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ExPhys > RCQ ch.7 - OLD > Flashcards

RCQ ch.7 - OLD Flashcards

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1
Q

cardinal presentation of chronic bronchitis

A

air trapping

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2
Q

cardinal presentation of emphysema

A

increased residual volume and total lung capacity

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3
Q

cardinal presentation of asthma

A

decreased FEV1/FVC

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4
Q

cardinal presentation of cystic fibrosis

A

decreased FEV1
CO2 retention
decreased DLCO
cyanosis
wheezing
dyspnea
cough

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5
Q

obstructive lung disease defined as

A

Cluster of problems that affect airways and the lung parenchyma
producing obstruction to expiratory airflow

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6
Q

diseases under OLDs

A

emphysema
chronic bronchitis
bronchoconstriction
CF
bronchiectasis
bronchopulmonary dysplasia

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7
Q

primary causes of OLD

A

inhalation factors
genetics

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8
Q

what genetic deficiency causes OLDs

A

a1-antitrypsin deficiency

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9
Q

what does a1-antitrypsin deficiency cause

A

decreased surfactant production
decreased alveolar sac integrity

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10
Q

symptoms of OLDs

A

dyspnea on exertion
secretion production
cough

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11
Q

what can dyspnea lead to

A

increased anxiety

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12
Q

lung obstruction causes

A

retained secretions
inflammation of mucosal lining
bronchial constriction
weakening of airway wall structure
air sac destruction / overinflation with destruction of surfactant

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13
Q

what is the cascade of inflammatory response

A

inhalation exposure leads to increased protease activity and decreased antiprotease activity

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14
Q

what does inflammatory response cause in the lung tissue

A

elastin and CT breakdown
hyperplasia of mucus secreting cells
ciliary elevator damage

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15
Q

what causes obstruction

A

hypersecretion of mucus
mucus plugging
edema of mucosal lining
increased reactivity of airways
bronchial fibrosis

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16
Q

how does chronic inflammation decrease elastic recoil of the lung

A

narrowing small airways
damage of lung parenchyma
loss of alveolar attachments in small airways

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17
Q

loss of recoil leads to

A

loss of gas exchange capability
chronic lung hyperinflation

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18
Q

sequalae related to loss of elastic recoil

A

o Hyperinflation
o v/q mismatching
o hypoxemia
o hypercapnia

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19
Q

how does hyperinflation of the lung affect the thorax

A

Rib cage turns barrel shaped
Affects bucket handle and pump handle motions

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20
Q

what causes diaphragm flattening at the tissue level

A

loss of sarcomeres
change in length tension relationship
exhalation becomes forced

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21
Q

when the diaphragm becomes flattened, what can happen

A

increase intraabdominal pressure

more stress on pelvic floor and possible urinary incontinence

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22
Q

how is inspiration affected by flattened diaphragm

A

Rely on accessory muscles
Postural deviations

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23
Q

what muscles are recruited when the diaphragm is overworked

A

SCM, upper trap, scalenes, pectoralis muscles

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24
Q

what postural deviations are seen when the diaphragm is flattened

A

forward head
rounded shoulders
thoracic kyphosis
posterior thoracic musculature to lengthen and weaken

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25
how is muscle affected by pulmonary obstructive disease
Reduction of mitochondrial density per fiber bundle Reduction of capillary density Reduction of aerobic metabolism / poor muscle endurance Poorer exercise capacity
26
general changes to the thorax due to obstructive lung diseases
* Elevation of the shoulder girdle * Horizontal ribs * Barrel shaped thorax * Low, flattened diaphragm
27
psychological impairment associated with OLD
depression and anxiety 2.5x more likely
28
normal vs obstructive values of FEV1/FVC ratio
normal = >75% obstructive = <70%
29
COPD is described as
Mixture of parenchymal alveolar disease (emphysema) and small airway disease (obstructive bronchiolitis)
30
what is the value for respiratory failure
PaO2 < 60mmHg +/- PaCO2 >50mmHg
31
what can be seen in patients with COPD
barrel chest jugular vein distension ankle/lower leg swelling
32
how is auscultation affected by COPD
Prolonged expiratory phase - exhalation more than 4 seconds diminished breath sounds
33
what is the 1:2 ratio of breathing
1 sec of inhalation to 2 sec of exhalation
34
Stage 1 COPD described as
- FEV1 = >80 - FEV1/FVC = <0.7 - Chronic cough +/- productivity
35
Stage 2 COPD described as
- FEV1 = 50-80 - FEV1/FVC = <0.7 - Chronic cough +/- productivity and dyspnea
36
Stage 3 COPD
- FEV1 = 30-50 - FEV1/FVC = <0.7 - Chronic cough +/- productivity and dyspnea
37
Stage 4 COPD
- FEV1 = <30 - FEV1/FVC = <0.7 - Chronic cough +/- productivity and dyspnea - Respiratory failure / weight loss
38
when is supplemental oxygen administered
resting PaO2 55mmHg or less / SpO2 of 88% or less
39
end stage COPD has these progressions
cor pulmonale vasoconstriction to combat alveolar hypoxia increased pulmonary vascular resistance pulmonary HTN Right HF
40
PT Interventions for COPD
1. Secretion clearence 2. Controlled breathing techniques 3. Breathing retraining 4. Ambulation 5. Endurance exercise training 6. Optimal use of o2 with activity 7. Strength/weight training 8. Thoracic stretching 9. Postural reeducation 10. Self management of disease 11. Instruction of Recovery from shortness of breath
41
emphysema described as
destruction of alveolar walls, enlargement of air spaces distal to terminal bronchioles (ie respiratory bronchioles, alveolar ducts, alveoli)
42
subtypes of emphysema
centriacinar panacinar distal acinar
43
centriacinar emphysema
proximal dilation of respiratory bronchioles with alveolar ducts and sacs remaining normal frequent in upper lobes and posterior portion
44
panacinar emphysema is described as ____? it can be found in ____ and is most associated with
dilation of respiratory airspaces in acinus frequent in base of lung most associated with a1-antitrypsin deficiency
45
distal acinar emphysema
dilation of airspaces underneath the apical pleura apical bullae leading to spontaneous pneumothorax
46
acinus definition
tissue distal to terminal bronchiole, composed of respiratory bronchioles, alveolar ducts, and alveolar sacs
47
chronic bronchitis is diagnosed when
presence of chronic productive cough for 3 months in each of two successive years
48
characteristics of chronic bronchitis
hypersecretion thickening of airway walls mucociliary clearance system damage hypertrophy of submucosal glands, increase in gland to bronchial wall thickness ratio surface of epithelial secretory cells increases degree of small airway involvement indicates level of disability
49
bronchiectasis is characterized by
Characterized by irreversible dilation of one or mor bronchi with chronic inflammation and infection Distortion of conducting airways
50
pathophys of bronchiectasis
Bronchial wall injury / structural weakness of bronchial walls Traction from adjacent lung fibrosis Bronchial lumen obstruction
51
symptoms of bronchiectasis
Cough with chronic sputum forming 3 layers Recurrent/chronic lung infections Hemoptysis Dyspnea / tiredness Sinusitis
52
explain the sputum associated with bronchiectasis
3 layers  White frothy  Mucoid  Purulent
53
auscultation findings of bronchiectasis
Crackles over involved lobes rhonchi during periods of mucus retention dullness to percussion and decreased breathing sound
54
PT for bronchiectasis
Secretion clearance Controlled breathing techniques Inspiratory muscle training Strength training Endurance
55
cystic fibrosis is
autosomal recessive, multisystem disorder affecting every organ system with epithelial surfaces
56
pulmonary involvement of CF is associated with
Chronic airway obstruction, inflammation, thick tenacious mucus, recurrent bacterial infections
57
intestine involvement of CF is associated with
Thick mucus interfering with nutrient absorption Malnourishment and low weight
58
pancreatic involvement of CF is associated with
Obstruction of biliary tract and biliary cirrhosis Exocrine pancreatic insufficiency
59
symptoms of CF
Salty skin Frequent lung infections Wheezing/shortness of breath Poor growth/slow weight gain despite healthy appetite Bowel issues
60
PT for CF
Airway clearance technique Controlled breathing techniques inspiratory muscle training Thoracic stretching postural reeducation Exercise
61
asthma is described as
Chronic inflammatory disorder that results in recurrent episodes of wheezing, dyspnea, chest tightness and coughing due to bronchial hyperresponsiveness
62
pahtophys of asthma
Acute inflammation resulting from viral or allergen exposures Thickening of airway walls in both large (cartilaginous) and small (membranous) airways Narrowing of peripheral airways V/Q mismatching and increased alveolar arterial o2 difference
63
narrowing of small airways leads to
increased residual volume breathing at higher lung volumes
64
V/Q mismatch associated with asthma can affect
Hypoxia in acute severe asthma Hypocapnia = asthma attack due to respiratory drive Hypercapnia = extreme asthma attacks, treated with bronchodilators
65
symptoms of asthma
wheezing, chest tightness, SOB, cough
66
PT for asthma
clearance techniques controlled breathing techniques Exercise/strength training Thoracic stretching Postural reeducation Medications and timing of medications

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