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Mod 3 > Pulmonary Patho > Flashcards

Pulmonary Patho Flashcards

1
Q

obstructive:
increase resistance to (expiration or inhalation)
alveolar ___
alveolar ___ventilation

A

expiration
hyperinflation (air trap)
hypoventilation

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2
Q

Restrictive:
decrease lung or thoracic ___

A

compliance

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3
Q

What is the primary presentation of chronic bronchitis?

A

chronic productive cough

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4
Q

What is the primary presentation of emphysema?

A

SOB

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5
Q

What is the primary PFT increased with emphysema

A

increased RV and/or TLC

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6
Q

What is the primary problem with asthma?

A

reversible bronchospasm secondary to trigger with inflammatory response

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7
Q

What PFT is gonna be decreased with asthma?

A

FEV1/FVC

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8
Q

what is the primary pathophysiology of CF?

A

Genetic mutation of CFTR and increases viscosity of secretions across systems.

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9
Q

someone with CF is going to have (increased or decreased) DLCO?

A

decreased

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10
Q

what is the primary presentation in someone with idiopathic pulmonary fibrosis or other restrictive diseases?

A

decreased compliance and decreased lung volume secondary to lung tissue resistance.

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11
Q

What happens when there is increased goblet cells in CB?

A

hypersecretion of mucus in large airways –> progress to small airways –> obstuction

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12
Q

What kind of lung sounds in someone with CB? what is causing this?

A

course crackles when air pops mucus as it goes through

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13
Q

What is the pathophysiology of emphysema?

A

abnormal and permanent changes of alveoli distal to terminal bronchioles

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14
Q

What effects does emphysema have on the alveoli?

A

loss of gas exchange

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15
Q

Emphysema:
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - diminished
tactile fremitus - decreased bc air
mediate percussion - hyperressonant bc air

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16
Q

COPD:
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - crackles (course), low pitched wheeze
tactile fremitus - increased
mediate percussion - normal upper lobes, hyperresonant lower lobes

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17
Q

is someone with emphysema likely to have a cough?

A

no

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18
Q

What happens in emphysema when alveolar connective tissue gets damaged?

A

loss of support for airway causing it to narrow causing air to trap in lung, decreased elastic recoil

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19
Q

primary pathophysiology in asthma

A

reversible bronchospasm and inflammatory response in response to trigger

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20
Q

asthma: (during attack)
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - high pitch wheeze, possible decrease sounds
tactile fremitus - norm or dec in lower lobes from air trapping
mediate percussion - hyperresonance

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21
Q

asthma: (after attack)
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - maybe wheeze and crackles
tactile fremitus - normal or increase over secretions
mediate percussion - normal or diffuse scattered secretions

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22
Q

does someone with asthma have a cough after attack?

A

yes, with some secretions to clear

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23
Q

how is someones pulse ox and dyspnea after attack?

A

should be normal

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24
Q

What are the postural changes with air-trapping

A

elevated shoulder girdle
horizontal ribs increased A/P diameter
Flattened Diaphragm

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25
Q

when the diaphragm flattens there is __ abd pressure causing ___

A

increased abd pressure causing stress on pelvic floor leading to incontinence

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26
Q

when the diaphragm is flattened there is hypertrophy of ___
why?

A

accessor muscles
because it is harder to breath with a flat diaphragm

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27
Q

COPD muscle composiiton
decreased density of __ and __
type __ to type __
muscle __ and weakness
decreased __ metabolism of skeletal muscle

A

mitochondrial and capillary
I to II
atrophy
aerobic

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28
Q

bronchiectasis: ___ and abnormal __ of __

A

irreversible dilation of terminal bronchi

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29
Q

bronchiectasis:
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - coarse crackles
tactile fremitus - increased over involvement
mediate percussion - dull over involvement

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30
Q

cough in bronchiectasis

A

very productive (copious) (possible hemoptysis)
frothy
mucus
pus

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31
Q

What is the result of the massive immune response in bronchiectasis

A

edema, ulceration, cratering or airways, and pus with surrounding tissue inflammation

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32
Q

primary pathophysiology in CF

A

genetic mutation of CFTR and increases viscosity of secretions across all systems

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33
Q

What happens with pancreatic insufficiency in CF

A

failure to thrive

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34
Q

CF:
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - course crackles, low pitched wheeze
tactile fremitus - increased
mediate percussion - normal or hyperressonant from air trapping

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35
Q

does someone with CF have a cough

A

yes with cups of purulent secretions

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36
Q

people with CF have frequent infections, what is the most common bacteria

A

pseudamonous

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37
Q

What is complications that can happen later on with CF

A

enlarged heart, cor pulmonale, JVD, pulmonary HTN, clubbing

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38
Q

What MSK challenges with CF

A

possible developmental delays
osteoporosis

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39
Q

what is the best options for instruments for someone with CF

A

flute, trumpet, trombone

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40
Q

whats the most valuable measure in someone with asthma

A

peak flow meter

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41
Q

how does CF effect the reproductive system?

A

absence of vas deferens (infertile)
women have issues but usually can have children

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42
Q

Restrictive lung dysfunction:
___ compliance of lung and thorax
___ lung volumes
___ work of breathing

A

deceased
deceased
increased

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43
Q

Intrapulmonary restrictive lung function

A

decreased lung compliance from lung tissue resistance

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44
Q

extra pulmonary restrictive lung dysfunction

A

conditions that change lung and thoracic cage compliance

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45
Q

pulmonary edema, pulmonary fibrosis, ARDS, sarcoidosis, asbestosis are example of what

A

intrapulmonary restrictive lung dysfunction

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46
Q

scarring from burn, surgical pain, rib fx, scoliosis, obesity, SLE, RA, ankylosing spondylitis are examples of what

A

extra pulmonary restrictive lung dysfunction

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47
Q

extra-pulmonary RLD:
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - decreased/diminished
tactile fremitus - normal
mediate percussion - normal

48
Q

how is the pulse ox and dyspnea of someone with extra pulmonary RLD

A

yes dyspnea/SOB
pulse ox may be normal or decreased

49
Q

intrapulmonary RLD:
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - diminished, fine crackles
tactile fremitus - normal but depends on condition
mediate percussion - dullness with ARDS and pulmonary edema but normal with pulmonary fibrosis (clubbing) disorders

50
Q

how does NM disorders effect respiratory muscles

A

may be weak from lack of innervation, progressive muscle disorder
muscle tone changes (high or low)

51
Q

chest excursion:
NM:
intrapulmonary:
extra pulmonary:

A

NM: decreased due to tone or weakness
intrapulmonary: decreased
extra pulmonary: symmetrical or asymmetrical decrease

52
Q

NM RLD:
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - diminished (symmetrical or asymmetrical
tactile fremitus - normal
mediate percussion - normal

53
Q

how does a NM disorder effect cough

A

diminished from weakness or decreased vital capacity

54
Q

What is atelectasis?

A

large areas of alevoli that are unable to inflate resulting in lung tissue collapse

55
Q

What is resorptive atelectasis

A

obstruction due to tumor, mucus, or foreign body, alveoli distal to obstruction do not expand

56
Q

What is passive atelectasis?

A

loss of volume due to low Tidal Volume, weak diaphragm, post-op, muscle dystropothy, meds

57
Q

What is adhesive atelectasis?

A

due to surfactant deficiency
alveolar walls adhere making it difficult to inflate

58
Q

what kind of atelectasis would result from ARDS?

A

adhesive atelectasis

59
Q

what is compressive atelectasis?

A

compression from space occupying lesion, pleural effusion

60
Q

what is cicatrization atelectasis?

A

decrease compliance due to fibrosis

61
Q

atelectasis:
Lung sounds -
tactile fremitus -
mediate percussion -

A

lung sounds - bronchial breath sounds
tactile frem - normal or decreased due to lack of sections
mediate percussion - dull over area

62
Q

What MSK issue can come with atelectasis?

A

tracheal deviation toward side of lesion (ipsilateral)

63
Q

What is pnemonia?

A

acute infection with inflammation of lung parenchyma causing secretions not getting out

64
Q

What are the 4 types of pneumonia? which is most common

A

hospital acquired
health-care associated
community acquired - most common
ventilator acquired

65
Q

what are s/s of bacterial pneumonia

A

high fever, chills, SOB, cough, leukocytosis

66
Q

What is the complication of viral pneumonia?

A

destroys mucociliary function
can lead to ARDS

67
Q

What is the chest excursion in someone with pnemonia?

A

diminished in area of consolidation

68
Q

pneumonia:
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - bronchial and bronchovesicular in abnormal locations, crackles and egophany, bronchophony, and whispered pectoriloquy
tactile fremitus - increased over consolidation
mediate percussion - dull over areas of consolidation

69
Q

what is the cough like in someone with pneumonia?

A

cough with or without secretions, may or may not be productive

70
Q

What is the pathophysiology of pulmonary edema

A

cariogenic - L sided heart failure
noncardiogenic causes

71
Q

What is the L side of the heart doing to cause pulmonary edema

A

LV pump fails causing blood to back up into the pulmonary venous system

72
Q

What is the backwards flow with pulmonary edema

A

LA
pulm veins
pulm capillaries
interstitial space
*Interstitial fluid pushed into alveoli by reverse pressure gradient
“Congested”HF

73
Q

What happens to alveoli with pulmonary edema

A

alveolar hypoventilation likely leading to atelectasis
if pressure is high enough it can push fluid into pleural cavity

74
Q

What is pleural effusion?
between what cavities?

A

abnormal amount of fluid in the pleural space between visceral and parietal pleura

75
Q

trasudate vs exudate

A

transudate: low protein content and due to changes in hydrostatic pressure in pleural capillaries
exudate: high protein content and due to changed in pleural permiability

76
Q

What are some causes for pleural effusion?

A

CHF, pneumonia, neoplasm, post-op

77
Q

pleural effusion:
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - diminished
tactile fremitus - decreased
mediate percussion - dull

78
Q

Pleural effusion may cause tracheal deviation to what side?

A

the contralateral side

79
Q

what is the chest excursion of pleural effusion?

A

decreased because physical barrier compressing it

80
Q

What is an open pneumothorax?

A

air moves in and out through opening in chest wall

81
Q

what are the 2 kinds of closed pneumothorax?

A

tension: air in pleural space but cannot exit
spontaneous: without precipitating event, with underlying pulmonary pathology

82
Q

What kind of pneumothorax is life threatening emergency

A

tension pneumothorax

83
Q

in an open pneumothorax, whats happening with pressure?

A

patient cannot maintain negative pleural space pressure

84
Q

in open pneumothorax lung volume (increase or decrease)

A

decrease

85
Q

pneumothorax:
Lung sounds -
tactile fremitus -
mediate percussion -

A

Lung sounds - absent
tactile fremitus - decreased from air barrier
mediate percussion - hyperressonant

86
Q

a pneumothorax may cause tracheal deviation to what side?

A

tension: contralateral

87
Q

chest excursion and cough in pneumothorax

A

decreased chest excursion in area of pneumothorax
no cough

88
Q

What is idiopathic pulmonary fibrosis

A

chronic progressive irreversible lung disease occurring in older adults
inflammation, fibrosis, scarring

89
Q

idiopathic pulmonary fibrosis leads to

A

hypoventilation of alveoli and atelectasis with steady decline in lung function with some exacerbations

90
Q

What is the threshold values for vent:
FVC
MIP
MEP

A

FVC < 20
MIP < 30
MEP <40

91
Q

What are the functional levels of COPD: 0, 1, 2, 3&4

A

0: no symptoms, at risk
1: chronic cough and spututum, SOB with some work
2: SOB that limits exertion, breathless after few minutes (100m on level ground)
3&4: too breathless to leave house or breathless with dressing

92
Q

MRC levels to Functional levels

A

Stage 1: MRC 2
stage 2: MRC 3-4
stage 2&4: MRC 5

93
Q

what is staticus asthmaticus

A

emergency!!
attack with meds not working, may need vent

94
Q

I:E ration in obstructive and restrictive

A

O - 1:3 longer expiration, with tachypnea 1:1 bc air trapping
R - 1:1

95
Q

(Restrictive)normal TLC:
mild:
mod:
severe:

A

norm: >80%
mild: 70-75%
mod: 50-69%
severe: <50

96
Q

How does the flow volume loop shift with O and R

A

O: shift to left
R: shifts to right

97
Q

what re the 2 kinds of mechanical vent?

A

Assist control: machine doing most of work, pt breaths and vent will compensate
SIMV: if pt breaths vent will not compensate

98
Q

What are the qualifications to evaluation someones hypoxemia with this scale
mild
mod
severe

A

<60 years old and on room air (21%)
mild: 60-80
mod: 60-40
severe: <40

99
Q

What is the absolute PaO2 that the pt needs supplental O2

A

<55 PaO2

100
Q

Whats the rule with PaO2 and Spo2

A

add 30
PaO2 60mmhg…….SpO2 90%

101
Q

whats the relationship between FI02 and PaO2

A

PaO2 should be 5x FIO2

102
Q

what is the ratio that is an indicator of hypoxemia

A

PaO2/FIO2 ratio

103
Q

What is the norm PaO2/FIO2 ratio? what is that indicator for mechanical vent

A

400-500 –> norm
200-300 –> VENT

104
Q

s/s of SP02 in 80-90

A

restlesness, light headed, incoordination, virgo, nausea

105
Q

s/s SPO2 60 - 82

A

marked confusion, dysrhythmias, labored respiration

106
Q

s/s SPO2 48 - 60

A

cartiac arrest, dec renal BF, dec UO, lactic acidosis

107
Q

What our primary and secondary drive to breath

A
  1. CO2
  2. O2
108
Q

what is hypoxic drive
what is impaired in COPD?

A

PaO2 drops and chemoreceptors notice (back up)
CO2 receptors desensitized in COPD so the primary drive isnt working

109
Q

What is BNP and what does it tell us?

A

that the pt has heart failure and how bad it is

110
Q

What is normal, mild, marked, and bad BNP values

A

Normal is <100
Over 300 → mild
Over 600 → marked
Over 900 → bad

111
Q

what is heart failure?

A

Unable to pump efficiently to provide oxygen and nutrients to body due to workload

112
Q

what are some red flags in HF?

A

Red flags: weight gain (2-3 lb in a day, 5-6lb in a week), SOB, dyspnea on exertion or rest

113
Q

in ICU change in muscle fibers within__ hours, loss of bone mineral density, ALI, frailty

A

18 to 69

114
Q

Fried Fraility index: Every 1 point increase equals __ risk of dying in next __ months related to neuromuscular weakness

A

3x
6

115
Q

with ICU weakness what are some muscle groups that get weak?

A

Trunk
Symmetrical limbs
Diaphragm

Mod 3 (6 decks)

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