Pulmonary Disease Flashcards
What are the 5 classifications of pulmonary disease?
- Obstructive
- Restrictive
- Infectious
- Vascular
- Pleural
What are 4 non-septic obstructive pulmonary diseases?
- Emphysema
- Alpha-1 antitrypsin deficiency
- Bronchiolitis obliterans
- Asthma
What are 3 septic obstructive pulmonary diseases?
- Chronic bronchitis
- Cystic fibrosis
- Bronchiectasis
What is the major pathologic function of COPDs?
- Trapping air in the lungs
Where does COPD rank in cause of death in the US? Worldwide? (1st, 2nd, 3rd, etc?)
3rd in US
6th Worldwide
How much did COPD cost the American economy in 2007?
42.6 billion dollars.
Where does COPD rank in the US in terms of cause of disability? (numerical)
2nd.
Is COPD treatable? Is it reversible?
- COPD can be prevented, and treated to an extent, but is not fully reversible.
What is the greatest risk factor for COPD? How many cases of COPD is it responsible for?
- Cigarette smoking responsible for 80 - 90 percent of COPD cases.
What is remarkable about the death rate of COPD when compared to other pathologies?
- Rising at a time when most other diseases are lessening in incidence.
Which type of COPD produces a large volume of sputum?
Septic.
** Slide 7 **
** Slide 7 **
How does the residual volume of the lungs change in obstructive disease?
Increases.
What is the clinical diagnosis for chronic bronchitis?
- Cough and sputum for over 3 months for over 2 years
What is the pathologic diagnosis of emphysema?
- Gas exchange surfaces of lungs (alveoli and capillaries) are destroyed
What are the pulmonary function test findings of Non-septic obstructive diseases?
- Increased TLC
- Increased IRC
- Increased RV
- Decreased FVC
- Decreased FEV1
- Decreased Carbon monoxide diffusion capacity
- Decreased FEV1/ FVC
Why is the lung volume larger in non-septic obstructive diseases?
- Premature airway closure
What actions help the lungs hyperinflate in non-septic obstructive diseases?
- Excessive accessory respiratory muscle use
What deformity results from hyperinflation of the lungs due to non-septic obstructive diseases?
- Barrel chest deformity
What would be the results of an ABG test performed on a patient with non-septic obstructive disease?
- Low oxygen
- High or low carbon dioxide
What are 3 secondary effects due to medications prescribed for non-septic obstructive diseases?
- Muscle atrophy/ weakness
- Osteopenia and osteoperosis
- R-sided heart failure
What is the most prevelant COPD?
- Asthma
What is the second most prevalent COPD disease?
- Emphysema
What is hypothetical pathogenesis of emphysema?
- Elastase normally inactivated by alpha1-antitrypsin
- Smoking upsets the balance of elastase and alpha1-antitrypsin
- Connective tissue matrix of alveolar walls destroyed by elastase released by alveolar neutrophils
What is the effect of emphysema’s destruction of the connective tissue matrix?
- Airways are dilated distal to the terminal bronchioles
- Decreased pressure in lumen
- Impaired airflow during inspiration
- Airways close early and trap air destroying acini
What volume is increased by emphysema?
Residual volume.
Since there is decreased pressure in the lumen of the respiratory vessels, what muscles have to work hard? What are their physiological changes?
Inspiratory muscles are shortened, have decreased sarcomeres, and are hypertrophied.
What are 4 signs/symptoms of Emphysema (early stage)?
- Cough and phlegm
- Dyspnea on exertion
- Increased A-P diameter (Barrel chest)
- Increased rib angle
What will be heard on auscilation of emphysema?
- Decreased distant breath sounds
- Prolonged expiratory phase’
- Wheezing and ronchi (coarse rattling sound) due to secretions
What are 13 (ugh..) complications of emphysema?
- Cachexia
- R-side heart failure
- Peripheral pitting edema
- Weight gain
- JVD
- Decreased appetite
- RUQ discomfort
- Ventricular gallop
- S3 heart sound
- Osteoporosis
- Depression
- CVD
What are 4 categories of medication prescribed for emphysema.
- Smoking cessation drugs
- Bronchodilators
- Methylxanthines
- Antibiotics (during exacerbations)
What are 3 classes of bronchodilators?
- Anticholinergics
- B2- agonists
- Inhaled corticosteroids
What are 2 specific anticholinergics?
- Ipratropium
- Tiotropium
What are 3 specific B2-agonists?
- Albuterol
- Salmeterol
- Formoterol
What are 3 specific inhaled corticosteroids?
- Beclomethasone
- Fluticasone
- Triamcinolone
What is the purpose of methylxanthines in the treatment of emphysema?
- Improves respiratory muscle strength and endurance
What relieves SOB in exacerbations of emphysema?
Inhaled systemic corticosteroids.
What is the only therapy for emphysema that is proven to increase survival?
- Supplemental oxygen
In what type of cases is supplemental oxygen especially important in treating emphysema?
- HTN and polycythemia
What type of supplemental oxygen is usually appropriate for emphysema treatment?
- Low flow O2 via nasal canula.
What type of behavioral management is typically applied when treating emphysema?
- Smoking cessation.
What vaccines help control symptoms and exacerbations of emphysema?
- Influenza
- Pneumococcal
What type of replacement therapy is appropriate for emphysema?
Alpha1-antitrypsin.
What 2 mechanical devices can assist in emphysema management/ treatment?
- BiPAP to assist in breathing
- Mucous clearance devices
What type of rehab is recommended for emphysema patients?
Pulmonary rehab.
What cells produce elastase?
Neutrophils.
What organ produces alpha-1 antitrypsin? What the enzyme’s function?
The liver produces Alpha-1 antitrypsin to control elastase.
What structures are damaged by alpha-1 antitrypsin deficiency?
- Lungs (usually coated by AAT)
- Liver (AAT trapped in the liver)
What is the most common autosomal recessive genetic liver disease in children?
- AAT deficiency
What is the most common genetic pulmonary disease?
- Cystic Fibrosis
Where is alpha-1 antitripsin synthesized?
- The liver
What is neutrophil elastase’s useful function?
- Break down bacteria from airway
When does AAT deficiency become primarily a pulmonary disease, and when does emphysema typically develop from the disease?
- Becomes pulmonary problem in second decade
- Emphysema develops in 3rd or 4th decade of life
What is the mechanism of injury in Bronchiolitis Obliterans?
- Acute inflammation injury with diffuse destruction of bronchioles associated with underlying inflammatory pathology
- Fibroproliferation in bronchioles
- Collagen deposition in cartilaginous airways
What is the most common cause of Bronchiolitis Obliterans?
- Lung transplants (rejections)
What percent of individuals develop Bronchiolitis Obliterans 5 years after transplant?
80 %.
When does BO typically onset after a lung transplant?
In 16 - 20 months.
What percent of people who survive a transplant for 3 months or more develop BO?
50 %
Besides patients who receive lung transplants, what other patients typically develop BO?
- Children and infants following a severe respiratory infections.
What are 8 clinical signs/ symptoms of BO?
- SOB with exertion
- Wheezing, crackles, ronchi
- Persistent cough
- Hypoventilation
- Hypercapnia
- Intercostal retraction
- Tachypnea
- Grunting
What is typically found in a chest radiograph (CXR) in BO?
- Hyperinflated lungs
- Patchy atelectasis (collapsed alveoli)
What are 3 results of a pulmonary function test of BO?
- Decreased forced vital capacity
- Decreased Forced Expiratory Volume over 1 second
- Increased residual volume
What are 3 findings of a CT scan of a patient with BO?
- Mosaic perfusion (patchwork of different weakening/ attenuation)
- Vascular attenuation (weakened or thinned vascularture)
- Central bronchiactasis (wide, flabby, scarred bronchioles)
What is the primary factor in treatment of BO?
- Prevention!
Once a patient develops BO, what are 4 treatments (medications)?
- Supplemental oxygen
- Antivirals
- Corticosteroids
- Bronchodilators
What is the cause of asthma?
- Unknown.
- Associated with a maturing immune system and lung tissue
What are 11 risk factors of asthma?
- Maternal smoking
- Secondhand smoke
- Family history
- Genetics
- Atopy (allergies)
- Childhood asthma
- Occupational exposures
- Environmental exposures
- Early infection (respiratory syncytial virus)
- Female gender
Is asthma an acute or chronic disease?
Chronic.
Asthma is the most common chronic disease in which age group?
Children.
What percent of children’s asthma onset before the age of 5?
80 %.
What percentage of children outgrow asthma?
- 50 - 70 %.
What percentage of children are limited in activity and play due to their asthma?
- 35 - 40 %.
What major risk factor do most children who develop asthma possess?
- Family history
What demographic is disproportionately affected by asthma?
Those in lower socio-econmic levels.
What was the prevelance of asthma in the US in 2000?
7.5 %.
What was RI’s ranking of asthma prevalence in the US states?
5th highest at 8.5 %.
What are happening to worldwide asthma prevalence and death rates?
Increasing.
What are the 3 defining factors of asthma?
- Airway inflammation
- Airflow can become limited, but is reversible
- Bronchii are hyperresponsive
What is a the name of a severe asthma attack that is resistive to bronchodilators?
- Status asthmaticus
What are 11 symptoms/ signs of asthma?
- Wheezing
- Dyspnea
- Chest pain/ tightness (especially at night)
- Facial distress
- Non-productive cough
- Decreased breath sounds
- Cyanosis
- Exhaustion
- Hypercapnia
- Pending respiratory failure
What are 7 categories of environmental factors that aggravate asthma symptoms?
- Indoor irritants
- Air pollution
- Allergens
- Pesticides
- Molds
- Dust mites, rodents, cockroaches, animal dander, and other animal/ insect related environmental factors.
- Cold air
What are some examples of indoor irritants that aggravate asthma?
- Cigarette smoke
- Carbon monoxide
- Nitric oxide
- Poorly ventilated heating systems
What are 3 examples of air pollution that can aggravate asthma?
- Diesel exhaust
- Ozone
- Smoke
What type of infection can trigger asthma?
- Respiratory infection
What activity can trigger asthma?
Exertion and/or exercise for 10 - 15 minutes.
How long does asthma induced from exertion/ exercise usually take to resolve?
- 30 - 60 minutes
What 4 medications can trigger asthma?
- NSAIDs
- ACE inhibitors
- Aspirin
- Beta-blockers
What causes Exercise Induced Asthma?
- Loss of water and heat from lower respiratory system. (due to mouth breathing)
- Loss of heat causes hyperemia, vascular engorgement & bronchial edema (narrows bronchioles)
How long does bronchoconstriction persist following exercise in EIA?
6 - 8 hours.
How is a diagnosis of EIA determined in children?
Simply by a history of symptoms consistent with EIA.
How is EIA diagnosed in adults?
- 15 % drop in Peak Expiratory Flow after exercise
- Greater than 15 % increase in FEV1 following use of a bronchodilator
What 4 factors increase the severity of EIA?
- Minute ventilation during exercise
- Cold temperatures
- Dry air
- High baseline reactivity of airways
What is the pathogenesis of EIA?
- Trigger
- Inflammatory process
- Bronchorestriction
- Airway obstruction
What are 5 types of asthma medication?
- Short and long acting beta-2 agonist bronchodilators
- B-Adrenergic agonists
- Cromolyn
- Leukotreiene modifiers
- Immunosuppressive medications
How do B-Adrenergic agonist medications manage asthma?
- Relaxes smooth muscles
- Results in brochodilation
- Inhibits release of inflammatory mediators
What type of medication is used to prevent an asthma attack? (not a rescue medication)
Cromolyn.
How do Leukotriene modifiers manage asthma?
- Blocks proinflammatory mediators that promote:
- Smooth muscle contractions
- Vascular leakage
- Mucous secretion
- Airway hyperactivity
In what type of patients with asthma are immunosuppresive medications used?
- Chronic, severe asthma
What are 4 beta2-selective bronchodilators?
- Albuterol
- Bioterol
- Pirbuterol
- Salmeterol
What preparation can be made prior to exercise to reduced the effects of EIA?
- Medication, and warm up 45 - 60 minutes prior to exercise.
- Warm up –> 30 second bouts with 2 minute rest periods
What non-pharacologic treatments can help reduce symptoms of EIA?
- Environmental control to reduce allergens
- Routine exercise to: increase O2 consumption, decrease blood lactate, and increase minute ventilation
What differentiates septic obstructive diseases from non-septic obstructive diseases?
- Purulent sputum productive coughs
- High incidence of pulmonary infection
- Excessive secretion production
What are typical results of a PFT in septic obstructive disease?
- Decreased expiratory effort
- Increased Total lung capcity
- Hypercapnia (high CO2)
What vessels change pressure in septic obstructive diseases, and what is the effect of this?
- High pressure in pulmonary arteries
- Heart enlargement and failure
- Cor pulmonale
What is the clinical diagnosis of chronic bronchitis?
Cough and sputum production for 3 months or more for 2 years or more.
What is the number one risk factor of chronic bronchitis?
Smoking.
What is the 4 step pathogenesis of chronic brochitis?
- There is an increase in the size and nbumber of bronchial mucous glands leading to excess mucus in airways
- Larger and more number glands in addition to airway inflammation thickens the walls of the airways
- Cilia’s structure and function are impeded causing less mucous to be cleared
- Small airways (less than 2mm) narrow, develop inflamation, and become fibrous
What are 8 common categories of medications for individuals with Chronic Bronchitis Medications?
- Various antibiotics for bacterial and fungal infection
- Short acting beta-agonists
- Long acting bronchodilators
- Inhaled corticosteroids
- Smoking cessation drug therapy
- Expectorants and mucolytics
- Antiprotease treatment (to decrease destruction of elastin by inflammation)
- Supplemental oxygen
What 2 vaccines are commonly prescribed for individuals with chronic bronchitis?
- Influenza
- Pneymococcal
What behavioral therapy can be prescribed for chronic bronchitis?
Smoking cessation.
What are 3 therapy treatments for individuals with chronic bronchitis?
- Bronchial hygiene
- Pulmonary rehab
- Early mobilization
What pathology does “Pink puffer” refer to?
Emphysema
What pathology does “Blue bloater” refer to?
Chronic bronchitis.
What is the major symptom of a “Pink puffer” and a “Blue bloater”?
PP: Dyspnea
BB: Cough and sputum
What is the appearance of a “Pink puffer” and a “Blue bloater”?
PP: Thin, wasted, not cyanotic
BB: Obese and cyanotic
How are “Pink puffer”s and “Blue bloater”s PO2 and PCO2 affected?
PP: Decreased O2 and Decreased or normal CO2
BB: Very decreased O2, and normal or high CO2
How is the elastic recoil of the lung affected in a “Pink puffer” and a “Blue bloater”?
PP: Decreased
BB: Normal
How is the diffusing capacity affected in a “Pink puffer” and a “Blue bloater”?
PP: Decreased
BB: Normal
How is the hematocrit affected in a “Pink puffer” and a “Blue bloater”?
PP: Normal
BB: Frequently incrased
Does cor pulomale occur more often in a “Pink puffer” or a “Blue bloater”?
Blue bloater.
What devices can be used to help a patient with chronic bronchitis clear mucus?
- Flutter mucus clearance device
- Acapella mucus clearance device
Which septic obstructive disease is an autosomal recessive trait?
- Cystic fibrosis
How common is cystic fibrosis?
The most common genetic disease in US.
How lethal is cystic fibrosis?
Most lethal genetic disease in US.
What is the incidence of cystic fibrosis?
1 in 3900 live white births.
What type of cells are affected by cystic fibrosis?
- Epithelial cells of exocrine glands
What 8 organs are targeted by cystic fibrosis?
- Sinuses
- Lungs
- Pancreas
- Intenstines
- Biliary tracts
- Vas deferens
- Uterine cervix
- Sweat glands
What are the implications of cystic fibrosis being an autosomal recessive trait?
There are many asymptomatic carriers.
Describe the chloride ion transfer defect caused by cystic fibrosis.
- Na+ and Cl- transport disturbed
- Pulls water back into cell making secretions thicker and drier
Describe the process of injury caused by cystic fibrosis in the lungs.
- Cilia cannot clear mucus
- Secretions settle in lungs
- Bacteria grow in stagnant secretions
- Cycle begins of: inflammation, infection, and tissue destruction
What does the thickened, stagnant secretions of cystic fibrosis lead to?
Obstruction and malabsorption (as in GI tract)
What is the hallmark clinical sign of cystic fibrosis in babies?
They taste salty.
What is the median lifespan of an individual with cystic fibrosis?
38 years.
What are 2 signs/symptoms of cystic fibrosis shortly after birth?
- Meconium ileus: (obstruction of intestines due to overly thick meconium)
- Failure to thrive/ regain birth weight
What are 5 respiratory signs/symptoms of cystic fibrosis?
- Recurrent respiratory infections
- Chronic productive cough
- SOB with excessive inspiratory accessory muscle use
- Inspiratory crackles and wheezing
- Nasal polyps
What 2 symptoms secondary to respiratory complications of cystic fibrosis?
- Clubbing of nails
- Decreased activity tolerance
What are 3 metabolic effects of cystic fibrosis?
- Pancreatic insufficiency, pancreatitis, and diabetes
- Osteoporosis
- Muscle wasting
What are 5 other clinical signs/symptoms of cystic fibrosis?
- Salty kiss
- GERD
- Weight loss
- Chronic low back pain
- Developmental delays
Why is early detection of cystic fibrosis important?
- So aggressive nutritional support can begin
What are two PT treatments for cystic fibrosis?
- Aerobic and strengthening exercise
- Energy conservation techniques
What 6 medications, and treatment techniques can increase life expectancy when faced with CF?
- Pancreatic enzyme replacement
- Vitamin supplements
- High caloric diets
- Airway clearance techniques
- Antibiotics and antifungal treatment
- Mucolytic and bronchodilator medications
What are 4 serious complications due to cystic fibrosis?
- Respiratory failure
- Right-sided heart failure
- Severe hemoptysis
- Spontaneous pneumothorax
What are 4 common medications for cystic fibrosis?
- Glucocorticoid steroids (anti-inflammatory)
- Bronchodilators
- Antibiotics
- Pancreatic enzymes (assist with digestion)
What are the two key causes of bronchiectasis?
- Intense chronic inflammation
- Inadequate defense to minimize infection resulting in tissue damage
What are 5 characteristics of bronchiectasis?
- Thickened bronchial walls
- Impaired mucociliary blanket
- Hypersecretion of purulent sputum
- Associated with other pulmonary diseases
- Permanent dilation of bronchi due to destruction of muscular and elastic properties of lungs
What is the best imaging technique for diagnosis of bronchiectasis?
- High resolution CT
Which imaging technique is non-specific when diagnosing bronchiectasis?
- Chest x-ray
What 2 respiratory sounds are associated with bronchiectasis?
- Crackles
- High and low pitch ronchi
What are 9 signs and symptoms of bronchiectasis?
- Persistent cough
- Copious secretions
- Frequent hemoptsis
- Recurrent infections
- Pleural rubs
- Fever
- Fatigue
- Dyspenea
- Digital clubbing
What determines the prognosis of bronchiectasis?
- Underlying disease
What are 5 methods of treatment of bronchiectasis?
- Treat the underlying disease
- Antibiotics, corticosteroids, and brochodilators
- Nutritional support
- Supplemental O2
- Airway clearance/ bronchial hygiene
What 4 other pathologies is pulmonary fibrosis linked to?
- Immune disorders
- Occupational exposures
- Genetic and hormonal abnormalities
- Complications of lung injuries
How does a patient with pulmonary fibrosis ‘s oxygen saturation differ from a normal patients?
- Lower oxygen saturation generally
- Rapid desaturation with exercise
What are 2 associated complications of pulmonary fibrosis?
- Pulmonary hypertension
- Cor pulmonale
How are an individual’s PFTs affected by pulmonary fibrosis?
- Decreased FVC and FEV1
- Normal FEV1/ FVC
- Reduced VB and TLC
What pathology is typically involved in Interstitial lung diseases?
- Fibrosis
What are 6 categories used to classify restrictive lung disease?
- Inhaled substances
- Drug induced
- Connective tissue disease
- Infection
- Idiopathic
- Malignancy
What are 3 common inorganic substances that can cause restrictive lung disease?
- Silicosis
- Asbestosis
- Beryliosis
What can cause restrictive lung disease by a mechanism of inhaled organic materials?
- Hypersensitivity pneumonitis
What 3 drugs can induce restrictive lung disease?
- Antibiotics
- Chemotherapeutic drugs
- Antiarrhythmic agents
What 5 connective tissue diseases can lead to restrictive lung disease?
- Systemic sclerosis
- Polymyositis
- Dermatomyositis
- Systemic lupus erythematosus
- Rheumatoid arthritis
What 3 infections can lead to restrictive lung disease?
- Atypical penumonia
- Pneumocystis pneumonia
- Tuberculosis
What are 3 idiopathic causes of restrictive lung disease?
- Atypical pneumonia
- Idiopathic pulmonary fibrosis
- Hamman-Rich syndrome
What malignancies are linked to restrictive lung disease?
- Lymphangitic carcinomatosis
What are 4 signs and symptoms of restrictive lung disease?
- Dry cough
- Gradual dyspnea with walking
- Crackles at the lung bases
- Clubbing
How is restrictive lung disease treated?
Treat the underlying cause.
What drug treatment is recommended for idiopathic pulmonary fibrosis?
No specific drug treatment.
What 2 drugs have an unproven benefit on restrictive lung disease?
- Corticosteroids
- Cytotoxic agents
What 5 medicines may be useful for restrictive lung disease?
- N-acetylcysteine
- IFN-gamma
- Pirfenidone
- Bosentan
- Etanercept
What 3 non-medicinal treatments should be considered for restrictive lung disease?
- Pulmonary rehabilitation
- Oxygen
- Lung transplantation
What is empyema?
Pus in the pleural space.
What is the pathogenesis of pneumonia?
- Acute inflammation of lungs
- Small bronchioles and alveoli become plugged with fibrotic exudate
What is the ranking of Pneumonia in cause of death in the US?
6th.
What 2 classifications are there for infectious lung disease?
- By agent (bacteria, fungus, virus)
- By environment of infection (community, hospital, nursing home, school, etc…)
What are the 3 categories of risk factors for infectious pulmonary disease?
- Medical
- Environmental
- Respiratory function
What are 6 medical related risk factors for infectious pulmonary disease?
- Age
- Integrity of immune system
- Acute head
- Neck trauma
- Chest trauma
- Surgery
What are some environmental risk factors for infectious pulmonary disease?
- Hospital environment
- Exposure to infected individuals
- Tracheal or gastric device
What are 2 mechanized treatments are associated with respiratory risk factors for pulmonary disease?
- Use of mechanical ventilation
- Aerosolized breathing treatments
What medical procedure is a risk factor for infectious pulmonary disease?
- Aspiration
What are 2 clinical signs/symptoms of infectious pulmonary disease?
- Fever
- Productive cough with yellow-green or rust colored sputum
What are 2 lab tests that help diagnose infectious pulmonary disease?
- Elevated WBC count
- Positive sputum culture
What are 3 methods of prevention of infectious pulmonary disease?
- Flu shots
- Proper care and cleaning of respiratory equipment
- Hand washing
How is infectious pulmonary disease specifically diagnosed?
- Chest X-ray showing consolidaiton for at least 48 hours, and at least 2 clinical signs such as:
- Dyspnea
- Fever
- Cough
- Leukocytosis
- Leukopenia
How many cases of TB were diagnosed in 2006?
9 million
How many deaths occurred due to TB in 2006?
1.7 million
In what 2 populations is tuberculosis the leading cause of death?
- Individuals with HIV/AIDS
- Women of child bearing years
What pathology is TB associated with in 95 % of diagnoses and 98 % of deaths?
- HIV
How many are co-infected with HIV and TB in the US?
15 million.
What 7 medical pathologies are risk factors for TB?
- HIV
- Cancer of the head/ neck
- Leukmia
- Hodgkin’s disease
- Diabetes mellitus
- Severe kidney disease
- Silicosis
What 4 medical treatments are risk factors for TB?
- Corticosteroid treatment
- Organ transplants
- RA treatment
- Crohn’s disease treatment
What behavior is a risk factor for TB?
- Substance abuse
What personal factor is a risk factor for TB?
- Low body weight
By what method is TB transmitted?
- Airborne transmission by dry droplet nuclei
- Become airborne from an infected person’s cough or sneeze
How far into the respiratory system must TB particles reach to cause an infection?
The alveoli.
What type of TB must the carrier have to transmit the infection?
- Laryngeal TB
or - Extensive spread of TB
What 3 factors increase the risk of TB infection? (not related to pathology related risk factors)
- Concentration of particles in air
- Length of exposure
- Host’s immune system
How long is the incubation period for TB?
2 - 12 weeks.
When will a test for TB become positive after the individual is initially infected?
6 - 8 weeks.
When is TB mostly asymptomatic? What symptoms may be present during this time?
- During the primary infection
- Unproductive cough and fever may be present
What percent of TB is pulmonary, and what percent affects other systems?
- 80 % pulmonary
- 20 % other systems/ organs
What type of medication is TB unresponsive to?
- Antibiotics
What are the non-specific symptoms of TB?
- Cough
- Fever
- Weight loss
What is the gold standard for TB diagnosis?
- Smear/ culture
What percent accuracy does a positive smear and culture have for TB in an HIV negative individual?
- 90 %
What percentage of TB cultures are negative?
20 %
How is a medicine regimen for TB deemed appropriate?
- Patient can tolerate it
- Won’t select resistant organisms
- Won’t interact adversely with other medications
What should be assessed when following up a TB regimen?
- Compliance
- Effectiveness of regimen
- Complications of therapy
Describe the regimen for TB during the intensive phase.
- For two months
- Four drug regimen
- Exact mixture of drugs can be modified with susceptibility testing
Describe the drug regimen during the continuation phase.
- INH - Rifampin
- INH - Ethambutol
How many cases of pulmonary embolism are there per year?
600,000
What other pathology typically precipitates a pulmonary embolism?
- A DVT
What rank are PEs in terms of causing cardiovascular death?
3rd.
What percent of treated PEs are symptomatic?
1/3rd/ 33%
What amount of post-op deaths are caused by PE?
3 %
What other sources besides thrombi can cause pulmonary emobilisms?
- Air
- Fat
- Amniotic fluid
What are 5 risk factors for pulmonary embolism? (There are 14 overall)
- Immobilization
- Surgery within last 3 months
- Stroke
- Previous h/o thromboembolism
- Chronic heart disease
- Acute MI
- CHF
- Cancer
- Over 40 years old
- Obese
- Lupus
- Major trauma
- SCI
- Oral contraceptives
(Anything that causes a blood clot is a risk factor for a pulmonary embolism)
What are the 3 MAJOR signs and symptoms of PE? (97 % of cases) (which is the number 1 symptom)
- Dyspnea (Unexplained/ rapid onset) (#1)
- Pleuritic chest pain
- Tachypnea
What are the 7 NON-MAJOR signs and symptoms of PE.
- Cough
- Hemoptysis
- Crackles
- Syncope
- Tachycardia
- Decreased breath sounds
- Abnormal lung sounds
What is the gold standard of imaging for diagnosis of a PE?
Spiral angiography.
What are the sensitivity and specificity of spiral CT angiography?
Sensitivity: 83 %
Specificity: 96 %
What imaging is used to detect a DVT?
- Color flow duplex imaging
What is the best treatment of PE?
Prevention.
List 4 treatments for prevention of PE.
- Early mobilization
- Compression stockings
- Anticoagulants
- Inferior vena cava filter
What are 3 treatments for a current PE?
- Thrombolysis
- Anticoagulative drugs (heparin, aspirin)
- Surgical and catheter embolectomy
What is the normal mean pressure in the pulmonary arterial system?
15 mmHg.
What mean pulmonary arterial pressure is considered hypertension during exercise, and at rest?
- 25 mmHg at rest
- 30 mmHg during exercise
What causes pulmonary hypertension?
Increase in pulmonary vascular resistance.
What is the cause of idiopathic pulmonary hypertension?
Unknown
or
Genetic
Who is most susceptible to pulmonary hypertension?
Young and middle aged women.
What is the 9 step pathophysiology of pulmonary hypertension?
- Sustained blood pressure elevation in pulmonary vesselks
- Overload of pressure in right vengtricle
- RV hypertrophy
- Cor pulmonale
- Compensatory tachycardia and RVH maintain CO at rest, but not during exertion
- RV overload results in RV failure
- Venous congestion
- Inadequate CO at rest
- Death by (mostly) RV failure.
What are 6 signs and symptoms of pulmonary hypertension?
- Dyspnea on exertion
- Fatigue, weakness
- Exertional chest pain
- Lightheadedness/ syncope
- Palpitations
- Possible hemoptysis
What other pathology shares the same symptoms as pulmonary hypertension?
- Cor Pulmonale
What is the gold standard diagnostic tool for pulmonary hypertension?
- Cardiac catherization
What are 4 other diagnostic tools for pulmonary hypertension?
- Pulmonary function tests
- Echocardiograms
- Pulmonary angiography
- V/ Q & CT scans
What are 4 types of treatment for pulmonary hypertension?
- Treat underlying disease
- Supplemental O2
- Medication
- Lung transplant
What are 3 types of medication prescribed for pulmonary hypertension?
- Anticoagulants
- Diuretics
- Vasodilators
What is the mean survival time of pulmonary HTN?
2.8 years
What is pulmonary edema?
- Accumulation of extravascular fluid in the interstitial and alveolar spaces in the lung
What are the 2 types of pulomnary edema?
- Increased pressure in left heart reflects to small vessels, and flood the pulmonary interstitial space
- Increased permeability due to acute lung injury (Acute respiratory distress syndrome)
What heart sound is present in pulmonary edema?
- S3
What types of lung sounds are heard in pulmonary edema?
- Diffuse crackles
- Possible wheezes
What are 2 psychosocial signs/ symptoms of pulmonary of edema?
- Anxiety
- Agitation
What are 4 physological signs and symptoms of pulomary edema?
- Dyspnea/ respiratory distress
- Orthropnea/ paroxysmal nocturnal dyspnea
- Diaphoresis
- Tachycardia/ arrhythmias
What 2 skin changes will be apparent in pulmonary edema?
- Pallor
- Cyanosis
What is critical in the treatment of pulmonary edema?
- Prompt diagnosis
What are 4 treatments for pulmonary edema?
- Treat underlying cause
- Supplemental O2
- Prevent and treat complications
- May require assisted ventilation
What are the 3 pleural pulmonary diseases?
- Pneumothorax
- Hemothorax
- Plerual effusion
How is pleural effusion different from pulmonary edema?
- Effusion is between the pleural linings
- Edema occurs in the interstitium of the lungs
What type of tumor develops from the pleura? What material is it associated with?
- Mesothelioma
- Associated with asbestos exposure
What type of surgery may be required in pleural disease?
- Drainage of the fluid/ air
What can enter the pleura to causing pleural disease?
- Air
- Fluid
What are primary and secondary pneumothorax?
Secondary is caused by an underlying disease, while primary is a spontaneous collapse of the pleura.
What disease is associated with secondary pneumothorax?
- COPD
What types of patients are at risk for primary pneumothorax?
- Tall, thin, young men
What enzymes and cells are imbalanced in blebs and bullae?
- Protease and antiprotease are imbalanced
- Increased numbers of neutrophils and macrophages
How are blebs and bullae related to pneumothorax?
They can rupture under pressure (cough, valsalva) causing air to rush into the pleural space.
What is latrogenic pneumothorax?
- Complications related to diagnostic or treatment procedures
What is traumatic pneumothorax?
- Penetrating wound allows air to rush in.
What is tension pneumothorax?
- Air enters pleural space and can’t escape
Which type of pneumothorax is life threatening?
Tension pneumothorax.
To which side is the medistinum displaced in tension pneumothorax?
- To the contralateral side
How will pneumothorax present on a CXR?
- Black, dark space in lung with a shifted mediastinum.
What is hemothorax?
- Effusion of blood into the pleura
What are 3 surgical procedures for pneumothorax?
- Needle or chest tube to aspirate air or blood from pleural space
- Chemical pleurodesis
- Thoractomy to resect bullae
How is the prognosis of a patient following pneumothorax determined?
- The size of the pneumothorax.
What is pleural effusion?
- Excessive collection of fluid between parietal and visceral pleurae.
What are the 2 types of pleural effusion?
- Transudate
- Exudate
What causes transudate pleural effusion?
3 pathologies
- Increased hydrostatic pressure within pleural capillaries due to:
- CHF
- PE
- Renal disease
What are 4 causes of exudate pleural effusion?
- Infection
- Malignancy
- Pulmonary embolism
- Infarct
What is the term pleural effusion with grossly purulent fluid?
Empyema.
What is the 6 step pathogenesis of pleural effusion?
- Excess fluid compresses lung tissue
- Atelectasis
- Reduced alveolar ventilation
- Increased work of breathing
- Incresaed fluid pressure restricts lung expansion
- Mediastinum shifts away from affected side
How will percussion sound with pleural effusion?
Fluid: Dull
Air: Hollow
What will be heard upon ausciltation of pleural effusion? (2 characteristics)
- Decreased/ absent breath sounds over effusion
- Possible pleural rub
What 3 systemic symptoms will be present in pleural effusion?
- Fever
- Shaking chills
- Night sweats
What are 2 respiratory symptoms of pleural effusion?
- Dyspnea
- Pleuritic chest pain that is aggravated by deep breathing and coughing
What are 3 conservative treatments of pleural effusion?
- Watch for natural reabsorption
- Segmental expansion/ diaphragmatic breathing exercises to prevent atelectasis
- Increased mobilization
What surgical procedure is used for pleural effusion?
- Thoracentesis
Which direction will the mediastinum shift towards in atelectasis?
- Towards the atelectasis
** Check end of pulmonary disease for cases **
** Check end of pulmonary disease for cases **