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Diseases Final
| Question | Answer |
|---|---|
| What are the five obstructive diseases? | Cystic Fibrosis, Bronchiectasis, Asthma, Chronic Bronchitis, Emphysema |
| What two diseases make up COPD? | Chronic Bronchitis and Emphysema |
| How do obstructive diseases affect the lung volumes, capacities, and flows? | Increased lung volumes, decreased capacities, and decreased flow |
| What is the definition of COPD? | Refers to a disease state characterized by the presence of incompletely reversible airflow obstruction |
| What causes the abnormal values and capacities in COPD? | Air trapping |
| What patients are called "pink puffers" and why? | Emphysema patients are referred to as pink puffers due to air trapping and their reddish skin |
| What patients are called "blue bloaters" and why? | Chronic bronchitis patients are referred to as blue bloaters due to their stocky and over weight build and cyanosis |
| What is the definition of Chronic Bronchitis? | Chronic, productive cough for three months for two consecutive years; other causes have been ruled out |
| What is the definition of Emphysema? | Permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by alveolar walls, without pbvious fibrosis |
| What are the CXR findings of a patient with Emphysema? | Hyperinflation, narrow mediastinum, normal or small vertical heart, low, flat diaphragms, blebs or bullae |
| How does chronic hypoxemia cause cor pulmonale? | Hypoxemia increases viscosity of blood due to polycythemia, decreased PaO2 causes vasoconstriction, increased pulmonary vascular resistance, right heart works harder to compensate |
| What are the signs and symptoms of cor pulmonale upon physical assessment? | JVD, peripheral edema, large, tinder liver |
| What is involved in the general management of Chronic Bronchitis and Emphysema? | O2 therapy, bronchopulmonary hygiene, aerosolized medication therapy, rehab, surgery, vaccines, AAT augmentation, antibiotics, mucolytics, bronchodilators, corticosteroids, methylxanthines |
| What treatment modalities are included in bronchial hygiene therapy? | CPT and PD |
| How much does hemoglobin have to reduce before a patient is considered cyanotics? | <5g/L |
| What are the two types of emphysema? | Panacinar (Panlobular) and Centriacinar (Centrilobular) |
| Which type of emphysema is the most common and associated with cigarette smoking? | Centriacinar (Centrilobular) |
| What are the clinical manifestations of bronchiectasis? | Large quantities of foul smelling sputum, hemoptysis, 24 hr sputum sample will form three layers, increased vitals, and common respiratory disease symptoms |
| What are the sputum characteristics found in bronchiectasis? | Forms 3 layers after 24 hours; frothy and pink, dark and opaque, translucent and mucopurulent |
| What are the major pathological changes during an asthmatic episode? | Retractions, increased AP diameter, cyanosis, cough with white sputum, wheezing, and rhonchi |
| What are the clinical manifestations in status asthmaticus? | Rapid deterioration, acute ventilatory failure with hypoxemia, bronchospasm, wheezing, increased HR, RR, and BP |
| What type of ABG is expected in an acute asthma exacerbation? | Acute Alveolar Hyperventilation with hypoxemia (UCRAK) |
| What is Cystic Fibrosis? | Genetic disorder caused by mutation in pair of genes located on chromosome 7. Characterized by dysfunction of the exocrine gland (mucous and sweat). Pancreatic insufficiency in 85%-malnutrition; failure to thrive |
| How do you get CF? | Genetics; one parent must be a carrier |
| How does CF affect the exocrine gland? | Malnutrition; failure to thrive |
| What is the most reliable test of CF? | Sweat Test (aka Sweat Chloride Test) |
| What is the definition of pneumonia? | Response to inflammation; fluid and some RBCs from pulmonary capillaries leak into alveoli |
| What type of pneumonia is most common in AIDS patients? | Pneumocystis Carinii Pneumonia |
| What drug is used to treat Pneumocystis Carinii Pneumonia? | Aerosolized Pentamidine (Nebupent) - given via Respigard Nebulizer |
| What is the definition of Pulmonary Edema? | Results from excessive movement of fluid from the pulmonary vascular system to the extravascular and air spaces of the lungs |
| What are the anatomical alterations associated with pulmonary edema? | Frothy, white or pink (blood tinged) sputum |
| What is the fluid movement in pulmonary edema? | First, fluid moves into the perivascular and peribronchial interstitial spaces, progressively moves into the alveoli, bronchioles, and bronchi |
| What is the normal hydrostatic pressure in the pulmonary capillaries? | 10-15 mmHg |
| What is the normal oncotic pressure in the pulmonary capillaries? | 25-30 mmHg |
| What are the two types of pulmonary edema? | Cardiogenic and Non-Cardiogenic |
| What are the CXR findings in a patient with cardiogenic pulmonary edema? | Butterfly or bat wing appearance, dense, fluffy, opacities- spread outward from the hilar region, kerley A and B lines, enlarged pulmonary vessels, left ventricle hypertrophy, pleural effusion |
| How will the CXR of a patient with non-cardiogenic pulmonary edema differ from a patient with cardiogenic pulmonary edema? | No pleural effusion or cardiac enlargement |
| What is the first line treatment for cardiogenic pulmonary edema? | Hyperinflation therapy: CPAP with 100% O2 |
| What drugs are used to treat pulmonary edema? | Diuretic agents (Lasix/Furosemide) and Inotropic agents (digitalis/digoxin) |
| What is a thoracentesis? | A procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest |
| What is the treatment for pleural effusion? | Treat the underlying cause, possible thoracentesis or chest tube, pleurodesis, O2 therapy, lung expansion therapy, mechanical ventilation |
| What is the most common cause of transudative pleural fluid? | Congestive heart failure |
| How will the deadspace ratio be effected by a pulmonary embolism? | Increased |
| How will ventilation and perfusion be affected by a pulmonary embolism? | Ventilation will be normal or increased, and perfusion will be decreased |
| What are the primary symptoms of pulmonary embolism? | Sudden onset dyspnea, increased HR, RR, pulmonary hypertension, severe chest pain (angina), anxiety, diaphoresis, crackles |
| What is a pulmonary infarction? | Embolus significantly disrupts blood flow causing lung tissue to die |
| What microorganism causes fungal disease? | Fungal spores |
| What is the primary antifungal drug? | Amphotericin B (Fungizone) |
| In what environment are the spores that cause coccidiodmycosis found? | Hot, dry regions |
| In what part of the country are the spores that cause ccoccidiodmycosis found? | Southwest USA |
| In what environment are the spores that cause blastomycosis found? | Areas high in organic matter: forest soil, decaying wood, animal manure, and abandoned buildings |
| In what part of the country are the spores that cause blastomycosis found? | South central and midwestern USA and Canada |
| In what environment are the spore that cause histoplasmosis found? | Found in soils rich in bird excrement |
| In what part of the country are the spores that cause histoplasmosis found? | River valleys; midwest USA |
| What is disseminated TB? | Bacilli escapes the lungs and travels to other parts of the body |
| What are the signs and symptoms of an uncontrolled TB infection? | Violent coughing episodes, greenish or bloody sputum, low grade fever, anorexia, weight loss, extreme fatigue, night sweats, and chest pain |
| What is the stain used to identify TB? | Acid Fast/ Ziehl-Neelsen Stain |
| What is the most effective drug used to treat TB? | Isoniazid (INH) |
| What are the anatomical alterations associated with a pneumothorax? | Lung collapse, atelectasis, asymmetrical chest wall movement, compression of the great veins and decreased cardiac venous return |
| What is an open pneumothorax? | Pleural space is in direct contact with the atmosphere; gas can move in and out |
| What is a closed pneumothorax? | Gas in the pleural space is not in direct contact with the atmosphere |
| What is a tension pneumothorax? | One-way valve-like action of ruptured parietal pleura; gas enters during inspiration but cannot leave during expiration (most serious) |
| What is a spontaneous pneumothorax? | Occurs suddenly without an underlying cause; can be secondary to pneumonia, TB, or COPD (blebs or bullae on lung surface pop); common in tall, thin persons ages 15-35 |
| What is the parietal pleura? | Outer layer |
| What is the visceral pleura? | Inner layer |
| What are the assessment findings of a tension pneumothorax? | Increased HR, RR, and BP, hypoxemia, pain, anxiety, cyanosis, hyperresonant percussion note over pneumothorax, diminished BS, tracheal shift, displaced heart sounds |
| What is the treatment of a pneumothorax with <15%-20% lung collapse? | Bed rest or limited physical activity; reabsorption of gas usually occurs within 30 days |
| What is the treatment of a pneumothorax with >20% lung collapse? | Chest tube to evacuate air |
| What is Myasthenia Gravis? | Chronic disorder of the neuromuscular junction that interferes with the chemical transmission of Ach between the axon terminal and the receptor site of voluntary muscles. Characterized by fatigue and weakness that improves with rest. |
| What happens to muscle strength after a period of rest in patients with Myastenia Gravis? | A dramatic improvement in muscle strength that typically lasts 10 minutes |
| Who is Myasthenia Gravis most common in (age/sex)? | Young women age 15-35 and older men age 40-70 |
| What is the clinical presentation of a patient with Myasthenia Gravis? | RR varies by degree of muscle paralysis, apnea (in severe cases), chest assessment: diminished BS, rhonchi, and crackles |
| What is Guillan Barre? | Causes inflammation and deterioration of the peripheral nervous system; elevated levels of IgM are present. Lymphocytes and macrophages appear to attack and strip off the myelin sheath and the peripheral nervous system, onset 1-4 weeks after fever |
| What are the anatomical alterations found in the lungs of a patient with Guillan Barre? | RR varies by severity, apnea in severe cases, crackles and rhonchi, diminished BS, mucus accumulation, airway obstruction, alveolar consolidation, and atelectasis |
| What happens to the nerves in a patient with Guillan Barre? | Lymphocytes and macrophages appear to attack and strip off the myelin sheath of the peripheral nerves (demyelination) |
| What is the clinical presentation of a patient with Guillan Barre? | Symmetrical muscle weakness, pain, numbness, muscle paralysis spreads upward, patient often drools, has difficulty chewing, swallowing, and speaking, respiratory muscle paralysis |
| How is Guillan Barre diagnosed? | Clinical history (sudden paralysis), CSF findings, EMG findings, CXR, and nerve conduction studies |
| How is the protein level in the CSF affected in Guillan Barre patients? | Increased |
| What breath sounds would be heard in a patient with Guillan Barre? | Diminished BS, crackles, and rhonchi |
| How are the lung volumes and capacities affected in Guillan Barre patients? | Decreased |
| What are the indicators of impending ventilatory failure in Myasthenia Gravis and Guillan Barre? | VC<20mL/kg, NIF<-25cmH2O (-80cmH2O is normal), pH<7.35 or PaCO2>45mmHg = mechanical ventilation |
| What is obstructive sleep apnea? | Blockage of ventilation due to upper airway obstruction. No airflow despite chest and abdomen movement |
| What is central sleep apnea? | Occurs when respiratory centers of the medulla fail to send signals to respiratory muscles |
| What are the most common symptoms of obstructive sleep apnea? | Snoring, periods or apnea, insomnia, abrupt awakenings with SOB, hypersomnia |
| What is the most common treatment of obstructive sleep apnea and what does it prevent? | CPAP, prevent airway collapse |
| How do age and water temperature affect the chance of survival in drowning? | The younger the age, and the colder the water, the greater the chance of survival |
| What are the breath sounds found in a wet drowning victim? | Crackles and rhonchi |
Created by:
ashconrad417
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