea

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52
Q

What happens to mucociliary escalator in small airways dz d/t basic irritation?

A

likely still intact

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53
Q

What happens to serous mucus production in small airways dz d/t irritation?

A

possible increase => productive cough

54
Q

What happens to mucociliary escalator in small airways dz d/t acute inflammation?

A

decreased activity

55
Q

What happens to mucus production in small airways dz d/t acute inflammation?

A

increased production of both serous AND viscous mucus

56
Q

What is considered the “real problem” concerning small airways dz?

A

chronic inflammation

57
Q

Why is chronic inflammation a problem in small airways dz?

A

it is a positive feedback loop - swollen inflamed endothelium cannot distribute the NO it produces

58
Q

What does dyspnea and a non-productive cough tend to indicate?

A

small airways dz

59
Q

When would productive cough be seen in small airways dz?

A

After airways patency restored

60
Q

Is severity of asthma attack based on intensity of wheeze?

A

NO

61
Q

What is hyper-reactive airways dz?

A

reversible bronchoconstriction

62
Q

What is bronchial asthma?

A

both bronchoconstriction and inflammation

63
Q

What is asthmatic bronchitis?

A

inflammation first, followed by reversible bronchoconstriction

64
Q

What is a mucus plug?

A

dried secretions in the already-narrowed airways

65
Q

What happens to smaller airways that have been chronically inflamed/infected?

A

distortion, expansion, extension of a distortion => permanent symptoms and potential bronchiectasis

66
Q

What is allergic alveolitis/hypersensitivity pneumonitis?

A

Type III or IV hypersensitivity rxn in response to antigens (usually FUNGAL)

67
Q

What is an acute response in allergic alveolitis?

A

dyspnea, fever, DRY cough and shivering 4-6 hrs after exposure

68
Q

What is a chronic response in allergic alveolitis?

A

progressive dyspnea over several years d/t progressive fibrosis of alveolar septae

69
Q

Common causes of allergic alveolitis?

A

Stachybotrys chartarum and other molds (Aspergillus, etc)

70
Q

What is bronchopneumonia?

A

foci (“patches”) of acute inflammation of tertiary bronchi

71
Q

What can bronchopneumonia result in?

A

LOBULAR pneumonia

72
Q

Significant risk factor of bronchopneumonia?

A

cigarette smoking

73
Q

What is lung parenchyma?

A

“functional” tissue of lung - involved in respiration

74
Q

What does lobar pneumonia usually follow?

A

viral respiratory tract infection

75
Q

Characteristics of lobar pneumonia?

A

ABRUPT ONSET, fever >101.3 F, productive cough, decreased intensity of normal breath sounds, abnormal bronchial sounds

76
Q

What is COPD?

A

chronic obstructive pulmonary dz

77
Q

What is chronic bronchitis?

A

long-term cough w/ mucus production

78
Q

What is emphysema?

A

destruction of alveolar septal tissue over time

79
Q

What happens to oxygenation in really complicated chronic bronchitis?

A

decreased oxygenation d/t obstructed bronchioles

80
Q

What happens d/t prei-bronchiolar inflammation and edema in COPD?

A

compresses arterioles and venules => larger workload on R ventricle => cor pulmonale

81
Q

What is cor pulmonale?

A

Heart failure d/t lung dz

82
Q

What is “the Blue Bloater”?

A

late-stage obstructive chronic bronchitis involving smaller airways w/ associated cor pulmonale

83
Q

Classic presentation of blue bloater?

A

can’t catch breath, cough all the time, pursed lip respiration

84
Q

What are blebs in the lung?

A

distended alveoli with no elastic properties

85
Q

What are bullae in the lung?

A

distened air-filled space >1 cm

86
Q

What can ruptured blebs/bullae lead to?

A

pneumothorax

87
Q

What does lung inflammation do to lytic enzymes?

A

Increased activity

88
Q

What does serous fluid that bathes lung tissue contain?

A

Serum protein = alpha-1 antitrypsin

89
Q

What does alpha-1 antitrypsin do?

A

protects lungs from lytic agents

90
Q

What does cigarette smoke do to alpha-1 antitrypsin?

A

“deactivates” it

91
Q

What happens when alpha-1 antitrypsin is deactivated?

A

decrease in elastic recoil, decreased surface area for gaseous exchange

92
Q

What is “the Pink Puffer”?

A

persistent non-productive cough, labored expiration, “air hunger” on inspiration, hypertrophy of clinical mm. of respiration, systemic vasodilation from increased resp. effort

93
Q

What is the common form of pulmonary edema?

A

Passive

94
Q

What causes passive pulmonary edema?

A

left heart failure (cardiogenic)

95
Q

What is interstitial pulmonary edema?

A

fluid accumulation around alveoli

96
Q

What is the cough like in interstitial pulmonary edema?

A

non-productive

97
Q

What is alveolar pulmonary edema?

A

fluid accumulation in the alveoli

98
Q

What is the cough like in alveolar pulmonary edema?

A

productive - serous fluid th/ may be blood tinged

99
Q

What happens in passive pulmonary edema if accumulated fluid compresses the alveoli?

A

orthopnea, basilar rales/crackles, NON-PRODUCTIVE cough

100
Q

What happens in passive pulmonary edema if accumulated fluid enters the alveoli?

A

orthopnea, worseing basilar rales/crackles, PRODUCTIVE cough

101
Q

What is non-cardiogenic ARDS?

A

acute respiratory distress syndrome

102
Q

What is pneumoconioses?

A

“lung dust” - d/t asbestos, coal dust, crystalline silica, SMOKING

103
Q

What is the onset of pneumoconiosis usually like?

A

insidious and work-related

104
Q

Risk factors for pneumoconiosis?

A

intensity/duration of exposure, size of inhaled particles, nature of inhaled material, and whether pt smokes cigarettes

105
Q

What is the most common pneumoconiosis in the US?

A

silicosis (“sand-blasters lung”)

106
Q

Important co-factor for silicosis?

A

SMOKING

107
Q

What is silicosis?

A

inhalation of crystalline silica

108
Q

What is “black lung”?

A

coal worker’s pneumonconiosis

109
Q

important co-factor for coal workers pneumoconiosis?

A

smoking

110
Q

What is asbestosis?

A

diffuse pulmonary fibrosis d/t inhalation of asbestos dusts

111
Q

important co-factor for asbestosis?

A

SMOKING

112
Q

Onset of asbestosis?

A

10-40 yrs after the start of exposure

113
Q

When might you get benign pleural plaques?

A

following “trivial” exposure to asbestos

114
Q

What are 2 additional risks for pts with asbestosis?

A

increased risk of lung cx and mesothelioma

115
Q

Is visceral pleura pain-sensitive?

A

no

116
Q

Is intra-pleural space pain-sensitive?

A

no

117
Q

is parietal pleura pain-sensitive?

A

Yes

118
Q

What does inflammation of lung tissue close to parietal pleura cause?

A

Vague chest wall pain

119
Q

What does direct inflammation of the parietal pleura lead to?

A

sharp, stabbing chest wall pain

120
Q

What happens to vibration and breath sounds with accumulation of large amts of air and fluid?

A

can block transmission to chest wall

121
Q

Which nerve contacts the parietal pleura (making it pain-sensitive)?

A

intercostal nerve

122
Q

What causes fine crackles that are heard on inspiration?

A

accumulation of excess serous fluid in intrapleural space

123
Q

What is spontaneous primary pneumothorax?

A

blebs/bullae rupture, usually during aerobic exercise, allow small amt of air into intrapleural space

124
Q

what is spontaneous secondary pneumothorax?

A

In emphysema pt - small amt of air in intrapleural space cause “respiratory embarassment”

125
Q

What is tension pneumothorax/”relaxation” atelectasis?

A

large amts of air enter intrapleural space, separate visceral pleura from chest wall. ER referral

126
Q

What is serous pleural effusion/”compressive” atelectasis?

A

large amts of fluid enter intrapleural space

127
Q

How does discomfort of the central tendon of the diaphragm present?

A

vague pain referral to ipsilateral shoulder via phrenic n.

128
Q

Will vague shoulder discomfort d/t diaphragm be made worse by palpation?

A

No

129
Q

How does irritation of the peripheral diaphragm present?

A

localized pain d/t parietal pleura

130
Q

Will pain d/t inflammation of parietal pleura be made worse by palpation?

A

no

PDX 1 (7 decks)

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