Obstructive and restrictive Pulmonary Disease

Question 1

What are the characteristics of COPD

Answer 1

• progressive airway obstruction that is not fully reversible
• gas exchange is normal
• always hyperinflated (difficulty getting air out)
• Decreased elastic recoil
• age of onset: middle aged to older adults

Question 2

COPD Rx

Answer 2

• Pharmacological FOCUS:
  1. smooth mm relaxation
  2. reduce airway inflammation
• O2 therapy: but not for pts with pulmonary HTN, CHF

Question 3

What is bronchitis

What is the key feature of bronchitis

Answer 3

inflammation of the lining of your bronchial tubes. Key feature is excess mucus production in bronchioles

Question 4

Main cause of emphysema

Answer 4

smoking

Question 5

Result of emphysema

Answer 5

Destruction of air spaces distal to the terminal bronchiole + destruction of alveolar septa
- causes merging of alveoli into larger air spaces - which leads to decreased surface area for gas exchange

loss of airways and capillaries as well

Question 6

Emphysema Impact

Answer 6

Difficulties with exhalation

• Damaged alveoli = old air becomes trapped
  
  • Decreased space available for O2-rich new air
• Hyperventilation flattens diaphragm
  - now at mechanical disadvantage

Question 7

Emphysema Rx

Answer 7

Can slow down progression but can’t reverse damage

Question 8

What is bronchiectasis

Answer 8

irreversible destruction (necrosis) + dilation of airways with chronic bacterial infection

Question 9

Bronchiectasis causes

Answer 9

CF
TB
Endobronchial tumour

Question 10

Bronchiectasis characteristics:

Answer 10

• excess mucus leading to SOB

- eventually alveoli replaced with scar tissue - due to chronic inflammation

Question 11

Bronchiectasis Rx

Answer 11

• bronchodilators, antibiotics, corticosteroids

- secretion clearance

Question 12

What is interstitial lung disease

Answer 12

Progressive scaring leading to stiffness and decreased lung compliance (not airway obstruction)

Question 13

Interstitial lung disease S&S

Answer 13

• dyspnea
• severe O2 desaturation (cyanosis)
• clubbing of fingers and toes
• decreased exercise tolerance

Question 14

Interstitial lung disease Rx

Answer 14

• O2 therapy
• lung transplant
• pulmonary rehab
• Cessation of exposure (known cause)

Question 15

What causes pulmonary fibrosis

Answer 15

2/3 no know cause
1/3 TB
Inhaling harmful particles

Question 16

Pulmonary fibrosis pathology

Answer 16

Fibrosis = scaring in lungs

Damage to bronchioles and alveoli - greatly decreased gas exchange

Question 17

Pulmonary fibrosis Rx

Answer 17

• Radiation therapy

- Meds

Question 18

Pneumoconiosis is also referred to as ___

Answer 18

coal worker’s lung

Question 19

What is tuberculosis

Answer 19

Infectious, inflammatory systemic disease that affects the lungs

Question 20

Tuberculosis cause

Answer 20

Inhaling airborne particles - myocobacterium tuberculosis

Question 21

Tuberculosis may disseminate to involve what other organs/structures?

Answer 21

involve kidneys, growth plates, meninges, avascular necrosis of hip joint, lymph nodes + other organs

Question 22

Tuberculosis testing

Answer 22

TB skin test: inject in forearm

- determines if body’s immune response has been activated by TB before

Question 23

Tuberculosis S&S

Answer 23

• Productive cough 3+ weeks
• Weight loss
• Fever
• night sweats
• Fatigue
• Bronchial breath sounds

Question 24

Tuberculosis result

Answer 24

Granulomas in lung tissue

Question 25

Tuberculosis Rx

Answer 25

- Medical MGMT: 10 drugs | - PT: Thorough history + self-protection (masks, etc.)

Question 26

What is pleural effusion?

Answer 26

Abnormal accumulation of fluid in the pleural space

Question 27

Pleural effusion types

Answer 27

- Transudate - commonly due to to heart or renal failure - low protein, clear - Exudate - formation of fluid by inflammation or disaese (infection or cancer of pleura) - opaque

Question 28

Pleural effusion S&S

Answer 28

- SOB - chest pain - percussion – dull - Decreased or ABSENT breath sounds - may hear a pleural rub

Question 29

Pleural effusion Chest xray findings

Answer 29

Possible mediastinal shift

Question 30

What is pulmonary edema

Answer 30

Increased fluid in extravascular spaces of the lungs

Question 31

Pulmonary edema possible causes

Answer 31

- Increased hydrostatic pressure d/t heart or kidney failure - pushes fluid out of vessels - Increased alveolar permeability - drug induced, ARDS, inhalation of noxious gas

Question 32

Pulmonary edema presentation

Answer 32

- Stiff lungs - increased work of breathing - Dyspnea - Classic symptom: cough that produces a frothy pink tinged sputum

Question 33

Pulmonary edema auscultation

Answer 33

Fine crackles

Question 34

Pulmonary embolus S&S

Answer 34

- bloody sputum - dyspnea - Increased RR - cyanotic

Question 35

What is cystic fibrosis

Answer 35

- inherited autosomal disorder affecting ALL EXOCRINE GLANDS

Question 36

Effects of cystic fibrosis

Answer 36

- defective Cl- : excretion and Na+ absorption = THICK MUCUS - recurrent chest infections - consolidation - atelectasis - thickened bronchial walls

Question 37

Cystic fibrosis Dx

Answer 37

- Family history, gene testing (autosomal recessive disease, need 2 copies of abnormal gene) - Sweat test - chloride content of sweat

Question 38

Cystic fibrosis S&S

Answer 38

- respiratory symptoms most common - finger clubbing - breathlessness - delayed puberty - skeletal maturity - infertility in males - symptomatic steatorrhea - diabetes mellitus - liver disease - osteoporosis

Question 39

Cystic fibrosis Rx

Answer 39

- airway clearance techniques - bronchodilators - aggressive antibiotics

Question 40

_____ accounts for 95% of arterial occlusive disease

Answer 40

peripheral arterial disease

Question 41

What is the underlying cause of peripheral arterial disease

Answer 41

atherosclerosis

Question 42

Peripheral arterial disease S&S

Answer 42

* *occur distal to site of narrowing or obstruction - intermittent claudication - acute ischemia (pallor, pain paralysis, pulseless) - ulceration and gangrene - skin (shiny, thin, hairless)  often occurs in feet

Question 43

Peripheral arterial disease outcome measure

Answer 43

Decreased mobility d/t pain + loss of function or loss of limb (leading cause of limb loss in adults)

Question 44

What is the difference between peripheral arterial disease and peripheral vascular disease

Answer 44

Vascular: problem with both veins and arteries Arterial: just arteries

Question 45

Underlying cause of peripheral vascular disease

Answer 45

Artherosclerosis

Question 46

Peripheral vascular disease S&S

Answer 46

- intermittent claudication - Decreased pulses - ulcers - cool skin - limit mobility - pain or loss of function of limb - Pain with PA, most often in calf