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Pathophysiology Quiz 1 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Portions of Respiratory System?

A

Upper airway- nasal cavities, sinuses, pharynx, tonsils, larynx
Lower airway- conducting A/W (tranches, bronchi, non-respiratory bronchioles)
Terminal Alveoli- respiratory bronchioles, alveolar ducts, alveolar sacs

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2
Q

How many generations of Airways are there?

A

26

  • 1st 16 are conducting
  • next are transitional
  • the 24th generation is the final respiratory zone consisting of alveoli
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3
Q

Split in Trachea?

A

Bifurcated Angle of Lewis

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4
Q

Which lung is bigger?

A

Right–left has heart resting on it

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5
Q

Dyspnea

A

Shortness of breath, but what patient is perceiving

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6
Q

Orthopnea

A

Inability to sleep flat; sign on pulmonary and cardiac disease (30 degrees of head elevation is best)

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7
Q

Pleuritic Pain

A

Pain with breathing around the lung tissue

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8
Q

Cyanosis

A

Blue–not enough oxygen

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9
Q

Clubbing

A

Swollen–ends of fingers on pads

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10
Q

Tachypnea

A

Fast respiratory rate

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11
Q

Abnormal Chest Wall Shape

A

Pigeon Breast, bad scoliosis, etc.

Interferes with breathing and exercise tolerance

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12
Q

Hemoptysis

A

Coughing up blood

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13
Q

DOE

A

Dyspnea on exertion

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14
Q

Parietal vs. Visceral Pleura?

A

Parietal is sensitive to pain while visceral is not

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15
Q

Parietal Pleura

A

Outermost of the pleural membranes

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16
Q

Visceral Pleura

A

thin serous membrane tissue layer that sticks to the lung surface

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17
Q

Hypoxemia

A

Deficient oxygenation of arterial blood; can lead to hypoxia

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18
Q

Signs and Symptoms of Hypoxemia?

A

PaO2:
80-100 = Normal
60-80 = Tachycardia, DOE, possible onset of respiratory distress
50-60 = malaise, light headed news, nausea, impaired judgement
This is emergency!
Below 90 for pulse oximetry is already about 60-80 for PaO2

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19
Q

Pulmonary Edema

A

Fluid in tissues and air spaces of the lung

Most commonly caused by heart disease, especially LVF

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20
Q

Pneumonia

A

Inflammation affecting parenchyma of the lungs
-Dx with sputum cultures, chest percussion, urine test
Tx- antibiotics, chest PT, rest, fluids
-risk factors= bronchitis, smoking, chemo, COPD…
-Signs= pleuritic chest pain,productive cough, rust or green sputum, Dyspnea…

Either lobar or Bronchopneumonia

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21
Q

Recovery from Pneumonia

A

Consolidation- fluid displaces some of the air so get SOB
Red Hepatization- blood leaks into air leaks
Gray Hepatization- breakdown of accumulated RBC
Resolution- can see dis colored or bloody sputum; infection clearing

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22
Q

Pneunocystis Carinii Pneumonia (PCP)

A

Parasitic infection seen in AIDs, it is the first indicator of conversion from HIC to AIDS; also seen in the immunosuppressed

Signs= impaired gas exchange, fever, Dyspnea, tachypnea, weight loss
Tx= Universal Precautions, breathing exercises, energy conservation
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23
Q

Tuberculosis- Primary Infection

A

Involves middle or lower lung area and spreads to bronchopulmonary lymph nodes and then travels to blood stream

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24
Q

Mycrobacterium TB

A

Characterized by granulomas, caseous necrosis, cavity formation

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25
Q

Tuberculosis

A

Infectious inflammatory systemic disease; affects lungs and may disseminate to involve lymph nodes and other organs

Risk factors= elderly, poor health, HIV, inadequate ventilation
Signs= appear late, night sweats, productive cough, fatigue, lung atelectasis, pulmonary infections weight loss
Etiology= inhalation of infected airborne particles
Dx= skin test, chest X-ray, culture of sputum, bronchoscopy
Ex= combo of drugs (rifampin and isoniazid), prevent transmission

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26
Q

Acute Bronchitis

A

Inflammation of the trachea and bronchi

Results from chemicals, viral infections

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27
Q

Signs of Acute Bronchitis

A

Cough, chest pain, constitutional symptoms

Lasts about 1-3 weeks

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28
Q

COPD

A

Refers to a number of disorders; chronic obstructive pulmonary disease–trouble getting air out so cannot really get it in

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29
Q

Diagnosis of COPD

A

Blood gas analysis, sputum culture, skin testing, X-ray, PFTs

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30
Q

COPD Goal?

A

Improve PaO2 and decrease CO2 retention, prevent respiratory infections

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31
Q

Treatment for COPD

A

Pharmacology managements, pulmonary hygiene, bullectomy, chest PT; low-level walking!

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32
Q

Chronic Obstructive Bronchitis

A

Productive cough lasting 3 months, for 2 consecutive years with a decreased FEV1/FVC

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33
Q

Chronic Obstructive Bronchitis Signs

A

Cough with mucus, cyanosis, prolonged expiration, recurrent infection, SOB, Hypoxemia, retention of CO2, accessory breathing muscles, hypertrophy of mucus producing cells, air trapping

-forced expiration tends to produce collapse of tissue

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34
Q

Emphysema

A

3 types:
Centrilobular, panlobular, and paraseptal–> all produce destruction of airways
Obstruction results from changes in lung tissue (not mucus)

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35
Q

Emphysema Signs

A

Dyspnea, tachypnea with prolonged expiration, wasting appearance, leaning forward with arms braced on knees to assist breathing

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36
Q

Asthma

A

Inflammation of airways causing bronchospasm with SOB and wheezing; release of inflammatory mediators produces bronchial smooth muscle spasm, vascular congestion, edema, increased mucus productions, and impaired much ciliary function–eosinophilia infiltration
-there is an airway spasm, trapping of air, a ventilation/perfusion mismatch, and Hypoxemia

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37
Q

Asthma Signs

A

Begins with sensation of chest constriction, inspirations and expiration wheezing, non-productive coughing, tachycardia, tachypnea, later cough becomes productive with nasal flaring and cyanosis of lips

-status asthmaticus–over 24 hours, very serious attack!

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38
Q

Asthma Diagnosis

A

PFTs, ABGs, pulse oximetry, will occur in families (possible genetic component)

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39
Q

Asthma Treatment

A

Bronchodilators, steroids, leukotriene inhibitors

Exercise induced- use inhaler 20-30 min prior to exercise

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40
Q

Intrinsic Asthma

A

No allergic, adult onset (over 40), secondary to chronic infections

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41
Q

Extrinsic Asthma

A

Allergic asthma (often seen in kids)

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42
Q

Bronchiectasis

A

Progressive form of obstructive lung disease characterized by irreversible destruction and dilation of airways associated with chronic bacterial infections

Chronic dilation of bronchi/bronchioles with wet secretions plug airways and cause more purple to mucus causing bronchospasm, destruction of bronchial walls occur with fibrosis that further obstructs lumen

Pockets of pus/infection–> can burst!!!

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43
Q

Bronchiectasis Signs

A

Persistent coughing, increased amounts of sputum, anemia, fever, may have hemoptysis, weight loss, weakness

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44
Q

Bronchiectasis Treatment

A

Chest PT, bronchodilators, antibiotics

45
Q

Bronchiolitis

A

Severe inflammation of the lower airways caused by viral infection; children under 2 yrs most commonly affected

46
Q

Bronchiolitis Characterized By:

A

Bronchioles muscle swelling and filling with mucus, hyperinflation, obstruction, cough respiration distress, cyanosis

47
Q

Sleep Apnea

A

Episodes of cessation of breathing occurring at transition from BREM to REM repeated awakenings
-once you start to go into REM sleep, PaO2 begins to drop

More than 5 cessation so for at least 10 seconds per hour

48
Q

Sleep Apnea Risk Factors

A

Narrowed upper airways, obesity, adenoid, uvula, and tonsil hypertrophy, smoking

49
Q

Sleep Apnea Signs

A

Snoring, breath cessation, thrashing movement of extremities, daytime sleepiness, headaches, personality changes

50
Q

Sleep Apnea Treatment

A

Weight loss, CPAP (positive pressure keeps alveoli open so you get better gas exchange)

51
Q

Restrictive Lung Diseases

A

Limits lung expansion–cannot get air into the lungs

Chronic hyperventilation, exertional Dyspnea and later at rest, respiratory muscle fatigue leading to decreased alveolar ventilation and CO2 retention, Hypoxemia

52
Q

Restrictive Lung Disease Causes

A

Weakness from neuromuscular disease, interstitial lung diseases

53
Q

Systemic Sclerosis Lung Disease

A

Scleroderma-autoimmune disease of connective tissue with excessive collagen deposition in skin and internal organs
Skin changes verbally precede visceral alterations
-about half will develop interstitial lung disease

54
Q

Systemic Sclerosis Lung Disease Treatment

A

Low-dose prednisone

55
Q

Sarcoidosis

A

Systemic disease of unknown cause, granulomas throughout body, collection of macrophages surrounded by lymphocytes taking nodular form

**lungs and lymph nodes commonly affected!

56
Q

Sarcoidosis Signs

A

Dyspnea, dry cough, fever, skin lesions

57
Q

Sarcoidosis Diagnosis

A

Chest X-ray

58
Q

Sarcoidosis Treatment

A

Steroids, may also come to PT for stiff joints and to increase aerobic endurance

59
Q

Pulmonary Fibrosis

A

Excessive fibrous tissue in lung that replace normal tissue due to chronic inflammation; also know as interstitial lung disease

60
Q

Pulmonary Fibrosis Causes

A

Healing scar tissue after TB, systemic sclerosis, ARDS, or inhalation of toxic substances

About 2/3 are idiopathic

61
Q

Pulmonary Fibrosis Treatment

A

Corticosteroids

62
Q

Pulmonary Fibrosis Prognosis

A

Poor; everything becomes stiff

63
Q

Chest Wall Disease

A

Range from superficial wounds to tension pneumothorax (air enters lungs because of trauma and prevents you from getting air out

64
Q

Chest Wall Disease- Flail Chest

A

Multiple rib fractures or fracture of the sternum which may cause paradoxical movement of the chest

2 or more fractures of adjacent ribs on the same side

65
Q

Chest Wall Disease Treatment

A

Pain meds, mechanical ventilation

66
Q

Pneumoconiosis

A

Group of disorders resulting from inhalation of industrial substances (iron, coal dust, asbestos, silica, talc, beryllium)

Exposure over 10 years

Smaller the dust particles, the more dangerous

Fibers are indestructible and produce inflammatory process that results in excess fibrosis

67
Q

Pneumoconiosis Signs

A

Progressive Dyspnea, chest pain, chronic cough, expectoration of mucus

68
Q

Smoke Inhalation

A

Produces mucosal injury via hot gases, asphyxia as O2 is consumed by fire; deficient supply of O2 to blood

Thermal injury in upper airway produces edema and obstruction

69
Q

Cystic Fibrosis

A

Inherited disease of exocrine glands; affects hepatic, digestive, male reproductive system, and respiratory system

Altered chloride and sodium channels

Dehydration with increased viscosity of secretions

Progresses from mucus plugging of small airways to bronchitis, to bronchi ecstasies, pneumonia, and fibrosis–>later involves all bronchi

70
Q

Cystic Fibrosis- Pancreas

A

Thick secretion blocks ducts, preventing enzymes from reaching the duodenum; results in fatty stools

Me odium ileum at birth, prolapse of rectum, risk of impacting

71
Q

Cystic Fibrosis- Pulmonary

A

Chronic cough and sputum production, increased risk of infection, reduced oxygen CO2 exchange, acidosis

72
Q

Cystic Fibrosis Dagnosis

A

Sweat test/stool fat measurements, pancreatic elastase-1

73
Q

Cystic Fibrosis Treatment

A

Antibiotics, drugs to thin secretions, adequate hydration, nutritional support, pancreatic enzymes, mucous tics, CPT, exercise

74
Q

Atelectasis

A

Lung collapse

Alveolars close, air is sucked out, alveoli collapse

75
Q

Obstructive Absorptive Type Atelectasis

A

Collapse resulting from removal of air from obstructed or hypoventilated alveoli

76
Q

Compressive Type Atelectasis

A

Due to air, blood, or fluid filling the pleural space

77
Q

Atelectasis Signs

A

Dyspnea, tachypnea, cyanosis, fever, decreased BP, shock

78
Q

Atelectasis Diagnosis

A

via X-ray

79
Q

Atelectasis Treatment

A

Remove cause, auctioning or bronchoscopy, prevention especially in post surgical patients, breathing exercises, percussion/vibration

**deep breathing and coughing best thing to do after surgery

80
Q

Pulmonary Edema

A

Fluid in the lungs which leak into interstitial tissue and in alveoli

81
Q

Pulmonary Edema Causes

A

Left ventricular failure, acute HBP, mitral valve disease

Non-cardiac causes: liver disorders and kidney disorders in which there is sodium and water retention

Increased capillary permeability, decreased albumin, and increased lymphatic obstruction

82
Q

Pulmonary Edema Signs

A

Persistent cough, Dyspnea, diaphoresis, intolerance to exercise

As fluid increases, these sing scan become more pronounced!

–> Cough may produce pink frothy sputum, wheezing occurs, respiration rate increases

83
Q

Pulmonary Edema Diagnosis

A

Clinical presentation and chest X-ray

84
Q

Pulmonary Edema Treatment

A

Meds, ventilation

85
Q

ARDS (Adults Respiratory Distress Syndrome)

A

Result of injury to the lung by a variety of disorders- a collection of symptoms

86
Q

ARDS Causes

A

Damage to capillary endothelial cells and alveolar epithelial cells which inactivated surfactant and allows fluids, proteins, and cells to leak from capillary

–leads to pulmonary edema and alveolar collapse, impairments of lung compliance (shuts lungs down)

87
Q

ARDS Signs

A

Initially increased respiration rate then Dyspnea, hyperventilation, cyanosis

88
Q

ARDS Diagnosis

A

Exam of ABGs and microbiological cultures, X-rays

89
Q

ARDS Treatment

A

Treat underlying condition, ventilation

90
Q

ARDS Prognosis

A

Unpredictable, pulmonary fibrosis may result, mortality rate is about 50-70%, if accompanied by sepsis it is 90%

91
Q

Lung Cancer

A

Most frequent cause of cancer death in U.S., classified as small cell lung Cancer (20%) or non-small cell lung cancer (80%)

92
Q

Four Main Types of Malignant Lung Tumors

A

SCLC- oat cell
NSCLC- squamous cell carcinoma, adenocarcinoma, large cell carcinoma

Small or non-small!

93
Q

Small Cell Lung Cancer

A

Oat cells become so dense that there is almost no cytoplasm, compressed into an ovoid mass, located centrally near hilum

Rapid growth with early mets, secretes ACTH, early symptoms similar to those of smoking

Treat with chemo and radiation

94
Q

Squamous Cell Cancer

A

Arise in central portion of lung near hilum, projecting in into bronchi, have a central cavity, stay local within thoracic cavity longer

95
Q

Adenocarcinoma Lung Cancer

A

Moderate growth rate, arise in periphery, early mets

96
Q

Large Cell Lung Cancer

A

Peripheral pulmonary tumors that cause sharp and significant pleural pain, early mets, poorest prognosis!

97
Q

Lung Cancer Symptoms

A

Depends on location

Central tumors obstruct airflow
Peripheral tumors only produce pain when pleura is affected, may limit lung expansion
Tumors of apex- Pancoast’s tumors-invade brachial plexus

98
Q

Lung Cancer Diagnosis

A

X-ray, CT, lung imaging fluorescence endoscope, bronchoscopy

99
Q

Lung Cancer Treatment

A

Surgery with lymph node resection, radiation, and chemo

Surgery choice in NSCLC and chemo

Radiation in SCLC with chemo

100
Q

Lung Cancer Paraneoplastic Syndromes

A

Effects of malignancy felt remotely-hyper alexia, osteoarthropathies, DVT

101
Q

Pulmonary Embolism

A

Lodging of blood clot in a pulmonary artery, with subsequent obstruction of blood supply to lung parenchyma

102
Q

Pulmonary Embolism Risk Factors

A

Blood stasis secondary to immobilization, endothelial injury secondary to hypercoagulable states (BCP), DVT, obesity, smoking, HTN, malignancy, fractures of hip or femur

103
Q

Pulmonary Embolism Signs

A

Depends on size of PE

Humans sign, pleuritic chest pain, persistent cough, hemoptysis, diaphoresis, fever, tachypnea, sudden death

104
Q

Pulmonary Embolism Prevention

A

LMW Heparin to prevent clot extension, thrombolytic therapy to lyse thromboemboli, greenfield filter in vena cava

105
Q

Pulmonary Embolism PT

A

Avoid restrictive clothing, crossing legs, prolonged sitting, pillow under knees in supine, extreme flexion at hips

No massage to legs if DVT or PE has been diagnosed

Bed exercises for LEs, compression stockings, early ambulation, hydration

106
Q

Pulmonary Hypertension

A

HBP in pulmonary arteries, with 5-10 mmHg above normal (15-18 mmHg)

107
Q

Pulmonary Hypertension Causes

A

Primary: narrowing of pulmonary arterioles by hypertrophy of smooth muscle
Secondary: increases in volume or pressure of blood entering the pulmonary arteries

108
Q

Pulmonary HTN Signs

A

Fatigue, tachypnea, cyanosis, Dyspnea

109
Q

Pulmonary HTN Treatment

A

Oxygen for Hypoxemia, digitalis, diuretics

Poor prognosis without a heart-lung transplant

Pathophysiology Quiz 1 (4 decks)

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