Chapter 12: respiratory Flashcards
- ______: this condition is characterized by chronically thickened and inflamed mucosa of the sinuses, and persistent fluid accumulation. The condition may arise as a result of: ______, ______, and _____ as a result of a severely deviated nasal septum or from the presence of nasal polyps.
- ______: due to rhinitis and bacterial infection. due to common cold; can be bacterial or viral
- ______: chronic inflammation of the larynx, most commonly seen in heavy cigarette smokers
acute upper respiratory infections chronic sinusitis inflamed sinus chronic inhalation of irritant (e.g., cigarette smoke, industrial, industrial exposure) nasal obstruction acute sinusitis chronic laryngitis
- a laryngo-tracheobronchitis in young children (______), with symptoms of ______ (seal barking noise), ______ cough, and hoarseness that result from varying degrees of ______ obstruction. croup is a complication of an upper respiratory infection and is marked by edema of the ______. croup is usually created by a virus infection, most often a ______ virus
- treatment: ______ air, steroids, ______ and endotracheal intubation (ET) may be needed
croup 6 months to 6 years stridor brass laryngeal larynx para influenza cool mist humidified epinephrine
- inflammation of the epiglottis is a serious condition most commonly caused by ______ type B (bacteria). occurring in young children (6 years and above), the infection may be a life-threatening emergency because swelling of the acutely inflamed the epiglottis can obstruct airflow.
- ______, ______ epiglottis, ______ ( a loud wheezing sound on inspiration) occurs, difficulty breathing and swallowing and the onset of ______ may indicate airway obstruction so severe as to require tracheostomy
- treatment: ______
epiglottitis haemophilus influenzae fever cherry red inspiratory stridor cyanosis antibiotic
- infection of the lung parenchyma: occurs when normal immune defenses are impaired. clinical features include ______ and ______, productive cough with ______ or rusty ______, tachypnea with ______, decrease breathing sounds, dullness to percussion, and evaluated ______ count.
- diagnosis is made by chest x-ray, ______, and blood cultures
- three main types from chest x-ray: ______ pneumonia, ______ and ______ pneumonia
pneumonia fever chills yellow-green (pus) bloody sputum pleuritic chest pain WBC sputum gram stain and culture lobar bronchopneumonia interstitial
- characterization by consolidation of an entire lobe of the lung. usually bacterial; most common causes are ______ (95%) and ______
- classis gross phases of lobar pneumonia A) ______: due to congested vessels and edema. B) ______: due to exudate, neutrophils, and hemorrhage filling the alveolar air spaces, giving the normally spongy lung a solid consistency. C) ______: due to degradation of red cells and accumulation of fibrin within the exudate. D) ______: most patients recover their normal lung structures and functions
lobar pneumonia streptococcus pneumoniae klebsiella pneumonia congestion red hepatization gray hepatization resolution
mostly bacterial infection and characterized by scattered patchy appearance centered around bronchioles
-can still breathe normally
bronchopneumonia
characterized by diffuse interstitial infiltrates. patients develop fever, dry cough, and ______, but there are no signs of ______, hence the term “atypical” pneumonia. caused by ______ or viruses (______). ______ (fungus) HIV patients
interstitial pneumonia dyspnea consolidation (structural change) bacteria influenza virus pneumocystis carinii
seen in patients at risk for aspiration in hospitals. Example: pseudomonas aeruginosa
nosocomial pneumonia
pseudomonas can be identified by its sweet, ______ odor and ______ pigment. the pigment known as, ______, is facultative, and is associated with more severe and more resistant illness
grape-like
blue-green
pyocyanin
- a highly communicable serious pulmonary infection, caused by an usual ______ that has spread rapidly though several countries since it was first identified in late 2002
- there are no effective ______that can influence the course of the disease
- the virus was probably an animal virus that ______ and was able to infect humans
- can be transmitted from person torsion through ______, ______, by hands, towels, and other items contaminated with the virus
SARS coronavirus antiviral drugs mutated coughing sneezing
- it is a special type of ______ disease caused by ______ (MTB)
- because the tubercle bacillus has a capsule composed of waxes and fatty substances, it is more ______ to destruction than others. only stained by ______ staining and known ______
- acquired from organisms inhaled in ______ droplets. organisms lodge within ______. sometimes the ling infection spreads to other parts such as kidneys, bones, uterus, fallopian tubes, or other sites
- two kinds: ______ and ______ infection
tuberculosis bacterial mycobacterium tuberculosis resistant acid fast acid fast rods airborne pulmonary alveoli primary secondary
an acid fast stain is used to diagnose the presence of ______ in tissue and cytologic preparations. Note the thin ______ organisms
mycobacteria
red rod-like
primary tuberculosis: pathogenesis
- previously ______ exposed to MTB and accruing the infection for the ______
- localized ______ inflammation via ______, ______, and ______, which will form granuloma
- granuloma becomes ______ and turns into ______ complex. this complex contains ______ (dead lung tissue) and may spread to other organs
- clinical symptoms of primary TB: ______ streaked purulent sputum with a chronic cough, loss of ______, and ______ at night with night ______
never first time lung macrophages neutrophils lymphocytes calcified Ghon caseous necrosis blood weight fever sweats
secondary tuberculosis: pathogenesis
- seen mostly in adults as a reactivation of ______ infection (or reinfection), particularly when health status declines. the patient maybe a previously ______ individual or had the infection and recovered. the immune system its compromised due to another infection, drugs or the immune compromise, leading to the breach in the ______ around the ______ in the lungs or bones. the ______ inflammation is much more widespread. typically, the upper lung lobes are most affected, and ______ can occur
- ______: when resistance to infection is particularly poor, a “miliary” pattern of spread can occur in which there are a myriad of small millet seed (1-3 mm) size granulomas, either in ling or in other organs
previous asymptomatic immunological barricade dormant bacilli granulomatous cavitation miliary
tuberculous osteomyelitis (bone infection) involves mainly the thoracic and lumbar vertebrae (known as Pott’s disease) followed by knee and hip. there is extensive necrosis and bony destruction and extension to soft tissues, including “cold” abscess
skeletal tuberculosis
tuberculosis diagnosis:
- ______: a positive test reveals recent infection
- chest x-ray: when the ______ is large enough to be detected
- ______ culture
- the healed granulomas, however, may contain small numbers of viable organisms, and the infection may become reactivated
- treatment: ______
- incase the bacteria is resistant against one antibiotic. example: INH, Rifampin, & ethambutol or streptomycin
skin test (mantoux)
granuloma
sputum
multiple antibiotics (2-3 types)
- ______ is a disorder characterized by the production of abnormally viscid secretions by ______ and ______, such as those is pancreas and respiratory tract
- pathogenesis: the most common mutation is a specific gene ______ in the codon for ______ at position 508 in the amino acid sequence. this results in a defect in a transmembrane regulator protein known as the ______. mutation causes a failure of opening of the ______ which prevents the release of sodium and water to ______ mucus resulting in thick viscous mucus.
- viscous mucus may cause ______ of the following systems
- bronchi-abnormally viscid mucus cannot be cleared from the ______
- intestine-causing ______ in newborn babies
- pancreas-causing deficiency of the ______, resulting in ______
cystic fibrosis exocrine glands mucus-secreting glands deletion phenylalanine cystic fibrosis transmembrane conductive regulator. (CFTR) chloride channels liquefy obstruction lungs meconium ileus pancreatic enzymes malabsorption
frequent infections with cough and wheeze as the child gets older
- almost all men with cystic fibrosis are ______; females may be ______
- tests include:
- sweat ______ test
- ______ testing
- ______ fat testing
- ______ and small bowel series
- ______ tests
infertile sub fertile chloride DNA fecal upper GI pancreatic
- ______ and ______ occur together so frequently that they are usually considered a single entity, designated ______. Two types: smoking and genetic
- pathogenesis (smoking): free ______ radicals and toxic gas inactive the ______ (AT), which acts as a proteolytic inhibitor and ______ inflammatory response which ultimately cause damage of the lung via protease from lysosome
- pathogenesis (genetic): due to the deficiency of a1-anti-trypsin (AT) produced by ______. AT-(A1) prevents the lung damage from the ______ (lysosomal)
emphysema chronic bronchitis COPD (chronic obstructive pulmonary disease) oxygen a1-anti-trypsin increase liver proteolytic enzymes
is most frequent and is usually symptomatic and associated with ______. it is characterized by the destruction of the cluster of ______ near the end of the bronchiolar tree in the central part of the pulmonary lobule.
-it is most severe in the ______ lobes and the superior segments of the ______ lobes
centrilobular emphysema cigarette smoking terminal bronchioles upper lower
the ______ (small alveoli with ducts) is uniformly involved, with destruction of the ______ from the center to the periphery of the acinus. tend to be on the ______ lobes
panacinar emphysema
acinus
alveolar septa
this condition, previously known as “paraseptal emphysema,” is characterized by destruction of ______ and resulting ______ in only one or, at most, a few locations. the remainder of the lungs is ______. May cause ______
localized emphysema alveoli emphysema normal pneumothorax
emphysema physical exam -\_\_\_\_\_\_ chest -prolonged \_\_\_\_\_\_ and \_\_\_\_\_\_ rest phase -thin -\_\_\_\_\_\_ skin due to extra \_\_\_\_\_\_ production -\_\_\_\_\_\_ of accessory muscles -\_\_\_\_\_\_
barrel expiration pink red cell production hypertrophy "pink puffers"
- an inflammation of the tracheobronchial mucosa which leads to the hypertrophy of ______
- ______: common and self-limiting
- ______: secondary to chronic irritation by smoking or atmospheric pollution
- coughing lasting at least ______ over minimum ______
bronchitis mucinous glands acute bronchitis chronic bronchitis 3 months two years
chronic bronchitis clinical symptoms -often \_\_\_\_\_\_ -\_\_\_\_\_\_ present on auscultation -Jugular vein \_\_\_\_\_\_ -ankle \_\_\_\_\_\_ -\_\_\_\_\_\_ -\_\_\_\_\_\_
overweight rhonchi distention edema "blue bloater" cur pulmonale
- all bronchial walls are weakened by inflammation and dilate. permanent damage
- distended bronchi retain secretions
- chronic ______
- production of large amounts of ______
- cystic fibrosis
- ______: associated with sinusitis, infertility and situs inversus (heart is on the right side)
bronchiectasis
cough
purulent sputum
kartagener’s syndrome
this is swelling and mucus buildup in the bronchioles, the ______ air passages in the lungs, usually due to a ______ infection. it normally occurs in children under the age of 2, with a peak age of 3 to 6 months and is usually associated with RSV. it begins as a ______ infection, within 2 to 3 days, the child develops more breathing problems including ______, ______, and a cough
bronchiolitis smallest viral mild upper respiratory wheezing crackles
a very common virus that leads to mild, cold-like symptoms in adults and older healthy children. it can be more serious in young babies, especially to those in certain high-risk groups. RSV is the most common germ that causes ______ and ______ infections in infants and young children. Most infants have had this infection by age ______. outbreaks of RSV infections most often begin in the fall and run into the spring
RSV- respiratory syncytial virus
lung
airway
2
pulmonary embolism pathophysiology -obstruction of a \_\_\_\_\_\_ -emboli may be of air, \_\_\_\_\_\_, fat, or \_\_\_\_\_\_ -\_\_\_\_\_\_ may also cause an embolus risk factors -recent surgery, \_\_\_\_\_\_ fractures, pregnancy -\_\_\_\_\_\_ use, \_\_\_\_\_\_ use focused history and physical exam -presence of risk factors -sudden onset of severe \_\_\_\_\_\_ and pain -cough, often \_\_\_\_\_\_ physical exam -signs of \_\_\_\_\_\_ failure, including \_\_\_\_\_\_ with hypotension -warm, swollen \_\_\_\_\_\_ management -maintain the \_\_\_\_\_\_ -high-flow, high-concentration \_\_\_\_\_\_ or assist ventilations as indicated -\_\_\_\_\_\_ may be indicated -establish \_\_\_\_\_\_ access -monitor vital signs closely -TPA or surgery
pulmonary artery thrombus amniotic fluid foreign bodies long-bone oral tobacco dyspnea blood-tinged heart JVD extremities airway oxygen intubation IV
-bronchial ______ is an increased irritability of the bronchial tree with paroxysmal narrowing of the airways, which may cause reverse either spontaneously or after treatment with ______. ______ and wheezing are common clinical symptoms
asthma
bronchodilators
dyspnea
common form of asthma and is usually seen in children. one third to of all patients with asthma have known or suspected to allergens such as pollens, animal hair, fur and dust contaminated with mites. allergic asthma correlates strongly with skin-test reactivity. ______ levels are raised and an immediate type ______ hypersensitivity
allergic asthma (Extrinsic)
IgE
1
common precipitating factors include childhood asthma is a ______ respiratory tract infection children under 2 years of age, ______ is the usual agent; in children, rhinovirus, influenza and para influenza are common. IgE levels are ______
infectious asthma (intrinsic)
viral
RSV
normal
Exercise can cause
______ in more than half of all asthmatics. The more rapid the ventilation (severity of exercise) and the colder and drier the air breathed, the more likely is an attack of asthma. The condition may be the consequence of mediator release or vascular congestion in the bronchi secondary to rewarming of the airways after the exertion.
exercise-induced asthma
bronchospasms
animal handlers, bakers and workers exposed to wood and vegetable dusts, metal salts, pharmaceutical agents, Brown lung in cotton fiber workers and industrial chemicals.
occupational asthma
Psychological stress can aggravate or precipitate an attack of bronchospasm in as many as half of all asthmatics
emotional factors of asthma
high pressure in the pulmonary circuit (mean arterial pressure > ______ mmHg; normal is 10mmHg). characterized by ______ in the ______ and smooth muscle ______ of pulmonary arteries. patient may develop right ventricular hypertrophy with eventual ______.
Two types:
______- in young adults. idiopathic
______- due to hypoxemia (COPD or interstitial lung disease) & may result in pulmonary embolism
pulmonary hypertension 25 plaque pulmonary trunk hypertrophy cor pulmonale primary pulmonary hypertension secondary pulmonary hypertension
a multi system disease of unknown etiology characterized by the presence of giant cell granulatomatous inflammatory reaction primarily affecting the ______ and ______
-maximum incidence is in people between 30 to 40 years of old, affecting ______ more than males. the pathogenesis is unknown but thought to involve type IV hypersensitivity reaction. no ______ like TB. patients with lung involvement present with slowly progressive ______ and cough are found to have lung shadowing on chest radiograph. High ______ due to high ACE (______)
Treatment: ______
-blood can come out of mouth when doing CPR on someone with sarcoidosis
sarcoidosis lymph nodes lungs black females central necrosis dyspnea BP angiotensin-converting enzyme steroids
pulmonary fibrosis
-______: lung injury produced by inhalation of injurious dust or other particulate material
the best known are
-______: a type of progressive nodular pulmonary fibrosis caused by inhalation of rock dust
-______: a diffuse pulmonary fibrosis caused by inhalation of asbestos fibers
-inhalation of ______ (coal-workers’ lung disease), cotton fibers, certain types of fungus spores, and many other substances attending certain occupations also may cause pulmonary fibrosis
pneumoconiosis
silicosis
asbestosis
coal dust
features of asbestosis:
there are two main forms of asbestos
______: this is the most common form; fibers persist in the lung for a limited time
______: fibers persist in the lung for many years, and they are the main cause of malignant mesothelioma
-the disease processes with an increasing restrictive defect associated with ______
-______ and ______ develop in the late stages
serpentine asbestos (including white asbestos)
amphibole asbestos (including blue and brown asbestos)
interstitial fibrosis
pulmonar hypertension
cor pulmonale
disturbances of ventilation
- ______
- ______
- respiratory failure
- loss of ______ control
- failure of ______ muscles
- ______ diseases
- ______ obstruction
suffocating drowning neural respiratory chest wall airway
different types of drowning -fresh water washes away \_\_\_\_\_\_-\_\_\_\_\_\_ -ventricular \_\_\_\_\_\_ usually occurs -salt water draws \_\_\_\_\_\_ from \_\_\_\_\_\_ and \_\_\_\_\_\_ occurs
surfactant alveoli collapse fibrillation fluids bloodstream pulmonary edema
pressure disorders -decompression illness -may occur with dives of \_\_\_\_\_\_ or more signs and symptoms -occur within \_\_\_\_\_\_ -\_\_\_\_\_\_ pain -fatigue, and CNS disturbances treatment: \_\_\_\_\_\_
33’
36 hours
joint/abdominal
hyperbaric chamber
respiratory distress syndrome
- neonatal respiratory distress syndrome (NRDS):
- pathogenesis: a) respiratory distress due to inadequate ______ levels. surfactant is responsible for decreasing ______ in the lung, preventing collapse of alveolar air sacs after expiration
- b) associated with ______ in neonates, maternal diabetics (insulin ______ surfactant production) and Caesarian section delivery due to lack of ______; steroids increase synthesis of ______
- clinical symptoms: increasing respiratory effort after birth, ______ with use of accessory muscles, and grunting. ______ with cyanosis and diffuse granular deposition on the lung (______) on X-ray
- treatment (NRDS): patients are on ______ which administered by continuous ______ airway pressure (CPAP) machine. simple manipulations of airway may relieve the temporary respiratory problems. Drug (______) treatment for surfactant production
surfactant surface tension prematurity decreases cortisol surfactant tachypnea hypoxemia ground glass appearance oxygen positive survanta
pathogenesis: mostly result of trauma or shock which causes damage to the ______ and edema formation in alveoli ad white out on chest x-ray.
- treatment: treat the ______ of trauma or shock, ventilation with ______ and other drugs
Acute respiratory distress syndrome (shock lung)
alveolar-capillary
underlying cause
positive end-expiratory pressure (PEEP)
