Restrictive Lung Diseases, Infectious and Inflammatory Diseases, Cystic Fibrosis Flashcards
RESTRICTIVE LUNG DISEASES
RESTRICTIVE LUNG DISEASES
In Restrictive Lung Disease, what happens to residual volume (RV), expiratory reserve volume (ERV), tidal volume (TV), and inspiratory reserve volume (IRV)?
They are all reduced.
Restrictive Lung Disease involves _______ lung volumes and _________ compliance.
reduced lung volumes and decreased compliance (less air moved and more work done)
Restrictive Lung Disease:
- ________ total lung capacity
- ________ inspiratory reserve capacity
- ________ secondary to inadequate alveolar ventilation
- Associated with conditions that reduce _____ ____ movement.
- decreased
- decreased
- hypoxemia
- cell wall
What is the medical management of Restrictive Lung Disease?
- symptom management
- corticosteroids
Is Restrictive Lung Disease reversible?
Most cases are not reversible.
___________ is a lung disease caused by breathing in certain kinds of dust particles that damage the lungs. It is often called an occupational lung disease.
Pneumoconiosis
Pneumoconiosis results in interstitial ________.
fibrosis
Pneumoconiosis:
- Characterized by breathing in particulate matter resulting in ________, _________, and _________
- Usually takes _______ to develop
- Inflammation leads to pulmonary ______
- Blood vessel and alveolar damage-become _______ and _______
- Not ___________
- Can be simple or complex/progressive which results in massive ___________
- inflammation, coughing, and fibrosis
- years
- scarring
- thicker and stiffer
- reversible
- FIBROSIS
What are some symptoms of Pneumoconiosis (Interstitial Disease)?
- Quite a range in disease severity
- Cough
- Phlegm
- SOB contributing to reduced physical functional capacity
- Progressive respiratory failure
- Lung cancer
- TB
- HF (cor pulmonale)
What are some examples of Pneumoconiosis?
- Black Lung Disease (coal dust)
- Brown Lung Disease (agricultural dust)
- Asbestoses
- Silicosis
What does treatment of Pneumoconiosis (Interstitial Diseases) look like?
- Treat complications
- Medications
- Chest Physiology (mobilize and remove secretions)
- Exercise
Pulmonary _________ refers to a variety of disorders in which ongoing epithelial damage or chronic inflammation of lung tissue leads to progressive scarring (fibrosis) of the lungs resulting in respiratory failure.
Fibrosis
- Pulmonary Fibrosis causes can be linked to _________ and _______ factors as well as age >__. Can also be caused from _____ tissue resulting from recovery from active disease (TB, ARDS, CT disease, XRT and chemotherapy).
- Most of the time, however, Pulmonary Fibrosis is ________ (accounts for 66%).
- environmental (smoking) and genetic
- 50
- scar
-idiopathic
Idiopathic Pulmonary Fibrosis Clinical Course:
- Begins __________ with gradual increasing _________ on exertion and dry cough
- __________ progression
- Hypoxemia, cyanosis and clubbing
- Decreased diffusing capacity of the alveolocapillary membrane leading to __________
- Median survival -_ yrs. after dx.
- Lung transplantation only definitive therapy
- insidious, dyspnea
- Unpredictable
- hypoxemia
- 3 years
What are some chest wall disorders that can lead to Restrictive Lung Disease?
- Neuromuscular (ALS, polio, MD, Guillain-Barre)
- Skeletal deformities (kyphosis, scoliosis, chest wall injury or deformity)
- Postsurgical status (abdominal and thoracic surgery)
- Obesity
- Collagen vascular disease (scleroderma, SLE, RA)
__________ _________ (___________) is an autoimmune disease of connective tissue characterized by excessive collagen deposition in the skin and internal organs, particularly the kidneys and lungs.
Systemic Sclerosis (Scleroderma)
In Systemic Sclerosis (Scleroderma) organ damage results from:
- __________
- Sever thickening and obstruction of _________
- Cutaneous _________ occurs
- Inflammation
- vessels
- fibrosis
With RA, about __-__% of them have pulmonary involvement.
30-40%
- About __% of people with SLE will experience lung involvement.
- What is the most distinctive sign of lupus?
- 50%
- Facial rash that resembles the wings of a butterfly unfolding across both cheeks.
SLE can be both _____ or _______. It can result in pneumonitis, what is this?
- acute or chronic
- General term that refers to inflammation of lung tissue. A term usually used to refer to noninfectious causes of lung inflammation.
Remember that SLE is a ____-______ pathology.
Multi-System
- Kidney
- CNS
- Blood and blood vessel
- Heart
Lastly, any chest wall _______ or lung injury can lead to Restrictive Lung Disease.
Trauma
- blunt force
- rib/sternal injuries
- surgical injury (thoracotomy)
Cystic Fibrosis is classified as a ________ _____ ________.
Restrictive Lung Disease
With Restrictive Lung Disease, anything that limits __________ of the thoracic cage is going to lead to it.
expansion
INFECTIOUS AND INFLAMMATORY DISEASES PART 1
INFECTIOUS AND INFLAMMATORY DISEASES PART 1
- List the order of the Conducting Zone.
- List the order of the Transitional and Respiratory Zones.
- Trachea
- Bronchi
- Bronchioles
- Terminal Bronchioles
- Respiratory Bronchioles
- Alveolar Ducts
- Alveolar Sacs
__________ is an acute lung injury where an inflammatory process affects the parenchyma of the lungs. What is parenchyma?
- Pneumonia
- Functional tissue of an organ, excludes CT
- Pneumonia is a leading cause of death in the _____ and ____.
- Nosocomial infections have ____ the mortality and morbidity of non-hospital-acquired infections.
- young and old
- twice
What are some causes of Pneumonia?
- Bacterial
- Viral
- Fungal
- Inhalation of toxic or caustic chemicals, smoke, dusts, or gases via airborne transmission
- ASPIRATION of food, fluids, or vomitus
Pneumonia Risk Factors:
- ____
- Chronic _________, poorly controlled __________, uremia, dehydration, malnutrition, and prior existing critical illnesses
- Confinement to an ________ stay facility, ____, or _________
- Intubation, surgery, receipt of immunosuppression drugs and chemotherapy
- Age
- bronchitis, diabetes
- extended stay facility, ICU, or hospital
Describe the pathogenesis of Pneumonia.
- Infectious agent reaches the alveoli, likely to be virulent.
- Causes a full-scale inflammatory and immune response with damaging side effects to the lung tissue.
- Endotoxins released damage bronchial and alveolar capillary membranes.
- Damage type II alveolar cells which produce surfactant.
What are the hallmarks of inflammation?
- Heat
- Redness
- Edema
- Pain
- Loss of Function
Systemic effects of Pneumonia?
- ↑ [IL-1, TNFα]-pro inflammatory state
- Fever, chills, malaise, and myalgias
What are some factors that affect the pathogenesis of Pneumonia?
- Virulence of the causative agent
- Status of local defenses
- Overall health of the individual
- Comorbidities
- Immunodeficiency
Most Pneumonias are _______ respiratory tract infections.
lower
What can lead to poor prognosis of patients with Pneumonia?
- advanced age
- aggressive organisms
- comorbidity
- respiratory failure
- neutropenia
- sepsis
What are the two “types” of pneumonia?
- Community-acquired Pneumonia
- Hospital-acquired Pneumonia
Hospital-acquired Pneumonia has a _______ mortality rate and accounts for almost __% of hospital deaths, __% of those fatalaties occur in people >65yo.
- higher
- 40%
- 90%
- In X-Rays, structures that are dense will block most of the x-ray particles and will appear ______.
- Structures containing air will be _______.
- Muscle, fat, and fluid will appear ______.
- white
- black
- grey
S/Sx of Pneumonia:
- Sudden and sharp ______ ______ _____ aggravated by chest movement and accompanied by a hacking, ________ cough with rust-colored or green purulent sputum.
- Inappropriate ________
- _________ accompanied by decreased chest excursion on the affected side
- ________
- ________ and ________
- Generalized _______ and myalgias
- May result in _______ mental status
- pleuritic chest pain, productive cough
- dyspnea
- tachypnea
- fatigue
- fever and chills
- aches and myalgias
- altered mental status
What is done with medical management of Pneumonia?
- Antibiotic therapy along with rest and fluids
- Pneumonia vaccine
- Chest PT
Pneumonia Implications For PT:
- Careful hand washing
- Teach ____________ techniques, ________ techniques, ____________ techniques
- Adequate _________
- Early __________, proper positioning, sitting – out of bed activities, _______ posture!!
- Observe patient position in bed-often lie on the side of the pleuritic pain
- Pneumonia vaccine and appropriate care of comorbidities
- deep breathing techniques, coughing techniques, airway clearance techniques
- hydration
- early ambulation, upright posture
INFECTIOUS AND INFLAMMATORY DISEASES PART 2
INFECTIOUS AND INFLAMMATORY DISEASES PART 2
__________ is a common viral infection that can be deadly especially in high risk groups and is caused by a virus.
Influenza
What are the symptoms of Influenza?
- Fever
- Chills
- Muscle aches
- Cough
- Congestion
- Runny nose
- HA
- Fatigue
How is Influenza treated?
- Primarily with rest and fluids to let the body fight the infection on its own.
- OTC anti-inflammatory pain relievers may help w/ symptoms.
__-__ million cases of severe illness and about ___ thousand to ___ thousand deaths a year. Death occurs mostly in high risk groups.
- 3-5 million
- 290-650 thousands
With patients with with Influenza we want to be conscious of ________ and ease back into therapeutic exercise. Probably wont treat active cases as a PT.
fatigue
With Influenza, there are pronounced catabolic effects of proinflammatory cytokines in various tissues contribute to local catabolism, with progressive ______ alterations of the skeletal muscle.
atrophic
What is Tuberculosis?
A potentially serious infectious bacterial disease that mainly affects the lungs.
What is the causative agent of Tuberculosis?
Mycobacterium tuberculosis
What is the main site of TB infection?
- Primarily the LUNGS
- Can also affect vertebral column, CNS, and heart
- __ countries account for 60% of the total TB cases.
- Who are the at risk groups for TB?
- 6 (India, Indonesia, China, Nigeria, Pakistan, South Africa)
- Homeless, malnourished, debilitated, immunocompromised esp HIV, transplant recipients
TB has become progressively _______ to treatment.
Resistant (multi-drug resistant strains)
- do not respond to the 2 most powerful first line agents (isoniazid and rifampicin)
- 2nd line treatments are available but limited and require up to 2 years of treatment
TB Transmission:
- _______, ___________ milk
- ___________ of infected airborne particles or droplets generated by an infected person
- Casual contact usually ________ to lead to infection
- Household exposure over _____ ______ required to develop an infection
- airborne, unpasteurized milk
- Inhalation
- insufficient
- many months
Progression of Primary TB:
- Infection established in the _______
- A proliferation of epithelial cells surrounds and encapsulates the multiplying focus of bacilli
- Cell-mediated ________ usually limits further multiplication and spread of the TB bacilli
- Initial encapsulation called a ________
- Tubercle → ________ [macrophages accumulate]
- Granulomas form when the immune system attempts to wall off substances it perceives as foreign but is unable to do so
- This walling off further isolates the bacilli area from the lung
- alveoli
- immunity
- tubercle
- granuloma
Progression of primary TB to secondary TB:
- Over time, the granulomas can become ______ in the center and eventually produce _______ and calcification of the tissues.
- If a granuloma _______, the bacteria can then spread and cause _________ TB
- Explains the reemergence of TB in an individual after ________ period lasting upwards of decades
- necrotic, fibrosis
- rupture, secondary TB
- quiescent
Clinical Manifestations and Symptoms:
- __________ when most curable
- Infection to development of a positive TB skin test: __-__ wks.
- Risk for developing active disease is the highest in the first ___ years after infection and development of a positive TB skin test reaction
- Productive cough, weight loss, anorexia
- Fever, night sweats, fatigue, malaise
- ________ (bloody sputum)
- Asymptomatic
- 2-12 weeks
- 2 years
- Hemoptysis
____-_________ TB disease is treated with a standard 6 month course of 4 antimicrobial drugs. The vast majority of TB cases can be cured when medicines are provided and taken properly.
Drug-susceptible
Miliary TB is characterized by a _____ dissemination throughout the body and by the tiny size of the lesions. May infect any number of organs.
wide
________ precautions are required when working with a patient with active TB.
Airborne
Types of Filters to prevent TB.
- HEPA FIlter (most effective)
- N95
- PAPR
TB Implications for the PT: Protect Yourself -\_\_-step tuberculin skin testing -Wear appropriate \_\_\_\_ -When treating pulmonary patients pay attention to their history -When in doubt protect yourself
- 2-step
- PPE
S/Sx of TB?
- malaise
- weight loss
- night sweats
- cough that is worse in the morning
- hemoptysis
When assessing a patient with TB we want to do a thorough ______ assessment. How?
- Chest
- Measure following a deep maximal inspiration and on maximal expiration with a tape measure
- Children = 2cm, Young males = 5-8cm, Emphysema <1cm
Do TB patients need exercise?
Yes, but not sure how much.
What can TB medications cause?
- peripheral neuropathy
- liver damage
- fatigue
- nausea
- vomiting
- abdominal pain
Once an individual tests positive for TB they will _______ test positive.
Always, requires periodic screening with chest x-ray studies.
What is Potts Disease?
TB of the spine.
-Immobilization and avoidance of weight bearing may be required to relieve pain.
CYSTIC FIBROSIS
CYSTIC FIBROSIS
_______ ________ is a genetic disease that causes a disorder of ion transport (sodium and chloride) in the lungs and in the exocrine glands of the liver, pancreas, digestive, male reproductive organs (vas deferns disrupted in nearly all cases)
Cystic Fibrosis (CF)
- Is CF a multi organ/system pathology?
- Is it recessive or dominant?
- What is it characterized by?
- Yes, just affects lungs more
- autosomal recessive
- secretion of thick mucous which is very difficult to move
CF predisposes an individual to chronic bacterial _______ infections, and almost all persons develop _________ _____ _________ associated with chronic infection that leads to progressive loss of pulmonary function.
- airway
- obstructive lung disease
CF is the most ______ inherited genetic disease in the white population and affects approximately ________ children and young adults in the US. There are about _____ new cases each year. The disease is inherited as an ______ _______ trait.
- common
- 30000
- 1000
- autosomal recessive
What structures can the CF affect?
- Bronchi (chronic bronchial pneumonia, generalized obstructive emphysema)
- Small Intestine (intestinal obstruction of newborn)
- Pancreatic Ducts (malabsorption syndrome)
- Bile Ducts (portal hypertension)
- Reproductive System (decreased fertility, >95% sterile)
What is the defect that is responsible for CF pathologies?
CFTR protein (cystic fibrosis transmembrane conductance regulator)
CFTR Protein:
-This protein is made _________ or _________.
Helps to maintain the balance of _____ and _______ on many surfaces in the body, such as the surface of the lung.
When the channel is not working correctly ____ is not transported to epithelial surfaces and remains trapped in cells.
- incorrectly or not at all
- salt and water
- Cl-
A non-functioning CFTR protein does what?
Limits Cl- movement and water movement resulting thick mucous I.e. mucous, salty sweat, reduced secretion of pancreatic digestive enzymes.
Thickened Mucous:
- Reduces movement of the _____ in the bronchiole tubes
- Obstructs the tubular network in the pancreas which reduces release of digestive enzymes (pancreatic insufficiency) and _________
- Obstruction of the terminal ileum by thick meconium in new borns
- Results in ______ _______ and ______ _________
- cilia
- insulin
- biliary fibrosis and portal hypertension
The ____________ resulting in thick, viscous mucous gland secretions causes a mechanical obstruction which is responsible for the multiple clinical manifestations of CF.
dehydration
CF progresses from mucous plugging and inflammation of small airways (bronchiolitis) to ___________ (inflammation of the bronchial tubes, followed by bronchiectasis, pneumonia, fibrosis, and the formation of large cystic dilations).
bronchitis
- What is the median survival age of CF?
- What is the most common cause of death?
- 36.8 years
- pulmonary failure
What drugs may patients with CF be on?
Maintenance -antibiotics -antiinflammatory -bronchodilators -mucolytic expectorants Acute Exacerbations -antibiotics
S/Sx of Pulmonary Exacerbation of CF?
- increased cough and sputum production
- fever
- weight loss
- increased respiratory rate
- decreased exercise tolerance
- wheezing/crackles on chest exam
Diagnosis of CF includes what?
- Genetic screening
- Sweat test
- Pancreatic elastase (marker of pancreatic insufficiency)
- Pulmonary Function Tests (FEV1, VC) (both assess flow of air in and out)
- Assessed for DM
Management of digestive problems with CF includes what?
- digestive enzymes, vitamin supplementation
- enemas and mucolytic agents to treat intestinal blockages
- diet rich in proteins and calories
- PT interventions
What MSK issues are associated with CF?
- Osteoporosis
- Muscle dysfunction
- Thoracic cage deformation
- Poorer postural control
- Reduced ventilation capacity
What treatment can PTs provide to those with CF?
- therapeutic exercise
- airway clearance techniques
