Pulm Intro And Obstructive

Question 1

Describe each structure: parenchyma, pleura, hilum, alveoli,

Answer 1

Parenchyma: spongy, cone-shaped and holds alveoli for gas exchange

Pleura: 2 serous membranes (visceral covers outside of lung, parietal covers inner chest wall)

Hilum: entrance for n/vessels/bronchi

Alveoli: spongy, where gas exchange occurs

Question 2

What are pneumocytes? Describe each type of

Answer 2

Epithelial cell

Type I: most abundant
Type II: cover minimal area and secretes surfactant to decrease surface tension and prevent collapse during exp

Question 3

What does the conducting zone consist of? Respiratory zone?

Answer 3

Conducting: nose and bronchioles

Respiratory: alveoli

Question 4

Describe the R and L main bronchus

Answer 4

R: shorter and downward, R upper and middle lobe bronchus

L: greater angle, upper and lower bronchus

Question 5

Clinical presentation of COPD (6)

Answer 5

-dyspnea w/ activity
-chronic cough
-barrel chest
-wheezing
-decreased or absent breath sounds
-retain CO2

Question 6

Grade 1 GOLD staging classification

Answer 6

-Grade 1: greater than or equal to 80% predicted FEV1
-MILD: symps mild and pt has SOB

Question 7

Grade 2 GOLD staging classification

Answer 7

-Grade 2: 79-50% predicted FEV1
- MOD: may seek help for SOB

Question 8

Grade 3 GOLD staging classification

Answer 8

-Grade 3: 30-49% predicted FEV1
-SEVERE: flare ups frequent

Question 9

Grade 4 GOLD staging classification

Answer 9

-Grade 4: <30% predicted FEV1
-VERY SEVERE: lung fxn decreasing

Question 10

General COPD medical management (6)

Answer 10

-quit smoking
-meds
-tx sleep disorders
-vaccines
-pulm rehab and exercises
-surgery

Question 11

Emphysema - what is it, cause, clinical signs (5)

Answer 11

“pink puffer”

destruction of alveolar walls, increases airspace

cause: smoking and environment

signs: accessory mus breathing, pursed lip breathing, minimal/no cough, lean fwd breathing, dyspnea on exertion

Question 12

Chronic bronchitis - what is it, cause, clinical signs (6)

Answer 12

“blue bloater”

cause: secretions block bronchioles, hypertrophy of submucosal glands

signs: gurgly/crackly breath sounds, excess body fluids, cyanosis, chronic cough, SOB on exertion, increased sputum

Question 13

Asthma what is it, risk factors

Answer 13

chronic airway inflam

risk factors: environment, genetics, sex, infections, allergens, obesity**

Question 14

Asthma clinical present

Answer 14

-alt breathing pattern
-wheezing w/ relaxed breathing or forced exhal
-decrease breath sounds during exacerbation
-dyspnea on exertion
-pursed lip breathing
-leaning fwd posture

Question 15

Asthma symptoms (5)

Answer 15

-SOB
-tight chest
-wheezing
-fatigue during exercise
-cough (worse at night and early morn)

Question 16

How to dx asthma?

Answer 16

spirometry - decreased FEV1 and increased RV and FRC

Question 17

Asthma severity descriptions (4)

Answer 17

-intermittent: norm spirometry when NOT having attack, exacerbations <2x/wk and month, no activity interference

-mild persistent: symps >2x/wk and 3-4/m, norm spirometry NOT having attacks, attacks interfere w/ act

-mod persistent: daily symps and meds, frequeny night symps, interferes act, >60% but <80% spirometry

-severe: continuous symps daily, act very limited, abnorm spirometry <60%

Question 18

Asthma medical management - PT exam, education, prevention

Answer 18

-exam: episodes of coughing, tight chest, wheezing, night symps, ADLS affected, flare up pattern

-edu: lifestyle mods, decrease environmental irritants, household mods, exercise induced asthma (warm up, nose/mouth covering outside, hydrate)

Question 19

COPD implications for PT (7)

Answer 19

-secretion clearance
-controlled breathing
-rolling walker amb
-endurance ex
-strength
-thoracic stx
-postural re-ed

Question 20

Asthma implications for PT (6)

Answer 20

-begin when med regimen stable
-secretion clearance
-controlled breathing
-ex and strength (aerobic improves asthma control but not inflam)
-thoracic stx
-postural re-ed

Question 21

Cystic fibrosis - what is it, symp (8)

Answer 21

genetic condition where protein affects mucus and sweat production - affects multiple systems

-persistent cough (green sputum)
-recurrent lung infections
-malabsorption of nutrients in GI
-decreased fat-soluble vitamins
-pancreatic insufficiency
-muscle pain
-decreased bone density -> osteop.
-diabetes

Question 22

Medical management (goal from NIHCE, prognosis, prevention, PT goals)

Answer 22

-goal: control lung infection, mucus clear, increase nutritional status, pancreatic status

-prognosis: increase in age of survival

-prevent: genetic counseling, screening for carrier

-PT goals: prevent secondary complications, increase QOL, maintain lung rxn

Question 23

Cystic fibrosis clinical presentation (8)

Answer 23

-GI and pancreas dysfxn
-chronic cough
-frequent pulmonary infections
-crackles and wheezes
-cyanosis
-digital clubbing
-pursed-lip breathing
-accessory mus hypertrophy

Question 24

PT tx for cystic fibrosis (7)

Answer 24

-secretion clearance
-controlled breathing
-ex and strength
-Inspiratory mus training
-thoracic stxing
-postural re-ed
-pt edu and home mgmt

Question 25

Obstructive disease: anatomy affected, breathing phase difficulty, pathophysio, useful measurements

Answer 25

-airways
-expiration
-increased airway resistance
-flow rates

Question 26

Restrictive disease: anatomy affected, breathing phase difficulty, pathophysio, useful measurements

Answer 26

-lung parenchyma, thoracic pump
-inspiration
-decreased lung or thoracic compliance
-volumes or capacities