CBABE exam review

Anatomical alterations of the lungs associated with chronic bronchitis

• Chronic inflammation and thickening of the wall of the peripheral airways

• Excessive mucous production and accumulation

• Partial or total mucous plugging of the airways

• Smooth muscle constriction of bronchial airways (bronchospasm) – a variable finding

• Air trapping and hyperinflation of alveoli – may occur in late stages

anatomical alterations of the lungs associated with emphysema

·      Permanent enlargement and destruction of the air spaces distal to the terminal bronchioles

·      Destruction of alveolar-capillary membrane

·      Weakening of the distal airways, primarily the respiratory bronchioles

·      Air trapping and hyperinflation

anatomical alterations of the lungs associated with asthma

·      Smooth muscle constriction of bronchial airways (bronchospasm)

·      Excessive production of thick, whitish bronchial secretions

·      Mucous plugging

·      Hyperinflation of alveoli (air trapping)

·      In severe cases, atelectasis caused by mucous plugging

·      Bronchial wall inflammation leading to fibrosis (in severe cases, caused by remodeling)

anatomical alterations of the lung associated with cystic fibrosis 

·      Excessive production and accumulation of thick, tenacious mucus in the tracheobronchial tree

·      Partial bronchial obstruction (mucus plugging)

·      Hyperinflation of alveoli

·      Total bronchial obstruction (mucus plugging)

Atelectasis

anatomical alterations of the lungs associated with bronchiectasis

·      Chronic dilation and distortion of bronchial airways

o   From obstructive COPD

·      Excessive production of often foul-smelling sputum

·      Bronchospasm

·      Hyperinflation of alveoli (air trapping)

o   Leads to atelectasis

·      Atelectasis

·      Consolidation and parenchymal fibrosis

·      Hemoptysis secondary to bronchial arterial erosion

Fibrotic changes

Clinical manifestations for chronic bronchitis

o   Excessive bronchial secretions

o   Bronchospasm

o   Distal airway and alveolar weakening

clinical manifestations for emphysema

o   Excessive bronchial secretions

o   Bronchospasm

o   Distal airway and alveolar weakening

clinical manifestations for asthma

o   Bronchospasm

o   Excessive bronchial secretions

clinical manifestations for bronchiectasis

o   Excessive bronchial secretions

o   Bronchospasm

o   Consolidation

o   Increased alveolar-capillary membrane thickness

clinical manifestation for cystic fibrosis

·      Cardiopulmonary clinical

o   Atelectasis

o   Bronchospasm

o   Excessive bronchial secretions

·      Nonrespiratory clinical

o   Distal intestinal obstruction syndrome (DIOS)

o   Malnutrition and poor body development

o   Deficiencies of vitamins A,D,E, and K

o   Nasal polyps and sinusitis

§  20%

o   Infertility (males)

§  99%

what would you expect to see in PFT’s for chronic bronchitis and emphysema

·      FVC, FEVt, FEV1/FVC, FEF 25%-75%, FEF 50%, FEF 200-1200, PEFR, MVV

• Decreased

·      VT, RV, TLC, RV/TLC

• Normal or increased

·      RV, ERV, IC

•   Normal or decreased

·      VC

• Decreased

·      FRC

• increased

what would you expect to see on a ABG for chronic bronchitis and emphysema

·      Mild to moderate stages

o   pH increased, PaCO2 decreased, HCO3 decreased, PaO2 decreased, SaO2/SpO2 decreased

·             -  severe stages

o   pH normal, PaCO2 increased, HCO3 increased, PaO2 decreased, SaO2/SpO2 decreased

what would you expect to see on CXR for chronic bronchitis

o   Lungs may be clear if only large bronchi are affected

o   Occasionally

•  Translucent

•  Depressed or flattened diaphragms

o   Common

• Cor pulmonale

what would you expect to see on CXR for emphysema

·       

o   Common

§  Translucent

§  Depressed or flattened diaphragms

§  Long and narrow heart

§  Increased retrosternal air space

o   Occasionally

§  Cor pulmonale

§  Emphysematous bullae

lab work for chronic bronchitis

·      Sputum examination (culture)

•             Streptococcus pneumoniae

• Haemophilus influenzae

• Moraxella catarrhalis

·      Electrolytes (abnormal)

o   Early and late stages:

§  Hypochloremia (Cl-)

·      When chronic ventilatory failure is present

§  Hypernatremia (Na+)

·      Hematocrit and hemoglobin

o   Polycythemia common during the early and late stage

lab work for emphysema

§  Hematocrit and hemoglobin

·      Normal – mild to moderate stage

·      Elevated – late stage

§  Electrolytes (abnormal)

·      Late stage:

o   Hypochloremia (Cl-)

§  When chronic ventilatory failure is present

o   Hypernatremia (Na+)

§  Sputum examination (culture)

·      Normal