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ALU 201 > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

How are the lung inflated?

A

by the diphramg, with inhalation, chest muscles move, including the diaphragm. This causes a negative airway pressure that draws air in throughout the nose and mouth, inflating the lungs. In exhalation the chest wall muscles relaxes, the diaphgragm moves upwards and the air is released.

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2
Q

Which part of the lung exhanges the oxygen contained in the inhaled air from for CO2 from the RBC and which cells exchange CO2 from the Alveoli?

A
  1. Alveoli

2. RBC

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3
Q

CO2 combines with water in the tissues of the body to form what?

A

A weak acid, carbonic acid

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4
Q

What is the definition of pH balance in the human body

A

A measure of balances level of alkalinity or acidity. This is measured by the balance of acid and alkali in the body.

Level of pH must remain small

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5
Q

What is hyperventilation syndrome?

A

When there is a tiny change in body pH, its characterized by rapid breathing that causes excess CO2> cabonic acid.
Sxs include dizziness, numbness, lightheadnesses, and possibly tetany (muscle contaction) and convulsion`

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6
Q

Define what happens with O2 toxicity.

A

Happens while breathing high [O2] during artificial ventilation. This can result in excessive O2 bound to hemoglobin and dissolves in the blood that can damage the eyes, CNS, and lungs.

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7
Q

What is the most fundamental and most frequently preformed respiratory test?

A

Pulmonary function test- basic spirometry which measures forceful excellation in 6 sec.

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8
Q

What is:

  1. FVC
  2. FEV1
  3. FEV1/FVC ratio
A
  1. forced vital capacity (max volume of air exhaled)
  2. Forced expiratory volume in one second
  3. ratio of the two. >80% is considered normal
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9
Q

What can a spirometry reveal?

A
  1. airway obstruction ( FEV1/FVC <80%)
  2. Chest wall or lung restriction (FEV1/FEC >80%)
  3. Normal all results being >89% predicted
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10
Q

Give two examples of chest wall problems and their affect on the spirometry results

A
  1. paralysis of the chest muscles in traumatic quadriplegia
  2. Chest deformities (kyphoscoliosis) – restricts chest wall motion
    Both these condition reduce the FVC and have normal FEV1/FVC.
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11
Q

What are some other respiratory tests that are used, besides PFT

A

MVV (max voluntary ventilation)- measures air flow when pt breaths as hard and fast as possible.
FRC (functional residual capcity) amount of air in chest cavity after normal exhalation
IC (ispiratory capacity) volume of air measured from normal exhalation to as much can be taking in on a maximal inspiration effot.

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12
Q

T or F: All lung volume measurements on PFTS begin at end-exhalation and measure FRC.

A

TRUE

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13
Q

How can you measure pulmonary diffusing capacity?

A

Measured by CO2 capacity (DLCO)

  • measured the total alveola-capillary volume available for gas exchange.
  • Decreased by inflammatory diseases.
  • Reported as a percentage
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14
Q

What is the significance of clinical history when underwriting respiratory diseases?

A
  1. Sxs (SOB/Dyspnea) – most common
  2. Hx- since it’s a progressive disease
  3. medications taken: daily? Type- steroids?,
  4. hospital visits?
  5. Possibly occupational history- if a cofactor
  6. Duration of exposure
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15
Q

How can Respiratory illnesses be detected thorugh a physician examination?

A

Its difficult, and often goes missed.
Markers include: rales, rhonchi and crackles heards with stethoscope (when theres fluid). Sxs of wheezes and whistlings here are a sign of bronchi spasm or fluid. Absent breath sounds can be a sign of emphysema or thick chest walls.
Signs of clubbing is associated with pulmonary disorders, cardiac and others. Cuanosis (blue nails) is a sign of poor O2.
» You look for abN sounds, and sxs

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16
Q

Why can an CXR be misleading?

A

They can be normal even with hx of pulmonary disorder.
People who take deep breaths can cause hyper-inflated results.
- its good for loss of lung markings, or bullae/nodles/ progressed disease.
» its not goo to determine lung function, but lung abN

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17
Q

What are Ventilation and perfusion lung scans? (V/Q lung scans)

A

Studies that use radionucleotide-tagged elements injected into the blood or inhaled to evaluation pulmonary emboli.
- perfusions read as: low or no probably for blood clots.

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18
Q

What is the golden standard test for evalutating pulmonary emboli, aterial wall dissection, or abN aneurysms of major blood vessles? Why

A

CT angiograms because there are many causes for false +ve on a perfusion scan.
But they use dye that can be harmful to the kidneys.

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19
Q

What test is best used to define the natomy of the lung and mediastinum

A

CT

MRI –rarely used d/t motion artifact with respiration.

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20
Q

What is PET (positron emission tomography) and why is it used?

A

Attaches radionucleotides to molecures of glucose and injects them into the body.
Used for imaging function with metabolically active nodules or masses.
Uptake is measured as SUV (std uptake value).

-not a good test for people with high glucose in the blood

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21
Q

What is the most common way of obtaining visual assessment of the tracheobronchial tree and to acquire sampling from the lung?

A

Using fiberoptic bronchoscope

This can also be used to get biopsies

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22
Q

Define lung abscess

A

An infection resulting in a localized destruction of and accumulation of pus in lung tissue.

  • d/t bacteria, tuberculosis, or fungi
  • txed with abx… rarely sugery
  • concern may be underlying cause of abscess when u/w
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23
Q

Define AAT (Alpha-1-antitrypsin) deficiency

A

AAT is a protein that protects the tissues from destruction from naturally occurring proteolutic enzymes of the pancreas that normally digest proteibns in the duodenum but can gain access to the general blood streams- needs to be neutralized.
A deficiency of this protein is a genetically-dertermined condition (homozygous form) that predisposes an individual to severe destructive emphysema and liver disease

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24
Q

How can you treat AAT deficiency?

A

You cant treat it, but replacement therapy with IV infusions of antitrypsin can mitigate ongoing liver/lung damage.

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25
Q

What are some typical sxs of OSA?

A

Chronic fatigue,
Difficulty with concentration/ task persistence
Irritability
Depression
– obesisty is a common co-factor, along with HTN

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26
Q

What is the definition of sleep apnea?

A

Absence of airflow for at least 10 sec during sleep.

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27
Q

What definitions of

  1. Central apnea
  2. Obstructive apnea
  3. Apnea
  4. Apnea index (AI)
  5. Hypopnea
  6. Apnea-Hypopnea index (AHI)
  7. Respiratory disturbance index (RDI)
A
  1. Failure of the respitaroy drive causes apneic episodes without any diaphragmatic effort to breath
  2. Obstruction of the upper airway- caused by –ve pressure in the pharynx during inspitarion causes posterior pharyngeal wall to collapse onto the back of the tongue
  3. Absence of air flow for >10 sec
  4. Number of apnea episodes in one hour
  5. Partial apnea with physical evidence such as a drop in the pO2
  6. Number of apnea and hypopnea per hour
  7. Apneas plus hypopneas per hour
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28
Q

Name some examples of many co-morbid risk factors for OSA

A
  1. male gender
  2. older age
  3. snoring
  4. obesity
  5. nasal obstruction
  6. tonsillar or uvular hypertrophy
  7. jaw abN
  8. ETOH abuse
  9. Hypothyroidism
  10. COPD
  11. Acromegaly
  12. Use of tranquilizers
  13. Post menopause
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29
Q

When are central apneas much more of a concern?

A

When found on the initial polysomogram (PSG)

The more = the worst

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30
Q

Central apneas elicited by CPAP often necessitate use of what machine rather than CPAP?

A

Bilevel positive airway pressure (BiPAP)

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31
Q

When sleep apnea is suspected, a full PSG study should be done. What is monitored during this test?

A
  1. EEG
  2. EOG
  3. EKG
  4. Oximetry
  5. Measure of airflow at the nose and mouth
  6. Measure of inspiratory effot
  7. Monitoring of limb movement.
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32
Q

Normal sleep consists of what two phases?

A

1,. REM sleep (rapid eye movement)

2. non-rem sleep

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33
Q

Non-REM sleep is divided into three stages on the basis of EEG patterns ranging from lightl sleep (stage 1) to deep (stage 3). Describe these stages

A

1.normal study: brief stage 1 > non-rem sleep» deep sleep» REM for 1-4 hours. Stage 2: cycle of alternating REM and non-REM for the night. (dreams)
Stage 3: deep, restorative .
2. abnormal: Stage 3 is interrupted with buy apneas and hypopneas causing hypoxemia

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34
Q

What are the two major consequences of sleep apnea?

A
  1. sleep fragmentation

2. episodes hypoxia

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35
Q

What are the results of severe O2 desaturation and hypercapnia caused by increased sleep disruption?

A
  1. arrhythmias,
  2. blood pressure change
  3. LV dysfuntion
  4. Increase pulmonary artery pressure
  5. R ventricular overload
  6. Depression
  7. Cognitive impairment
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36
Q

What are the treatment options for OSA?

A
  1. CPAP- compliance varyies - this value is measurable. People with severe dx are more compliant
  2. Surgery, including UPPP, nasal septum, tonsillectomy. Success is about 50% with UPPP. Trachostomy is done as last resort- and is def. cure. F/U study is required.
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37
Q

What are the typical causes of death for those with OSA?

A

People with OSA had a 13% increase of sleep-related accdients. Which includes MVA, MI, TIA, CHF, cardiac arrhythmia .

Long term untx leads to LVH, pulmonary HTN, and R heart failure

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38
Q

What are the most common arrhythmias associated with OSA?

A

Bradycardia,
Prolonged asystole
Second degree AV block

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39
Q

What should an u/w consider when u/w OSA?

A

Severity of condition
Compliance
Secondary effects (HTN)

40
Q

Define Asthma

A

Clinical syndrome characterized by completely reversible airway obstruction at some point in the clinical hx.
The obstruction is secondary to spasm and excess mucus in the bronchial tree.

> sxs of wheezing and SOB
triggers by asthma: environmental factors, exercise.

41
Q

What is lung remodeling?

A

When asthma is untx’ed and evolves into COPD

Bronchospasm and wheezing are often manifested with COPD.

42
Q

Underwriting evaluation for asthma is by history. What is some important historical information to consider (4)

A
  1. frequency and severity of attacks
  2. hospitalizations
  3. treatment
  4. long term therapy with corticostedoids.
43
Q

What are some warning flags, that an underwritier should consider in regards to a pt asthma and sxs/tx

A
  1. not on appropriate tx
  2. take oral corticosteroids daily
  3. do not have medical facilities or physician
  4. has attacks that are severe and require hospitalizations
  5. have EVER required intubation with mechanical ventilation
44
Q

What is Status asthmaticus?

A

What is Status asthmaticus? Severe attack that does not respond to the usual measured

  • requires hospitalization
  • poor prognosis if recurrant
45
Q

T or F
Use of “bolus” steroid therapy, consisting of high-dose oral steroids for 5-10 days several times a year for Upper respiratory infections (URIS) is associated with increased morbidity/mortality risk

A

False. Its not

46
Q

T or F. Inhalled corticosteroids have the same significance of steroid drugs uses systematically

A

False.

There are no sig adverse effects from the use of inhaled corticosteroids.

47
Q

Is there more concern for increased mortality in childhood or adulthood asthma

A

Adulthood. Children tend to grow out of it- unless they have poor tx compliance.

48
Q

What is Atelectasis?

A

The collapse of a portion of lung tissues.
➢ radiological observation
➢ signs and sxs absence
➢ caused by obstruction of the airways – plugged with mucus, aspiration of foreign bodies or tumors.

49
Q

What are plate-like atelectasis

A
  • small patches of lung collapses
    • invariable associate with diminished excursions of diaphragm
  • less concerning
  • notes on CXR
  • resolves typically on its own
  • obesity is a co-morbid
50
Q

Define Blebs, bullae and cysts

A

Air-containing cavities in the lungs
- blebs- small , on lung surface, lil sig
- bullae- large, can become infected or rupture causing pneumothrox. IF no associate lung diease susually insig.
Non sxs and are usually incidentally found on CXR

51
Q

What is the definition of Bronchectasis?

A

Define as abN dilation of distal bronchus.
Sxs: cough, septum production, hemoptysis, and maybe SOB
Caused by prior lung infection that has destroyed the normal muscular and elastic tissues of the bronchial wall and the cilia lining.
In presence of lung disease prognosis is poor., usually have recurring infections exacerbations.
- administration of chronic abx therapy is done only in sig sever disease where mortality is high

52
Q

Define the following Chest deformities

  1. funnel chest
  2. pigeon test
  3. Kyphosis
  4. Scoliosis
  5. Kyphoscolisosi
A
  1. depression of the sternum – associated with systolic murmurs, but usually benign
  2. protrusion of the sternum
    » rarely associated with any serious problems.
  3. AbN forward bending of the spine
  4. Lateral curvature of the spine.
  5. Combination of the two above
    » If severe bends, can affect respiratory systems
53
Q

What is the international definition of COPD?

A

When a post-bronchodilator FEV1/FEVC ratio is less than 70%, the serverity is measured by the FEV1 % predicted: >80%, mild
50-80%, moderate
30-49% severe.
<30% very severe

54
Q

COPD is an encompassing term to include which kind of respiratory disorders?

A
  1. chronic bronchitis
  2. emphysema
  3. chronic asthma (with remodling)
  4. bronchiectasis.
55
Q

Which condition is a much grater concern for morbidity and mortality:
COPD with/without exacerbation?

A

With

56
Q

Define Bronchitis

A

Inflammation of the inner lining of the bronchial tree and is manifested by cough and septum production.
Acute: not concerning
Chronic: serious- defined by chronic cough and septum production for 3mo -2 yrs

57
Q

Define emphysema.

What is centrilobular emphysema

A

Destruction of alveoli,

> > emphysema asspciate with cigarette smoking that preferentially destroys alveoli in the lung aspices and is called centrilobular emphysema

58
Q

What is a good test to determine the severity of COPD?

A

Serial PFT with current FEV1, progress can be evaluated by the hx of PFT

59
Q

What is the definition of Cystic Fibrosis (CF)?

A

Genetically determined disease of the lungs and pancreas with initial manifestations at an early age.
» production of thick mucus and progressively deteriorating lung function
» Suspected in children with recurrent RI, and Fx.
Dx’ed with choride concentration in the sweat
Life expectancy to 40’s now with new tx.

60
Q

What is a honeycomb lung

A

Term for CXR that indicate end-stage chornic lung fibrosis of any cause- usually end-stage idiopathic pulmonary fibrosis.

61
Q

What is hypersensitivity lung disease?

A

Pulmonary reaction to organic dusts.
Sxs begin after exposure and consist of fever, chills, dyspnea, dry cough and malaise.
-spontaneous recovery with no further exposure
- usually occupation or agent involved,.
-usually benign unless repetitively exposed leading to perm fibrosis.

62
Q

tx options for
DIP (desquamative interstitial pneumonintits)
Cryptogenic organizing pneumonitits (COP)
Other ILDS

A
    1. Can stabilize if pt stops smoking
    1. Can respond to high-dose corticosteroids
    1. Nothing
63
Q

Define interstitial lung disease (ILD)

A
  • causes inflammation and eventual fibrosis in the interstitial space (space around alveoli)
  • 200 known occupational causes, but most are exceedingly rare.
    » Worse when occurring along with a collagen vascular disease such as R.A. SLF or scleroderma. – death
64
Q

What is the most common ILD?

A

Usual interstitial peumonitits (UIP) leasing to idiopathic pulmonary fibrosis

65
Q

What are the sxs associated with pleural disease?

A

CP aggrevated by deep inspiration and is called pleurisy.

66
Q

What is the etiology of pleural disease? How is it diagnosed?

A

Infection (pleuritis)
Malignant

By analysis of pleural effusion

67
Q

What do you call fluid collection in the pleural space? And is it common in both poleurisy and lignancy pleural disease?

A

yes

68
Q

What is empyema?

A

Pleurisy with a collection of pus in the plueral space.
Its secondary to pneumonia.
Txed with abx
If tx’ed residual scaring from surgical drainage may be present

69
Q

What is hemothorax

A

Blood in the pleural space

Secondary to injury (mostly)

70
Q

What is pneumoconiosis?

A

A group of diseases produced by pronlonged inhalation of inorganic dusts as in hypersensitivity pneumonitis.
- offending agents are usuall asbestos, silica dust, coal dust

71
Q

What is asbestosis?

A

A lung disease caused by inhalation of asbestos fibers in enough quantity to cause pulmonary fibrosis

  • common in asbestos workers
  • risk of lung cancer is ^ 7-10x,
  • evidence of disease secondary to the exposure may appear 7-10 yrs later
72
Q

What is silicosis?

A

Caused by prolonged inhalation of silica dust

- common with hard coal miners and those digging tunnels through rocks

73
Q

Define Coal workers’ pneumoconiosis (black lung)

A

A complex spectrum of conditions that are linked to prolonged exposure to coal dust.

  • evaluated by the extend of the disease.
  • -
74
Q

Define pneumonia

A

Inflammation of the lungs caused by infection (bacterial/viral/fungal/parasites).

75
Q

What is pneumothorax?

A

Collapse of the lung, or part of the lung caused by the leakage of air into the pleural space.

  • commonly caused by: small bleb
  • SXS: CP, SOB,
  • Tx’ed: insertion of tube and maintenance of suction for several days to keep lung expanded.
  • Lung function usually returns to normal no residuals.
  • Reoccurance is common.
76
Q

What is a pulmonary emboli

A

Blood clots that form in the peripheral veins and migrate to the lungs are known as PTE.

The lungs can usually bounce back, no issues, unless its very large which can lead to sudden death

77
Q

What are the common sxs of a PTE?

A
  • sudden CP
  • SOB
  • coughing productive bloody sputum.

Dx is usually missed, since sxs are so common to other diseases.

78
Q

What are three overlapping factors that predispose venous thrombosis

A
  1. local trauma to the vessel wall
  2. hypercoagulability
  3. stasis
79
Q

Most emboli originate in the leg veins… why?

A

This is where DVT and thrombophlebitits are found. They occur here, and can move throughout the body.

80
Q

What are some issues with chronic emboli occurances?

A

Multiple small emboli can lead to compromise of pulmonary circulation, pulmonary HTN.
Large or recurrent DVT can lead to chronic changes in the veins that will predispose to further recurrent disease.

81
Q

What is provoked embolus?

A

When a embolus occurs following a surgery.

82
Q

What is the tx for embolism? What about for people with recurrent pulmonary emboli?

A

Anticoagulation medication ie heparin IV followed by warfarin (Px). Which can be acute or chronic.

May require surgery to the inferior vena cava, by complete ligation or by insertion of a devise to train the blood.

83
Q

What is a coin lesion or solitary pulmonary nodule

A

A finding on a CXR of a round shadow 1-2.9cm with no other lung abN.

Anything over 3cm is a mass and is considered to be cancer unless proven otherwise.

84
Q

What is a granuloma?

A

A common non-cancerous nodule. It’s a form of scar tissue caused by a prior infection such as tuberculosis or histoplasmosis.

85
Q

What is meant by the terms “speculated nodule” or “ground-glass-associated nodule” on a CT or CXR description?

A

This seams that the nodule should be considered malignant until proven otherwise. By PET.,

86
Q

What is the typical CT f/u requirements to consider a nodule to be benign?

A

Size, and CT f/u for 2 yrs with no change in size or appearance.

Can also consider a PET test, this however does not guarantee the malignancy or lack there of.

87
Q

Define pulmonary fibrosis

A

The presence of scar tissue in the longs,
Seen on CXR or CT and is caused by a variety of disease processes.

Its localized, usually insig. And is often a residual.

88
Q

What is Diffuse pulmonary fibrosis? (diffuse interstitial lung disease)

A

This has varied etiologies that share the findings of diffuse chronic inflammation and secondary fibrosis

  • age of onset 40-70
  • most common cause IPF – and is noted by its precursor UIP.
  • Deadly prognosis
89
Q

.What are the sxs or Diffuse pulmonary fibrosis?

What are the causes? (6)

A

Breathlessness,

  1. infection
  2. occupational exposure
  3. heart disease with chronic pulmonary congestion
  4. collagen vascular disease
  5. sarcoidosis
  6. cancer
90
Q

What is the name for newborn form of Respiratory Distress Syndrome?

A

Hyaline-membrane disease,

  • mild dx = full recovery
  • severe = left with bronchopulmonary dysplasia
91
Q

What is the etiology of Adult form of respiratory distress syndrome (ARDS)

A

Associated with severe acute disease or trauma and required ICU tx with Artifical ventilation.

92
Q

What is AIP? (acute interstitial pneumonitis)

A

Essentially ARDS of unkown etiology. Those who survive with this often left with abN lung function residuals

93
Q

What is Sarcoidosis

A

A disease of unkown cause characterized by microscopy inflammatory nodules called non0caseating granulomas that can be present in various tissues.

  • can affect all organs, but usually affects lungs/lymph nodes
  • ages 20-40
  • dx by lung biopsy – reveals non-caseating granulomas.
94
Q

How is sarcoidosis staged?

A

Based on the amount of lung and mediastinal/hilar lymph node incolment of a CXR.
Stage 1: bilateral enlargement of lymph nodes at the root and no lung involvement on CXR. No sxs, resolves over time, no +mortality.
Stage 2: both lung reticulonodular interstitial changes and prominent medisatinal/hilar lymph node enlargement. Mild sxs of SOB/cough. Tx’ed with corticoidsteroid.
Stage 3: persisting lung involvement with gradual resolution of the mediastinal/hilar lymph node enlargement. Changes are perminant.
Stage 4: end-stage fibrotic lung disease often indistinguishable from any other cause of end-stage lung fibrosis

95
Q

Smoking is associated to an increase risk in which cancers?

A

Lung, esophagus, pancreas, kidney, and bladder.

Asbestos ontop of cancer smoking multiplies this risk.

96
Q

What is TB? (tuberculosis)

A

An infectious disease affecting the lungs primarily, but any tissue or organ can be infected.

Was very common but now with good tx it is less deadly and less common- except if you are immunocompromised for any reason.

25-33% of people have =been primarily infected which is +ve skin test, but not active and no sxs.

97
Q

What is Mycobacteriam avian complex (MAC),

A

A group of related mycobacterium that cause infections in immunocompromised hosts such as those with AIDS and end-stage COPD, and/or bronchiectasis.

Tx’ed with abx, which places it in remission.

ALU 201 (16 decks)

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