Pathology Review: Obstructive Diseases

Question 0

Emphysema: Shortness of Breath?

Answer 0

Pursed lip breathing

Question 1

Emphysema: Past Medical History?

Answer 1

Smoking

Question 2

Emphysema: Cough?

Answer 2

Productive

Question 3

Emphysema: Appearance of chest?

Answer 3

Barrel Chest

Question 4

Emphysema: Respiratory Pattern?

Answer 4

Accessory Muscle Use

Question 5

Emphysema: Appearance of nail beds

Answer 5

Clubbing

Question 6

Emphysema: Diagnostic Chest Percussion

Answer 6

Hyperresonant/tympanic note

Question 7

Emphysema: breath sounds

Answer 7

Wheezing, diminished breath sounds

Question 8

Emphysema: what is involved in the Primary Assessment?

Answer 8

Past medical history, shortness of breath, cough, appearance of chest and nails, respiratory pattern, breath sounds and diagnostic chest percussion

Question 9

Emphysema: chest x-ray?

Answer 9

Hyperlucent lung fields, flattened diaphragm, long and narrow heart

Question 10

Emphysema: pulmonary function test

Answer 10

Decreased flow rates and decreased DLCO

Question 11

Emphysema: CBC and Sputum

Answer 11

Increased RBC/Hb/Hct and sputum may indicate bacterial infection

Question 12

Emphysema: what is the treatment/management?

Answer 12

Low flow oxygen therapy at 1-2 L/min (.24-.28)
Antibiotics
Pulmonary Rehab and Home Care
Aerosolized Medications
Consider NIPPV for acute exacerbation of ventilators failure
Annual flu injection
Smoking cessation programs
Pulmonary hygiene

Question 13

Emphysema: what should an RT consider when it comes to Oxygen Therapy (Decision Making)?

Answer 13

Consider oxygen conservation devices (i.e reservoir cannula, transtracheal catheters, for home use)

Question 14

Chronic bronchitis: what primary assessments will be similar to emphysema?

Answer 14

Smoking history, pursed-lip breathing, barrel chest, and hyperresonant/tympanic note

Question 15

Chronic bronchitis: what is the difference in breath sounds with Chronic Bronchitis and Emphysema?

Answer 15

Rales and wheezing

Question 16

Chronic bronchitis: in the secondary assessment, what is the only difference between Emphysema?

Answer 16

The electrolytes indicate chronic ventilators failure (increased HCO3)

Question 17

Chronic bronchitis: what is first treatment/management option?

Answer 17

Pulmonary hygiene therapy

Question 18

Chronic bronchitis: what are all of the treatment/management options for this disease?

Answer 18

Pulmonary hygiene therapy, antibiotics for infection, oxygen for hypoxemia, aerosolized medications, NIPPV, smoking cessation programs, and reduce risk factors

Question 19

Bronchiectasis: what is the past medical history?

Answer 19

Recurrent pulmonary infections

Question 20

Bronchiectasis: what type of cough will this patient present with?

Answer 20

Productive with purulent foul smelling sputum, hemoptysis, and 3 layer sputum

Question 21

Bronchiectasis: what special diagnostic test should be ordered if this disease is suspected?

Answer 21

CT Scan or bronchogram indicates a “tree in winter” pattern

Question 22

Bronchiectasis: what is the first treatment option? (Hint: the same as chronic bronchitis)

Answer 22

Pulmonary hygiene

Question 23

Bronchiectasis: which aerosolized medication is not indicated for this disease process?

Answer 23

No long acting beta 2 agonists

Question 24

Bronchiectasis: what are aloof the treatment options for this disease process?

Answer 24

Pulmonary hygiene, antibiotics, aerosolized medication, surgical resection if necessary, and oxygen for hypoxemia

Question 25

Asthma: what antibodies will be increased in the sputum?

Answer 25

IgE levels

Question 26

Asthma: what is a vital sign that is unique to this disease process?

Answer 26

Pulses paradoxus

Question 27

Asthma: what are the pulmonary function results?

Answer 27

Decreased flow rates, normal DLCO, pre and post bronchodilator improvement (at least 12%)

Question 28

Asthma: what are kinds of rescue medications?

Answer 28

Short acting Beta 2 Agonists and anticholinergics

Question 29

Asthma: what are examples of controller medications?

Answer 29

Long acting Beta 2 Agonists, inhaled corticosteroids, mast cell stabilizers (for prevention)

Question 30

Asthma: what should emergency room treatment for acute episodes include?

Answer 30

Oxygen therapy, aerosol therapy with SABA and anticholinergics (consider continuous aerosol therapy), steroids (oral or IV), close monitoring, intubation and mechanical ventilation, consider adjunct therapy: heliox, magnesium sulfate, subcutaneous epinephrine