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Cardiorespiratory Practical Exam > Pathologies > Flashcards

Pathologies Flashcards

1
Q

What is the definition of Chronic Obstructive Pulmonary Disease?

A

Group of lung conditions that includes both emphysema and chronic bronchitis

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2
Q

What is emphysema?

A

Pink Puffers

Primarily affects the alveoli and the small distal airways

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3
Q

What is chronic bronchitis?

A

Blue Bloaters

Primarily affects the bronchi and bronchioles

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4
Q

What does research suggest the prevalence of COPD is strongly related to?

A

Smoking

Air pollution

Occupation

Patients with susceptible genetic backgrounds

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5
Q

What is the pathophysiology of emphysema?

A

Inflammatory response leads to elastin fibre breakdown and breakdown of alveolar walls, leads to loss of elastic alveoli recoil = impairing ventilation and leads to air trapping

This increases end expiratory volume causing hyperinflation (O2 and CO2 still trapped in the alveoli at then end of expiration)

The reduced ventilation and loss of gas exchange surface area lead to matched V/Q deficit = hypoxaemia and hypercapnia

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6
Q

What is the pathophysiology of chronic bronchitis?

A

Inflammatory changes leading to mucociliary dysfunction and increase goblet cell function and numbers = excessive mucus production

Bronchoconstriction of the bronchi and bronchioles

Airway obstruction (bronchoconstricition & excessive mucus production) = Wheezing usually during expiration

Alveolar hypoxia due to imapaired flow of O2 through smaller airways = V/Q mismatch causing hypoxaemia and hypercapnia

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7
Q

In chronic bronchitis, what happens due to V/Q mismatch?

A

Body makes more haemoglobin due to hypoxaemia (Polycythemia)

Hypercapnia = blood becomes acidic

Polycythemia and acidic blood = cynosis (blue colour)

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8
Q

How does Right sided heart failure occur in patients with chronic bronchitis?

A

Alveolar hypoxaemia = constriction of pulmonary vessels to shunt blood flow to healthier alveoli

Pulmonary vasconstriction = increase in pulmonary vascular pressure (pulmonary hypertension)

Pulmonary hypertension causes back-flow of blood to the Right side of the heart and cause Right sided heart failure

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9
Q

What are the main problems that affects physiotherapy intervention in COPD patients?

A

Sputum retention

Increased work of breathing

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10
Q

What are the 2 types of asthma? And which is most common?

A

Atopic and non-atopic

Most common = Atopic

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11
Q

What is the definition of asthma?

A

Hyperactive airways that respond to various stimuli by widespread inflammation and airway narrowing

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12
Q

What is Atopic asthma?

A

Extrinsic triggered by the environment

Inflammation mediated by SYSTEMIC IgE production

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13
Q

What is Non-atopic asthma?

A

Intrinsic

Inflammation caused not by exposure to allorgen

Inflammation mediated by LOCAL IgE production

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14
Q

What is the pathophysiology of asthma?

A

Lumen in asthmatic bronchiole is narrower

Increases in mucus production and increase in goblet cells

Increase in eosinophils in mucus and tissue (highly inflammatory)

Increase mast cell numbers in lamina propria (release histamine)

Increase neutrophils and t helper cells (both highly inflammatory)

Increase in smooth muscle cell size (hypertrophy)

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15
Q

What is the 3 characteristics of asthma?

A
  1. Airflow obstruction
  2. Bronchiole hyperresponsiveness
  3. Inflammation
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16
Q

What are the symptoms of asthma?

A

Shortness of breath

Wheeze

Chest tightness

Dry cough

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17
Q

Explain the role of IgE antibodies in asthma

A

IgE antibodies bind to mast cells and release lots of histamine

Histamine causes bronchoconstriction by stimulating smooth muscle

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18
Q

Explain the role of T-Helper cells in asthma

A

T-Helper 2 cells not usually found in normal lungs

In asthmatic lungs, T-Helper 2 cells promote inflammation by increasing antibody production

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19
Q

What are the main problems that affects physiotherapy intervention in asthmatic patients?

A

Increased work of breathing

Sputum retention in severe cases

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20
Q

What is the definition of pneumonia?

A

Inflammation of the lungs caused by microbes

The infection brings water into lung tissue

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21
Q

What are the 3 main causative agents for pneumonia? And the most common?

A

Viruses, bacteria and fungi

Viruses e.g. staph aureus and strep pneumonia

22
Q

What are the symptoms of pneumonia?

A

Malaise

Confusion

Tachycardia

Rigor (sudden feeling of cold/shivering and rise in temperature/sweating)

Productive cough

23
Q

What is the pathophysiology of pneumonia?

A

Causative agents enter the lungs to the alvoeli and causes an immune response

Macrophages secret cytokines which cause vasodilation and increased vascular permeability

This causes fluid to pass into alveolar space leading to consolidation

Also see bronchoconstriction and increased mucus

24
Q

What is lobar pneumonia?

A

Consolidation of a lobe

Starts distally and spreads throughout

25
Q

What is broncho pneumonia?

A

Affects areas throughout the lung (bronchi and alveoli)

Begins proximally and moves distally

26
Q

What are the 6 catagories of pneumonia

A
  1. Community acquired pneumonia
  2. Hospital acquired pneumonia
  3. Ventilator associated pneumonia
  4. Broncho pneumonia
  5. Atypical or Interstitial pneumonia
  6. Lobar pneumonia
27
Q

What is Community acquired pneumonia?

A

Most common, patient becomes unwell outside a healthcare setting

28
Q

What is Hospital acquired pneumonia?

A

Patient becomes unwell in a hospital setting

More serious = Patient has weakened immune system and more resistant viruses e.g. MRSA

29
Q

What is Ventilator associated pneumonia?

A

Patient unable to cough so microbes move to lungs from airway

30
Q

What is Atypical or Interstitial pneumonia?

A

Infection of interstitium that surrounds alveoli

31
Q

What are the main problems that affects physiotherapy intervention in pneumonia patients?

A

Sputum retention

Loss of lung volume

32
Q

What would a chest examination show on a patient with pneumonia?

A

Reduced chest expansion

Impaired resonance during percussion

Bronchial breath sounds

Vocal resonance during auscultation

33
Q

What is the definition of cystic fibrosis?

A

Most common lung disease in young adults and children

Systemic dieases that affects the respiratory tract, gastrointestinal tract, reproductive organs and liver and pancreas

34
Q

Explain the pathophysiology of cystic fibrosis

A

Mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene

This gene regulates movement of chloride and sodium ions across epithelial cell membranes

The chloride channels do not work and chloride cannot be secreted across the epithelium to moisten the lung

As chloride ions are -ve and sodium ions are +ve they stay together and sodium is also not secreted across the epithelium

Water follows sodium = reduced water across the epithelium = mucus hyperviscosity

Hyperviscous mucus leads to impaired mucocillary clearance, pancreatic insufficiency and intestinal malabsorption

35
Q

What does impaired mucocillary clearance in cystic fibrosis lead to?

A

Inflammation (neutrophils and interleukins)

Neutrophil breakdown releases massive amounts of proteases that destroy the local host defences, induce oxidative stress, increase viscosity of endobrachial secretions, worsen mucociliary clearance and promote lung tissue destruction, mucus obstruction and infection

Impaired mucociliary clearance causes build-up of pathogens and debris in the airways that cannot be expectorated leading to further infection

This leads to further scaring of the epithelial tissue leading to greater damage and further impairment of mucocillary escalator

36
Q

What triggers recurrent cystic fibrosis exacerbations and what does this cause?

A

Triggered by acute bacterial infections

Promotes progressive loss of lung tissue architecture with bronchiectasis

37
Q

What is the most common bacteria that colonises airways in CF?

A

Pseudomonas aeruginosa

38
Q

What are the most prominent symptoms in CF?

A

Cough

Tachypnoea

Wheezing due to recurrent chronic bronchopulmonary infections

Lung hyperinflation starts early in the course of the disease

39
Q

What are the main problems that affects physiotherapy intervention in CF patients?

A

Sputum retention

Increase work of breathing

40
Q

What is the definition of bronchiectasis?

A

Permanent abnormal dilation of 1 or more bronchi with excessive mucus production

41
Q

What is bronchiectasis a common feature of?

A

Cystic fibrosis

Patients can get non-CF bronchiectasis

42
Q

What is the main cause of bronchiectasis?

A

Damage to the airways due to severe lower respiratory tract infections e.g. pneumonia

Also associated as a secondary manifestation of primary lung disease e.g. COPD and asthma

43
Q

What is the pathophysiology of bronchiectasis?

A

The inflammatory processes linked to acute and chronic lung infection damage the epithelial cells

Bacteria can enter and remain in the airways and colonise mucus

Bacteria stimulates many inflammatory response which further inhibit epithelial cell function, damages the elastic and muscular tissue of the bronchial walls and increases mucus production

Loss of elastic and muscular tissue in the airway walls = dilation of bronchi

Viscous cycle occurs where clearance of sputum from the dilated bronchi is impaired and secretions become chronically infected

This produces a persistent inflammatory response which results in progressive destructive lung disorder

Hyper secretion of mucus

44
Q

What is the clinical features of bronchiectasis?

A

Chronic cough

A lot of sputum

Dyspnoea

Wheezing

Chest pain

45
Q

What are the main problems that affects physiotherapy intervention in bronchiectasis patients?

A

Sputum retention

Increase work of breathing

46
Q

What is a restrictive disease?

A

Difficulty fully expanding the lungs (AIR IN)

Affects the respiratory zone

FEV1/FVC ratio is >70%

47
Q

What is an obstructive disease?

A

Difficulty fully exhaling air from lungs (AIR OUT)

Affects the conductive zone

FEV1/FVC ratio is <70%

48
Q

What type of disease is COPD?

A

Obstructive

49
Q

What type of disease is asthma?

A

Obstructive

50
Q

What type of disease is pneumonia?

A

Restrictive

51
Q

What type of disease is Cystic Fibrosis?

A

Obstructive

52
Q

What type of disease is bronchiectasis?

A

Obstructive

Cardiorespiratory Practical Exam (14 decks)

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