Pathologies

Question 1

Define atelectasis

Answer 1

Complete or partial collapse of lung or lobe of lung

Question 2

What happens to the alveoli in atelectasis?

What does this mean in terms of ventilation?

Answer 2

Become deflated or filled with fluid

There is no ventilation in these areas - gas exchange cannot occur

Question 3

Physiological process leading to atelectasis

Answer 3

Not deep breathing due to post op pain –> secretion retention
Anaesthesia paralyses cilia during surgery
No mucociliary clearance of sputum
Leads to mucus plug
No ventilation to lung areas distal to plug, but perfusion maintained
No gas exchange
Lack of O2 and hypoxaemia

Question 4

How does atelectasis occur in relation to functional residual capacity (FRC) and closing capacity (CC)?

Answer 4

FRC reduced during and filling surgery
When FRC becomes less than CC smaller airways close and stick together due to not enough air holding them open
Alveoli below this level don’t receive any new air
Closure of small distal airways leads to closure of large lung areas
Leads to lack of O2 and hypoxaemia

Question 5

Clinical features of atelectasis

Answer 5

SOB
Increased respiratory rate - rapid shallow breathing
Wheezing
Cough
Chest pain
Increased HR

Question 6

Physiotherapy interventions for atelectasis

Answer 6

Postural drainage
Chest wall percussion/vibration
FET

Question 7

Postoperative atelectasis occurs within how many hours post surgery?

Answer 7

72 hrs post general anaesthesia

Question 8

What V/Q mismatch occurs in atelectasis? Why?

Answer 8

“shunt” mismatch - no ventilation distal to blockage of airway but perfusion maintained

Question 9

Patients more at risk for post-op atelectasis

Answer 9

Longer anaesthesia duration
Smoker
Chronic lung disease
Inadequate post-op pain medication
Poor pre-op pulmonary education

Question 10

Complications of atelectasis

Answer 10

Type I respiratory failure
Lung infections from retained secretions - Pneumonia
Lung scarring

Question 11

Values of PaO2 and PaCO2 respectively, in an atelectasis patient

Answer 11

Low PaO2 and normal PaCO2

Question 12

What does COPD stand for?

Answer 12

Chronic Obstructive Pulmonary Disease

Question 13

What 2 conditions cover COPD?

Answer 13

Chronic bronchitis and emphysema

Question 14

Is COPD reversible?

Answer 14

No, it is a progressive disease

Question 15

What clinical feature defines chronic bronchitis?

Answer 15

Cough and sputum expectoration for at least 3 months over 2 successive years

Question 16

Symptoms of chronic bronchitis

Answer 16

Chronic sputum production
Chronic cough
Wheeze
Dyspnoea/SOB at rest
Fatigue
Difficulty with ADLs and exercise 
Depression/anxiety

Question 17

In chronic bronchitis, there is an overproduction of mucus due to what?

Answer 17

inflammation

Question 18

Pathophysiology of chronic bronchitis

Answer 18

• Inhalation of noxious particles > release of inflammatory mediators by epithelial cells > activation of macrophages & neutrophils > proteases released and protease/anti-protease imbalance > causes inflammation
• Increased swelling and blood flow in bronchial mucous membranes
• Increase size and number of goblet cells – hyperplasia > increased mucus production
• Cilia damage and dysfunction > Diminished mucociliary escalator
• Airflow limitation, reduced sputum clearance > further irritation, fibrotic changes and increased risk of infection

Question 19

Emphysema is disease of…

Answer 19

the alveoli

Question 20

Define emphysema

Answer 20

Enlargement of air spaces distal to the terminal bronchiole with destruction of their walls

Question 21

What 2 things are destroyed in emphysema?

Answer 21

Alveolar septa and capillary bed

Question 22

Main result of emphysema

Answer 22

gas trapping leading to hyperinflation

Question 23

Pathophysiology of emphysema

Answer 23

• Inhalation of noxious particles > release of inflammatory mediators by alveolar epithelial cells > activation of alveolar macrophages & neutrophils > proteases released and protease/anti-protease imbalance
• Inflammation, degradation and destruction of alveolar walls and elastic fibres
• Erosion of alveolar septa > enlarged airspaces (potential bullae formation) > decreased surface area
• Loss of elastic recoil > collapse of respiratory bronchioles and small airways > gas trapping
• Hyperinflation

Question 24

Symptoms of emphysema

Answer 24

Dyspnoea/SOB at rest
Fatigue
Difficulty with ADLs and exercise
Depression/anxiety

Question 25

What are the clinical features of COPD?

Answer 25

``` Barrel chest due to hyperinflation Accessory muscle use Decreased breath sounds - course crackles if sputum present Reduced functional exercise capacity O2 desaturation during exercise ```

Question 26

Risk factors for COPD

Answer 26

``` Cigarette smoking Passive smoking Occupational - dusts, fumes, chemicals Outdoor air pollution Genetic - eg. Alpha-1 antitrypsin deficiency Low socio-economic status ^risk with age ^risk if female ```

Question 27

Why should you be cautious giving O2 to a COPD patient?

Answer 27

Decreases hypoxic drive to breath

Question 28

Is COPD more common in men or women?

Answer 28

Women

Question 29

Acute exacerbation of COPD defined by...

Answer 29

a sustained worsening of patients condition that is acute in onset

Question 30

What may occur in an acute exacerbation of COPD?

Answer 30

Change in baseline dyspnoea, cough, sputum production that is beyond normal day-to-day variability

Question 31

Physiotherapy interventions for COPD

Answer 31

``` early mobilisation - prevent deconditioning sputum clearance control of dyspnoea self-management pulmonary rehab smoking cessation ```

Question 32

Describe the cycle of inactivity

Answer 32

feels breathless fear of activity increasing breathlessness avoids activities which increase breathlessness less active muscles become weaker weak muscles use more oxygen and are less efficient feeling breathless

Question 33

Describe the dyspnoea spiral

Answer 33

``` Respiratory impairment dyspnoea during moderate exercise avoidance of exercise physical deconditioning dyspnoea during mild exercise further avoidance of exercise further deconditioning dyspnoea during ADLs ```

Question 34

What does STEMI stand for?

Answer 34

ST elevation myocardial infarction

Question 35

Significant Ischaemia leads to...

Answer 35

significant necrosis of cardiac muscle

Question 36

What causes an MI?

Answer 36

prolonged or permanent occlusion of coronary arteries due to atherosclerosis

Question 37

What does CABG stand for?

Answer 37

Coronary artery bypass graft

Question 38

Pathophysiology of MI

Answer 38

• Atherosclerosis of coronary arteries o Foam cells are too big and become trapped in intima – plaque builds up o Plaque continues to grow • Occlusion of one/more coronary arteries due to an unstable atherosclerotic plaque that ruptures • Fatty plaque materials highly thrombogenic • Leads to large thrombus in the coronary artery • Reduced/complete loss of blood flow distal to the blockage • Not sufficient O2 • Ischaemia leading to necrosis of cardiac muscle

Question 39

Modifiable risk factors for MI

Answer 39

``` hypertension smoking obesity sedentary lifestyle hypercholesterolemia poor oral health alcohol drug use ```

Question 40

Non-modifiable risk factors for MI

Answer 40

``` Sex - more M>F age family history male pattern baldness previous MI ```

Question 41

Are women or men more at risk of an MI

Answer 41

men

Question 42

Purpose of CABG procedure

Answer 42

bypass atheromatous blockages in coronary arteries with harvested veins (long saphenous vein) revascularise ischaemic myocardium

Question 43

Aims of CABG

Answer 43

restore blood flow to cardiac muscle alleviate SOB and angina improve exercise tolerance

Question 44

Post-op complications - cardiac surgery following STEMI

Answer 44

``` infection - mediastinitis wound instability postoperative pulmonary complications (PPCs) arrhythmias haemorrhage pain reduced exercise capacity 'Post-pump syndrome' ```

Question 45

Clinical presentation of STEMI

Answer 45

``` intense pain - chest, left arm, left side neck nausea/vomiting sweating acute SOB syncope/collapse substernal heaviness ```

Question 46

Physiotherapy goals post STEMI

Answer 46

``` reduce myocardial demand mobility enhance QoL increase CV fitness reduced dyspnoea on exertion assist return to employment ```

Question 47

Physio interventions post-cardiac surgery following STEMI

Answer 47

``` Pre-op assessment and education cardiac rehab early post-op mobilisation wound supported FET and cough LTEE foot/ankle circulatory exercises posture - thoracic extension needed thoracic/shoulder mobility ```

Question 48

Examples of shoulder/thoracic exercises post cardiac surgery

Answer 48

``` shoulder shrugs - elevation/depression ball around body theraband abductions/flexions pendulum shoulder retraction thoracic rotations - hands on hips, hands on head ```

Question 49

Drugs used in medical management post-cardiac surgery

Answer 49

``` ACE inhibitors Beta blockers GNT spray Anticoagulants Antiplatelets Calcium channel blockers ```

Question 50

What are ACE inhibitors

Answer 50

vasodilators - lower BP

Question 51

What do beta blockers do?

Answer 51

lower BP and HR

Question 52

What is GNT spray?

Answer 52

vasodilator - reduces angina symptoms

Question 53

What do anticoagulants do?

Answer 53

inhibit thrombus formation

Question 54

What do anti platelets do?

Answer 54

inhibit thrombus formation

Question 55

What do calcium channel blockers do?

Answer 55

reduce myocardial contractility and propagation of electrical impulses