Obstructive Lung Disease

Question 1

Function of the following structures: trachea, carina, R/L main stem, lobar bronchi, segmental bronchi, subsegmental bronchi

Answer 1

They’re the tubes of the respiratory system

They carry gas

Question 2

Function of the following structures: terminal bronchioles, respiratory bronchioles, alveolar ducts, alveolar sacs

Answer 2

Exchange units of the lungs

Exchagen O2 for CO2

Question 3

Structure:

300 million clusters in the adult lung

SA of a tennis court

Elastic

Answer 3

Alveolar sacs

Question 4

Describe Chronic Obstructive Pulmonary Disease (COPD)

Answer 4

FLOW of air is IMPEDED; trouble getting air OUT

Question 5

Describe Restrictive Lung Disease (RLD)

Answer 5

VOLUME of air REDUCED, trouble getting air IN

Question 6

Disease: affects both the MECHANICAL function and gas EXCHANGE of the respiratory system

Answer 6

COPD

Question 7

Disease: LONG expiratory time; I:E of 1:4+

Answer 7

COPD

Question 8

Disease Risk Factors:

Smoking

Air Pollution

Familly Hx

Occupational Dusts

Answer 8

COPD

Question 9

Disease Physical Symptoms:

Dyspnea on Exertion

Fatigue

Chronic Cough

Wheezing/Rhonchi

Expectoration of Mucus

Answer 9

COPD

Question 10

Disease loss of normal elastic recoil and bronchial tubes collapse

Answer 10

COPD

Question 11

Describe the PFT changes with COPD

Answer 11

Decreased ERV

Increased RV and FRC

Question 12

With COPD both the _____________ and __________ of the respiratory system is affected

Answer 12

efficiency, function

Question 13

COPD Pathophysiology: ______1_____ bronchial lumen; ___2___ mucus production, _____3_____ of the mucosal lining (thickening) due to repeated ______4______. ____5____ (constriction) of bronchial smooth muscle. Respiratory muscles must work ____6____. Enlarged ____7____ is already inflated (___8___ chested). Must overcome _____9_____ to airflow obstruction. Alveolar ventilation is _____10______.

Answer 13

1. Decreased
2. Increased
3. Inflammation
4. Infection
5. Spasm
6. Harder
7. Thorax
8. Barrel
9. Resistance
10. Decreased

Question 14

List the signs and symptoms of COPD (4)

Answer 14

1. Hypoxemia (for most)
2. Polycythemia (increased RBC and visocisty = increased resistance)
3. Cor Pulmonale (R sided heart failure)
4. Respiratory Failure (frequent cause of death for COPD)

Question 15

List the Tx for COPD (3)

Answer 15

1. Remove irritant/afflicting agent
2. Inhaled medications (albuterol, anti-cholinergics, corticosteroids, antibiotics)
3. Exercise training

Question 16

List the disease grouped under COPD

Answer 16

1. Emphysema
2. Chronic Bronchitis
3. Asthma
4. Cystic Fibrosis

** Conditions can be separate or co-exist

Question 17

Disease:

Alveolar/Parenchymal Disease

Lung function altered [elastic recoil, collapse of airways w/exhalation and chronic airflow obstruction]

Abnormal PFTx & CXR

Answer 17

Emphysema

Question 18

Disease: Enlargement of air spaces distal to terminal bronchioles, loss of elastic fibers, and destruction of alveolar septal walls

Answer 18

Alveolar/Parenchymal Disease

Question 19

Type of Emphysema: destruction of more proximal or central alveoli

Answer 19

Centriacinar

Question 20

Type of Emphysema: destruction of more distal alveoli

Answer 20

Panacinar or Panlobular

Question 21

Term: Stretched out alveoli that are at risk for blowing out

Answer 21

Panlobular

Question 22

Centrilobular emphysema affects _____1_____ _____2_____ sparing distal avleoli, worse in the __3__ __4__, particularly the _____5_____. Most common in ___6___. Closely associated with ____7____.

Answer 22

1. Respiratory
2. Bronchioles
3. Upper
4. Lobes
5. Apices
6. Men
7. Smoking

Question 23

Panlobular emphysema affects airspaces _____1_____ to the respiratory bronchiole. ___2___ ____3____ most affected. Generally due to a ___4___ deficiency (alpha1 antitrypsin)

Answer 23

1. Distal
2. Lower
3. Lobes
4. Protein

Question 24

List the components of the lung affected by EMPHYSEMA (3)

Answer 24

1. Respiratory Bronchioles
2. Alveolar Ducts
3. Alveolar Sacs

Question 25

Disease Clinical Features Dry non-productive cough "Skin and Bones" All energy used to breath Absent/Decreased breath sounds w/auscultation Increased expiratory phase

Answer 25

Emphysema

Question 26

Disease: Pink Puffer

Answer 26

Emphysema

Question 27

Disease: Chronic productive cough for 3 mo/yr OR for \> 2 consecutive years

Answer 27

Chronic bronchitis

Question 28

Disease: Proliferation of submucosal glands and globet cells Insidious onset Smokers cough, morning cough, continual cough Recurrent pneumonia

Answer 28

Chronic Bronchitis

Question 29

List the response to irritants in chronic bronchitis (4)

Answer 29

1. Contraction of bronchial smooth mm 2. Denuded cilia 3. Increased secretions 4. Swelling of mucosa

Question 30

Disease Clinical Features: Chronic productive cough Overweight Cyanotic Lip/Nailbeds Rhonchi/Weezes on auscultation Expiratory Phase Increased Abnormal PFT and CXR

Answer 30

Chronic Bronchitis

Question 31

Describe why you shouldn't give O2 to those with Chronic Bronchitis

Answer 31

In chronic bronchitis, the CO2 trigger to breath is gone [sensors burned out], Thus the drive to breath is based on a hypoxic drive mechanism [O2]. If they are given O2, their drive to breath will decrease b/c they demand is met by the supplemental O2 If they are SOB just slow them down and work on retraining their breathing LOW FLOW O2 may be acceptable

Question 32

List the components of the lung affected by chronic bronchitis (3)

Answer 32

1. Lobar bronchi 2. Segmental bronchi 3. Subsegmental bronchi

Question 33

Disease: Blue Bloater

Answer 33

Chronic Bronchitis

Question 34

Disease: Reversible Bronchospasm [wheezing, obstruction, coughing] Younger patients

Answer 34

Asthma

Question 35

Disease: Inflammatory disease causing SOA and DOE, wheezing, coughing Bronchospasm/inflammation caused by hypersensitivity to extrinsic/intrinsic stimuli Structural changes (thickening) of airways

Answer 35

Asthma

Question 36

Asthma results in \_1\_ \_\_\_\_\_2\_\_\_\_\_ which \_\_\_\_\_3\_\_\_\_\_ RV, thus \_\_\_4\_\_\_ CO2 and \_\_\_\_5\_\_\_\_ O2. There is a reduction of \_\_6\_\_ and \_\_7\_\_ \_\_\_8\_\_\_. All of which are \_\_\_\_\_9\_\_\_\_\_.

Answer 36

1. Air 2. Trapping 3. Increasing 4. Increasing 5. Decreasing 6. FEV1 7. Peak 8. Flow 9. Reversible

Question 37

List the Tx for Asthma (2)

Answer 37

1. Trigger awareness 2. Inhaled agents (bronchodilators, anti-inflammatory, prophylactic)

Question 38

Disease: Caused by increased air flow and drying of airways Can experience w/o hx of dx asthma Prevent w/proper warm-up and pharm Up to 30% of olympic athletes

Answer 38

Exercise Induced Bronchospasm

Question 39

Disease: Developing pulmonary disease results in increasing hypoexmia (constricts pulmonary system) Vasoconstriction causes pulmonary hypertension (R heart working harder due to peripheral edema) R ventricular hypertrophy secondary to these abnormalities of lung structure/function

Answer 39

Cor Pulmonale

Question 40

Disease: Inherited chronic disease that affects the lung and digestive system Defective gene and protein that cause the body to produce unusually thick sticking mucus Clogs lungs causing lung infection Clogs pancreas and stop natural enzymes from breaking down/absorbing food

Answer 40

Cystic Fibrosis

Question 41

Disease Symptoms: Persistent Coughing Frequent Lung Infection Wheezing and SOB Salty-Tasting Skin Poor Growth/Weight Gain Greasy/Bulky Stools w/Difficult Bowel Movements

Answer 41

Cystic Fibrosis

Question 42

Cystic Fibrosis is caused by a dysregulation of the \_\_\_1\_\_\_ protein which leads to the \_\_\_\_2\_\_\_\_ of the airways to clear \_\_\_3\_\_\_. Lung function progresses from \_\_\_\_4\_\_\_\_ to the addition of a \_\_\_\_\_5\_\_\_\_\_ component.

Answer 42

1. CFTR (cystic fibrosis transmembrane conductance regulator) 2. Failure 3. Mucus 4. Obstruction 5. Restrictive

Question 43

List the Tx of Cystic Fibrosis (5)

Answer 43

1. Inhaled agents (bronchodilators, mucolytics, antibiotics) 2. Exercise 3. Nutrition 4. Lung Transplant 5. Drug Therapies

Question 44

Once a \_\_\_1\_\_\_ always a \_\_\_\_2\_\_\_\_. \_\_3\_\_ and \_\_4\_\_ for all. Hypoxia for \_\_\_\_\_5\_\_\_\_\_, hypercarbia for \_\_6\_\_. Dry cough for \_\_\_\_\_7\_\_\_\_\_, productive cough for \_\_8\_\_.

Answer 44

1. COPDer 2. COPDer 3. SOA 4. DOE 5. Emphysema 6. CB (chronic bronchitis) 7. Emphysema 8. CB

Question 45

Describe different breathing techniques for COPD

Answer 45

Pursed lip: creates backpressure, helps pt. get over the hump, no LT benefit Tripod Position [elbows on table]: allow accessory mm to more efficiently lift the chest wall

Question 46

Disease: Decreased flow rates, hypercapnia, hyperinflation

Answer 46

COPD