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S3 - Pathophysiology > Restrictive Lung Diseases, Infectious and Inflammatory Diseases, Cystic Fibrosis > Flashcards

Restrictive Lung Diseases, Infectious and Inflammatory Diseases, Cystic Fibrosis Flashcards

1
Q

RESTRICTIVE LUNG DISEASES

A

RESTRICTIVE LUNG DISEASES

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2
Q

In Restrictive Lung Disease, what happens to residual volume (RV), expiratory reserve volume (ERV), tidal volume (TV), and inspiratory reserve volume (IRV)?

A

They are all reduced.

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3
Q

Restrictive Lung Disease involves _______ lung volumes and _________ compliance.

A

reduced lung volumes and decreased compliance (less air moved and more work done)

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4
Q

Restrictive Lung Disease:

  • ________ total lung capacity
  • ________ inspiratory reserve capacity
  • ________ secondary to inadequate alveolar ventilation
  • Associated with conditions that reduce _____ ____ movement.
A
  • decreased
  • decreased
  • hypoxemia
  • cell wall
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5
Q

What is the medical management of Restrictive Lung Disease?

A
  • symptom management

- corticosteroids

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6
Q

Is Restrictive Lung Disease reversible?

A

Most cases are not reversible.

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7
Q

___________ 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.

A

Pneumoconiosis

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8
Q

Pneumoconiosis results in interstitial ________.

A

fibrosis

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9
Q

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 ___________
A
  • inflammation, coughing, and fibrosis
  • years
  • scarring
  • thicker and stiffer
  • reversible
  • FIBROSIS
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10
Q

What are some symptoms of Pneumoconiosis (Interstitial Disease)?

A
  • Quite a range in disease severity
  • Cough
  • Phlegm
  • SOB contributing to reduced physical functional capacity
  • Progressive respiratory failure
  • Lung cancer
  • TB
  • HF (cor pulmonale)
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11
Q

What are some examples of Pneumoconiosis?

A
  • Black Lung Disease (coal dust)
  • Brown Lung Disease (agricultural dust)
  • Asbestoses
  • Silicosis
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12
Q

What does treatment of Pneumoconiosis (Interstitial Diseases) look like?

A
  • Treat complications
  • Medications
  • Chest Physiology (mobilize and remove secretions)
  • Exercise
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13
Q

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.

A

Fibrosis

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14
Q
  • 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%).
A
  • environmental (smoking) and genetic
  • 50
  • scar

-idiopathic

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15
Q

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
A
  • insidious, dyspnea
  • Unpredictable
  • hypoxemia
  • 3 years
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16
Q

What are some chest wall disorders that can lead to Restrictive Lung Disease?

A
  • 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)
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17
Q

__________ _________ (___________) is an autoimmune disease of connective tissue characterized by excessive collagen deposition in the skin and internal organs, particularly the kidneys and lungs.

A

Systemic Sclerosis (Scleroderma)

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18
Q

In Systemic Sclerosis (Scleroderma) organ damage results from:

  • __________
  • Sever thickening and obstruction of _________
  • Cutaneous _________ occurs
A
  • Inflammation
  • vessels
  • fibrosis
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19
Q

With RA, about __-__% of them have pulmonary involvement.

A

30-40%

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20
Q
  • About __% of people with SLE will experience lung involvement.
  • What is the most distinctive sign of lupus?
A
  • 50%

- Facial rash that resembles the wings of a butterfly unfolding across both cheeks.

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21
Q

SLE can be both _____ or _______. It can result in pneumonitis, what is this?

A
  • acute or chronic
  • General term that refers to inflammation of lung tissue. A term usually used to refer to noninfectious causes of lung inflammation.
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22
Q

Remember that SLE is a ____-______ pathology.

A

Multi-System

  • Kidney
  • CNS
  • Blood and blood vessel
  • Heart
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23
Q

Lastly, any chest wall _______ or lung injury can lead to Restrictive Lung Disease.

A

Trauma

  • blunt force
  • rib/sternal injuries
  • surgical injury (thoracotomy)
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24
Q

Cystic Fibrosis is classified as a ________ _____ ________.

A

Restrictive Lung Disease

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25
Q

With Restrictive Lung Disease, anything that limits __________ of the thoracic cage is going to lead to it.

A

expansion

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26
Q

INFECTIOUS AND INFLAMMATORY DISEASES PART 1

A

INFECTIOUS AND INFLAMMATORY DISEASES PART 1

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27
Q
  • List the order of the Conducting Zone.

- List the order of the Transitional and Respiratory Zones.

A
  • Trachea
  • Bronchi
  • Bronchioles
  • Terminal Bronchioles
  • Respiratory Bronchioles
  • Alveolar Ducts
  • Alveolar Sacs
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28
Q

__________ is an acute lung injury where an inflammatory process affects the parenchyma of the lungs. What is parenchyma?

A
  • Pneumonia

- Functional tissue of an organ, excludes CT

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29
Q
  • Pneumonia is a leading cause of death in the _____ and ____.
  • Nosocomial infections have ____ the mortality and morbidity of non-hospital-acquired infections.
A
  • young and old

- twice

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30
Q

What are some causes of Pneumonia?

A
  • Bacterial
  • Viral
  • Fungal
  • Inhalation of toxic or caustic chemicals, smoke, dusts, or gases via airborne transmission
  • ASPIRATION of food, fluids, or vomitus
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31
Q

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
A
  • Age
  • bronchitis, diabetes
  • extended stay facility, ICU, or hospital
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32
Q

Describe the pathogenesis of Pneumonia.

A
  • 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.
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33
Q

What are the hallmarks of inflammation?

A
  • Heat
  • Redness
  • Edema
  • Pain
  • Loss of Function
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34
Q

Systemic effects of Pneumonia?

A
  • ↑ [IL-1, TNFα]-pro inflammatory state

- Fever, chills, malaise, and myalgias

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35
Q

What are some factors that affect the pathogenesis of Pneumonia?

A
  • Virulence of the causative agent
  • Status of local defenses
  • Overall health of the individual
  • Comorbidities
  • Immunodeficiency
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36
Q

Most Pneumonias are _______ respiratory tract infections.

A

lower

37
Q

What can lead to poor prognosis of patients with Pneumonia?

A
  • advanced age
  • aggressive organisms
  • comorbidity
  • respiratory failure
  • neutropenia
  • sepsis
38
Q

What are the two “types” of pneumonia?

A
  • Community-acquired Pneumonia

- Hospital-acquired Pneumonia

39
Q

Hospital-acquired Pneumonia has a _______ mortality rate and accounts for almost __% of hospital deaths, __% of those fatalaties occur in people >65yo.

A
  • higher
  • 40%
  • 90%
40
Q
  • 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 ______.
A
  • white
  • black
  • grey
41
Q

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
A
  • pleuritic chest pain, productive cough
  • dyspnea
  • tachypnea
  • fatigue
  • fever and chills
  • aches and myalgias
  • altered mental status
42
Q

What is done with medical management of Pneumonia?

A
  • Antibiotic therapy along with rest and fluids
  • Pneumonia vaccine
  • Chest PT
43
Q

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
A
  • deep breathing techniques, coughing techniques, airway clearance techniques
  • hydration
  • early ambulation, upright posture
44
Q

INFECTIOUS AND INFLAMMATORY DISEASES PART 2

A

INFECTIOUS AND INFLAMMATORY DISEASES PART 2

45
Q

__________ is a common viral infection that can be deadly especially in high risk groups and is caused by a virus.

A

Influenza

46
Q

What are the symptoms of Influenza?

A
  • Fever
  • Chills
  • Muscle aches
  • Cough
  • Congestion
  • Runny nose
  • HA
  • Fatigue
47
Q

How is Influenza treated?

A
  • Primarily with rest and fluids to let the body fight the infection on its own.
  • OTC anti-inflammatory pain relievers may help w/ symptoms.
48
Q

__-__ million cases of severe illness and about ___ thousand to ___ thousand deaths a year. Death occurs mostly in high risk groups.

A
  • 3-5 million

- 290-650 thousands

49
Q

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.

A

fatigue

50
Q

With Influenza, there are pronounced catabolic effects of proinflammatory cytokines in various tissues contribute to local catabolism, with progressive ______ alterations of the skeletal muscle.

A

atrophic

51
Q

What is Tuberculosis?

A

A potentially serious infectious bacterial disease that mainly affects the lungs.

52
Q

What is the causative agent of Tuberculosis?

A

Mycobacterium tuberculosis

53
Q

What is the main site of TB infection?

A
  • Primarily the LUNGS

- Can also affect vertebral column, CNS, and heart

54
Q
  • __ countries account for 60% of the total TB cases.

- Who are the at risk groups for TB?

A
  • 6 (India, Indonesia, China, Nigeria, Pakistan, South Africa)
  • Homeless, malnourished, debilitated, immunocompromised esp HIV, transplant recipients
55
Q

TB has become progressively _______ to treatment.

A

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
56
Q

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
A
  • airborne, unpasteurized milk
  • Inhalation
  • insufficient
  • many months
57
Q

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
A
  • alveoli
  • immunity
  • tubercle
  • granuloma
58
Q

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
A
  • necrotic, fibrosis
  • rupture, secondary TB
  • quiescent
59
Q

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)
A
  • Asymptomatic
  • 2-12 weeks
  • 2 years
  • Hemoptysis
60
Q

____-_________ 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.

A

Drug-susceptible

61
Q

Miliary TB is characterized by a _____ dissemination throughout the body and by the tiny size of the lesions. May infect any number of organs.

A

wide

62
Q

________ precautions are required when working with a patient with active TB.

A

Airborne

63
Q

Types of Filters to prevent TB.

A
  • HEPA FIlter (most effective)
  • N95
  • PAPR
64
Q 
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
A
  • 2-step

- PPE

65
Q

S/Sx of TB?

A
  • malaise
  • weight loss
  • night sweats
  • cough that is worse in the morning
  • hemoptysis
66
Q

When assessing a patient with TB we want to do a thorough ______ assessment. How?

A
  • Chest
  • Measure following a deep maximal inspiration and on maximal expiration with a tape measure
  • Children = 2cm, Young males = 5-8cm, Emphysema <1cm
67
Q

Do TB patients need exercise?

A

Yes, but not sure how much.

68
Q

What can TB medications cause?

A
  • peripheral neuropathy
  • liver damage
  • fatigue
  • nausea
  • vomiting
  • abdominal pain
69
Q

Once an individual tests positive for TB they will _______ test positive.

A

Always, requires periodic screening with chest x-ray studies.

70
Q

What is Potts Disease?

A

TB of the spine.

-Immobilization and avoidance of weight bearing may be required to relieve pain.

71
Q

CYSTIC FIBROSIS

A

CYSTIC FIBROSIS

72
Q

_______ ________ 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)

A

Cystic Fibrosis (CF)

73
Q
  • Is CF a multi organ/system pathology?
  • Is it recessive or dominant?
  • What is it characterized by?
A
  • Yes, just affects lungs more
  • autosomal recessive
  • secretion of thick mucous which is very difficult to move
74
Q

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.

A
  • airway

- obstructive lung disease

75
Q

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.

A
  • common
  • 30000
  • 1000
  • autosomal recessive
76
Q

What structures can the CF affect?

A
  • 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)
77
Q

What is the defect that is responsible for CF pathologies?

A

CFTR protein (cystic fibrosis transmembrane conductance regulator)

78
Q

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.

A
  • incorrectly or not at all
  • salt and water
  • Cl-
79
Q

A non-functioning CFTR protein does what?

A

Limits Cl- movement and water movement resulting thick mucous I.e. mucous, salty sweat, reduced secretion of pancreatic digestive enzymes.

80
Q

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 ______ _________
A
  • cilia
  • insulin
  • biliary fibrosis and portal hypertension
81
Q

The ____________ resulting in thick, viscous mucous gland secretions causes a mechanical obstruction which is responsible for the multiple clinical manifestations of CF.

A

dehydration

82
Q

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).

A

bronchitis

83
Q
  • What is the median survival age of CF?

- What is the most common cause of death?

A
  • 36.8 years

- pulmonary failure

84
Q

What drugs may patients with CF be on?

A 
Maintenance
-antibiotics
-antiinflammatory
-bronchodilators
-mucolytic expectorants
Acute Exacerbations
-antibiotics
85
Q

S/Sx of Pulmonary Exacerbation of CF?

A
  • increased cough and sputum production
  • fever
  • weight loss
  • increased respiratory rate
  • decreased exercise tolerance
  • wheezing/crackles on chest exam
86
Q

Diagnosis of CF includes what?

A
  • 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
87
Q

Management of digestive problems with CF includes what?

A
  • digestive enzymes, vitamin supplementation
  • enemas and mucolytic agents to treat intestinal blockages
  • diet rich in proteins and calories
  • PT interventions
88
Q

What MSK issues are associated with CF?

A
  • Osteoporosis
  • Muscle dysfunction
  • Thoracic cage deformation
  • Poorer postural control
  • Reduced ventilation capacity
89
Q

What treatment can PTs provide to those with CF?

A
  • therapeutic exercise

- airway clearance techniques

S3 - Pathophysiology (14 decks)

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