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Pathophysiology - Test 2 > Pulmonary Pathophysiology > Flashcards

Pulmonary Pathophysiology Flashcards

0
Q

What is the difference between obstructive and restrictive pulmonary diseases?

A

Obstructive diseases - flow of air is impeded (during expiration)
Restrictive diseases - volume of air is decreased

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1
Q

What are the four main categories of pulmonary diseases?

A
  1. Infectious/inflammatory disorders
  2. Obstructive
  3. Restrictive
  4. Malignancy
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2
Q

What are two types of infectious pulmonary disorders?

A
  1. Pneumonia

2. Tuberculosis (TB)

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3
Q

What are two types of obstructive pulmonary diseases?

A
  1. COPD

2. Asthma

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4
Q

What are the two types of COPD?

A
  1. Chronic bronchitis

2. Emphysema

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5
Q

What are two types of restrictive pulmonary disease?

A
  1. Pulmonary fibrosis

2. Cystic fibrosis

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6
Q

What is pneumonia?

A

Infectious process in the lungs

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7
Q

What are risk factors for pneumonia?

A

Increasing age, dysphagia, immunosuppression, diabetes, malnutrition, dehydration, hospitalization, immobility, altered consciousness, and smoking history

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8
Q

What is the pathogenesis of pneumonia?

A

Normal immune response does not eliminate bacteria/virus - fluid buildup (parenchyma) causes mucosal membrane damage and alveolar capillary membrane damage (impedes oxygen diffusion)

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9
Q

What are the two types of pneumonia and what do lobes do they affect?

A
  1. Bacteria - limited to 1 or 2 lobes

2. Virus - bilateral (both sides of lungs)

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10
Q

What is aspiration pneumonia?

A

Impaired airway protection - fluid or food aspirated into the lungs

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11
Q

Which lung is aspiration pneumonia more likely to affect?

A

Right - main bronchus is more vertical

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13
Q

What are two symptoms associate with aspirated pneumonia?

A

Seizures and depressed gag reflex

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14
Q

What is the mortality rate for aspirated pneumonia?

A

5% (low)

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15
Q

What is a major sign/symptom aspiration pneumonia?

A

Coughing/SOB with eating or shortly after

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16
Q

What is a PT implication for aspiration pneumonia?

A

Head/neck positioning and posture during swalling

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17
Q

What is PCP?

A

Pneumocystis carinii pneumonia - new pneumocytes formed affecting participation in gas exchange

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18
Q

What population is most likely to get PCP?

A

AIDS or immunosuppressed patients

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19
Q

How long does pneumonia last?

A

1-2 weeks

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20
Q

What is treatment for pneumonia?

A

Antibiotics, hydration, exercise for pulmonary hygiene, and vaccines for >65 years old, diabetes, chronic lung disease, or immunocompromized patient

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21
Q

How is pneumonia diagnosed?

A

History of URI, sputum culture, chest x-ray, urine antigen, auscultation (crackles, wheezing, decreased lung sounds)

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22
Q

What disease is the 6th leading cause of death in the US?

A

Pneumonia

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23
Q

What is TB?

A

Infectious disease of the lungs - transmitted by inhaled droplets (sneeze, cough, etc) - causes proliferation of epithelial cells in alveoli

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24
Q

Is TB asymptomatic or symptomatic?

A

Asymptomatic

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25
Q

What are the signs/symptoms of active TB seen on chest x-rays?

A

Necrotic center, fibrosis of tissue, and spread through bloodstream/lymphatics

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26
Q

What are other signs/symptoms of TB?

A

Productive cough (>3 weeks), weight loss, fever, and malaise

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27
Q

What are the risk factors for TB?

A

Age, HIV, homeless, overcrowded living arrangements, malnutrition, prison inmates, ESRD, immunocompromised, and health care workers

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28
Q

What is the diagnosis of TB?

A

History, chest x-ray, sputum culture, and skin test (TB test)

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29
Q

What is the treatment for TB?

A

Medications to prevent cell wall biosynthesis (6-9 months) and chest x-rays to monitor people who already have TB

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30
Q

What is the prognosis for TB?

A

Untreated - 50-80% fatal in 2.5 years

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31
Q

What are PT implications for TB?

A

2 step PPD test yearly, cover mouth and nose when sneezing, masks, disinfect stethoscope, and hand washing

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32
Q

What are risk factors for obstructive diseases?

A

Smoking, age, sex, environmental allergens, and heredity

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33
Q

What sex is more likely to develop obstructive diseases?

A

Men - although this is changing

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34
Q

What are characteristics of COPD?

A

Airway obstruction, air trapping, gas exchange abnormalities, mucus production, pulmonary HTN, systemic effects

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35
Q

What type of muscle fibers are lost for patients with COPD?

A

Type I

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36
Q

What are factors of chronic bronchitis?

A

Productive cough (at least 3 months each year for two consecutive years), decreased expiratory flow (FEV1), and effects to large and small bronchi

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37
Q

What is the pathogenesis of chronic bronchitis?

A

Inflammation on bronchi with scarring of bronchial lining, increases mucous production (wheezing, productive cough, decreases size of lumen), frequent infections, and airway collapse/trapping (decreases amount of air that reaches alveoli and decreases ventilation)

38
Q

What are signs/symptoms of chronic bronchitis?

A

Cough, sputum productions, SOB, activity intolerance, enlarged A-P diameter, use of accessory muscles with activity, wheezing, cyanosis, and cor pulmonale

39
Q

What is emphysema?

A

Destruction of the distal airways beyond the terminal bronchiole, destruction of elastic properties of the alveolar wall, and pockets of air formed between alveolar spaces

40
Q

What structure does emphysema affect?

A

Alveoli

41
Q

What are signs and symptoms of emphysema?

A

Dyspnea progressing to SOB at rest, cor pulmonale, accessory muscle use, cachectic, barrel chest, and atrophy of endurance muscles

42
Q

What disease presents with a barrel chest and why?

A

Emphysema - more air left in the lungs after expiration (residual volume)

43
Q

Which pulmonary disease presents with an enlarged A-P diameter?

A

COPD - chronic bronchitis and emphysema

44
Q

What are the three diagnostic tests for obstructive pulmonary diseases?

A
  1. Pulmonary function test (PFT)
  2. Gas flow rates
  3. Forced vital capacity
45
Q

What is the function of a PFT?

A

Test the function of respiratory muscles, health and function of airways, and classify diseases - indicate airflow abnormalities

46
Q

What is the function of gas flow rates?

A

Measure gas flow in various parts of the lungs and to test function of the lung, magnitude of impairment, and location of impairment

47
Q

What is the function of a spirometer?

A

Measures volume - IRV, ERV, RV, TV, etc

48
Q

What are signs and symptoms for pneumonia?

A

URI, productive cough, dyspnea, tachypnea, tachycardia, fever, fatigue, myalgias, and cyanosis

49
Q

What is the function of forced vital capacity (FVC) test?

A

Measures the maximum volume of gas a patient can exhale forcefully and quickly

50
Q

What is forced expiratory volume in one second (FEV1)?

A

Amount of air exhaled during 1st second of a FVC test

51
Q

How are PFT’s interpreted?

A

Actual value divided by predicted value - <80% to be abnormal

52
Q

What are the PFT values for COPD?

A

> or equal to 80% - mild
50-79% - moderate
30-49% - severe

53
Q

What has to be confirmed in order to diagnose COPD?

A

FEV1/FVC < or equal to .70 after a bronchodilator has been given

54
Q

What is the diagnosis for COPD?

A

Chest x-ray, arterial blood gas, sputum cultures, PFT’s, history (smoking and environmental exposure)

55
Q

What is the treatment for COPD?

A

Smoking cessation, steroids, bronchodilators, mucolytics, antibiotics, oxygen, exercise, breathing retraining, posture retraining, lung volume reduction surgery, and lung transplant

56
Q

What is a reversible obstructive lung disease?

A

Asthma

57
Q

What is the most common chronic disease?

A

Asthma

58
Q

What is asthma?

A

Chronic inflammatory disorder that leads to airway hyper-responsiveness, airway edema, mucous, and bronchoconstriction

59
Q

What sex is more likely to develop asthma?

A

Men - after puberty incidence is the same for men and women

60
Q

What population is more likely to develop asthma?

A

Children before age 5

61
Q

What are risk factors for asthma?

A

Premature birth, urban settings, cold climates, low SES, African Americans, overcrowded living areas, and obesity

62
Q

What are some protective factors to developing asthma?

A

Older siblings, early exposure to pets, large families, and attending daycare

63
Q

What are the three types of etiologies regarding asthma?

A
  1. Extrinsic asthma - triggers from external environment
  2. Intrinsic asthma - no known triggers
  3. Occupational asthma - allergen in the workplace
64
Q

When is the onset generally for intrinsic asthma?

A

Adults >40 years old

65
Q

Whom is occupational asthma more common amongst?

A

Housecleaners, homemakers, textile workers, bakers, farmers, and animal handlers

66
Q

What is the pathogenesis of asthma?

A

Narrowing of airway, mucus plugging, air trapping, V/Q mismatch, and increased workload of breathing

67
Q

What is important about airway inflammation with asthma?

A

Airway inflammation is always present

68
Q

How do asthma patients present?

A

Sensation of airway narrowing, tickle in airways, nonproductive cough, wheezing, tachypnea, tachycardia, fatigue, nostril flaring, accessory muscle use, cyanosis, and restlessness

69
Q

What is the diagnosis for asthma?

A

Pulse ox, PFT with medications, arterial blood gas, x-rays, and history

70
Q

What is prevention for asthma?

A

Education, medication compliance, and aerobic fitness

71
Q

What is the main treatment for asthma?

A
  1. Identify the trigger - symptoms abate after treatment

2. Inhalers, oral meds, and injections

72
Q

What are the two types of treatment management for asthma?

A
  1. Controllers - take on a daily basis

2. Relievers - taken as needed

73
Q

What is exercise induced bronchospasm (EIB)?

A

When exercise is a trigger for asthma: 5-15 minutes after exercise begins and can last 15-60 after exercise ends

74
Q

What is the diagnosis of EIB?

A

10-15% or greater drop in FEV1 when 80% of max HR is reached for at least four minutes

75
Q

What is significant of restrictive lung diseases?

A

Decreased total lung capacity, decreased exercise intolerance, increased work of breathing, accessory muscle use, weight loss, and hypoxemia

76
Q

What is pulmonary fibrosis?

A

Chronic inflammation leads to lung fibrosis - lung is no longer elastic so you can’t get a lot of volume in

77
Q

What are risk factors for pulmonary fibrosis?

A

Idiopathic, TB, ARDS, asbestos, lupus, chemotherapy, and radiation

78
Q

What is the pathogenesis of pulmonary fibrosis?

A

Irreversible proliferation of fibroblasts –> decreased lung compliance and alveolar and capillary injury

79
Q

What is the treatment for pulmonary fibrosis?

A

Corticosteroids, maximize use of diaphragm, maintain airway opening, maintain oxygenation, and cough training

80
Q

What is the prognosis for pulmonary fibrosis?

A

Chronic, progressive disease with <4 years

81
Q

What is cystic fibrosis?

A

Autosomal recessive disorder with an abnormality in the CFTR protein on chromosome 7 - disorder of sodium and chloride channels

82
Q

What race is most likely to get CF?

A

Caucasians

83
Q

What is the average lifespan of a person with CF?

A

37.4 years

84
Q

What is the pathogenesis of CF?

A

Obstruction by mucus (thick mucus from dehydration), frequent infections, hyperinflation, bronchiolitis/bronchiectasis

85
Q

How does a patient with CF present?

A

“Salty” sweat, productive cough, wheezing, frequent infections, weight loss, exercise intolerance, increased WOB, and decreased FEV1

86
Q

What are some problems associated with CF?

A

Problems with GI system, liver, pancreas, genitourinary (sterility and infertility), musculoskeletal (rheumatoid arthritis and osteopenia), and lungs (hypoxia and barrel chest)

87
Q

What is the diagnosis of CF?

A

Prenatal screening, sweat test, pancreatic elastase, and PFT’s

88
Q

What is the treatment for CF?

A

Bronchodilators, mucolytics, corticosteroids, oxygen, and antibiotics

89
Q

What are PT implications for CF?

A

Secretion management - chest PT, postural drainage, exercise, positioning, theravest, autogenic drainage, and adjunct airway clearance (PEP and flutter)

90
Q

Are FEV1 and FVC reduced or increased in people with lung disorders?

A

Reduced

Pathophysiology - Test 2 (4 decks)

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