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Cardiopulmonary PT > Pulmonary Disease > Flashcards

Pulmonary Disease Flashcards

1
Q

What are the 5 classifications of pulmonary disease?

A
  • Obstructive
  • Restrictive
  • Infectious
  • Vascular
  • Pleural
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2
Q

What are 4 non-septic obstructive pulmonary diseases?

A
  • Emphysema
  • Alpha-1 antitrypsin deficiency
  • Bronchiolitis obliterans
  • Asthma
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3
Q

What are 3 septic obstructive pulmonary diseases?

A
  • Chronic bronchitis
  • Cystic fibrosis
  • Bronchiectasis
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4
Q

What is the major pathologic function of COPDs?

A
  • Trapping air in the lungs
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5
Q

Where does COPD rank in cause of death in the US? Worldwide? (1st, 2nd, 3rd, etc?)

A

3rd in US

6th Worldwide

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6
Q

How much did COPD cost the American economy in 2007?

A

42.6 billion dollars.

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7
Q

Where does COPD rank in the US in terms of cause of disability? (numerical)

A

2nd.

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8
Q

Is COPD treatable? Is it reversible?

A
  • COPD can be prevented, and treated to an extent, but is not fully reversible.
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9
Q

What is the greatest risk factor for COPD? How many cases of COPD is it responsible for?

A
  • Cigarette smoking responsible for 80 - 90 percent of COPD cases.
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10
Q

What is remarkable about the death rate of COPD when compared to other pathologies?

A
  • Rising at a time when most other diseases are lessening in incidence.
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11
Q

Which type of COPD produces a large volume of sputum?

A

Septic.

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12
Q

** Slide 7 **

A

** Slide 7 **

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13
Q

How does the residual volume of the lungs change in obstructive disease?

A

Increases.

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14
Q

What is the clinical diagnosis for chronic bronchitis?

A
  • Cough and sputum for over 3 months for over 2 years
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15
Q

What is the pathologic diagnosis of emphysema?

A
  • Gas exchange surfaces of lungs (alveoli and capillaries) are destroyed
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16
Q

What are the pulmonary function test findings of Non-septic obstructive diseases?

A
  • Increased TLC
  • Increased IRC
  • Increased RV
  • Decreased FVC
  • Decreased FEV1
  • Decreased Carbon monoxide diffusion capacity
  • Decreased FEV1/ FVC
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17
Q

Why is the lung volume larger in non-septic obstructive diseases?

A
  • Premature airway closure
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18
Q

What actions help the lungs hyperinflate in non-septic obstructive diseases?

A
  • Excessive accessory respiratory muscle use
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19
Q

What deformity results from hyperinflation of the lungs due to non-septic obstructive diseases?

A
  • Barrel chest deformity
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20
Q

What would be the results of an ABG test performed on a patient with non-septic obstructive disease?

A
  • Low oxygen

- High or low carbon dioxide

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21
Q

What are 3 secondary effects due to medications prescribed for non-septic obstructive diseases?

A
  • Muscle atrophy/ weakness
  • Osteopenia and osteoperosis
  • R-sided heart failure
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22
Q

What is the most prevelant COPD?

A
  • Asthma
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23
Q

What is the second most prevalent COPD disease?

A
  • Emphysema
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24
Q

What is hypothetical pathogenesis of emphysema?

A
  • 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
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25
Q

What is the effect of emphysema’s destruction of the connective tissue matrix?

A
  • Airways are dilated distal to the terminal bronchioles
  • Decreased pressure in lumen
  • Impaired airflow during inspiration
  • Airways close early and trap air destroying acini
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26
Q

What volume is increased by emphysema?

A

Residual volume.

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27
Q

Since there is decreased pressure in the lumen of the respiratory vessels, what muscles have to work hard? What are their physiological changes?

A

Inspiratory muscles are shortened, have decreased sarcomeres, and are hypertrophied.

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28
Q

What are 4 signs/symptoms of Emphysema (early stage)?

A
  • Cough and phlegm
  • Dyspnea on exertion
  • Increased A-P diameter (Barrel chest)
  • Increased rib angle
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29
Q

What will be heard on auscilation of emphysema?

A
  • Decreased distant breath sounds
  • Prolonged expiratory phase’
  • Wheezing and ronchi (coarse rattling sound) due to secretions
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30
Q

What are 13 (ugh..) complications of emphysema?

A
  • Cachexia
  • R-side heart failure
  • Peripheral pitting edema
  • Weight gain
  • JVD
  • Decreased appetite
  • RUQ discomfort
  • Ventricular gallop
  • S3 heart sound
  • Osteoporosis
  • Depression
  • CVD
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31
Q

What are 4 categories of medication prescribed for emphysema.

A
  • Smoking cessation drugs
  • Bronchodilators
  • Methylxanthines
  • Antibiotics (during exacerbations)
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32
Q

What are 3 classes of bronchodilators?

A
  • Anticholinergics
  • B2- agonists
  • Inhaled corticosteroids
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33
Q

What are 2 specific anticholinergics?

A
  • Ipratropium

- Tiotropium

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34
Q

What are 3 specific B2-agonists?

A
  • Albuterol
  • Salmeterol
  • Formoterol
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35
Q

What are 3 specific inhaled corticosteroids?

A
  • Beclomethasone
  • Fluticasone
  • Triamcinolone
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36
Q

What is the purpose of methylxanthines in the treatment of emphysema?

A
  • Improves respiratory muscle strength and endurance
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37
Q

What relieves SOB in exacerbations of emphysema?

A

Inhaled systemic corticosteroids.

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38
Q

What is the only therapy for emphysema that is proven to increase survival?

A
  • Supplemental oxygen
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39
Q

In what type of cases is supplemental oxygen especially important in treating emphysema?

A
  • HTN and polycythemia
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40
Q

What type of supplemental oxygen is usually appropriate for emphysema treatment?

A
  • Low flow O2 via nasal canula.
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41
Q

What type of behavioral management is typically applied when treating emphysema?

A
  • Smoking cessation.
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42
Q

What vaccines help control symptoms and exacerbations of emphysema?

A
  • Influenza

- Pneumococcal

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43
Q

What type of replacement therapy is appropriate for emphysema?

A

Alpha1-antitrypsin.

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44
Q

What 2 mechanical devices can assist in emphysema management/ treatment?

A
  • BiPAP to assist in breathing

- Mucous clearance devices

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45
Q

What type of rehab is recommended for emphysema patients?

A

Pulmonary rehab.

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46
Q

What cells produce elastase?

A

Neutrophils.

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47
Q

What organ produces alpha-1 antitrypsin? What the enzyme’s function?

A

The liver produces Alpha-1 antitrypsin to control elastase.

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48
Q

What structures are damaged by alpha-1 antitrypsin deficiency?

A
  • Lungs (usually coated by AAT)

- Liver (AAT trapped in the liver)

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49
Q

What is the most common autosomal recessive genetic liver disease in children?

A
  • AAT deficiency
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50
Q

What is the most common genetic pulmonary disease?

A
  • Cystic Fibrosis
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51
Q

Where is alpha-1 antitripsin synthesized?

A
  • The liver
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52
Q

What is neutrophil elastase’s useful function?

A
  • Break down bacteria from airway
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53
Q

When does AAT deficiency become primarily a pulmonary disease, and when does emphysema typically develop from the disease?

A
  • Becomes pulmonary problem in second decade

- Emphysema develops in 3rd or 4th decade of life

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54
Q

What is the mechanism of injury in Bronchiolitis Obliterans?

A
  • Acute inflammation injury with diffuse destruction of bronchioles associated with underlying inflammatory pathology
  • Fibroproliferation in bronchioles
  • Collagen deposition in cartilaginous airways
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55
Q

What is the most common cause of Bronchiolitis Obliterans?

A
  • Lung transplants (rejections)
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56
Q

What percent of individuals develop Bronchiolitis Obliterans 5 years after transplant?

A

80 %.

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57
Q

When does BO typically onset after a lung transplant?

A

In 16 - 20 months.

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58
Q

What percent of people who survive a transplant for 3 months or more develop BO?

A

50 %

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59
Q

Besides patients who receive lung transplants, what other patients typically develop BO?

A
  • Children and infants following a severe respiratory infections.
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60
Q

What are 8 clinical signs/ symptoms of BO?

A
  • SOB with exertion
  • Wheezing, crackles, ronchi
  • Persistent cough
  • Hypoventilation
  • Hypercapnia
  • Intercostal retraction
  • Tachypnea
  • Grunting
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61
Q

What is typically found in a chest radiograph (CXR) in BO?

A
  • Hyperinflated lungs

- Patchy atelectasis (collapsed alveoli)

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62
Q

What are 3 results of a pulmonary function test of BO?

A
  • Decreased forced vital capacity
  • Decreased Forced Expiratory Volume over 1 second
  • Increased residual volume
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63
Q

What are 3 findings of a CT scan of a patient with BO?

A
  • Mosaic perfusion (patchwork of different weakening/ attenuation)
  • Vascular attenuation (weakened or thinned vascularture)
  • Central bronchiactasis (wide, flabby, scarred bronchioles)
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64
Q

What is the primary factor in treatment of BO?

A
  • Prevention!
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65
Q

Once a patient develops BO, what are 4 treatments (medications)?

A
  • Supplemental oxygen
  • Antivirals
  • Corticosteroids
  • Bronchodilators
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66
Q

What is the cause of asthma?

A
  • Unknown.

- Associated with a maturing immune system and lung tissue

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67
Q

What are 11 risk factors of asthma?

A
  • Maternal smoking
  • Secondhand smoke
  • Family history
  • Genetics
  • Atopy (allergies)
  • Childhood asthma
  • Occupational exposures
  • Environmental exposures
  • Early infection (respiratory syncytial virus)
  • Female gender
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68
Q

Is asthma an acute or chronic disease?

A

Chronic.

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69
Q

Asthma is the most common chronic disease in which age group?

A

Children.

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70
Q

What percent of children’s asthma onset before the age of 5?

A

80 %.

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71
Q

What percentage of children outgrow asthma?

A
  • 50 - 70 %.
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72
Q

What percentage of children are limited in activity and play due to their asthma?

A
  • 35 - 40 %.
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73
Q

What major risk factor do most children who develop asthma possess?

A
  • Family history
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74
Q

What demographic is disproportionately affected by asthma?

A

Those in lower socio-econmic levels.

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75
Q

What was the prevelance of asthma in the US in 2000?

A

7.5 %.

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76
Q

What was RI’s ranking of asthma prevalence in the US states?

A

5th highest at 8.5 %.

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77
Q

What are happening to worldwide asthma prevalence and death rates?

A

Increasing.

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78
Q

What are the 3 defining factors of asthma?

A
  • Airway inflammation
  • Airflow can become limited, but is reversible
  • Bronchii are hyperresponsive
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79
Q

What is a the name of a severe asthma attack that is resistive to bronchodilators?

A
  • Status asthmaticus
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80
Q

What are 11 symptoms/ signs of asthma?

A
  • Wheezing
  • Dyspnea
  • Chest pain/ tightness (especially at night)
  • Facial distress
  • Non-productive cough
  • Decreased breath sounds
  • Cyanosis
  • Exhaustion
  • Hypercapnia
  • Pending respiratory failure
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81
Q

What are 7 categories of environmental factors that aggravate asthma symptoms?

A
  • Indoor irritants
  • Air pollution
  • Allergens
  • Pesticides
  • Molds
  • Dust mites, rodents, cockroaches, animal dander, and other animal/ insect related environmental factors.
  • Cold air
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82
Q

What are some examples of indoor irritants that aggravate asthma?

A
  • Cigarette smoke
  • Carbon monoxide
  • Nitric oxide
  • Poorly ventilated heating systems
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83
Q

What are 3 examples of air pollution that can aggravate asthma?

A
  • Diesel exhaust
  • Ozone
  • Smoke
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84
Q

What type of infection can trigger asthma?

A
  • Respiratory infection
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85
Q

What activity can trigger asthma?

A

Exertion and/or exercise for 10 - 15 minutes.

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86
Q

How long does asthma induced from exertion/ exercise usually take to resolve?

A
  • 30 - 60 minutes
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87
Q

What 4 medications can trigger asthma?

A
  • NSAIDs
  • ACE inhibitors
  • Aspirin
  • Beta-blockers
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88
Q

What causes Exercise Induced Asthma?

A
  • Loss of water and heat from lower respiratory system. (due to mouth breathing)
  • Loss of heat causes hyperemia, vascular engorgement & bronchial edema (narrows bronchioles)
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89
Q

How long does bronchoconstriction persist following exercise in EIA?

A

6 - 8 hours.

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90
Q

How is a diagnosis of EIA determined in children?

A

Simply by a history of symptoms consistent with EIA.

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91
Q

How is EIA diagnosed in adults?

A
  • 15 % drop in Peak Expiratory Flow after exercise

- Greater than 15 % increase in FEV1 following use of a bronchodilator

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92
Q

What 4 factors increase the severity of EIA?

A
  • Minute ventilation during exercise
  • Cold temperatures
  • Dry air
  • High baseline reactivity of airways
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93
Q

What is the pathogenesis of EIA?

A
  • Trigger
  • Inflammatory process
  • Bronchorestriction
  • Airway obstruction
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94
Q

What are 5 types of asthma medication?

A
  • Short and long acting beta-2 agonist bronchodilators
  • B-Adrenergic agonists
  • Cromolyn
  • Leukotreiene modifiers
  • Immunosuppressive medications
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95
Q

How do B-Adrenergic agonist medications manage asthma?

A
  • Relaxes smooth muscles
  • Results in brochodilation
  • Inhibits release of inflammatory mediators
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96
Q

What type of medication is used to prevent an asthma attack? (not a rescue medication)

A

Cromolyn.

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97
Q

How do Leukotriene modifiers manage asthma?

A
  • Blocks proinflammatory mediators that promote:
  • Smooth muscle contractions
  • Vascular leakage
  • Mucous secretion
  • Airway hyperactivity
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98
Q

In what type of patients with asthma are immunosuppresive medications used?

A
  • Chronic, severe asthma
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99
Q

What are 4 beta2-selective bronchodilators?

A
  • Albuterol
  • Bioterol
  • Pirbuterol
  • Salmeterol
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100
Q

What preparation can be made prior to exercise to reduced the effects of EIA?

A
  • Medication, and warm up 45 - 60 minutes prior to exercise.

- Warm up –> 30 second bouts with 2 minute rest periods

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101
Q

What non-pharacologic treatments can help reduce symptoms of EIA?

A
  • Environmental control to reduce allergens

- Routine exercise to: increase O2 consumption, decrease blood lactate, and increase minute ventilation

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102
Q

What differentiates septic obstructive diseases from non-septic obstructive diseases?

A
  • Purulent sputum productive coughs
  • High incidence of pulmonary infection
  • Excessive secretion production
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103
Q

What are typical results of a PFT in septic obstructive disease?

A
  • Decreased expiratory effort
  • Increased Total lung capcity
  • Hypercapnia (high CO2)
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104
Q

What vessels change pressure in septic obstructive diseases, and what is the effect of this?

A
  • High pressure in pulmonary arteries
  • Heart enlargement and failure
  • Cor pulmonale
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105
Q

What is the clinical diagnosis of chronic bronchitis?

A

Cough and sputum production for 3 months or more for 2 years or more.

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106
Q

What is the number one risk factor of chronic bronchitis?

A

Smoking.

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107
Q

What is the 4 step pathogenesis of chronic brochitis?

A
  • 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
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108
Q

What are 8 common categories of medications for individuals with Chronic Bronchitis Medications?

A
  • 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
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109
Q

What 2 vaccines are commonly prescribed for individuals with chronic bronchitis?

A
  • Influenza

- Pneymococcal

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110
Q

What behavioral therapy can be prescribed for chronic bronchitis?

A

Smoking cessation.

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111
Q

What are 3 therapy treatments for individuals with chronic bronchitis?

A
  • Bronchial hygiene
  • Pulmonary rehab
  • Early mobilization
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112
Q

What pathology does “Pink puffer” refer to?

A

Emphysema

113
Q

What pathology does “Blue bloater” refer to?

A

Chronic bronchitis.

114
Q

What is the major symptom of a “Pink puffer” and a “Blue bloater”?

A

PP: Dyspnea
BB: Cough and sputum

115
Q

What is the appearance of a “Pink puffer” and a “Blue bloater”?

A

PP: Thin, wasted, not cyanotic
BB: Obese and cyanotic

116
Q

How are “Pink puffer”s and “Blue bloater”s PO2 and PCO2 affected?

A

PP: Decreased O2 and Decreased or normal CO2
BB: Very decreased O2, and normal or high CO2

117
Q

How is the elastic recoil of the lung affected in a “Pink puffer” and a “Blue bloater”?

A

PP: Decreased
BB: Normal

118
Q

How is the diffusing capacity affected in a “Pink puffer” and a “Blue bloater”?

A

PP: Decreased
BB: Normal

119
Q

How is the hematocrit affected in a “Pink puffer” and a “Blue bloater”?

A

PP: Normal
BB: Frequently incrased

120
Q

Does cor pulomale occur more often in a “Pink puffer” or a “Blue bloater”?

A

Blue bloater.

121
Q

What devices can be used to help a patient with chronic bronchitis clear mucus?

A
  • Flutter mucus clearance device

- Acapella mucus clearance device

122
Q

Which septic obstructive disease is an autosomal recessive trait?

A
  • Cystic fibrosis
123
Q

How common is cystic fibrosis?

A

The most common genetic disease in US.

124
Q

How lethal is cystic fibrosis?

A

Most lethal genetic disease in US.

125
Q

What is the incidence of cystic fibrosis?

A

1 in 3900 live white births.

126
Q

What type of cells are affected by cystic fibrosis?

A
  • Epithelial cells of exocrine glands
127
Q

What 8 organs are targeted by cystic fibrosis?

A
  • Sinuses
  • Lungs
  • Pancreas
  • Intenstines
  • Biliary tracts
  • Vas deferens
  • Uterine cervix
  • Sweat glands
128
Q

What are the implications of cystic fibrosis being an autosomal recessive trait?

A

There are many asymptomatic carriers.

129
Q

Describe the chloride ion transfer defect caused by cystic fibrosis.

A
  • Na+ and Cl- transport disturbed

- Pulls water back into cell making secretions thicker and drier

130
Q

Describe the process of injury caused by cystic fibrosis in the lungs.

A
  • Cilia cannot clear mucus
  • Secretions settle in lungs
  • Bacteria grow in stagnant secretions
  • Cycle begins of: inflammation, infection, and tissue destruction
131
Q

What does the thickened, stagnant secretions of cystic fibrosis lead to?

A

Obstruction and malabsorption (as in GI tract)

132
Q

What is the hallmark clinical sign of cystic fibrosis in babies?

A

They taste salty.

133
Q

What is the median lifespan of an individual with cystic fibrosis?

A

38 years.

134
Q

What are 2 signs/symptoms of cystic fibrosis shortly after birth?

A
  • Meconium ileus: (obstruction of intestines due to overly thick meconium)
  • Failure to thrive/ regain birth weight
135
Q

What are 5 respiratory signs/symptoms of cystic fibrosis?

A
  • Recurrent respiratory infections
  • Chronic productive cough
  • SOB with excessive inspiratory accessory muscle use
  • Inspiratory crackles and wheezing
  • Nasal polyps
136
Q

What 2 symptoms secondary to respiratory complications of cystic fibrosis?

A
  • Clubbing of nails

- Decreased activity tolerance

137
Q

What are 3 metabolic effects of cystic fibrosis?

A
  • Pancreatic insufficiency, pancreatitis, and diabetes
  • Osteoporosis
  • Muscle wasting
138
Q

What are 5 other clinical signs/symptoms of cystic fibrosis?

A
  • Salty kiss
  • GERD
  • Weight loss
  • Chronic low back pain
  • Developmental delays
139
Q

Why is early detection of cystic fibrosis important?

A
  • So aggressive nutritional support can begin
140
Q

What are two PT treatments for cystic fibrosis?

A
  • Aerobic and strengthening exercise

- Energy conservation techniques

141
Q

What 6 medications, and treatment techniques can increase life expectancy when faced with CF?

A
  • Pancreatic enzyme replacement
  • Vitamin supplements
  • High caloric diets
  • Airway clearance techniques
  • Antibiotics and antifungal treatment
  • Mucolytic and bronchodilator medications
142
Q

What are 4 serious complications due to cystic fibrosis?

A
  • Respiratory failure
  • Right-sided heart failure
  • Severe hemoptysis
  • Spontaneous pneumothorax
143
Q

What are 4 common medications for cystic fibrosis?

A
  • Glucocorticoid steroids (anti-inflammatory)
  • Bronchodilators
  • Antibiotics
  • Pancreatic enzymes (assist with digestion)
144
Q

What are the two key causes of bronchiectasis?

A
  • Intense chronic inflammation

- Inadequate defense to minimize infection resulting in tissue damage

145
Q

What are 5 characteristics of bronchiectasis?

A
  • 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
146
Q

What is the best imaging technique for diagnosis of bronchiectasis?

A
  • High resolution CT
147
Q

Which imaging technique is non-specific when diagnosing bronchiectasis?

A
  • Chest x-ray
148
Q

What 2 respiratory sounds are associated with bronchiectasis?

A
  • Crackles

- High and low pitch ronchi

149
Q

What are 9 signs and symptoms of bronchiectasis?

A
  • Persistent cough
  • Copious secretions
  • Frequent hemoptsis
  • Recurrent infections
  • Pleural rubs
  • Fever
  • Fatigue
  • Dyspenea
  • Digital clubbing
150
Q

What determines the prognosis of bronchiectasis?

A
  • Underlying disease
151
Q

What are 5 methods of treatment of bronchiectasis?

A
  • Treat the underlying disease
  • Antibiotics, corticosteroids, and brochodilators
  • Nutritional support
  • Supplemental O2
  • Airway clearance/ bronchial hygiene
152
Q

What 4 other pathologies is pulmonary fibrosis linked to?

A
  • Immune disorders
  • Occupational exposures
  • Genetic and hormonal abnormalities
  • Complications of lung injuries
153
Q

How does a patient with pulmonary fibrosis ‘s oxygen saturation differ from a normal patients?

A
  • Lower oxygen saturation generally

- Rapid desaturation with exercise

154
Q

What are 2 associated complications of pulmonary fibrosis?

A
  • Pulmonary hypertension

- Cor pulmonale

155
Q

How are an individual’s PFTs affected by pulmonary fibrosis?

A
  • Decreased FVC and FEV1
  • Normal FEV1/ FVC
  • Reduced VB and TLC
156
Q

What pathology is typically involved in Interstitial lung diseases?

A
  • Fibrosis
157
Q

What are 6 categories used to classify restrictive lung disease?

A
  • Inhaled substances
  • Drug induced
  • Connective tissue disease
  • Infection
  • Idiopathic
  • Malignancy
158
Q

What are 3 common inorganic substances that can cause restrictive lung disease?

A
  • Silicosis
  • Asbestosis
  • Beryliosis
159
Q

What can cause restrictive lung disease by a mechanism of inhaled organic materials?

A
  • Hypersensitivity pneumonitis
160
Q

What 3 drugs can induce restrictive lung disease?

A
  • Antibiotics
  • Chemotherapeutic drugs
  • Antiarrhythmic agents
161
Q

What 5 connective tissue diseases can lead to restrictive lung disease?

A
  • Systemic sclerosis
  • Polymyositis
  • Dermatomyositis
  • Systemic lupus erythematosus
  • Rheumatoid arthritis
162
Q

What 3 infections can lead to restrictive lung disease?

A
  • Atypical penumonia
  • Pneumocystis pneumonia
  • Tuberculosis
163
Q

What are 3 idiopathic causes of restrictive lung disease?

A
  • Atypical pneumonia
  • Idiopathic pulmonary fibrosis
  • Hamman-Rich syndrome
164
Q

What malignancies are linked to restrictive lung disease?

A
  • Lymphangitic carcinomatosis
165
Q

What are 4 signs and symptoms of restrictive lung disease?

A
  • Dry cough
  • Gradual dyspnea with walking
  • Crackles at the lung bases
  • Clubbing
166
Q

How is restrictive lung disease treated?

A

Treat the underlying cause.

167
Q

What drug treatment is recommended for idiopathic pulmonary fibrosis?

A

No specific drug treatment.

168
Q

What 2 drugs have an unproven benefit on restrictive lung disease?

A
  • Corticosteroids

- Cytotoxic agents

169
Q

What 5 medicines may be useful for restrictive lung disease?

A
  • N-acetylcysteine
  • IFN-gamma
  • Pirfenidone
  • Bosentan
  • Etanercept
170
Q

What 3 non-medicinal treatments should be considered for restrictive lung disease?

A
  • Pulmonary rehabilitation
  • Oxygen
  • Lung transplantation
171
Q

What is empyema?

A

Pus in the pleural space.

172
Q

What is the pathogenesis of pneumonia?

A
  • Acute inflammation of lungs

- Small bronchioles and alveoli become plugged with fibrotic exudate

173
Q

What is the ranking of Pneumonia in cause of death in the US?

A

6th.

174
Q

What 2 classifications are there for infectious lung disease?

A
  • By agent (bacteria, fungus, virus)

- By environment of infection (community, hospital, nursing home, school, etc…)

175
Q

What are the 3 categories of risk factors for infectious pulmonary disease?

A
  • Medical
  • Environmental
  • Respiratory function
176
Q

What are 6 medical related risk factors for infectious pulmonary disease?

A
  • Age
  • Integrity of immune system
  • Acute head
  • Neck trauma
  • Chest trauma
  • Surgery
177
Q

What are some environmental risk factors for infectious pulmonary disease?

A
  • Hospital environment
  • Exposure to infected individuals
  • Tracheal or gastric device
178
Q

What are 2 mechanized treatments are associated with respiratory risk factors for pulmonary disease?

A
  • Use of mechanical ventilation

- Aerosolized breathing treatments

179
Q

What medical procedure is a risk factor for infectious pulmonary disease?

A
  • Aspiration
180
Q

What are 2 clinical signs/symptoms of infectious pulmonary disease?

A
  • Fever

- Productive cough with yellow-green or rust colored sputum

181
Q

What are 2 lab tests that help diagnose infectious pulmonary disease?

A
  • Elevated WBC count

- Positive sputum culture

182
Q

What are 3 methods of prevention of infectious pulmonary disease?

A
  • Flu shots
  • Proper care and cleaning of respiratory equipment
  • Hand washing
183
Q

How is infectious pulmonary disease specifically diagnosed?

A
  • Chest X-ray showing consolidaiton for at least 48 hours, and at least 2 clinical signs such as:
  • Dyspnea
  • Fever
  • Cough
  • Leukocytosis
  • Leukopenia
184
Q

How many cases of TB were diagnosed in 2006?

A

9 million

185
Q

How many deaths occurred due to TB in 2006?

A

1.7 million

186
Q

In what 2 populations is tuberculosis the leading cause of death?

A
  • Individuals with HIV/AIDS

- Women of child bearing years

187
Q

What pathology is TB associated with in 95 % of diagnoses and 98 % of deaths?

A
  • HIV
188
Q

How many are co-infected with HIV and TB in the US?

A

15 million.

189
Q

What 7 medical pathologies are risk factors for TB?

A
  • HIV
  • Cancer of the head/ neck
  • Leukmia
  • Hodgkin’s disease
  • Diabetes mellitus
  • Severe kidney disease
  • Silicosis
190
Q

What 4 medical treatments are risk factors for TB?

A
  • Corticosteroid treatment
  • Organ transplants
  • RA treatment
  • Crohn’s disease treatment
191
Q

What behavior is a risk factor for TB?

A
  • Substance abuse
192
Q

What personal factor is a risk factor for TB?

A
  • Low body weight
193
Q

By what method is TB transmitted?

A
  • Airborne transmission by dry droplet nuclei

- Become airborne from an infected person’s cough or sneeze

194
Q

How far into the respiratory system must TB particles reach to cause an infection?

A

The alveoli.

195
Q

What type of TB must the carrier have to transmit the infection?

A
  • Laryngeal TB
    or
  • Extensive spread of TB
196
Q

What 3 factors increase the risk of TB infection? (not related to pathology related risk factors)

A
  • Concentration of particles in air
  • Length of exposure
  • Host’s immune system
197
Q

How long is the incubation period for TB?

A

2 - 12 weeks.

198
Q

When will a test for TB become positive after the individual is initially infected?

A

6 - 8 weeks.

199
Q

When is TB mostly asymptomatic? What symptoms may be present during this time?

A
  • During the primary infection

- Unproductive cough and fever may be present

200
Q

What percent of TB is pulmonary, and what percent affects other systems?

A
  • 80 % pulmonary

- 20 % other systems/ organs

201
Q

What type of medication is TB unresponsive to?

A
  • Antibiotics
202
Q

What are the non-specific symptoms of TB?

A
  • Cough
  • Fever
  • Weight loss
203
Q

What is the gold standard for TB diagnosis?

A
  • Smear/ culture
204
Q

What percent accuracy does a positive smear and culture have for TB in an HIV negative individual?

A
  • 90 %
205
Q

What percentage of TB cultures are negative?

A

20 %

206
Q

How is a medicine regimen for TB deemed appropriate?

A
  • Patient can tolerate it
  • Won’t select resistant organisms
  • Won’t interact adversely with other medications
207
Q

What should be assessed when following up a TB regimen?

A
  • Compliance
  • Effectiveness of regimen
  • Complications of therapy
208
Q

Describe the regimen for TB during the intensive phase.

A
  • For two months
  • Four drug regimen
  • Exact mixture of drugs can be modified with susceptibility testing
209
Q

Describe the drug regimen during the continuation phase.

A
  • INH - Rifampin

- INH - Ethambutol

210
Q

How many cases of pulmonary embolism are there per year?

A

600,000

211
Q

What other pathology typically precipitates a pulmonary embolism?

A
  • A DVT
212
Q

What rank are PEs in terms of causing cardiovascular death?

A

3rd.

213
Q

What percent of treated PEs are symptomatic?

A

1/3rd/ 33%

214
Q

What amount of post-op deaths are caused by PE?

A

3 %

215
Q

What other sources besides thrombi can cause pulmonary emobilisms?

A
  • Air
  • Fat
  • Amniotic fluid
216
Q

What are 5 risk factors for pulmonary embolism? (There are 14 overall)

A
  • 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)

217
Q

What are the 3 MAJOR signs and symptoms of PE? (97 % of cases) (which is the number 1 symptom)

A
  • Dyspnea (Unexplained/ rapid onset) (#1)
  • Pleuritic chest pain
  • Tachypnea
218
Q

What are the 7 NON-MAJOR signs and symptoms of PE.

A
  • Cough
  • Hemoptysis
  • Crackles
  • Syncope
  • Tachycardia
  • Decreased breath sounds
  • Abnormal lung sounds
219
Q

What is the gold standard of imaging for diagnosis of a PE?

A

Spiral angiography.

220
Q

What are the sensitivity and specificity of spiral CT angiography?

A

Sensitivity: 83 %
Specificity: 96 %

221
Q

What imaging is used to detect a DVT?

A
  • Color flow duplex imaging
222
Q

What is the best treatment of PE?

A

Prevention.

223
Q

List 4 treatments for prevention of PE.

A
  • Early mobilization
  • Compression stockings
  • Anticoagulants
  • Inferior vena cava filter
224
Q

What are 3 treatments for a current PE?

A
  • Thrombolysis
  • Anticoagulative drugs (heparin, aspirin)
  • Surgical and catheter embolectomy
225
Q

What is the normal mean pressure in the pulmonary arterial system?

A

15 mmHg.

226
Q

What mean pulmonary arterial pressure is considered hypertension during exercise, and at rest?

A
  • 25 mmHg at rest

- 30 mmHg during exercise

227
Q

What causes pulmonary hypertension?

A

Increase in pulmonary vascular resistance.

228
Q

What is the cause of idiopathic pulmonary hypertension?

A

Unknown

or

Genetic

229
Q

Who is most susceptible to pulmonary hypertension?

A

Young and middle aged women.

230
Q

What is the 9 step pathophysiology of pulmonary hypertension?

A
  • 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.
231
Q

What are 6 signs and symptoms of pulmonary hypertension?

A
  • Dyspnea on exertion
  • Fatigue, weakness
  • Exertional chest pain
  • Lightheadedness/ syncope
  • Palpitations
  • Possible hemoptysis
232
Q

What other pathology shares the same symptoms as pulmonary hypertension?

A
  • Cor Pulmonale
233
Q

What is the gold standard diagnostic tool for pulmonary hypertension?

A
  • Cardiac catherization
234
Q

What are 4 other diagnostic tools for pulmonary hypertension?

A
  • Pulmonary function tests
  • Echocardiograms
  • Pulmonary angiography
  • V/ Q & CT scans
235
Q

What are 4 types of treatment for pulmonary hypertension?

A
  • Treat underlying disease
  • Supplemental O2
  • Medication
  • Lung transplant
236
Q

What are 3 types of medication prescribed for pulmonary hypertension?

A
  • Anticoagulants
  • Diuretics
  • Vasodilators
237
Q

What is the mean survival time of pulmonary HTN?

A

2.8 years

238
Q

What is pulmonary edema?

A
  • Accumulation of extravascular fluid in the interstitial and alveolar spaces in the lung
239
Q

What are the 2 types of pulomnary edema?

A
  • 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)
240
Q

What heart sound is present in pulmonary edema?

A
  • S3
241
Q

What types of lung sounds are heard in pulmonary edema?

A
  • Diffuse crackles

- Possible wheezes

242
Q

What are 2 psychosocial signs/ symptoms of pulmonary of edema?

A
  • Anxiety

- Agitation

243
Q

What are 4 physological signs and symptoms of pulomary edema?

A
  • Dyspnea/ respiratory distress
  • Orthropnea/ paroxysmal nocturnal dyspnea
  • Diaphoresis
  • Tachycardia/ arrhythmias
244
Q

What 2 skin changes will be apparent in pulmonary edema?

A
  • Pallor

- Cyanosis

245
Q

What is critical in the treatment of pulmonary edema?

A
  • Prompt diagnosis
246
Q

What are 4 treatments for pulmonary edema?

A
  • Treat underlying cause
  • Supplemental O2
  • Prevent and treat complications
  • May require assisted ventilation
247
Q

What are the 3 pleural pulmonary diseases?

A
  • Pneumothorax
  • Hemothorax
  • Plerual effusion
248
Q

How is pleural effusion different from pulmonary edema?

A
  • Effusion is between the pleural linings

- Edema occurs in the interstitium of the lungs

249
Q

What type of tumor develops from the pleura? What material is it associated with?

A
  • Mesothelioma

- Associated with asbestos exposure

250
Q

What type of surgery may be required in pleural disease?

A
  • Drainage of the fluid/ air
251
Q

What can enter the pleura to causing pleural disease?

A
  • Air

- Fluid

252
Q

What are primary and secondary pneumothorax?

A

Secondary is caused by an underlying disease, while primary is a spontaneous collapse of the pleura.

253
Q

What disease is associated with secondary pneumothorax?

A
  • COPD
254
Q

What types of patients are at risk for primary pneumothorax?

A
  • Tall, thin, young men
255
Q

What enzymes and cells are imbalanced in blebs and bullae?

A
  • Protease and antiprotease are imbalanced

- Increased numbers of neutrophils and macrophages

256
Q

How are blebs and bullae related to pneumothorax?

A

They can rupture under pressure (cough, valsalva) causing air to rush into the pleural space.

257
Q

What is latrogenic pneumothorax?

A
  • Complications related to diagnostic or treatment procedures
258
Q

What is traumatic pneumothorax?

A
  • Penetrating wound allows air to rush in.
259
Q

What is tension pneumothorax?

A
  • Air enters pleural space and can’t escape
260
Q

Which type of pneumothorax is life threatening?

A

Tension pneumothorax.

261
Q

To which side is the medistinum displaced in tension pneumothorax?

A
  • To the contralateral side
262
Q

How will pneumothorax present on a CXR?

A
  • Black, dark space in lung with a shifted mediastinum.
263
Q

What is hemothorax?

A
  • Effusion of blood into the pleura
264
Q

What are 3 surgical procedures for pneumothorax?

A
  • Needle or chest tube to aspirate air or blood from pleural space
  • Chemical pleurodesis
  • Thoractomy to resect bullae
265
Q

How is the prognosis of a patient following pneumothorax determined?

A
  • The size of the pneumothorax.
266
Q

What is pleural effusion?

A
  • Excessive collection of fluid between parietal and visceral pleurae.
267
Q

What are the 2 types of pleural effusion?

A
  • Transudate

- Exudate

268
Q

What causes transudate pleural effusion?

3 pathologies

A
  • Increased hydrostatic pressure within pleural capillaries due to:
  • CHF
  • PE
  • Renal disease
269
Q

What are 4 causes of exudate pleural effusion?

A
  • Infection
  • Malignancy
  • Pulmonary embolism
  • Infarct
270
Q

What is the term pleural effusion with grossly purulent fluid?

A

Empyema.

271
Q

What is the 6 step pathogenesis of pleural effusion?

A
  • 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
272
Q

How will percussion sound with pleural effusion?

A

Fluid: Dull
Air: Hollow

273
Q

What will be heard upon ausciltation of pleural effusion? (2 characteristics)

A
  • Decreased/ absent breath sounds over effusion

- Possible pleural rub

274
Q

What 3 systemic symptoms will be present in pleural effusion?

A
  • Fever
  • Shaking chills
  • Night sweats
275
Q

What are 2 respiratory symptoms of pleural effusion?

A
  • Dyspnea

- Pleuritic chest pain that is aggravated by deep breathing and coughing

276
Q

What are 3 conservative treatments of pleural effusion?

A
  • Watch for natural reabsorption
  • Segmental expansion/ diaphragmatic breathing exercises to prevent atelectasis
  • Increased mobilization
277
Q

What surgical procedure is used for pleural effusion?

A
  • Thoracentesis
278
Q

Which direction will the mediastinum shift towards in atelectasis?

A
  • Towards the atelectasis
279
Q

** Check end of pulmonary disease for cases **

A

** Check end of pulmonary disease for cases **

Cardiopulmonary PT (10 decks)

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