Chapter 7 - Respiratory System Flashcards
what is the name for the tiny air sacs where blood exchanges carbon dioxide for oxygen
alveoli
define respiration
the gas exchange that takes place in the alveoli by which carbon dioxide is exhaled and oxygen is taken up by the RBC
how does deoxygenated blood reach the lungs
through the pulmonary arteries from the rt side of the heart (RV) which has received deoxygenated blood from the rest of the body.
where does blood go once oxygenated
it is returned by the pulmonary veins to the lt atrium then the LV to be distributed to the rest of the body
what is the avg pressure in the pulmonary arteries
10-20 mmHg
what does spirometry measure
forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and the ratio of the two.
what FEV1/FVC ratio can be considered normal
> 80%
what spirometry result is consistent with GOLD criteria for COPD
FEV1/FVS <70% post bronchodilator
what can spirometry reveal
airway obstruction, chest wall or lung restriction, normal lung function
what is FVC
max volume of air exhaled
what is FEV1
forced expiratory volume in one second
what test best evaluates for pulmonary emboli
CTA
name risk factors for OSA (13 in textbook)
male gender, older age, snoring, obesity, nasal obstruction, tonsils or uvular hypertrophy, jaw abnormalities, ETOH abuse, hypothyroidism, COPD, acromegaly, use of tranquilizers, postmenopause
what are symptoms of sleep apnea
snoring, gasping, thrashing, daytime sleepiness, fatigue, cognitive impairment, personality change, morning headache
what does a full PSG include
EEG, EOG, EKG, Oximetry, measurement of airflow at nose and mouth, measurement of inspiratory effort, monitoring of limb movement.
what are the 2 major consequences of sleep apnea
sleep fragmentation, episodic hypoxia
what are causes of death with sleep apnea
MVAs, MIs, stroke, CHF, sudden death from cardiac arrhythmias.
what are some results of long term untreated sleep apnea
hypertensive LVH, pulmonary HTN, rt heart failure
what is lung remodeling
if asthma is sub optimally treated or untreated, it can evolve into COPD in a process called remodeling
what info is important to underwrite asthma
frequency and severity of attacks, hospitalizations, treatment, long term therapy with systemic corticosteroids
what is status asthmaticus
a severe asthma attach that does not respond to the usual measures
poorer prognosis in those diagnosed with asthma after age ____
40
when is increased mortality in childhood asthma a concern
adolescents who refuse to use their meds, and children who lived in impoverished communities
what is atelectasis
the collapse of a portion of lung tissue
what is usual cause of atelectasis
obstruction of an airway, as seen in pneumonia when airways plugged with mucus. other causes: aspiration, tumors
what are blebs and bullae
air0conditioning cavities within the lungs. rarely significant
what is bronchiectasis and what are the usual manifestations
abnormal dilatation of a distal bronchus. clinical manifestation by chronic cough, sputum production, hemoptysis, poss SOB
what is cause of bronchiectasis
prior lung infection that has destroyed the normal muscular and elastic tissues of the bronchial wall and the cilia lining that helps clear secretions.
is bronchiectasis present with underlying problem what is prognosis
long term prognosis usually poor due to recurring infectious exacerbations
what are major hazards with localized bronchiectasis in an otherwise healthy person
recurrent and severe hemoptysis and ongoing and ever-worsening lung infection
when is chronic abx given for bronchiectasis
only when significant, severe disease with high mortality risk
what is COPD
encompassing term including chronic bronchitis, emphysema, chronic asthma (with remodeling), and bronchiectasis
what is the 3rd leading cause of death worldwide and 4th leading in USA
COPD
what are risk factors with COPD
ongoing smoking, repeated respiratory infections, family hx of chronic bronchitis
what is best way to assess progression of COPD
PFTs
what FEV1 is consistent with good prognosis in COPD
stable over 80%
what FEV1 indicates increased mortality in COPD
60-80%
careful uwing needed in COPD with FEV1 under what
60%
what is chronic bronchitis
chronic cough and sputum production for at least 3 months a year for 2 consecutive years
what is emphysema
destruction of alveoli
what is cystic fibrosis
a genetic disease of the lungs and pancreas and/or intestinal malabsorption who have a family hx of CF.
how is cystic fibrosis diagnosed
through chloride concentration in the sweat
what is honeycomb lung
serious disease, occ seen on CXRs, end stage chronic lung fibrosis f any cause, most commonly end stage idiopathic/infectious disease (Sarcoidosis, chronic TB, fungal disease)
what is hypersensitivity lung disease
pulmonary reaction to organic dust with spontaneous recovery if there is no further exposure (farmers lung, pigeon breeders disease, etc)
interstitial lung dsiease
causes inflammation and eventual fibrosis in the interstitial space. most serious consequence of ILD is seen when it occurs along with collagen vascular disease such as RA, SLE or scleroderma
what is empyema
pleurisy with collection of pus in the pleural space, usually s/t pneumonia
what is classic presentation of pulmonary embolism
chest pain, SOB, cough productive of bloody sputum
what are the three overlapping factors that predispose to venous thrombosis
local trauma to the vessel wall, hyper coagulability, stasis
a lung nodule that is over what size is called a mass and considered to be cancer until proven otherwise
3cm
how long does pulmonary nodule have to be present and unchanged before considered most certainly benign
3 or more eyars
pulmonary nodules in which zones are more significant or more likely to be malignant
upper lung zone solitairy nodules or multiple nodules of varying sizes in the lower lung zones
what terms on CXR or CT should be considered malignant until proven otherwise
speculated nodule or ground glass associated nodule
does positive uptake on PET scan prove cancer
no, can be caused by infection too. also some slow growing cancers can show no uptake
what is the only way to absolutely prove innocent nodule
surgical removal with path report
what s pulmonary fibrosis
presence of scar tissue in the lungs
what are some causes for diffuse interstitial lung disease
infections, occupational exposure, heart disease with chronic pulmonary congestion, collagen vascular dseiases (SLW, RA, progressive systemic sclerosis), sarcoidosis, cancer
how is sarcoidosis staged
amount of lung and mediastinal/hilar lymph node involvement on a regular CXR (Not CT)
lung cancer is ____ times more frequent in smokers
5-10 times
what is the number one cause of cancer death in males and female in US
lung cancer
what does pulmonary diffusing capacity measure?
a. capacity of the lungs during rapid breathing
b. total alveolar-capillary volume available for gas exchange
c. amount of air expelled in the first second of forced expiration.
d. total amount of air that can be exhaled after deep inspiration
b. total alveolar-capillary volume available for gas exchange
lung diseases attributable to asbestos exposure include all of the following EXCEPT:
- mesothelioma
- asbestosis
- black lung
- lung cancer
- black lung
respiratory sounds caused by fluid in the airways include which of the following?
a. rales
b. rhonchi
c. crackles
a b and c
which of the following is most likely y to be malignant?
a. bronchial adenoma
b. speculated nodule
c. granuloma
d. hamartoma
b
a family history of early onset emphysema is suggestive of
alpha-1-antitrypsin deficiency
describe the staging criteria for sarcoidosis
stage 1- b/l enlargment of the LNs of lungs (hilar nodes and no lung involvement. stage 2- both lung reticulonodular interstitial changes and prominent mediastinal/hilar LN enlargement. stage 3 - persisting lung involvement with gradual resolution of the mediastinal/hilar LN enlargement. stage 4- end stage fibrotic lung disease
what is DLCO
DLCO or TLCO (diffusing capacity or transfer factor of the lung for carbon monoxide (CO),[1]) is the extent to which oxygen passes from the air sacs of the lungs into the blood
The pulmonary veins carry oxygenated blood from the lung to the___
Left atrium
All of the following statements regarding tuberculosis are correct except:
- False positives and testing are common place
- TB can affect any tissue or organ
- Before the advent of affective therapy it was a disease with high mortality
- Primary infections with TB bacillus are extraordinarily common
- False positives and testing are common place (false)
What does pulmonary diffusing capacity measure
Capacity of the lungs to exchange carbon dioxide
What are the respiratory sounds caused by fluid in the airways
Rales, rhoncho, crackles
Is tuberculosis an inflammatory lung disease
Yes
