Pulmonary Pathology Part 2 Flashcards
1
Q
What is a bronchoscopy
A
Use of a fiberoptic scope that is used to diagnosis and treat pulmonary conditions
2
Q
What can be done with a bronchoscopy (2)
A
- Secretions can be obtained
2. Visualize the upper airways
3
Q
What are the 3 type of cough
A
- Dry
- Productive
- Hemoptysis
4
Q
What is a productive cough
A
Purulent sputum
5
Q
What is hemoptysis
A
Coughing up blood
6
Q
What can hemoptysis be due to (5)
A
- Abscess
- Infection
- Inflammation
- Tumor
- Infarction
7
Q
What is dsypnea
A
Shortness of breath
8
Q
True or False:
Digital clubbing occurs to all digits
A
True
9
Q
When is an acute cough seen
A
Upper respiratory infection
10
Q
When is a chronic cough seen
A
COPD
11
Q
What is a dry cough
A
Little value, often spirals into a self perpetuated cough
12
Q
What are the 3 types of sputum
A
- Bloody (hemoptysis)
- Purulent (pussy)
- Non-purulent
13
Q
When do you have non-purulent sputum
A
Post nasal drip
14
Q
True or False:
Dsypnea is usually indicating poor ventilation or perfusion
A
True
15
Q
What are 3 causes of dsypnea
A
- Increase awareness of normal breathing
- Increased work to breath
- Abnormal ventilatory function
16
Q
What is orthopnea
A
Being in a recumbent position causes SOB
17
Q
What si paroxsymal nocturnal dyspnea
A
Sudden SOB at night that wakes patient up
18
Q
What are the 2 general types of dyspnea
A
- At rest
2. With exertion
19
Q
What are the 2 onsets of dyspnea
A
- Acute
2. Gradual
20
Q
True or False:
Acute onset of dyspnea may be indicative of a PE
A
True
21
Q
If the chest pain is in the chest wall is the origin due to pulmonary dysfunction
A
Nope
22
Q
Chest wall chest pain characteristics (2)
A
- Superficial
2. Localized
23
Q
If chest pain is visceral is the origin due to visceral organs
A
True
24
Q
Visceral chest pain characteristics (2)
A
- Deep
2. Hard to localize
25
True or False:
| Pulmonary chest pain can present like musculoskeletal pain
True
26
Pulmonary chest pain characteristics (3)
1. Substernal or chest
2. Directly over the involved lung fields
3. Anterior, lateral or posterior
27
True or False:
| Chest pain can radiate
True
28
When does chest pain usually occur (4)
1. Inspiration
2. Deep breath
3. Cough
4. Laugh
29
What is cyanosis
Bluish tint often due to low PaO2 or HgB
30
What is central cyanosis
Poor gas exchange to mucous membranes (tongue, lips) and arterial saturation is often less than 75-80%
31
What is peripheral cyanosis
Excess peripheral oxygen extraction seen in the fingertips, toes, nose, and nails often associated with cold external temps, anxiety, heart failure, or shock
32
What is another name for clubbing
Hypertrophic pulmonary osteoarthropathy
33
What is clubbing
Thick and wide terminal phalanges with loss of the angle between the nail and the nail bed
34
What is clubbing normally due to
Hypoxia
35
What is the normal respiratory rate
12-16 per minute
36
What is depth of breathing
Chest excursion
37
What is effort of breathing
How hard one works to breathe
38
What is apnea
Temporary stop in breathing
39
What is tachypnea
Rapid shallow breathing more than 20 in a minute
40
What is bradypnea
Slow rate of brathing less than 12 per minute
41
True or False:
| Lung disease is the 2nd most common cause of disibility in adults of 65
True
42
True or False:
| Lung disease is the 3rd leading cause of death in the US
True
43
What are the 2 chronic respiratory diseases
1. Obstructive
| 2. Restrictive
44
What are 3 types of obstructive lung diseases
1. COPD
2. Asthma
3. Chronic bronchitis
45
What are 2 types of restrictive lung diseases
1. Extrapulmonary disorders
| 2. Parenchyma disorders
46
What is an obstructive lung disease
Increased airway resistance
47
What is a restrictive lung disease
Lungs are prevented from expanding fully
48
Characteristics of COPD (4)
1. Bronchial wall inflammation and fibrosis
2. Hypertrophy and hypersecretion of submucosal glands
3. Loss of elastic lung fibers and alveolar tissue
4. Decreased ability to get air out
49
Is the TLC, FRC, and FEV1/FVC of a patient with COPD increased or decreased
```
TLC increased (can't get air out so the more air that comes in stays in)
FRC Increased (can't get air out)
FEV1/FVC severely decreased (can't get air out)
```
50
What does blood gas measurements of someone with COPD look like
Hypoxemia or hypercapnia
51
What is hypercapnia
Excess CO2 in blood
52
What does an x-ray show in a patient with COPD (5)
Hyperinflation, flattened diaphragm, enlarged residual volume, increased costophrenic angle, increased translucency of lungs
53
How does one manage COPD (8)
1. Smoking cessation
2. Pulmonary hygiene (coughing/chest PT)
3. Exercise
4. Drugs
5. Control complications
6. Avoid irritants
7. Psychological support
8. Diet management
54
What are the goals of COPD management (8)
1. Increase oxygenation
2. Increase activity tolerance
3. Decrease CO2 retention
4. Decrease airway edema/inflammation
5. Decrease secretions
6. Decrease anxiety/depression
7. Prevent infection
8. Control complications
55
True or False:
| A patient with COPD has a poor prognosis
True
56
IS there a cure for COPD
Nope but oxygen can increase survival rate
57
True or False:
| Asthma is a reversible obstructive lung disease
True
58
What is asthma
Chronic airway inflammation and narrowing due to airways overreacting
59
What is asthma due to (6)
1. Biochemical
2. Immunological
3. Infectious
4. Endocrine
5. Psychological
6. Autonomic
60
True or False:
| Asthma is the most common chronic disease in adults and children
True
61
What are the 2 types of asthma
1. Extrinsic (allergic) asthma
| 2. Intrinsic (non-allergic) asthma
62
What is extrinsic asthma triggered by
Environmental factors or sports
63
What is intrinsic asthma triggered by
Unknown but may be secondary to respiratory infection
64
When is asthma most likely to occur
Before 5 years old
65
True or False:
| Childhoof aasthma is 3 times more likely and severe in boys
True
66
What makes a person more susceptible to asthma (11)
1. High BMI
2. LBW babies
3. Premature babies
4. Urban/industrialized setting
5. Colder climates
6. Poverty
7. Exposure to smoke
8. Dust
9. Cockroaches
10. Mold
11. Gas stove
67
What is the pathophys of asthma in 4 steps
1. Airway inflammation due to infiltration, mucosal edema
2. Bronchial smooth muscle spasm due to irritaiton
3. Thick mucous production and impaired mucocilliary function
4. Airway spasms and mucous plugs the airway so distal air is trapped
68
True or False:
| Asthma has VQ mismathc, hypoxemia, and increase work to breathe
True
69
True or False:
| With asthma the airway is always inflammed
True
70
Signs and symptoms of asthma (5)
1. Chest tightness
2. Wheezing
3. Breathlessness (prolonged expiration)
4. Cough often worse at night
5. Tachypnea
71
What can be observed by looking at someone with asthma (3)
1. Signs of fatigue
2. Pale/cyanotic skin
3. Dry or productive cough
72
How does one prevent/treat asthma (4)
1. Education
2. Identify triggers
3. Exercise below bronchospasm threshold
4. Medications (bronchodilators and anti-inflammatory)
73
True or False:
| 25% of childhood asthma resolves or the symptoms lessen
True
74
What is status astmaticus
Acute asthma attack with severe bronchospasm that is a medical emergency
75
What are the symptoms of status astmaticus (3)
1. Diminished.absent breath sounds
2. May lead to hypoxemia or acidosis
3. Can lead to respiratory and cardiac arrest
76
What is chronic bronchitis
History of a productive cough of at least 3 months in duration for 2 consecutive years
77
What is the pathophysiology of chronic bronchitis
Inflammation and scarring of the bronchial lining
78
What are effected first small or large airways
Larger then smaller airways
79
What happens in chronic bronchitis
Inflammation obstruct airflow and increases mucous secretions decreasing airway clearance increasing risk of infection
80
What happens when more proximal airways collapse with chronic bronchitis
Air becomes trapped in distal airways and there is decreased alveolar ventilation leading to hypoxia and acidosis
81
Early symptoms of chronic bronchitis (5)
1. Persistent cough with sputum production
2. Worse in am and pm
3. SOB
4. Prolonged expiration
5. Recurrent infection
82
Later symptoms of chronic bronchitis (8)
1. Decreased chest expansion, alveolar ventilation, and exercise tolerance
2. Wheezing
3. Cyanosis
4. Increased PaCO2
5. Hypoxemia leading to polycythemia
6. Increased risk of infection
7. Sleep distrubances
8. Severe disability or death
83
What is polcythemia
Overproduction of RBCs to compensate for O2 deficiency in blood
84
How does one manage chronic bronchitis (7)
1. Clear secretions
2. Reduce work of breathing
3. Maximize aerobic capacity, exercise tolerance, and strength
4. Monitor signs of pulmonary distress
5. Education
6. Smoking cessation
7. Meds
85
What does the chest x-ray of someone with chronic bronchitis look like
Low diaphragm with decreased radiolucency due to gas being trapped in
86
True or False:
| Emphysema is the second characteristic of COPD
True
87
What causes emphysema (3)
1. Smoking
2. Heredity
3. Genetic (AAT protein deficiency)
88
When is genetics considered to be the cause of emphysema
Someone under 40 who is a non smoker
89
What is emphysema
Increased release of elastase that leads to destruction of elastin and loss of elasticity and recoil of lungs and overdistended air spaces or destroyed alveolar walls
90
What does the loss of elasticity cause
Airway narrowing/collapse
91
True or False:
| In emphysema airway narrowing is not due to mucous production
True
92
What are the 2 types of emphysema
1. Centriacinar
| 2. Pantracinar
93
When is centriacinar emphysema most commonly seen
In men who smoke with chronic bronchitis
94
When is pantracinar emphysema seen
AAT deficiency
95
What are the 2 types of centriacinar emphysema
1. Centrilobular
| 2. Panlobular
96
Where is centrilobular emphysema most common
UPPER lung
97
What happens in centrilobular emphysema
Destruction of bronchioles but alveolar sacs stay intact and inflammation and edema develop around the airways
98
Where is panlobular emphysema most common
LOWER lung
99
What happens in panlobular emphysea
Destruction of the airspaces in the entire love beginning in the alveolie and expanding centrally creating bullae
100
What is bullae
Dead space
101
Initial symptoms of emphysema (6)
1. Exertional dyspnea
2. Cough is uncommon
3. Tacypnea with prolonged expiration
4. Accessory muscle use increases
5. Thin (cachectic)
6. Barrell chest due to hyper expansion and air being trapped in lungs
102
What causes the cachectic/thin body
Breathing is more important than eating to the patient
103
Later symptoms of emphysema (3)
1. Dyspnea at rest
2. Loss of surface area for gas exchange
3. Cardiac complications
4. Depression
5. Malnutrition
6. Insomnia
7. Pneumonia
8. CHF
9. PE
104
What are the cardiac complications that come with later stage emphysema
Dilated/enlarged right ventricle (cor pulmonale) leading to increased SV, CO, and RBC count
105
What does the x-ray of a patient with emphysema look like
Hyperinflated, flattened hemidiaphragms, elongated heart (due to cor polmonale, may look twisted)
106
How do you treat emphysema (7)
1. Smoking cessation
2. Pursed lip breathing
3. O2 therapy is limited
4. Education
5. Meds
6. Reduce work of breathing
7. Maximize aerobic capacity, physical endurance, and strength
107
How does one with emphysema normally die
Cardiac complications
108
What is bronchiectasis
Extreme bronchitis that is irreversible airway destruction and dilation of medium sized bronchi and bronchioles
109
True or False:
| Bronchiectasis is associated with chronic bacterial infections
True
110
What increases your risk of bronchiectasis (4)
1. Tb
2. Pneumonia
3. Immunodeficiences
4. Cancer
111
What is the cycle seen in bronchiectasis
Inflammatory lung damage then irreversible fragmentation of bronchial wall then fibrosis and damage of bronchial lumen
112
Where does bronchiectasis most commonly occur
Lower lungs
113
Signs and symptoms of bronchiectasis (10)
1. Persistent cough with large amound of purulent sputum with a foul smell
2. Weight loss
3. Anemia
4. Fever
5. Hemoptysis
6. Fatigue
7. Weakness
8. Nasal congestion
9. Sinusitis draingage
10. Clubbing
114
Treatment of bronchiectasis (5)
1. Pulmonary PT
2. Meds
3. Hydration
4. O2 therapy
5. Surgical resection if well localized
115
What are complications of bronciectasis (5)
1. Spread of infection
2. Recurrent pneumonia
3. Lung abscesses
4. Metastatic infections
5. Respiratory failure
116
What is bronchiolitis
Severe lower airway (bronchiole) inflammation due to viral infection with hyperinflation or patchy ares of atelectasis distal to inflammation
117
When does bronchiolitis occur
Children under 2 years old
118
What is bronchiolitis obliterans
Bronchiolitis in adults due to complication in heart-lung transplant
119
True or False:
| Bronchiolitis can be caused by pulmonary infection, viruses, pertussis, or measels
True
120
True or False:
| Bronchiolitis is seasonal seen in the winter and spring
True
121
How are the organisms that cause bronchiolitis spread
Hand, nose, or eyes
122
What is atelectasis
Complete or partial collapse of part lung
123
What happens to air trapped distally
It will diffuse into the capillaries and the alveoli will collapse
124
What are the signs of bronchiolitis (10)
1. Upper respiratory infection
2. Nasal discharge
3. Mild fever
4. Cough
5. cyanosis
6. dyspnea
7. sputum production
8. Wheezing
9. Hypercapnea
10. Respiratory acidosis
125
Is a chest x-ray useful for diagnosis bronchiolitis
Nope
126
How do you treat bronchiolitis (7)
1. No specific treatment
2. Steroids
3. Humidified air
4. Hydration
5. Postural drainage
6. Deep breathing
7. Oxygen hood/tent
127
What is the prognosis of bronchiolitis
3-10 days
128
What happens when air gets into the blood stream
You die
