Pulmonary Disease Flashcards
(279 cards)
1
Q
What are the 5 classifications of pulmonary disease?
A
- Obstructive
- Restrictive
- Infectious
- Vascular
- Pleural
2
Q
What are 4 non-septic obstructive pulmonary diseases?
A
- Emphysema
- Alpha-1 antitrypsin deficiency
- Bronchiolitis obliterans
- Asthma
3
Q
What are 3 septic obstructive pulmonary diseases?
A
- Chronic bronchitis
- Cystic fibrosis
- Bronchiectasis
4
Q
What is the major pathologic function of COPDs?
A
- Trapping air in the lungs
5
Q
Where does COPD rank in cause of death in the US? Worldwide? (1st, 2nd, 3rd, etc?)
A
3rd in US
6th Worldwide
6
Q
How much did COPD cost the American economy in 2007?
A
42.6 billion dollars.
7
Q
Where does COPD rank in the US in terms of cause of disability? (numerical)
A
2nd.
8
Q
Is COPD treatable? Is it reversible?
A
- COPD can be prevented, and treated to an extent, but is not fully reversible.
9
Q
What is the greatest risk factor for COPD? How many cases of COPD is it responsible for?
A
- Cigarette smoking responsible for 80 - 90 percent of COPD cases.
10
Q
What is remarkable about the death rate of COPD when compared to other pathologies?
A
- Rising at a time when most other diseases are lessening in incidence.
11
Q
Which type of COPD produces a large volume of sputum?
A
Septic.
12
Q
** Slide 7 **
A
** Slide 7 **
13
Q
How does the residual volume of the lungs change in obstructive disease?
A
Increases.
14
Q
What is the clinical diagnosis for chronic bronchitis?
A
- Cough and sputum for over 3 months for over 2 years
15
Q
What is the pathologic diagnosis of emphysema?
A
- Gas exchange surfaces of lungs (alveoli and capillaries) are destroyed
16
Q
What are the pulmonary function test findings of Non-septic obstructive diseases?
A
- Increased TLC
- Increased IRC
- Increased RV
- Decreased FVC
- Decreased FEV1
- Decreased Carbon monoxide diffusion capacity
- Decreased FEV1/ FVC
17
Q
Why is the lung volume larger in non-septic obstructive diseases?
A
- Premature airway closure
18
Q
What actions help the lungs hyperinflate in non-septic obstructive diseases?
A
- Excessive accessory respiratory muscle use
19
Q
What deformity results from hyperinflation of the lungs due to non-septic obstructive diseases?
A
- Barrel chest deformity
20
Q
What would be the results of an ABG test performed on a patient with non-septic obstructive disease?
A
- Low oxygen
- High or low carbon dioxide
21
Q
What are 3 secondary effects due to medications prescribed for non-septic obstructive diseases?
A
- Muscle atrophy/ weakness
- Osteopenia and osteoperosis
- R-sided heart failure
22
Q
What is the most prevelant COPD?
A
- Asthma
23
Q
What is the second most prevalent COPD disease?
A
- Emphysema
24
Q
What is hypothetical pathogenesis of emphysema?
A
- Elastase normally inactivated by alpha1-antitrypsin
- Smoking upsets the balance of elastase and alpha1-antitrypsin
- Connective tissue matrix of alveolar walls destroyed by elastase released by alveolar neutrophils
25
What is the effect of emphysema's destruction of the connective tissue matrix?
- Airways are dilated distal to the terminal bronchioles
- Decreased pressure in lumen
- Impaired airflow during inspiration
- Airways close early and trap air destroying acini
26
What volume is increased by emphysema?
Residual volume.
27
Since there is decreased pressure in the lumen of the respiratory vessels, what muscles have to work hard? What are their physiological changes?
Inspiratory muscles are shortened, have decreased sarcomeres, and are hypertrophied.
28
What are 4 signs/symptoms of Emphysema (early stage)?
- Cough and phlegm
- Dyspnea on exertion
- Increased A-P diameter (Barrel chest)
- Increased rib angle
29
What will be heard on auscilation of emphysema?
- Decreased distant breath sounds
- Prolonged expiratory phase'
- Wheezing and ronchi (coarse rattling sound) due to secretions
30
What are 13 (ugh..) complications of emphysema?
- Cachexia
- R-side heart failure
- Peripheral pitting edema
- Weight gain
- JVD
- Decreased appetite
- RUQ discomfort
- Ventricular gallop
- S3 heart sound
- Osteoporosis
- Depression
- CVD
31
What are 4 categories of medication prescribed for emphysema.
- Smoking cessation drugs
- Bronchodilators
- Methylxanthines
- Antibiotics (during exacerbations)
32
What are 3 classes of bronchodilators?
- Anticholinergics
- B2- agonists
- Inhaled corticosteroids
33
What are 2 specific anticholinergics?
- Ipratropium
| - Tiotropium
34
What are 3 specific B2-agonists?
- Albuterol
- Salmeterol
- Formoterol
35
What are 3 specific inhaled corticosteroids?
- Beclomethasone
- Fluticasone
- Triamcinolone
36
What is the purpose of methylxanthines in the treatment of emphysema?
- Improves respiratory muscle strength and endurance
37
What relieves SOB in exacerbations of emphysema?
Inhaled systemic corticosteroids.
38
What is the only therapy for emphysema that is proven to increase survival?
- Supplemental oxygen
39
In what type of cases is supplemental oxygen especially important in treating emphysema?
- HTN and polycythemia
40
What type of supplemental oxygen is usually appropriate for emphysema treatment?
- Low flow O2 via nasal canula.
41
What type of behavioral management is typically applied when treating emphysema?
- Smoking cessation.
42
What vaccines help control symptoms and exacerbations of emphysema?
- Influenza
| - Pneumococcal
43
What type of replacement therapy is appropriate for emphysema?
Alpha1-antitrypsin.
44
What 2 mechanical devices can assist in emphysema management/ treatment?
- BiPAP to assist in breathing
| - Mucous clearance devices
45
What type of rehab is recommended for emphysema patients?
Pulmonary rehab.
46
What cells produce elastase?
Neutrophils.
47
What organ produces alpha-1 antitrypsin? What the enzyme's function?
The liver produces Alpha-1 antitrypsin to control elastase.
48
What structures are damaged by alpha-1 antitrypsin deficiency?
- Lungs (usually coated by AAT)
| - Liver (AAT trapped in the liver)
49
What is the most common autosomal recessive genetic liver disease in children?
- AAT deficiency
50
What is the most common genetic pulmonary disease?
- Cystic Fibrosis
51
Where is alpha-1 antitripsin synthesized?
- The liver
52
What is neutrophil elastase's useful function?
- Break down bacteria from airway
53
When does AAT deficiency become primarily a pulmonary disease, and when does emphysema typically develop from the disease?
- Becomes pulmonary problem in second decade
| - Emphysema develops in 3rd or 4th decade of life
54
What is the mechanism of injury in Bronchiolitis Obliterans?
- Acute inflammation injury with diffuse destruction of bronchioles associated with underlying inflammatory pathology
- Fibroproliferation in bronchioles
- Collagen deposition in cartilaginous airways
55
What is the most common cause of Bronchiolitis Obliterans?
- Lung transplants (rejections)
56
What percent of individuals develop Bronchiolitis Obliterans 5 years after transplant?
80 %.
57
When does BO typically onset after a lung transplant?
In 16 - 20 months.
58
What percent of people who survive a transplant for 3 months or more develop BO?
50 %
59
Besides patients who receive lung transplants, what other patients typically develop BO?
- Children and infants following a severe respiratory infections.
60
What are 8 clinical signs/ symptoms of BO?
- SOB with exertion
- Wheezing, crackles, ronchi
- Persistent cough
- Hypoventilation
- Hypercapnia
- Intercostal retraction
- Tachypnea
- Grunting
61
What is typically found in a chest radiograph (CXR) in BO?
- Hyperinflated lungs
| - Patchy atelectasis (collapsed alveoli)
62
What are 3 results of a pulmonary function test of BO?
- Decreased forced vital capacity
- Decreased Forced Expiratory Volume over 1 second
- Increased residual volume
63
What are 3 findings of a CT scan of a patient with BO?
- Mosaic perfusion (patchwork of different weakening/ attenuation)
- Vascular attenuation (weakened or thinned vascularture)
- Central bronchiactasis (wide, flabby, scarred bronchioles)
64
What is the primary factor in treatment of BO?
- Prevention!
65
Once a patient develops BO, what are 4 treatments (medications)?
- Supplemental oxygen
- Antivirals
- Corticosteroids
- Bronchodilators
66
What is the cause of asthma?
- Unknown.
| - Associated with a maturing immune system and lung tissue
67
What are 11 risk factors of asthma?
- Maternal smoking
- Secondhand smoke
- Family history
- Genetics
- Atopy (allergies)
- Childhood asthma
- Occupational exposures
- Environmental exposures
- Early infection (respiratory syncytial virus)
- Female gender
68
Is asthma an acute or chronic disease?
Chronic.
69
Asthma is the most common chronic disease in which age group?
Children.
70
What percent of children's asthma onset before the age of 5?
80 %.
71
What percentage of children outgrow asthma?
- 50 - 70 %.
72
What percentage of children are limited in activity and play due to their asthma?
- 35 - 40 %.
73
What major risk factor do most children who develop asthma possess?
- Family history
74
What demographic is disproportionately affected by asthma?
Those in lower socio-econmic levels.
75
What was the prevelance of asthma in the US in 2000?
7.5 %.
76
What was RI's ranking of asthma prevalence in the US states?
5th highest at 8.5 %.
77
What are happening to worldwide asthma prevalence and death rates?
Increasing.
78
What are the 3 defining factors of asthma?
- Airway inflammation
- Airflow can become limited, but is reversible
- Bronchii are hyperresponsive
79
What is a the name of a severe asthma attack that is resistive to bronchodilators?
- Status asthmaticus
80
What are 11 symptoms/ signs of asthma?
- Wheezing
- Dyspnea
- Chest pain/ tightness (especially at night)
- Facial distress
- Non-productive cough
- Decreased breath sounds
- Cyanosis
- Exhaustion
- Hypercapnia
- Pending respiratory failure
81
What are 7 categories of environmental factors that aggravate asthma symptoms?
- Indoor irritants
- Air pollution
- Allergens
- Pesticides
- Molds
- Dust mites, rodents, cockroaches, animal dander, and other animal/ insect related environmental factors.
- Cold air
82
What are some examples of indoor irritants that aggravate asthma?
- Cigarette smoke
- Carbon monoxide
- Nitric oxide
- Poorly ventilated heating systems
83
What are 3 examples of air pollution that can aggravate asthma?
- Diesel exhaust
- Ozone
- Smoke
84
What type of infection can trigger asthma?
- Respiratory infection
85
What activity can trigger asthma?
Exertion and/or exercise for 10 - 15 minutes.
86
How long does asthma induced from exertion/ exercise usually take to resolve?
- 30 - 60 minutes
87
What 4 medications can trigger asthma?
- NSAIDs
- ACE inhibitors
- Aspirin
- Beta-blockers
88
What causes Exercise Induced Asthma?
- Loss of water and heat from lower respiratory system. (due to mouth breathing)
- Loss of heat causes hyperemia, vascular engorgement & bronchial edema (narrows bronchioles)
89
How long does bronchoconstriction persist following exercise in EIA?
6 - 8 hours.
90
How is a diagnosis of EIA determined in children?
Simply by a history of symptoms consistent with EIA.
91
How is EIA diagnosed in adults?
- 15 % drop in Peak Expiratory Flow after exercise
| - Greater than 15 % increase in FEV1 following use of a bronchodilator
92
What 4 factors increase the severity of EIA?
- Minute ventilation during exercise
- Cold temperatures
- Dry air
- High baseline reactivity of airways
93
What is the pathogenesis of EIA?
- Trigger
- Inflammatory process
- Bronchorestriction
- Airway obstruction
94
What are 5 types of asthma medication?
- Short and long acting beta-2 agonist bronchodilators
- B-Adrenergic agonists
- Cromolyn
- Leukotreiene modifiers
- Immunosuppressive medications
95
How do B-Adrenergic agonist medications manage asthma?
- Relaxes smooth muscles
- Results in brochodilation
- Inhibits release of inflammatory mediators
96
What type of medication is used to prevent an asthma attack? (not a rescue medication)
Cromolyn.
97
How do Leukotriene modifiers manage asthma?
- Blocks proinflammatory mediators that promote:
* Smooth muscle contractions
* Vascular leakage
* Mucous secretion
* Airway hyperactivity
98
In what type of patients with asthma are immunosuppresive medications used?
- Chronic, severe asthma
99
What are 4 beta2-selective bronchodilators?
- Albuterol
- Bioterol
- Pirbuterol
- Salmeterol
100
What preparation can be made prior to exercise to reduced the effects of EIA?
- Medication, and warm up 45 - 60 minutes prior to exercise.
| - Warm up --> 30 second bouts with 2 minute rest periods
101
What non-pharacologic treatments can help reduce symptoms of EIA?
- Environmental control to reduce allergens
| - Routine exercise to: increase O2 consumption, decrease blood lactate, and increase minute ventilation
102
What differentiates septic obstructive diseases from non-septic obstructive diseases?
- Purulent sputum productive coughs
- High incidence of pulmonary infection
- Excessive secretion production
103
What are typical results of a PFT in septic obstructive disease?
- Decreased expiratory effort
- Increased Total lung capcity
- Hypercapnia (high CO2)
104
What vessels change pressure in septic obstructive diseases, and what is the effect of this?
- High pressure in pulmonary arteries
- Heart enlargement and failure
- Cor pulmonale
105
What is the clinical diagnosis of chronic bronchitis?
Cough and sputum production for 3 months or more for 2 years or more.
106
What is the number one risk factor of chronic bronchitis?
Smoking.
107
What is the 4 step pathogenesis of chronic brochitis?
- There is an increase in the size and nbumber of bronchial mucous glands leading to excess mucus in airways
- Larger and more number glands in addition to airway inflammation thickens the walls of the airways
- Cilia's structure and function are impeded causing less mucous to be cleared
- Small airways (less than 2mm) narrow, develop inflamation, and become fibrous
108
What are 8 common categories of medications for individuals with Chronic Bronchitis Medications?
- Various antibiotics for bacterial and fungal infection
- Short acting beta-agonists
- Long acting bronchodilators
- Inhaled corticosteroids
- Smoking cessation drug therapy
- Expectorants and mucolytics
- Antiprotease treatment (to decrease destruction of elastin by inflammation)
- Supplemental oxygen
109
What 2 vaccines are commonly prescribed for individuals with chronic bronchitis?
- Influenza
| - Pneymococcal
110
What behavioral therapy can be prescribed for chronic bronchitis?
Smoking cessation.
111
What are 3 therapy treatments for individuals with chronic bronchitis?
- Bronchial hygiene
- Pulmonary rehab
- Early mobilization
112
What pathology does "Pink puffer" refer to?
Emphysema
113
What pathology does "Blue bloater" refer to?
Chronic bronchitis.
114
What is the major symptom of a "Pink puffer" and a "Blue bloater"?
PP: Dyspnea
BB: Cough and sputum
115
What is the appearance of a "Pink puffer" and a "Blue bloater"?
PP: Thin, wasted, not cyanotic
BB: Obese and cyanotic
116
How are "Pink puffer"s and "Blue bloater"s PO2 and PCO2 affected?
PP: Decreased O2 and Decreased or normal CO2
BB: Very decreased O2, and normal or high CO2
117
How is the elastic recoil of the lung affected in a "Pink puffer" and a "Blue bloater"?
PP: Decreased
BB: Normal
118
How is the diffusing capacity affected in a "Pink puffer" and a "Blue bloater"?
PP: Decreased
BB: Normal
119
How is the hematocrit affected in a "Pink puffer" and a "Blue bloater"?
PP: Normal
BB: Frequently incrased
120
Does cor pulomale occur more often in a "Pink puffer" or a "Blue bloater"?
Blue bloater.
121
What devices can be used to help a patient with chronic bronchitis clear mucus?
- Flutter mucus clearance device
| - Acapella mucus clearance device
122
Which septic obstructive disease is an autosomal recessive trait?
- Cystic fibrosis
123
How common is cystic fibrosis?
The most common genetic disease in US.
124
How lethal is cystic fibrosis?
Most lethal genetic disease in US.
125
What is the incidence of cystic fibrosis?
1 in 3900 live white births.
126
What type of cells are affected by cystic fibrosis?
- Epithelial cells of exocrine glands
127
What 8 organs are targeted by cystic fibrosis?
- Sinuses
- Lungs
- Pancreas
- Intenstines
- Biliary tracts
- Vas deferens
- Uterine cervix
- Sweat glands
128
What are the implications of cystic fibrosis being an autosomal recessive trait?
There are many asymptomatic carriers.
129
Describe the chloride ion transfer defect caused by cystic fibrosis.
- Na+ and Cl- transport disturbed
| - Pulls water back into cell making secretions thicker and drier
130
Describe the process of injury caused by cystic fibrosis in the lungs.
- Cilia cannot clear mucus
- Secretions settle in lungs
- Bacteria grow in stagnant secretions
- Cycle begins of: inflammation, infection, and tissue destruction
131
What does the thickened, stagnant secretions of cystic fibrosis lead to?
Obstruction and malabsorption (as in GI tract)
132
What is the hallmark clinical sign of cystic fibrosis in babies?
They taste salty.
133
What is the median lifespan of an individual with cystic fibrosis?
38 years.
134
What are 2 signs/symptoms of cystic fibrosis shortly after birth?
- Meconium ileus: (obstruction of intestines due to overly thick meconium)
- Failure to thrive/ regain birth weight
135
What are 5 respiratory signs/symptoms of cystic fibrosis?
- Recurrent respiratory infections
- Chronic productive cough
- SOB with excessive inspiratory accessory muscle use
- Inspiratory crackles and wheezing
- Nasal polyps
136
What 2 symptoms secondary to respiratory complications of cystic fibrosis?
- Clubbing of nails
| - Decreased activity tolerance
137
What are 3 metabolic effects of cystic fibrosis?
- Pancreatic insufficiency, pancreatitis, and diabetes
- Osteoporosis
- Muscle wasting
138
What are 5 other clinical signs/symptoms of cystic fibrosis?
- Salty kiss
- GERD
- Weight loss
- Chronic low back pain
- Developmental delays
139
Why is early detection of cystic fibrosis important?
- So aggressive nutritional support can begin
140
What are two PT treatments for cystic fibrosis?
- Aerobic and strengthening exercise
| - Energy conservation techniques
141
What 6 medications, and treatment techniques can increase life expectancy when faced with CF?
- Pancreatic enzyme replacement
- Vitamin supplements
- High caloric diets
- Airway clearance techniques
- Antibiotics and antifungal treatment
- Mucolytic and bronchodilator medications
142
What are 4 serious complications due to cystic fibrosis?
- Respiratory failure
- Right-sided heart failure
- Severe hemoptysis
- Spontaneous pneumothorax
143
What are 4 common medications for cystic fibrosis?
- Glucocorticoid steroids (anti-inflammatory)
- Bronchodilators
- Antibiotics
- Pancreatic enzymes (assist with digestion)
144
What are the two key causes of bronchiectasis?
- Intense chronic inflammation
| - Inadequate defense to minimize infection resulting in tissue damage
145
What are 5 characteristics of bronchiectasis?
- Thickened bronchial walls
- Impaired mucociliary blanket
- Hypersecretion of purulent sputum
- Associated with other pulmonary diseases
- Permanent dilation of bronchi due to destruction of muscular and elastic properties of lungs
146
What is the best imaging technique for diagnosis of bronchiectasis?
- High resolution CT
147
Which imaging technique is non-specific when diagnosing bronchiectasis?
- Chest x-ray
148
What 2 respiratory sounds are associated with bronchiectasis?
- Crackles
| - High and low pitch ronchi
149
What are 9 signs and symptoms of bronchiectasis?
- Persistent cough
- Copious secretions
- Frequent hemoptsis
- Recurrent infections
- Pleural rubs
- Fever
- Fatigue
- Dyspenea
- Digital clubbing
150
What determines the prognosis of bronchiectasis?
- Underlying disease
151
What are 5 methods of treatment of bronchiectasis?
- Treat the underlying disease
- Antibiotics, corticosteroids, and brochodilators
- Nutritional support
- Supplemental O2
- Airway clearance/ bronchial hygiene
152
What 4 other pathologies is pulmonary fibrosis linked to?
- Immune disorders
- Occupational exposures
- Genetic and hormonal abnormalities
- Complications of lung injuries
153
How does a patient with pulmonary fibrosis 's oxygen saturation differ from a normal patients?
- Lower oxygen saturation generally
| - Rapid desaturation with exercise
154
What are 2 associated complications of pulmonary fibrosis?
- Pulmonary hypertension
| - Cor pulmonale
155
How are an individual's PFTs affected by pulmonary fibrosis?
- Decreased FVC and FEV1
- Normal FEV1/ FVC
- Reduced VB and TLC
156
What pathology is typically involved in Interstitial lung diseases?
- Fibrosis
157
What are 6 categories used to classify restrictive lung disease?
- Inhaled substances
- Drug induced
- Connective tissue disease
- Infection
- Idiopathic
- Malignancy
158
What are 3 common inorganic substances that can cause restrictive lung disease?
- Silicosis
- Asbestosis
- Beryliosis
159
What can cause restrictive lung disease by a mechanism of inhaled organic materials?
- Hypersensitivity pneumonitis
160
What 3 drugs can induce restrictive lung disease?
- Antibiotics
- Chemotherapeutic drugs
- Antiarrhythmic agents
161
What 5 connective tissue diseases can lead to restrictive lung disease?
- Systemic sclerosis
- Polymyositis
- Dermatomyositis
- Systemic lupus erythematosus
- Rheumatoid arthritis
162
What 3 infections can lead to restrictive lung disease?
- Atypical penumonia
- Pneumocystis pneumonia
- Tuberculosis
163
What are 3 idiopathic causes of restrictive lung disease?
- Atypical pneumonia
- Idiopathic pulmonary fibrosis
- Hamman-Rich syndrome
164
What malignancies are linked to restrictive lung disease?
- Lymphangitic carcinomatosis
165
What are 4 signs and symptoms of restrictive lung disease?
- Dry cough
- Gradual dyspnea with walking
- Crackles at the lung bases
- Clubbing
166
How is restrictive lung disease treated?
Treat the underlying cause.
167
What drug treatment is recommended for idiopathic pulmonary fibrosis?
No specific drug treatment.
168
What 2 drugs have an unproven benefit on restrictive lung disease?
- Corticosteroids
| - Cytotoxic agents
169
What 5 medicines may be useful for restrictive lung disease?
- N-acetylcysteine
- IFN-gamma
- Pirfenidone
- Bosentan
- Etanercept
170
What 3 non-medicinal treatments should be considered for restrictive lung disease?
- Pulmonary rehabilitation
- Oxygen
- Lung transplantation
171
What is empyema?
Pus in the pleural space.
172
What is the pathogenesis of pneumonia?
- Acute inflammation of lungs
| - Small bronchioles and alveoli become plugged with fibrotic exudate
173
What is the ranking of Pneumonia in cause of death in the US?
6th.
174
What 2 classifications are there for infectious lung disease?
- By agent (bacteria, fungus, virus)
| - By environment of infection (community, hospital, nursing home, school, etc...)
175
What are the 3 categories of risk factors for infectious pulmonary disease?
- Medical
- Environmental
- Respiratory function
176
What are 6 medical related risk factors for infectious pulmonary disease?
- Age
- Integrity of immune system
- Acute head
- Neck trauma
- Chest trauma
- Surgery
177
What are some environmental risk factors for infectious pulmonary disease?
- Hospital environment
- Exposure to infected individuals
- Tracheal or gastric device
178
What are 2 mechanized treatments are associated with respiratory risk factors for pulmonary disease?
- Use of mechanical ventilation
| - Aerosolized breathing treatments
179
What medical procedure is a risk factor for infectious pulmonary disease?
- Aspiration
180
What are 2 clinical signs/symptoms of infectious pulmonary disease?
- Fever
| - Productive cough with yellow-green or rust colored sputum
181
What are 2 lab tests that help diagnose infectious pulmonary disease?
- Elevated WBC count
| - Positive sputum culture
182
What are 3 methods of prevention of infectious pulmonary disease?
- Flu shots
- Proper care and cleaning of respiratory equipment
- Hand washing
183
How is infectious pulmonary disease specifically diagnosed?
- Chest X-ray showing consolidaiton for at least 48 hours, and at least 2 clinical signs such as:
- Dyspnea
- Fever
- Cough
- Leukocytosis
- Leukopenia
184
How many cases of TB were diagnosed in 2006?
9 million
185
How many deaths occurred due to TB in 2006?
1.7 million
186
In what 2 populations is tuberculosis the leading cause of death?
- Individuals with HIV/AIDS
| - Women of child bearing years
187
What pathology is TB associated with in 95 % of diagnoses and 98 % of deaths?
- HIV
188
How many are co-infected with HIV and TB in the US?
15 million.
189
What 7 medical pathologies are risk factors for TB?
- HIV
- Cancer of the head/ neck
- Leukmia
- Hodgkin's disease
- Diabetes mellitus
- Severe kidney disease
- Silicosis
190
What 4 medical treatments are risk factors for TB?
- Corticosteroid treatment
- Organ transplants
- RA treatment
- Crohn's disease treatment
191
What behavior is a risk factor for TB?
- Substance abuse
192
What personal factor is a risk factor for TB?
- Low body weight
193
By what method is TB transmitted?
- Airborne transmission by dry droplet nuclei
| - Become airborne from an infected person's cough or sneeze
194
How far into the respiratory system must TB particles reach to cause an infection?
The alveoli.
195
What type of TB must the carrier have to transmit the infection?
- Laryngeal TB
or
- Extensive spread of TB
196
What 3 factors increase the risk of TB infection? (not related to pathology related risk factors)
- Concentration of particles in air
- Length of exposure
- Host's immune system
197
How long is the incubation period for TB?
2 - 12 weeks.
198
When will a test for TB become positive after the individual is initially infected?
6 - 8 weeks.
199
When is TB mostly asymptomatic? What symptoms may be present during this time?
- During the primary infection
| - Unproductive cough and fever may be present
200
What percent of TB is pulmonary, and what percent affects other systems?
- 80 % pulmonary
| - 20 % other systems/ organs
201
What type of medication is TB unresponsive to?
- Antibiotics
202
What are the non-specific symptoms of TB?
- Cough
- Fever
- Weight loss
203
What is the gold standard for TB diagnosis?
- Smear/ culture
204
What percent accuracy does a positive smear and culture have for TB in an HIV negative individual?
- 90 %
205
What percentage of TB cultures are negative?
20 %
206
How is a medicine regimen for TB deemed appropriate?
- Patient can tolerate it
- Won't select resistant organisms
- Won't interact adversely with other medications
207
What should be assessed when following up a TB regimen?
- Compliance
- Effectiveness of regimen
- Complications of therapy
208
Describe the regimen for TB during the intensive phase.
- For two months
- Four drug regimen
- Exact mixture of drugs can be modified with susceptibility testing
209
Describe the drug regimen during the continuation phase.
- INH - Rifampin
| - INH - Ethambutol
210
How many cases of pulmonary embolism are there per year?
600,000
211
What other pathology typically precipitates a pulmonary embolism?
- A DVT
212
What rank are PEs in terms of causing cardiovascular death?
3rd.
213
What percent of treated PEs are symptomatic?
1/3rd/ 33%
214
What amount of post-op deaths are caused by PE?
3 %
215
What other sources besides thrombi can cause pulmonary emobilisms?
- Air
- Fat
- Amniotic fluid
216
What are 5 risk factors for pulmonary embolism? (There are 14 overall)
- Immobilization
- Surgery within last 3 months
- Stroke
- Previous h/o thromboembolism
- Chronic heart disease
- Acute MI
- CHF
- Cancer
- Over 40 years old
- Obese
- Lupus
- Major trauma
- SCI
- Oral contraceptives
(Anything that causes a blood clot is a risk factor for a pulmonary embolism)
217
What are the 3 MAJOR signs and symptoms of PE? (97 % of cases) (which is the number 1 symptom)
- Dyspnea (Unexplained/ rapid onset) (#1)
- Pleuritic chest pain
- Tachypnea
218
What are the 7 NON-MAJOR signs and symptoms of PE.
- Cough
- Hemoptysis
- Crackles
- Syncope
- Tachycardia
- Decreased breath sounds
- Abnormal lung sounds
219
What is the gold standard of imaging for diagnosis of a PE?
Spiral angiography.
220
What are the sensitivity and specificity of spiral CT angiography?
Sensitivity: 83 %
Specificity: 96 %
221
What imaging is used to detect a DVT?
- Color flow duplex imaging
222
What is the best treatment of PE?
Prevention.
223
List 4 treatments for prevention of PE.
- Early mobilization
- Compression stockings
- Anticoagulants
- Inferior vena cava filter
224
What are 3 treatments for a current PE?
- Thrombolysis
- Anticoagulative drugs (heparin, aspirin)
- Surgical and catheter embolectomy
225
What is the normal mean pressure in the pulmonary arterial system?
15 mmHg.
226
What mean pulmonary arterial pressure is considered hypertension during exercise, and at rest?
- 25 mmHg at rest
| - 30 mmHg during exercise
227
What causes pulmonary hypertension?
Increase in pulmonary vascular resistance.
228
What is the cause of idiopathic pulmonary hypertension?
Unknown
or
Genetic
229
Who is most susceptible to pulmonary hypertension?
Young and middle aged women.
230
What is the 9 step pathophysiology of pulmonary hypertension?
- Sustained blood pressure elevation in pulmonary vesselks
- Overload of pressure in right vengtricle
- RV hypertrophy
- Cor pulmonale
- Compensatory tachycardia and RVH maintain CO at rest, but not during exertion
- RV overload results in RV failure
- Venous congestion
- Inadequate CO at rest
- Death by (mostly) RV failure.
231
What are 6 signs and symptoms of pulmonary hypertension?
- Dyspnea on exertion
- Fatigue, weakness
- Exertional chest pain
- Lightheadedness/ syncope
- Palpitations
- Possible hemoptysis
232
What other pathology shares the same symptoms as pulmonary hypertension?
- Cor Pulmonale
233
What is the gold standard diagnostic tool for pulmonary hypertension?
- Cardiac catherization
234
What are 4 other diagnostic tools for pulmonary hypertension?
- Pulmonary function tests
- Echocardiograms
- Pulmonary angiography
- V/ Q & CT scans
235
What are 4 types of treatment for pulmonary hypertension?
- Treat underlying disease
- Supplemental O2
- Medication
- Lung transplant
236
What are 3 types of medication prescribed for pulmonary hypertension?
- Anticoagulants
- Diuretics
- Vasodilators
237
What is the mean survival time of pulmonary HTN?
2.8 years
238
What is pulmonary edema?
- Accumulation of extravascular fluid in the interstitial and alveolar spaces in the lung
239
What are the 2 types of pulomnary edema?
- Increased pressure in left heart reflects to small vessels, and flood the pulmonary interstitial space
- Increased permeability due to acute lung injury (Acute respiratory distress syndrome)
240
What heart sound is present in pulmonary edema?
- S3
241
What types of lung sounds are heard in pulmonary edema?
- Diffuse crackles
| - Possible wheezes
242
What are 2 psychosocial signs/ symptoms of pulmonary of edema?
- Anxiety
| - Agitation
243
What are 4 physological signs and symptoms of pulomary edema?
- Dyspnea/ respiratory distress
- Orthropnea/ paroxysmal nocturnal dyspnea
- Diaphoresis
- Tachycardia/ arrhythmias
244
What 2 skin changes will be apparent in pulmonary edema?
- Pallor
| - Cyanosis
245
What is critical in the treatment of pulmonary edema?
- Prompt diagnosis
246
What are 4 treatments for pulmonary edema?
- Treat underlying cause
- Supplemental O2
- Prevent and treat complications
- May require assisted ventilation
247
What are the 3 pleural pulmonary diseases?
- Pneumothorax
- Hemothorax
- Plerual effusion
248
How is pleural effusion different from pulmonary edema?
- Effusion is between the pleural linings
| - Edema occurs in the interstitium of the lungs
249
What type of tumor develops from the pleura? What material is it associated with?
- Mesothelioma
| - Associated with asbestos exposure
250
What type of surgery may be required in pleural disease?
- Drainage of the fluid/ air
251
What can enter the pleura to causing pleural disease?
- Air
| - Fluid
252
What are primary and secondary pneumothorax?
Secondary is caused by an underlying disease, while primary is a spontaneous collapse of the pleura.
253
What disease is associated with secondary pneumothorax?
- COPD
254
What types of patients are at risk for primary pneumothorax?
- Tall, thin, young men
255
What enzymes and cells are imbalanced in blebs and bullae?
- Protease and antiprotease are imbalanced
| - Increased numbers of neutrophils and macrophages
256
How are blebs and bullae related to pneumothorax?
They can rupture under pressure (cough, valsalva) causing air to rush into the pleural space.
257
What is latrogenic pneumothorax?
- Complications related to diagnostic or treatment procedures
258
What is traumatic pneumothorax?
- Penetrating wound allows air to rush in.
259
What is tension pneumothorax?
- Air enters pleural space and can't escape
260
Which type of pneumothorax is life threatening?
Tension pneumothorax.
261
To which side is the medistinum displaced in tension pneumothorax?
- To the contralateral side
262
How will pneumothorax present on a CXR?
- Black, dark space in lung with a shifted mediastinum.
263
What is hemothorax?
- Effusion of blood into the pleura
264
What are 3 surgical procedures for pneumothorax?
- Needle or chest tube to aspirate air or blood from pleural space
- Chemical pleurodesis
- Thoractomy to resect bullae
265
How is the prognosis of a patient following pneumothorax determined?
- The size of the pneumothorax.
266
What is pleural effusion?
- Excessive collection of fluid between parietal and visceral pleurae.
267
What are the 2 types of pleural effusion?
- Transudate
| - Exudate
268
What causes transudate pleural effusion?
| 3 pathologies
- Increased hydrostatic pressure within pleural capillaries due to:
- CHF
- PE
- Renal disease
269
What are 4 causes of exudate pleural effusion?
- Infection
- Malignancy
- Pulmonary embolism
- Infarct
270
What is the term pleural effusion with grossly purulent fluid?
Empyema.
271
What is the 6 step pathogenesis of pleural effusion?
- Excess fluid compresses lung tissue
- Atelectasis
- Reduced alveolar ventilation
- Increased work of breathing
- Incresaed fluid pressure restricts lung expansion
- Mediastinum shifts away from affected side
272
How will percussion sound with pleural effusion?
Fluid: Dull
Air: Hollow
273
What will be heard upon ausciltation of pleural effusion? (2 characteristics)
- Decreased/ absent breath sounds over effusion
| - Possible pleural rub
274
What 3 systemic symptoms will be present in pleural effusion?
- Fever
- Shaking chills
- Night sweats
275
What are 2 respiratory symptoms of pleural effusion?
- Dyspnea
| - Pleuritic chest pain that is aggravated by deep breathing and coughing
276
What are 3 conservative treatments of pleural effusion?
- Watch for natural reabsorption
- Segmental expansion/ diaphragmatic breathing exercises to prevent atelectasis
- Increased mobilization
277
What surgical procedure is used for pleural effusion?
- Thoracentesis
278
Which direction will the mediastinum shift towards in atelectasis?
- Towards the atelectasis
279
** Check end of pulmonary disease for cases **
** Check end of pulmonary disease for cases **
