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COPD Flashcards

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1
Q

a permanent abnormal enlargement of the__________ , associated with destructive changes of the________

A

Emphysema, air spaces distal to the terminal bronchioles, alveolar walls

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2
Q

What are the two major types of emphysema

A

Panlobular (panacinar), Centrilobular (centriacinar)

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3
Q

Type of emphysema wherein the entire acinus is involved.

(3) There is a significant loss of lung parenchyma.
(4) Alveoli are destroyed.
(5) Bullae are present.
(6) Usually is associated with emphysema resulting from a1-antitrypsin deficiency

A

Panlobular emphysema

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4
Q

Lesion is in the center of the lobules, which results in enlargement and destruction of the respiratory bronchioles.

A

Centrilobular

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5
Q

Usually involves the upper lung fields and is most commonly associated with chronic bronchitis.

A

Centrilobublar

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6
Q

Emphysematous changes are isolated and accompanied by the development of , which are weak air spaces and susceptible to rupture.

A

Bullous emphysema, bullae

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7
Q

are defined as air spaces adjacent to the pleura, usually less than 1 cm in diameter
in their distended state.

A

Blebs

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8
Q

are defined as air spaces in their distended state, more than 1 cm in diameter

A

Bullae

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9
Q

_______ of the lung is diminished, which results in premature airway closure.
__________flow rates are normal, while__________ flow rates are reduced. Air-trapping leads to chronic hyperinflation of the lungs and an_______ FRC.

A

Elastic recoil, Inspiratory, expiratory, increased

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10
Q 
Lung compliance (CL) is\_\_\_\_\_\_\_\_\_\_\_  as a result of the destruction of elastic lung tissue. Emphysema diminishes the area over which gas exchange occurs and is accompanied by regional differences in ventilation and perfusion. This accounts for increased\_\_\_\_\_\_\_  and the abnormal ABG results observed 
in patients with emphysema
A

increased, physiologic dead space

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11
Q

Clinical signs and symptoms of emphysema

D,I-Ap, ACM, HG,ABG,DCY,COR

A

a. Dyspnea: initially occurs on exertion, then progressively worsens.
b. Digital clubbing: results from chronic hypoxemia.
c. Increased anteroposterior (AP) chest diameter
(barrel chest).
d. The use of accessory muscles during normal
breathing.
e. Elevated hemoglobin (Hg) level, hematocrit
(Hct), and red blood cell (RBC) count.
f. ABG levels reveal chronic CO2 retention and
hypoxemia (advanced stages of the disease).
g. Diminished breath sounds and hyper resonance
to percussion.
h. Cyanosis.
i. Right-sided heart failure (cor pulmonale) in
advanced stages.

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12
Q

Cor pulmonale results from an increased________ as it attempts to deliver blood through constricted pulmonary blood vessels. These vessels are constricted (causing pulmonary hypertension) as a result of _______. Chronic pulmonary hypertension results in right ventricular hypertrophy and, eventually, cor pulmonale. Cor pulmonale results in ___________

A

workload on the right ventricle, arterial hypoxemia and hypercapnia, peripheral edema, such as pedal (ankle) edema, distended neck (jugular) veins, and an enlarged liver.

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13
Q

Characteristics of Chest X-ray of emphysema

F,H,R,B

A

a. Flattened diaphragm
b. Hyperinflation
c. Reduced vascular markings
d. Bullous lesions

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14
Q

Treatment for emphysema

A

a. Smoking cessation program
b. Adequate hydration
c. Bronchial hygiene therapy
d. Bronchodilators
(1) Inhaled short-acting beta-adrenergic (SABAs) such as albuterol or levalbuterol
(Xopenex) that are referred to as rescue drugs and are recommended for symptomatic management of all COPD patients
(2) Short-acting anticholinergics such as ipratropium (Atrovent)
(3) Long-acting beta-adrenergic (LABAs) such as salmeterol (Serevent) or long-acting anticholinergics such as tiotropium bromide.
e. Methylxanthines such as theophylline
f. Prevention of infections by immunizations
g. Pulmonary rehab
h. Breathing exercise training
(1) Diaphragmatic breathing exercises
(2) Pursed-lip breathing: prevents premature airway closure by producing a back pressure into the airways on exhalation

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15
Q

chronic excessive mucus production, resulting from an increase in the number and size of mucus glands and goblet cells. Symptoms are cough and increased mucus production for at least__________ years. Males are most commonly affected.

A

Chronic Bronchitis, 3 months of the year for more than 2 consecutive

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16
Q

Pathophysiology

a. Increase in the______
b. Increase in the ______
c. Inflammation of _______
d. Mucus plugs in _____
e. Loss of cilia
f. ______ changes in advanced stages of the disease
g. Narrowing airways, leading to airflow limitation

A

size of mucus glands, number of goblet cells, bronchial walls, peripheral airways, Emphysematous

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17
Q 
Clinical signs and symptoms
a. Cough with\_\_\_\_\_\_ 
b. Dyspnea on\_\_\_\_\_ progresses to dyspnea with less effort.\_\_\_\_\_\_\_\_ in advanced stages
d. Increased \_\_\_\_\_\_\_ (PVR) in advanced stages
e. Increased \_\_\_\_\_\_ count in 
advanced stages
f. Cor pulmonale in advanced stages
g. Breath sounds: \_\_\_\_\_\_
A

sputum production, exertion, CO2 retention and hypoxemia, pulmonary vascular resistance, Hb level, Hct, and RBC, coarse crackles and wheeze

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18
Q

Characteristics of Chest x-ray of CB

A

A. Not significant in early disease

b. Hyperinflation (in advanced stages)

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19
Q

Abnormal, irreversible dilation of the bronchi caused by destructive and inflammatory changes in the walls of the airway

A

Bronchiectasis

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20
Q

Causes of Bronchiectasis

A
  1. Chronic respiratory infections
  2. TB lesion
  3. Secondary to cystic fibrosis
  4. Bronchial obstruction
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21
Q
  1. It is not clear whether the chronic dilation is a result of destructive changes in the bronchial walls caused by inflammation and infection or, possibly, a congenital defect of the airways.
  2. Bronchial obstruction may render the__________ ineffective, which may lead to an accumulation of thick secretions.
  3. The bronchial wall is destroyed, which results in atrophy of the _______
  4. Because of the decreased values in both flows and volumes, this disease may be either obstructive or restrictive in nature
A

the mucociliary transport system, mucosal layer

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22
Q

Clinical Signs and Symptoms

1. Productive cough with large amounts of _________. Often, a layering of the sputum occurs.

A

thick, purulent secretions that may be foul-smelling
2. Tachypnea and tachycardia.
3. Hemoptysis.
4. Recurrent pulmonary infections.
5. Digital clubbing.
6. Cyanosis.
7. Respiratory alkalosis with hypoxemia (in the early stage).
8. Chronic respiratory acidosis with hypoxemia (in
the late stage).
9. Barrel chest

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23
Q

Characteristics of Chest X-ray of bronchiectasis

A
  1. Increased lung markings
  2. Flattened diaphragm
  3. Segmental atelectasis
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24
Q

treatment for bronchiectasis

A
  1. Bronchial hygiene therapy
  2. Aerosol therapy
  3. Bronchodilator therapy
  4. Mucolytics (e.g., acetylcysteine [Mucomyst],
    dornase alfa [Pulmozyme])
  5. Antibiotics: inhaled, oral, and/or IV
  6. O2 therapy
  7. Expectorant: such as guaifenesin (Humibid)
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25
_______disease that characterized by persistent respiratory symptoms and airflow limitations that is due to airway and/ alveolar abnormalities usually caused by significant exposure to noxious particle or gases.
COPD, Common, preventable and treatable
26
It is made in the liver and one of its functions is to protect the lungs from_____, an enzyme that can breakdown connective tissue.
Alpha-1 antitrypsin, neutrophil elastase
27
What are the risk for developing COPD
Genes, Age, Exposure to particles
28
Common cause of COPD
cigarette smoking, alpha-1 antitrypsin deficiency, outdoor air pollution, long-standing asthma, biomass, and occupational exposure
29
It is the most commonly encountered risk factor for COPD
Cigarette smoking
30
Type of exposure that involves organic and inorganic dust and chemical agents and fumes
occupational exposure
31
Type of exposure wherein air pollution from biomass cooking and eating in poorly ventilated areas
Indoor air pollution
32
Disease that weakens the connective tissue of the body, especially the tendons and ligaments
Ehlers- Danlos syndrome
33
Inherited disorders that support anchor organs and other structures in the body. Affects the eyes, blood vessels and skeleton
Marfan syndrome
34
is a disorder of connective tissue, which is the tissue that provides structure and strength to the muscles, joints, organs, and skin.
Cutis laxa
35
is a disorder that affects copper levels in the body. It is characterized by sparse, kinky hair; failure to gain weight and grow at the expected rate (failure to thrive); and deterioration of the nervous system
Menkes syndrome
36
Signs and symptoms of what disease include intellectual disability and developmental delay, seizures, problems with movement and balance (ataxia), abnormal tensing of the muscles (spasticity), and involuntary slow, sinuous movements of the limbs (athetosis).
Salla
37
What are the common symptoms of COPD
``` Cough phlegm production Wheezing SOB, typically on exertion Dyspnea ```
38
Goals in managing patients with COPD
Establish the diagnosis of COPD Optimize lung infection Maximize the patient's ability to perform daily activities Simplify the medical treatment program ASAP Avoid exacerbation of COPD Prolong survival
39
Other term for "blue bloaters"
CB or Type B chronic obstructive pulmonary disease
40
Unlike emphysema, the pulmonary capillaries in the patient with CB respond to the increase in airway obstruction by decreasing __________ and increasing _______
ventilation, cardiac output
41
The chronic hypoventilation and increase in cardiac output lead to decreased _______, an increased _______, and _________.
arterial oxygen level, arterial CO2 level, compensated pH level or chronic ventilatory failure arterial blood gas values
42
The persistent low v/q ratio and depressed respiratory drive both continue to a _______ level and ________ that in turn causes cyanosis.
chronically reduced arterial oxygenation, polycythemia
43
the normal amount of alpha-1 antitrypsin is
150-350 mg/dl or 1.5-3.5g/l
44
What method determines a good range of alpha-1 antitrypsin
radial immunodiffusion
45
Inflammation of blood vessels and low complement protein
hypocomplementemic urticarial vasculitis
46
Bloater means what
overweight because of edema
47
Disease characterized by high level of RBC
polycythemia
48
Major pathologic or structural change that are associated with CB
1. Chronic inflammation and thickening of the walls of the peripheral airways 2. Excessive mucus production and accumulation 3. Partial/ total mucus plugging of the airways 4. Smooth muscle constriction of bronchial airways 5. Air trapping and hyperinflation of alveoli may occur in late stages
49
Chest findings in CB
1. low tactile vocal fremitus 2. hyper resonance 3. diminish breath sounds 4. crackles, rhonchi, wheezes and use of accessory muscles
50
It is an abnormal weakening and enlargement of all the alveoli distal to the terminal bronchioles, including the respiratory bronchioles, alveolar ducts, alveolar sacs, and entire alveoli. It is also the most severe type of emphysema.
panacinar/panlobular emphysema
51
What is the main cause of panlobular emphysema
alpha-1 antitrypsin deficiency
52
The pathology involves the respiratory bronchioles in the proximal portion of the acinus. The respiratory bronchial walls enlarge, and become confluent and then destroyed.
Centriacinar/centrilobular emphysema
53
It is the most common form of emphysema
Centriacinar emphysema
54
What are the two causes of centriacinar
Cigarette smoking and CB
55
Other term for "pink Puffers"
Emphysema, type A COPD
56
Other term for "pink Puffers"
Emphysema, type A COPD
57
meaning of puffing
purse-lip breathing
58
The term pink puffers is derived from the
reddish complexion
59
Structures affected in centriacinar emphysema
respiratory bronchioles and upper lobes
60
Structure affected in panacinar emphysema
respiratory bronchioles, alveolar ducts and sacs and entire alveoli
61
what type of emphysema often appears anxious, experienced dyspnea and rapid weight loss
Bullous emphysema
62
Major pathologic or structural changes (emphysema)
1. permanent enlargement and destruction of the air spaces distal to terminal bronchioles 2. Destruction of the alveolar-capillary membrane 3. Weakening of distal airways primarily the respiratory bronchioles 4. Air trapping and hyperinflation
63
4 main organisms (isolated)
Haemophilus influenza Streptococcus pneumoniae Staphylococcus aureus Pseudomonas aeroginosa
64
CT scan of bronchiectasis
Increase bronchial opacity or end on signet ring opacity an abnormal large branch of bronchi (alpha-1 chuchu) Lower left lung scarring or damage (post-tuberculosis)
65
Three major anatomic patterns of bronchiectasis
Cylindrical (tubular) Varicose (Fusiform) Cystic (saccular)
66
The bronchi are dilated and rigid and have regular outlines similar to a tube.
Cylindrical (tubular)
67
The bronchi are dilated and constricted in an irregular fashion similar to ________ resulting in distended bulbous chape
Varicose (fusiform)
68
The bronchi progressively increase in diameter until the end in large cystic-like sacs in the lung parenchyma.
Cystic (saccular)
69
Major pathologic or structural changes associated with bronchiectasis
1. Chronic dilation and distortion of bronchial airways 2. Excessive production of often foul-smelling sputum 3. Bronchospasm 4. hyperinflation of alveoli 5. Atelectasis 6. Consolidation and parenchymal fibrosis 7. Hemoptysis secondary to bronchial arterial erosion
70
Additional causes of bronchiectasis
``` Acquired bronchial obstruction congenital anatomic defect Immunodeficiency state Abnormal secretion clearance Miscellaneous disorders ```
71
They are the mainstays of bronchiectasis management.
Antibiotic and bronchial hygiene

Cardiopulmonary Pathology (2 decks)

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