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ExPhys > RCQ ch.7 - OLD > Flashcards

RCQ ch.7 - OLD Flashcards

1
Q

cardinal presentation of chronic bronchitis

A

air trapping

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2
Q

cardinal presentation of emphysema

A

increased residual volume and total lung capacity

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3
Q

cardinal presentation of asthma

A

decreased FEV1/FVC

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4
Q

cardinal presentation of cystic fibrosis

A

decreased FEV1
CO2 retention
decreased DLCO
cyanosis
wheezing
dyspnea
cough

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5
Q

obstructive lung disease defined as

A

Cluster of problems that affect airways and the lung parenchyma
producing obstruction to expiratory airflow

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6
Q

diseases under OLDs

A

emphysema
chronic bronchitis
bronchoconstriction
CF
bronchiectasis
bronchopulmonary dysplasia

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7
Q

primary causes of OLD

A

inhalation factors
genetics

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8
Q

what genetic deficiency causes OLDs

A

a1-antitrypsin deficiency

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9
Q

what does a1-antitrypsin deficiency cause

A

decreased surfactant production
decreased alveolar sac integrity

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10
Q

symptoms of OLDs

A

dyspnea on exertion
secretion production
cough

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11
Q

what can dyspnea lead to

A

increased anxiety

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12
Q

lung obstruction causes

A

retained secretions
inflammation of mucosal lining
bronchial constriction
weakening of airway wall structure
air sac destruction / overinflation with destruction of surfactant

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13
Q

what is the cascade of inflammatory response

A

inhalation exposure leads to increased protease activity and decreased antiprotease activity

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14
Q

what does inflammatory response cause in the lung tissue

A

elastin and CT breakdown
hyperplasia of mucus secreting cells
ciliary elevator damage

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15
Q

what causes obstruction

A

hypersecretion of mucus
mucus plugging
edema of mucosal lining
increased reactivity of airways
bronchial fibrosis

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16
Q

how does chronic inflammation decrease elastic recoil of the lung

A

narrowing small airways
damage of lung parenchyma
loss of alveolar attachments in small airways

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17
Q

loss of recoil leads to

A

loss of gas exchange capability
chronic lung hyperinflation

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18
Q

sequalae related to loss of elastic recoil

A

o Hyperinflation
o v/q mismatching
o hypoxemia
o hypercapnia

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19
Q

how does hyperinflation of the lung affect the thorax

A

Rib cage turns barrel shaped
Affects bucket handle and pump handle motions

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20
Q

what causes diaphragm flattening at the tissue level

A

loss of sarcomeres
change in length tension relationship
exhalation becomes forced

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21
Q

when the diaphragm becomes flattened, what can happen

A

increase intraabdominal pressure

more stress on pelvic floor and possible urinary incontinence

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22
Q

how is inspiration affected by flattened diaphragm

A

Rely on accessory muscles
Postural deviations

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23
Q

what muscles are recruited when the diaphragm is overworked

A

SCM, upper trap, scalenes, pectoralis muscles

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24
Q

what postural deviations are seen when the diaphragm is flattened

A

forward head
rounded shoulders
thoracic kyphosis
posterior thoracic musculature to lengthen and weaken

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25
Q

how is muscle affected by pulmonary obstructive disease

A

Reduction of mitochondrial density per fiber bundle

Reduction of capillary density

Reduction of aerobic metabolism / poor muscle endurance

Poorer exercise capacity

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26
Q

general changes to the thorax due to obstructive lung diseases

A
  • Elevation of the shoulder girdle
  • Horizontal ribs
  • Barrel shaped thorax
  • Low, flattened diaphragm
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27
Q

psychological impairment associated with OLD

A

depression and anxiety
2.5x more likely

28
Q

normal vs obstructive values of FEV1/FVC ratio

A

normal = >75%
obstructive = <70%

29
Q

COPD is described as

A

Mixture of parenchymal alveolar disease (emphysema) and small airway disease (obstructive bronchiolitis)

30
Q

what is the value for respiratory failure

A

PaO2 < 60mmHg +/- PaCO2 >50mmHg

31
Q

what can be seen in patients with COPD

A

barrel chest
jugular vein distension
ankle/lower leg swelling

32
Q

how is auscultation affected by COPD

A

Prolonged expiratory phase
- exhalation more than 4 seconds
diminished breath sounds

33
Q

what is the 1:2 ratio of breathing

A

1 sec of inhalation to 2 sec of exhalation

34
Q

Stage 1 COPD described as

A
  • FEV1 = >80
  • FEV1/FVC = <0.7
  • Chronic cough +/- productivity
35
Q

Stage 2 COPD described as

A
  • FEV1 = 50-80
  • FEV1/FVC = <0.7
  • Chronic cough +/- productivity and dyspnea
36
Q

Stage 3 COPD

A
  • FEV1 = 30-50
  • FEV1/FVC = <0.7
  • Chronic cough +/- productivity and dyspnea
37
Q

Stage 4 COPD

A
  • FEV1 = <30
  • FEV1/FVC = <0.7
  • Chronic cough +/- productivity and dyspnea
  • Respiratory failure / weight loss
38
Q

when is supplemental oxygen administered

A

resting PaO2 55mmHg or less / SpO2 of 88% or less

39
Q

end stage COPD has these progressions

A

cor pulmonale
vasoconstriction to combat alveolar hypoxia
increased pulmonary vascular resistance
pulmonary HTN
Right HF

40
Q

PT Interventions for COPD

A
  1. Secretion clearence
  2. Controlled breathing
    techniques
  3. Breathing retraining
  4. Ambulation
  5. Endurance exercise training
  6. Optimal use of o2 with activity
  7. Strength/weight training
  8. Thoracic stretching
  9. Postural reeducation
  10. Self management of disease
  11. Instruction of Recovery from
    shortness of breath
41
Q

emphysema described as

A

destruction of alveolar walls, enlargement of air spaces distal to terminal bronchioles (ie respiratory bronchioles, alveolar ducts, alveoli)

42
Q

subtypes of emphysema

A

centriacinar
panacinar
distal acinar

43
Q

centriacinar emphysema

A

proximal dilation of respiratory bronchioles with alveolar ducts and sacs remaining normal

frequent in upper lobes and posterior portion

44
Q

panacinar emphysema is described as ____? it can be found in ____ and is most associated with

A

dilation of respiratory airspaces in acinus

frequent in base of lung

most associated with a1-antitrypsin deficiency

45
Q

distal acinar emphysema

A

dilation of airspaces underneath the apical pleura

apical bullae leading to spontaneous pneumothorax

46
Q

acinus definition

A

tissue distal to terminal bronchiole, composed of respiratory bronchioles, alveolar ducts, and alveolar sacs

47
Q

chronic bronchitis is diagnosed when

A

presence of chronic productive cough for 3 months in each of two successive years

48
Q

characteristics of chronic bronchitis

A

hypersecretion

thickening of airway walls

mucociliary clearance system damage

hypertrophy of submucosal glands, increase in gland to bronchial wall thickness ratio

surface of epithelial secretory cells increases

degree of small airway involvement indicates level of disability

49
Q

bronchiectasis is characterized by

A

Characterized by irreversible dilation of one or mor bronchi with chronic inflammation and infection

Distortion of conducting airways

50
Q

pathophys of bronchiectasis

A

Bronchial wall injury / structural weakness of bronchial walls

Traction from adjacent lung fibrosis

Bronchial lumen obstruction

51
Q

symptoms of bronchiectasis

A

Cough with chronic sputum forming 3 layers

Recurrent/chronic lung infections

Hemoptysis

Dyspnea / tiredness

Sinusitis

52
Q

explain the sputum associated with bronchiectasis

A

3 layers
 White frothy
 Mucoid
 Purulent

53
Q

auscultation findings of bronchiectasis

A

Crackles over involved lobes

rhonchi during periods of mucus retention

dullness to percussion and decreased breathing sound

54
Q

PT for bronchiectasis

A

Secretion clearance

Controlled breathing techniques

Inspiratory muscle training

Strength training

Endurance

55
Q

cystic fibrosis is

A

autosomal recessive, multisystem disorder affecting every organ system with epithelial surfaces

56
Q

pulmonary involvement of CF is associated with

A

Chronic airway obstruction, inflammation, thick tenacious mucus, recurrent bacterial infections

57
Q

intestine involvement of CF is associated with

A

Thick mucus interfering with nutrient absorption

Malnourishment and low weight

58
Q

pancreatic involvement of CF is associated with

A

Obstruction of biliary tract and biliary cirrhosis

Exocrine pancreatic insufficiency

59
Q

symptoms of CF

A

Salty skin

Frequent lung infections

Wheezing/shortness of breath

Poor growth/slow weight gain despite healthy appetite

Bowel issues

60
Q

PT for CF

A

Airway clearance technique
Controlled breathing techniques
inspiratory muscle training Thoracic stretching
postural reeducation
Exercise

61
Q

asthma is described as

A

Chronic inflammatory disorder that results in recurrent episodes of wheezing, dyspnea, chest tightness and coughing due to bronchial hyperresponsiveness

62
Q

pahtophys of asthma

A

Acute inflammation resulting from viral or allergen exposures

Thickening of airway walls in both large (cartilaginous) and small (membranous) airways

Narrowing of peripheral airways

V/Q mismatching and increased alveolar arterial o2 difference

63
Q

narrowing of small airways leads to

A

increased residual volume
breathing at higher lung volumes

64
Q

V/Q mismatch associated with asthma can affect

A

Hypoxia in acute severe asthma

Hypocapnia = asthma attack due to respiratory drive

Hypercapnia = extreme asthma attacks, treated with bronchodilators

65
Q

symptoms of asthma

A

wheezing, chest tightness, SOB, cough

66
Q

PT for asthma

A

clearance techniques

controlled breathing techniques

Exercise/strength training

Thoracic stretching

Postural reeducation

Medications and timing of medications

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