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Pathophysiology > Exam 2: Chap 8 > Flashcards

Exam 2: Chap 8 Flashcards

1
Q

Bronchoscopy

A

Expectoration of sputum sample/ tracheal suction

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2
Q

Analysis of sputum

A

amount, quality, color

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3
Q

The sputum sample may be examined for

A
  1. Culture and sensitivity 2. gram stain 3. acid fast smear and culture and 4. cytology
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4
Q

Culture and sensitivity study

A

single sputum sample is collected in a sterile container. Test is performed to diagnose bacterial infection, select an antibiotic, and evaluate the effectiveness of antibiotic therapy

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5
Q

Turn around time for Culture and sensitivity study

A

48 to 72 hours

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6
Q

Gram staining of sputum is performed to

A

to classify bacteria into gram negative organisms and gram positive organisms

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7
Q

Acid fast smear and culture is performed to

A

determine the presence of acid fast bacili (myobacterium, TB). a series of 3 early morning sputum samples is tested.

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8
Q

Cytology

A

examination entails the collection of a single sputum sample in a special container with fixative solution. Sample is evaluated under a microscope for the presence of abnormal cells that may indicate a malignant condition

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9
Q

Skin tests are commonly performed to evaluate

A

allergic reactions or exposure to tuberculous bacilli or fungi

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10
Q

Positive test/ negative test

A

patient has been exposed/ no exposure

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11
Q

anergy

A

Depression of cellmediated immunity which can show a negative test. such as which develops with (HIV)

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12
Q

Bronchoscope allows direct visualization of the

A

upper airways (nose, oral cavity, and pharynx), larynx, vocal cords, subglottic area, trachea, bronchi, lobar bronchi, segmental bronchi down to the third or fourth generation

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13
Q

Yellow sputum correlation

A

acute infection

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14
Q

Green sputum correlation

A

Associated with old, retained secretions, green and foul smelling secretions are freq found in pts with anaerobic or pseudomonas infection, such as bronchiectasis, CF, and lung abscess

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15
Q

Thick, stringy, and white or mucoid sputum correlation

A

Bronchial asthma

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16
Q

brown sputum correlation

A

Presence of old blood

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17
Q

Red sputum correlation

A

fresh blood

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18
Q

A diagnostic bronchoscopy is usually performed when an

A

infectious disease is suspected and not otherwise diagnosed or to obtain a lung biopsy sample when the abnormal lung tissue is located or near the bronchi

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19
Q

Bronchoscopy is indicated for a number of clinical conditions, including further inspection and assessment of

A
  1. abnormal radiographic findings 2. persistent atelectasis 3. excessive bronchial secretions 4. acute smoke inhalation injuries 5. intubation damage 6. bronchiectasis 7. foreign bodies 8. hemoptysis 9. lung abscess 10. major thoracic trauma 11. stridor or localized wheezing and 12. unexplained cough
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20
Q

Bronchoalveolar lavage (BAL)

A

A common diagnostic bronchoscopic technique. Involves injecting a small amount (30mL) of sterile saline through the bronchoscope and then withdrawing the fluid for examination of cells

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21
Q

Therapeutic Bronchoscopy includes

A
  1. suctioning of excessive secretions or mucous plugs, especially when lung atelectasis is present or forming 2. the removal of foreign bodies or cancer obstructing the airway 3. selective lavage and 4. management of life threatening hemoptysis
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22
Q

First line of defense in the treatment of atelectasis from retained secretions

A

Respiratory therapy modalities at the pts bedside (CPT, intermittent percussive vent, postural drainage, deep breathing and coughing tech, and PEP therapy)

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23
Q

Endobronchial unltrasound (EBUS) examination

A

may be performed during a bronchoscopy to help establish the stage of lung cancer and, importantly, establish if- and how- the cancer may have spread

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24
Q

EBUS can provide an accurate

A

staging of lung cancer and can help reduce the amount of tissue that needs to be removed during surgery without invasive procedures

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25
Q

During EBUS procedure

A

an ultrasound probe is used to send sound waves through the walls of the airways into the surrounding areas, lungs, and mediastinum. When abnormal areas are detected, a small sample of tissue is taken with asmall needle guided by the ultrasound. Sample then sent to lab

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26
Q

4 reasons EBUS is recommended

A

To detect the presence of tumors or enlarged lymph nodes, To diagnose tumors within the lung, To diagnose lymph node abnormalities in the mediastinum or hilum, To diagnose tumors in the mediastinum

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27
Q

Mediastinoscopy

A

Insertion of a scope through a small incision in the suprasternal notch; the scope is then advanced into the mediastinum.

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28
Q

Mediastinoscopy test is used to

A

inspect and biopsy lymph nodes in the mediastinal area

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29
Q

Transbronchial lung biopsy entails

A

passing a forceps or needle through a bronchoscope to obtain a specimen

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30
Q

Open lung biopsy involves

A

surgery to remove a sample of lung tissue. An incision is made over the area of the lung from which the tissue sample is to be collected. Then chest tube is inserted for drainage and suction for 7-14 days

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31
Q

An open lung biopsy is usually performed when

A

either a bronchoscopic biopsy or a needle biopsy has been unsuccessful or cannot be performed or when a larger piece of tissue is necessary to establish a diagnosis. More invasive and thus more likely to cause complications

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32
Q

a lung biopsy is especially useful in investigating

A

peripheral lung abnormalities, such as recurrent infiltrates and pleural or subpleural lesions

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33
Q

Video Assisted Thoracoscopy Surger (VATS)

A

a small incision is made in the chest wall, and a device called a thoracoscope is inserted. This device is equipped with a fiberscope that can examine the pleural cavity

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34
Q

Thoracentesis

A

is a procedure in which excess fluid accumulation (pleural effusion) between the chest cavity and lungs is aspirated through a needle inserted through the chest wall

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35
Q

Diagnostic Thoracentesis may be performed to identify the

A

cause of pleural effusion

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36
Q

Therapeutic thoracentesis may be performed to relieve

A

shortness of breath or pain caused by a large pleural effusion, to remove air trapped, or to administer medication directly into the lung cavity to treat the cause of the fluid accumulation or to treat cancer

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37
Q

Transudate or an exudate

A

fluid in the lung cavity

38
Q

Transudates

A

develop when fluid from the pulmonary capillaries moves into the pleural space. Fluid produced is thin and watery and usually has a low WBC coung, a low lactate dehydrogenase (LDH) enzyme level, and a low protein level

39
Q

A transudate may be caused by

A

left ventricular heart failure, cirrhosis, nephrotic syndrome, and peritoneal dialysis

40
Q

Exudates

A

may be caused by a variety of conditions including pulmonary infections, cancer, chest trauma, pancreatitis, autoimmune disease, or a pulmonary embolism

41
Q

When an infection is present…

A

WBC count is high, as well as the LDH enzyme level, a high protein level, a large amount of cellular debris, and the presence of bacteria or other infectious organism

42
Q

When cancer is present…

A

High WBC count, high LDH enxyme level, high protein level, abnormal cells may also be found

43
Q

When pulmonary embolism is present…

A

a large number of RBCs are usually present and the WBC and protein levels are low

44
Q

Pleurodesis

A

is performed to prevent the recurrence of a pneumothorax or pleural effusion. Achieved by injecting any number of agents into the pleural space through a chest tue

45
Q

Most frequent hematology test is the

A

complete blood count (CBC)

46
Q

CBC

A

provides important info about the patients blood counts, clotting ability, and blood content. includes the RBC count, Hb, Hct, and total WBC count, and at least an estimate of the platelet count

47
Q

Constitute the major portion of the blood cells

A

RBCs (erythrocytes)

48
Q

Healthy man has about how much RBCs in each cubic mm of blood/ women

A

5 million/ 4 million

49
Q

Clinically, the total number of RBCs and the RBC indices are useful in assessing the pats overal

A

oxygen carrying capacity

50
Q

The RBC indices are helpful in identification of

A

specific RBC deficiencies

51
Q

Major functions of the WBCs (leukocytes)

A
  1. fight against infection 2. defend the body by phagocytosis against foreign substances and 3. produce or at leasts transport and distribute antibodies in the immune response
52
Q

WBCs per cubic mm of blood

A

5000 to 10,000

53
Q

Two types of WBCs

A

granular leukocytes and nongranular leukocytes

54
Q

Granular leukocytes (granulocytes)

A

classified because of the granules present in their cytoplasm. Neutrophils, eosinophils, and basophils. Polymorphanuclear leukocytes

55
Q

Neutrophils comprise about/ function

A

60-70% of the total number of WBCs. first to arrive at the site of inflammation

56
Q

They are phagocytes and Neutrophils also release an enzyme called lysozyme which

A

(Ingest and destroy bacterial organisms and particulate matter) destroys certain bacteria

57
Q

An increased neutrophil count is associated with

A
  1. bacterial infection 2. physical and emotional stress 3. tumors 4. inflammatory or traumatic disorders 5. some leukemias 6. myocardial infarction and 7. burns
58
Q

Eosinophils comprise total/ function

A

2% to 4% of the total number of WBCs. Unknown function, thought to play a role in the breakdown of protein material. Activated by allergies/ parasitic infection

59
Q

Basophils comprise total/ function

A

only about 0.5% to 1% of the total WBC count. function not clearly understood.

60
Q

Increased basophils are primarily associated with

A

certain myeloproliferative disorders. Are involved in allergic and stress response

61
Q

Nongranular leukocytes

A

Monocytes and lymphocytes, have spheric nuclie

62
Q

monocytes function

A

second order of cells to arrive at inflammation site, usually appearing about 5 hours or more after injury. after 48 hours the more predominant cell type in inflamed area

63
Q

Monocytes comprise

A

3-8% of the total leukocyte count. they are short lived, phagocytic WBCs with a half life of about 1 day.mature into macrophages

64
Q

Macrophages

A

large wandering cells that engulf larger and greater quantities of foreign material than the neutrophils. first line of inflammatory defense, involved in immune response, and malignancies

65
Q

Therefore an elevated number of monocytes suggest

A

infection and inflammation

66
Q

Lymphocytes

A

viral infection, and production of antibodies.

67
Q

Lymphocytes divided into 2 categories

A

B cells and T cells

68
Q

Rosettes (T cells)

A

have a smooth surface, comprise 70-90% of the total lymphocytes. formed in thymus

69
Q

T cells form in thymus and further divide into four categories

A
  1. Cytoxic T cells (killer) 2. Helper T cells, recognize foreign antigens and help activate cytotoxic T cells and plasma cells (b cells) 3. inducer T Cells, stimulate the prod of different t cells 4. Suppressor T cells, suppress the responses of the other cells and prov feedback info to the system
70
Q

T cells may also be classified according to their surface antigens

A

T4; 60%-70% of the circulating T cells, mainly of the helper and inducer cells, T8; consists mainly of the cytotoxic and suppressor cells

71
Q

B cells

A

comprise 10-30% of the total lymphocytes, formed in bone marrow, further divide into either plasma cells or memory cells

72
Q

Plasma cells

A

secrete antibodies in response to foreign antigens

73
Q

Memory cells

A

retain the ability to recognize specific antigens long after the initial exposure and therefore contribute to long term immunity against future exposures to invading pathogens

74
Q

Sequence of Lymphocyte Response to Infection

A

Initially, the macrophages attack and engulf the foreign antigens. Which stimulates the production of T cells, and ultimately, the B cells (plasma cells). The T4 cells play a pivotal role in the overall modulation of this immune response (next slide 5)

75
Q

The T4 cells play a pivotal role in the overall modulation of this immune response

A
  1. Secreting a substance called lymphokine, which is potent stimulus to T cell growth and differentiation 2. recognizing fireign antigetns 3. causing clonal proliferation of T cells 5. enabling B cells to secrete specific antibodies
76
Q

Platelets (thrombocytes)

A

are the smallest of the formed elements in the blood. Essential for blood clotting produced in bone marrow and possibly in lungs.

77
Q

A low platelet count (thrombocytopenia) is associated with

A
  1. massive blood transfusion 2. pneumonia 3. cancer chemotherapy 4. infection 5. allergic reaction 6. toxic effects of certain drugs
78
Q

A high platelet count is associated with

A
  1. cancer 2. trauma 3. asphyxiation 4. rheumatoid arthritis 5. iron deficiency 6. acute infections 7. heart disease 8. TB and 9. polycythemia vera
79
Q

A platelet count of less than what is associated with spontaneous bleeding

A

20,000/mm

80
Q

Therapeutic platelet count

A

50,000/mm

81
Q

In the healthy women, what is the hct?

A

42% (45% in male)

82
Q

Which of the following represent the primary defense against bacterial organisms through phagocytosis?

A

Neutrophils

83
Q

What is the normal hemoglobin value for men

A

14 to 16 g% (women 12-15g%)

84
Q

What percent of the normal WBC count are neutrophils

A

60%-70%

85
Q

In the healthy man what is the RBC count?

A

5,000,000/mm3 (4,000,000 women)

86
Q

What is the normal WBC count

A

5,000 to 10,000/mm3

87
Q

Which of the following are activated by allergies?

A

Eosinophils

88
Q

Various clinical procedures such as bronchoscopy or the insertion of an arterial catheter are generally safe when the platelet count is no lower than which of the following?

A

50,000/mm3

89
Q

Which of the following are associated with hyperglycemia? 1. Diabetes mellitus 2. myocardial infarction 3. Thiazide and loop diuretics 4. Acute infection

A

all of the above

90
Q

Which of the following are clinical manifestations associated with hyponatremia

  1. seizures
  2. confusion
  3. muscle twitching
  4. abdominal cramps
A

all of the above

Pathophysiology (9 decks)

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