obstructive lung disease

Question 1

what is the gas exchange unit within the lungs

Answer 1

alveloi

Question 2

what is atelectasis

Answer 2

alveolar collapse
very common in patients who are immobilized

Question 3

what is atelectasis associated with

Answer 3

compression: external force
Obstruction: hypoventilation
decreased surfactant: may be reduction of production or alternation in makeup of surfactant

Question 4

what creates surfactant

Answer 4

type 2 alvelolar epithelial cells
mix of phospholipids, proteins, ions

Question 5

what does surfactant do to the surface tension

Answer 5

keeps surface tension lower
creates water tension for recoil

Question 6

what is the presentation of atelectasis

Answer 6

typically asymptomatic
may have SOB, cough, fever, elevated WBC

Question 7

what are obstructive lung diseases

Answer 7

disease state in which it is difficult for the patient to get air OUT of the lung

Question 8

what can cause obstructive lung disease

Answer 8

mechanical obstruction: FB, tumor, mucus plug
increased resistance: thickening associated with inflam changes, chronic bronchitis
airway closure : asthma/emphysema

Question 9

what is lowered with obstructive patterns

Answer 9

Decreased FEV1
FEV1/FVC ratio

Question 10

what is FEV1

Answer 10

forced expiratory volume in 1 second

Question 11

what is restrictive lung disease

Answer 11

disease state in which it is difficult for the patient to get air IN to the lung

Question 12

what can restrictive lung disease be associated with

Answer 12

stiffening of the lungs
stiff chest wall
muscular weakness of respiratory musculature

Question 13

What is emphysema

Answer 13

progressive destruction of alveolar membranes and dilation of the distal airways

Question 14

what is emphysema associated with

Answer 14

most commonly associated with smoking (inhaled pollutant)
less commonly associated with alpha-1 antitrypsin deficiency

Question 15

what occurs with emphysema

Answer 15

macrophages try to protect alveoli and engulf foreign substance (pollutant)
inflammatory activation with cytokine release
increased WBC recruitment
WBC release proteases
break down the connective tissue surrounding alveoli

Question 16

what are the layers of the cronchioles

Answer 16

epithelial lining: contains goblet-cells and cilia
smooth muscle layer
connective tissue

Question 17

what presents with a honeycombing appearance

Answer 17

emphysema - large airspace

Question 18

is emphysema reversible or irreversible

Answer 18

irreversible damage

Question 19

what are complications of emphysema

Answer 19

hypoxemia, hypercapnia
pneumothorax

Question 20

what is the presentation of emphysema

Answer 20

dyspnea
prolonged expiratory phase
accessory breathing
wheezing
barrel shaped chest
dyspnea
decreased FEV1/FVC ratio

Question 21

what is a bleb vs bulla

Answer 21

bleb- small
bulla - large

Question 22

what is chronic bronchitis

Answer 22

obstructive airflow secondary to thick mucus - not as much structural, more mucus plugging
associated with smoking

Question 23

what occurs during chronic bronchitis

Answer 23

exposure (smoking) will cause irritation/inflammation
cellular damage, ciliary damage
over production of mucus
goblet cells will unregulated/increase the number and size, thickening in the airway

Question 24

what is air trapping

Answer 24

decreased air out during expiration compared to air in during inspiration

Question 25

what is a mucus plug

Answer 25

increased mucus with chronic bronchitis can lead to a mucus plug which further reduces the passage of air

Question 26

what is the presentation of chronic bronchitis

Answer 26

dyspnea - worse with exertion decreased FEV1/FVC ratio flare will lead to decreased alveolar lumen

Question 27

what are complications of chronic bronchitis

Answer 27

pneumonia distal to obstruction hypoxemia hypercapnia VQ mismatch

Question 28

What is bronchiectasis

Answer 28

considered a chronic obstructive pulmonary disease but not COPD abnormal dilation of the bronchi dilated airways more readily collapse chronic inflammatory state will cause increased mucus production/stasis

Question 29

what is the most common cause of bronchiectasis

Answer 29

cystic fibrosis aspiration immunodeficiencies connective tissue diseases

Question 30

what is the presentation of bronchiectasis

Answer 30

productive cough - foul smelling sputum, purulent hemoptysis

Question 31

what is the atopic triad

Answer 31

atopic dermatitis (eczema) allergic rhinitis (Hay fever) asthma

Question 32

what are common triggers for asthma

Answer 32

allergens cold exercise illness pets increased emotional stress/anxiety

Question 33

what is the process of asthma

Answer 33

trigger - leads to activation of dendritic cells activated T cells releases interleukins activated B cells and eosinophils activation of mast cells degranulation -> histamine production

Question 34

what occurs during asthma exacerbation

Answer 34

patient will have increased lung volumes (like emphysema) muscular fatigue respiratory failure intrathoracic pressure can increase to the point patient has pulsus paradoxus

Question 35

what are complications of asthma

Answer 35

chronic complications associated with repetitive cellular damage - fibrosis

Question 36

what is cystic fibrosis

Answer 36

autosomal recessive abnormality resulting in mutation of CF transmembrane conductance regulator (CFTR protein)

Question 37

what is CFTR

Answer 37

chronic transportation protein on the exocrine glands found in epithelial cells of the airways, bile ducts, pancreas, sweat glands, sinuses, vas deferens

Question 38

what is the pulmonary manifestations of CF

Answer 38

mucus plugs inflammatory reaction increased risk of infection recurrent infections - chronic inflammatory changes - COPD/Bronchiectasis

Question 39

what are complications of CF

Answer 39

peripheral bullae pneumothorax hemoptysis cor pulmonale

Question 40

what is the presentation of CF

Answer 40

neonatal difficulty with passage of meconium foul smelling stool failure to thrive cough infections SOB

Question 41

what is the typical cause of death in patient with CF

Answer 41

respiratory failure

Question 42

what occurs with CF alternation

Answer 42

change in water concentration/movement thickening of secretions (dehydration)