Class 7&8

Question 1

Manifestations of Pulmonary Diseases

Answer 1

Cough
Abnormal Sputum (evaluate color, amount, consistency)
Hemoptysis (spitting up blood)
Dyspnea (difficulty breathing, SOB, transient, chronic or positional) due to pulmonary congestion
Pain (from pleura, lung tissue or chest wall, sharp & localized, worse when cough or deep breathing, location & type can determine problem)
Digital Clubbing (ends of fingers & toes nails touch, associated with chronic hypoxia)
Abnormal breathing patterns
Cyanosis (bluish mucous membranes, reflects hypoxemia)

Question 2

Kussmaul Respiration (hyperpnea)

Answer 2

Increased resp rate, rapid & deep

Can be due to obstruction, exercise

Question 3

Cheyne-Stokes breathing

Answer 3

big breath/sigh & then becomes shallow, no breathing (apnea) then big sigh
Due to lack of proper oxygenation to brain and slow blood flow to brain stem

Question 4

Hypercapnia

Answer 4

Associated with hypoventilation, increased CO2 in blood, results in respiratory acidosis
Can be due to hypoventilation, spinal cord injuries or paralysis of diaphragm
Manifestations: greater than 45 CO2, pH lower than 7.35, initially breathe fast & then becomes sleepy & disoriented, headaches, muscles twitching

Question 5

Hypocapnia

Answer 5

Less CO2 in blood, hyperventilation
Results in respiratory alkalosis
Due to anxiety, acute head injury, pain & in response to conditions with insufficient oxygenation of the brain

Question 6

Normal paO2 Level

Answer 6

80-100mmHg

Question 7

Hypoxemia

Answer 7

Decrease of O2 in the blood
Proper breathing requires ventilation & perfusion so this leads to ventilation-perfusion abnormalities
Caused by altitude changes, vasoconstriction of all vessels, embolus thats clogging vessels, shunt (very low ventilation)
Results from problems with:
1. O2 delivery to alveoli
2. Diffusion of O2 from alveoli into blood
3. Perfusion of pulmonary capillaries

Question 8

Hypoxia

Answer 8

Lack of oxygen in the entire body, not just the blood.

Question 9

Common disorders of chest wall, pleura & lungs

Answer 9

Pneumothorax
Atelectasis
Pulmonary edema

Question 10

Pneumothorax

Answer 10

Air present in thorax due to punctured lung (rupture in visceral pleura)
Can spontaneously occur due to bleds(holes punctured in lung)
The lack of negative pressure disrupts the equilibrium between elastic recoil forces of lung & chest wall causing the lung to collapse

Question 11

Atelectasis

Answer 11

Individual alveoli collapse due to the air being absorbed out of the alveoli & no fresh air coming in.
2 types:
1. Compression: caused by external pressure causing alveoli to collapse
2. Absorption: caused by removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated O2 or anesthetic agents
Open pore of Kohn allows deep breathing
Shunt**

Question 12

Pulmonary Edema

Answer 12

Excess water is pressent in the lung, caused by increased pressure to the lungs while the blood is pushing back up into the tissue
There is no ability to pick up extra fluid
Predisposing factors are heart disease**, acute respiratory distress, inhalation of toxic gases

Question 13

Pneumonia

Answer 13

More prominent in the chronically ill or immunocompromised or elderly
Caused by bacteria, virus, & fungi (facilitated by exposure to large amounts of pathogens)
Risk factors: age, unconscious (inability to cough out secretions), smoking
Can lead to respiratory failure
Community acquired –> strep. pneumoniae, mycoplasma pneumonia
Hospital acquired –> staphy. aureus, pseudomonas aureus
Treat with antibiotics, antivirals, hydration & pulmonary hygiene

Question 14

Pathophysiology of Pneumonia

Answer 14

1. Breathe in bacteria that attract macrophages
2. Macrophages put antigens on cell wall to instigate inflammatory response w/ lots of exudate
3. Red hepatization (change appearance of lungs to look like liver due to exudate accumulation)
4. Grey hepatization (RBC are broken down & lungs look grey like)

Question 15

Clinical Manifestations of Pneumonia

Answer 15

Decreased O2 sats
Persistent coughing
Exudate present in cough (1st stage: yellow, 2nd stage: hemopytosis, 3rd stage: grey sputum)
Consolidation (decreased breathing sounds)
Tachypnia (rapid breathing)
Fatigue
Fever, leukocytosis, chills

Question 16

Levels of Prevention for Pneumonia

Answer 16

Primary: pneumococcal vaccines for infants & influenza vaccines for older people, Hand hygiene
Secondary Level: Early recognition via chest x-ray, blood count, cultures, physical assessment
Tertiary Level: antibiotics, supportive treatmetn (O2, fluids, nutrition & rest)

Question 17

Infant Pneumonia Manifestations

Answer 17

Signs of distress whilst breathing
Retraction of skin between ribs
Substernal caving
Nausea, Vomiting, Restlessness

Question 18

Older Adults Pneumonia Manifestations

Answer 18

Confusion & delirium
Incontinent
Lathargic
Weak, high fall risk

Question 19

Viral Pneumonia

Answer 19

Most common in infants
Can set the stage for a secondary bacterial infection
Enters upper resp tract & invades bronchi & alveoli
Replicate inside the cells & burst out forecefully causing widespread cell death
DO NOT USE ANTIBIOTIC THERAPY! Use antivirals

Question 20

Acute Bronchitis

Answer 20

Caused by acute infection or inflammation of the lower airways
Caused by Respiratory Synyctial Virus (RSV)
Reoccurs as it doesn’t confer immunity
Common in infants, in the winter, transmitted via sneezing & secretions
Enters mucosal cells & burst out invading neighboring cells, living together in chunks (syncytial) which irritate tissue * mechanical obstruction

Question 21

Acute Bronchitis Manifestations

Answer 21

Decreased sound 
Crackling
Retraction of skin
Tachypnea
Tachycardia 
Chest pain

Question 22

Treatment of Acute Bronchitis

Answer 22

Rest
Aspirin
Humidity
Cough suppressent

Question 23

Tuberculosis

Answer 23

Aerosol Transmission
Primary TB (95% of cases)
Secondary TB
Diagnosed via mantoux test (positive test shows that you’ve been exposed to the virus)
Manifestations: extreme weight loss & hemopotysis

Question 24

Primary TB

Answer 24

Inhalation of M. tuberculosis bacteria
Macrophages surround bacili forming a tubercule & then present antigen to T cells
Infected tissue within tubercle die (caseous necrosis)
Surrounded bacilli enter dormant phase

Question 25

Secondary TB

Answer 25

Reinfection or reactivation of primary lesions & tubercle (possibly due to stress) Caseous granuloma rupture Bacteria spreads to lungs or other organs via blood stream & lympathic system

Question 26

Obstructive Pulmonary Disease

Answer 26

``` Airway obstruction that is worse with expiration Signs are dyspnea & wheezing Asthma is the most common *** Chronic bronchitis Emphysema ```

Question 27

Asthma

Answer 27

Chronic inflammation of the airway resulting from hyperresponsiveness of the airways to environmental allergens, microbes, exercise..., genetic predisposition. Can lead to obstruction (air becomes pressurized increasing difficulty of breathing & hyperinflation, hypercapnia & hypoxia will lead to resp acidosis) & staus asthamticus Symptoms: expiratory wheezing, dyspnea & tachypnea

Question 28

Systemic Complications of Asthma

Answer 28

``` Panic coughing not enough air intake use of accessory muscles prolonged expiratory phase heart & resp rate increase Might be a secondary reaction (another influx of mediators that set on another response) ```

Question 29

Asthma Treatments

Answer 29

Peak flow meters (measures how narrow your airways are) Oral corticosteroids Inhaled beta-agonists Anti-inflammatories (histamines), cause secretions to dry up Rescuer Puffers: Beta 2 agonist, provides bronchodilation Controller Puffers: Corticosteroids, reduces inflammation

Question 30

Emphysema

Answer 30

Permanent enlargement of acini (terminal broncioles & alveoli) due to destruction of walls between alveoli, accompanying capillary bed & walls between terminal bronchioles Genetic cause:(Primary Emphysema) lack of alpha 1 antitrypsine enzyme (develop emphysema at a very young age & quicken via smoking)

Question 31

Emphysema Manifestations

Answer 31

Air trapping due to loss of elastic recoil Hyperinflation of lungs Increased work of breathing Barrel Chesting --> airs is stuck in it, diameter of lungs get larger from over expanding lungs Pink puffer --> breathing quickly, leaning & breathing Pneumothorax 2 types: 1. Centriacinar: septal destruction occurs in resp bronchioles & alveolor ducts causing inflammation (smokers) 2. Panacinar: involves entire acinus with damage more random (more common inolder people & with that deficiency)

Question 32

Chronic Bronchitis

Answer 32

Usually pts have bronchitis & emphysema Hypersecretion of mucus & chronic productive cough that last for at least 3 months of the year for 2 consecutive years Hypertrophy & hyperplasia results in lots of mucous Inspired irritants (smoke, pollution, infection) increase mucus production & size & number of mucous glands Inflammation of bronchi Hypersecretion of thick tenacious mucus

Question 33

Chronic Bronchitis Manifestations

Answer 33

Hypercapnia Crackling Expiratory phase is longer Labored breathing decreased exercise tolerance Polycythemia (Increased RBC count to compensate for O2 loss but doesn't help) Pulmonary Hypertension: causes pulmonary artery constriction due to resp acidosis, which increase pulmonary artery pressure. Right side of heart has to work harder to push blood (Cor pulmonale --> right side heart failure)

Question 34

Chornic Bronchitis - Blue Bloater

Answer 34

``` Dependent edema (increased volume, pressure & cyanosis because of deoxygenation) due to back up of blood in venous system (due to pulmonary hypertension) Retain a lot of CO2 (hypoxic drive begins & breathing is stimulated due to decresaed O2 levels) ```

Question 35

Cystic Fibrosis

Answer 35

Autosomal recessive disease with mutation on chromosome 7 Mutation of gene affects the cystic fibrosis transmembrane conductance regulator (CFTR) resulting in decreased chloride absorption in epithelial cell membranes Affects primarily caucasians Mostly affects lungs, but also the sweat glands, pancreas & GI system

Question 36

Cystic Fibrosis Manifestations

Answer 36

Increased salt in sweat Dehydrated Thick mucus in lungs Impaired exocrine pancreatic function (leads to issues with digestion & absorption)

Question 37

Cystic Fibrosis Effects on Lungs

Answer 37

Increase mucus production pluggin airways Decreased cilia motility Chronic inflammation excess neutrophils which cause direct damage to structural proteins of the lungs Wheezes, cough, recurrent pneumonia, GI-pancreatic enzyme & insulin deficiency Recurrent lung infections caused by Pseudomonas aeroguinosa & staphy. aureus Diagnosed via sweat test, genotyping, newborn screening,

Question 38

Cystic Fibrosis Treatments

Answer 38

Chest physio, resp medication, antibiotic therapy, enzyme replacement, dietary adjustment

Question 39

Lung Cancer

Answer 39

Bronchogenic carcinomas, common cause is smoking. (20X greater chance) Risk factors: environmental or occupational exposure, second-hand smoke, genetic predisposition. Results in Obstruction & tissue compression, tissue breakdwon, extopic hormone secretion, changes in organ function due to inflammation & cellular damage

Question 40

Lung Cancer Tumor Types

Answer 40

Non-small lung cancer (squamous cell carcinoma, adenocarcinoma (moderate growth, tumor arising for glands), include nonproductive cough or hemoptysis) Large cell carcinoma (undifferentiated with dark nuclei, rapid growth rate) Small cell carcinoma (very rapid growth rate associated with extopic hormone production of PTH, ACTh, ADH)

Question 41

Lung Cancer Symptoms

Answer 41

``` Chronic cough Hoarseness of voice Weight loss Hemoptysis Difficulty breathing Shortness of Breath Facial swelling & distended jugular veins Hypercalcemia Cushing Syndrome Water retention & hypotonic overload Weakness of shoulder muscles Wheezing Pleural effusion(fluid in pleura) Retrosternal (pain in sternum) ```