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82 Cards in this Set

  • Front
  • Back
There are two groups of pulmonary pathology, what are they?

Which is more common?
1. Obstructive Lung disease
2. Restrictive lung dysfunction

Obstructive: 4th leading cause of death in US
What is obstructive lung disease caused by?
Increased resistance to airflow inside the lumen and in the wall of the airway.
What does COPD stand for?

The term COPD is used in conjunction w/ what?
Chronic Obstructive Pulmonary Disease

Emphysema and/or chronic bronchitis. Childhood asthma can make COPD worse in adults.
What are the radiographic findings for someone with COPD? (3)
1. Hyperinflated lungs: obstruction to flow, trapped air.
2. Flattened diaphragms: changes the shape of the chest
3. Enlarged right ventricles: as a result of increased pulmonary pressure. Right side has to work harder to pump blood to lungs.
What is the clinical definition for chronic bronchitis?
A pt who has a cough producing sputum for at least three months for 2 consecutive years.
What are some characteristics of chronic bronchitis? (5)
1. Excessive mucous production.
2. Increase in size of tracheobronchial mucous glands
3. Hyperplasia of goblet cells
4. Decreased number of cilia
5. Bronchiolar narrowing
What causes chronic bronchitis?
Long-term irritation of the traceobronchial tree. 9/10 directly related to smoking.
What would you expect to find during an assessment of a pt w/ chronic bronchitis? (8)
1. Stocky and dusty
2. Uses access mm?
3. Wheezing
4. Intercostal retraction
5. Polycythemia - increased RBCs
6. Edema in extremities
7. Neck vein distention
8. Lots of secretions
Would the following be increased or decreased?
-Vital capacity
-Forced expiratory volume
-Residual capacity
-Residual volume
-VC decreased
-Forced expiratory volume decreased
-Residual capacity and volume increases
What are the three types of emphysema?
1. Centrilobular
2. Panlobular
3. Alpha-1 Antitryspin Deficiency (Panacinar)
What is the pathology of centrilobular emphysema?
Destruction of the respiratory BRONCHIOLE. Central part of lobule and peripheral alveolar ducts are damaged.
What are some signs/symptoms of centrilobular emphysema? (3)
Edema, inflammation, thickened bronchiolar walls.
Where in the lung does centrilobular emphysema start?
Starts in apex of upper lobe, but decends as the disease progresses.
Who gets centrilobular emphysema? (3)
Mostly men, smokers, common w/ chronic bronchitis.
What is the pathology of panlobular emphysema?
Destructive of the alveoli. Distention and destruction of the whole lobule, including the alveoli. Airway obstruction due to loss of lung elastic recoil.
What is a secondary complication of panlobular emphysema?
The bronchiole are left unsupported and prone for collapse w/ exhalation.
Where in the lung is panlobular emphysema most likely to occur?
Lower lobes.
How does someone get Alpha-1 deficiency emphysema?
Primarily linked to inherited deficiency of the enzyme alpha - antititrypsin.
Where in the lungs does Alpha-1 usually start?

At what age?
Lower lobes, but can originate anywhere.

Manifests about age 40.
Name four physical appearance characteristics you would expect to see with a patient with emphysema.
1. Thin, increase AP chest diameter
2. Increased use of accessory muscles
3. Support UEs
4. Pursed lip breathing.
What are 3 symptoms you would see with an emphysema patient?
1. SOB
2. Increased use of accesory mm.
3. Decreased breath sounds on auscultation.
What would you expect to see on radiograph findings for a pt w/ emphysema?
May not see anything. May see a flattened diaphragm.
Increase or decrease w/ emphysema?
-Max voluntary ventilation
Increased: TLC and RV
Decreased: VC, FEV, max voluntary ventilation. All these reflect airway obstruction.
ABGs (arterial blood gases) in a pt w/ emphysema?
Mildly lowered O2 and slightly elevated CO2. Normal pH.
At the end stages of emphysema what happens?
Heart failure
COPD is categorized into Type A and Type B. What does each type stand for?
Type A: Emphysema
Type B: Bronchitis

In reality, most pts have both.
Type A or B COPD:
1. Dyspnea on exertion
2. Pink Puffer
3. "Blue Bloater"
4. Physical inactivity
5. Progresses to respiratory failure
6. Elastic recoil low
7. Polycythemia
8. Cyanosis
9. Fluid retention
10. Radiograph showing hyperinflation
11. Radiograph showing congested lung fields.
1. A
2. A
3. B
4. A
5. B
6. A
7. B
8. B
9. B
10. A
11. B
What is a V/Q issue that is associated with COPD?
Arterial pressure?
Ventilation/perfusion inequalities are inevitable, which leads to HYPOXEMIA.

Pulmonary arterial pressure frequently rises.
Asthma is characterized by...
Increased responsiveness (hypersensitive) of the trachea and bronchi to various stimuli which results in widespread narrowing of the airways.
What happens physiologically during an asthma attack?
The lumen of the airways is narrowed or occluded by smooth muscle spasms.

Mucosa becomes inflammed

Overproduction of viscous, tenacious mucus.
What is another name for asthma?
Twitchy lung
What are 4 symptoms of asthma?
1. Cough
2. Dyspnea
3. Wheezing
4. Chest tightness
What is the difference btwn extrinsic and intrinsic asthma?
Extrinsic has a history of being exposed to a specific allergen that triggers attack. i.e. pollens, inhalants, foods, meds, etc.

Intrinsic has no known allergen. Could be bacterial or viral infection, air pollution, emotions, laughter.
What are 7 things that happen during an asthma attack?
1. Coughing and wheezing
2. Extreme dyspnea
3. Use of accessory muscles
4. Sputum
5. Hyperinflated lungs
6. Increased pulse
7. Tachypnea
Increase or decrease?
Airway resistance
FEV reduced
VC reduced due to premature airway closure toward end of full expiration
Increased airway resistance
Arterial hypoxemia due to V/Q mismatch
Name 4 things PT's can do for asthma pts.
1. Exercise and conditioning
2. Increased tolerance to exercise
3. Control breathing
4. Improved chest and trunk mobility. i.e. young boys, balance musculature of pes excarvatum.
What would you expect to find anatomically with bronchiectasis?
-Abnormal DILATION of medium-sized bronchi and bronchioles.
-Usually LOCALIZED to few segments or entire lobe.
-UNILATERAL in basal segements of LOWER lobes.
What is commonly a precurser for bronchiectasis?
Generally associated w/ a previous, chronic necrotizing infection. Repeat infections/pneumonia.
What do the airways of someone w/ bronchiectasis look like?
Mucosa is edematous and ulcerated. Destruction of elastic and muscular structures of airways lends to dilation and fibrosis.
What is present in the lumen of pt w/ bronchiectasis?

What happens to the epithelium?
Pus is present in the lumen

Ciliated epithelium replaced w/ non-ciliated, mucus-secreting cells
What does the surrounding lung tissue look like in a pt w/ bronchiectasis?
Often shows fibrosis and old inflammatory changes.
Name four clinical presentations associated with bronchiectasis.
1. Physically emaciated
2. Clubbing of the fingers
3. Chronic cough, thick sputum
4. Limited change on pulmonary function tests
Name 4 interventions a PT could use w/ a bronchiectasis pt.
1. Percussion
2. Postural drainage
3. Vibration
4. Forced expiratory technique.

Bottom line: Increased secretions and increased mucous. GET IT OUT!
How does someone get cystic fibrosis?

Who is most likely to get it?
Automsomal-recessive gene that is genetically inerited.

Caucasian children. Have a 25 year life expectancy.
Cystic Fibrosis is characterized by what? Where is the dysfunction?
Extremely thick, viscous secretions (except sweat and saliva).

Dysfunction of the exocrine glands
Name 5 ways that cystic fibrosis can be diagnosed.
1. Positive famiily history
2. Obstructive pulmonary disease
3. Recurrent pulmonary infection
4. Intestinal malabsorption and poor growth
5. Positive sweat chloride test
What two organs are usually involved with cystic fibrosis?
1. Lungs
2. Pancreas
Describe the following associated with cystic fibrosis.
1. Secretions
2. Mucus-secreting glands
3. Mucociliary transport
4. Lung inflation
5. Lung parenchyma
6. Infections
7. Airway in general
1. Secretions are viscous
2. Hyperplasia and hypertrophy of mucus-secreting glands
3. Impaired mucociliary transport
4. Hyperinflated lungs
5. Fibrotic changes in lung parenchyma
6. Recurrent infections
7. Airway obstruction
What is the primary cause of death in persons with cystic fibrosis?

Therefore, what is the treatment focused on? What can PT's do?
Respriatory involvement.

Secretion clearance/airway clearance. Postural drainage, percussion, vibration, PEP device, flutter, acapella, generalized mobility/exercise.
Assisted cough techniques, i.e. forced-expiratory techniques.
Ventilatory muscle trainers.
Copious mucous production in cystic fibrosis is due to 4 things...
1. Frequent infections
2. Bronchiectasis
3. Bronchitis
4. Pneumonia
What are the 6 conditions/pathologies associated with Obstructive Lung Disease?
2. Emphyesema
3. Chronic bronchitis
4. Asthma
5. Bronchiectasis
6. Cystic Fibrosis
In restrictive lung disease, what is restricted?
Inspiratory capacity, due to lungs that are prevented from expanding fully. Volume of lungs moved in/out of lung is reduced. Abnormal reduction in pulmonary ventilation.
Increase or decrease?
Inspiratory capacity
VC, TLC, IC are all decreased while RV remains the same or slightly reduced
How is chest/lung wall compliance affected by restrictive lung dysfunction?
One or both are REDUCED.
What does a decrease in lung compliance indicate?
That the lungs are becoming stiffer.
What happens to the lung volumes with restrictive lung disease?
Eventually, they are all decreased, and there is an increased work of breathing.
What happens to the work of breathing?

It's increased because it takes an increased amt. of pressure for the same volume of air to expand the lungs.

RR is also increased and inspiratory muscles have to work harder.
What is the normal amout of O2 used during resting respiration? With restrictive disease?
At rest = 5%
Restrictive disease = 24%
What are 8 signs associated with restrictive disease?
1. Tachypnea
2. Hypoxemia
3. Decreased breath sounds
4. Decreased lung volume and capacity
5. Decreased diffusing capacity
6. Cor Pulmonale - right sided heart failure
7. Decreased chest wall expansion
8. Cyanosis, clubbing
What are some symptoms of restrictive disease?
1. Dyspnea
2. Cough - irritating, dry, non-productive
3. Wasted, emaciated appearance - cachetic
What are 5 pulmonary causes of restrictive lung dysfunction?
1. Idiopathic pulmonary fibrosis
2. Adult Respiratory Distress Syndrome (ARDS)
3. Pleural effusions
4. Pneumonia
5. Atelectasis
What is idiopathic pulmonary fibrosis?
Destruction of the respiratory membrane after an inflammatory phase, in which the alveoli become scarred with collagen during the fibrosis phase. Thickened alveolar walls resulting in patchy focal lesions.
What are 6 symptoms associated with pulmonary fibrosis?
1. fatigue
2. SOB w/ exertion
3. Chronic unproductive cough
4. Ausultation - sharply crackling rales
5. Chest expansion limited
6. Clubbing of digits.
What are the treatment options for Pulmonary fibrosis?
1. Corticosteriods
2. Smoking cessation
3. O2
4. Nutrition
5. Infection prevention
What is ARDS stand for?
Adult Respiratory Distress Syndrome.
What is ARDS?
Caused by an acute lung injury and characterized by severe hypoxemia and increased permeability of the alveolar capillary membrane. Get atelectasis due to edema.
How does someone get ARDS?
Trauma, aspiration, drugs, inhaled toxins, shock, massive blood transfusion, metabolic, pneumonia
Pleural effusions are what?
Accumulation of fluid within the pleural space.
How is pleural effusion caused? (6)
1. CHF
2. Left ventricular failure
3. Cirrhosis
4. Kidney disease
5. Pulmonary emboli
6. Atelectasis
What is the pathophysiology of Pulmonary effusion?

How do you treat it?
Change in pressure gradient of fluids.

Find underlying cause and treat it.
What is the pathophysiology of pneumonia?
An inflammatory process of the lung parenchyma.
What is the most common agent involved in pneumonia?
Streptococcus pneumonia or nosicomial = an infection you get in the hospital
Signs and symptoms of pneumonia?


Consequences of VQ?


VQ mismatch = hypoxemia
What is atelectasis?

Results from?

Partial or total collapse of hte alveoli, lung segments or lobes.

Results from hypoventilation or ineffective pulmonary secretion clearance. May also be due to compression of lung parenchyma, diaphragmatic restriction from weakness or paralysis, inactivity, post-obstructive pneumonia, presence of foreign body, upper abdominal or thoracic incisional pain.

Results from hypoxemia from v/q mismatch
What are the two cariovascular causes of restrictive disease?
1. Pulmonary edema
2. Pulmonary emboli
What is pulmonary edema?
Increase in the amt. of fluid within the lung.

Increase in pulmonary capillary hydrostatic pressure

Increased alveolar capillary membrane permeability.
What are the two kinds of pulmonary edema?
Cardiogenic and non-cardiogenic
What is cardiogenic pulmonary edema due to?
Imbalance of pressures within pulmonary vessels that result in backflow of blood from the heart.

Back flow increases the mvmt of fluid from pulmonary capillaries to alveolar spaces.
What is non-cardiogenic pulmonary edema?
Alterations in capillary permeability and intrapleural pressure from airway obstructions or lymph vessel obstruction.
What are pulmonary emboli?
Blood clots or thrombi that travel from the veins to the right side of the heart and into the pulmonary circulation, lodging into the branches of the pulmonary artery.
What are 3 risk factors for developing pulmonary emboli?
1. Immobility
2. Prolonged travel
3. Fracture stabilization
What is the pathophysiology of a pulmonary emboli?

Occlusion of pulmonary artery causes edema hemorrhage into the surrounding lung parenchyma.

Lack of blood flow causes necrosis of the alveolar walls and an inflammatory response occurs.

Ventilation, no perfusion.