Exam #4 - Respiratory

Question 1

triggers for breathing regulating chemoreceptors

Answer 1

blood pH - increase in CO2, decrease in pH (acidosis)

in chronic hypercapnia -> hypoxia becomes stimulus to breathe - can’t overtreat with O2

Question 2

PFTs tests - MVV

Answer 2

maximal voluntary ventilation - the max amount that can be breathed of air in a given time

Question 3

Forced vital capacity

Answer 3

max amt rapidly/forcefully exhaled after full inspiration

Question 4

FEV 1.0

Answer 4

volume of air exhaled in first second of FVC

Question 5

percentage of FVC

Answer 5

FEV1.0/FVC%

Question 6

V/Q = 0

Answer 6

V-ventilation Q-perfusion
Shunt - perfusion without ventilation
e.g. mucous

Question 7

V/Q= high

Answer 7

ventilation without perfusion - e.g. pulmonary embolism

Question 8

2 sequelae of chronic hypoxemia

Answer 8

increased pulmonary HTN - vasoconstriction compensatory - can lead to RSHF
Polycythemia - inc RBC count

Question 9

atelectisis

Answer 9

incomplete expansion of the lungs or portion of the lung -> reduced gas exchange

eti: tumor, post surgery, narcotics, anesthesia, pain, immobility

Question 10

aspiration

Answer 10

eti - trouble clearing lungs due to diminished gag or cough or decreased LOC

aspiration can turn into pneumonia - higher risk is lower right lobe

Question 11

Rhinitis

Answer 11

inflammation of the mucous membranes of the nose, generally viral

Question 12

acute pharyngitis

Answer 12

usually viral, can be bacterial such as Strep or Gr. A Strep. if bacterial - worry about rheumatic heart disease as a complication

Question 13

acute sinusitis

Answer 13

inflammation of the sinuses, can be acute or chronic, caused by virus or bacteria. HA, facial pain, pressure over sinuses, fever

Question 14

tonsillitis

Answer 14

sore throat, difficulty swallowing, viral or bacterial

Question 15

influenza

Answer 15

viral - either A, B or C
droplet
starts as upper, travels to lower (risk of pneumonia)
vaccine

Question 16

Acute Bronchitis

Answer 16

typically viral
starts as upper respiratory, but marked by persistent cough (10-20 days)
inflammation of bronchi w/o evidence of pneumonia or COPD

Question 17

pneumonia

Answer 17

bacterial or viral
inflammation of the lung tissue in the alveolar space which fills with purulent drainage. Can start as upper respiratory infection or aspiration inflammation - inhaled droplets result in mucus and exudate and edema hindering gas exchange. Lobar or bronchopneumonia (patchy and across lobes)

Question 18

Hospital acquired vs community acquired pneumonia

Answer 18

HA - 48 hours after admission or while in hospital. 20-50% mortality

CA - usually someone who is not immunocompromised

treatment is different - HA is more aggressive

Question 19

atypical pneumonia

Answer 19

viral or mycoplasma involving alveolar septum and interstitium of lung. minimal CMs
no leukocytosis no purulent sputum, nonproductive cough

Question 20

typical pneumonia

Answer 20

bacterial
cough, fever, leukocytosis

Question 21

Asthma

Answer 21

chronic, obstructive
bronchial hyperresponsiveness - restriction and spasms

triggers - smoke, fust, frequent viral infections can predispose

IgE mediated

Question 22

Chronic Bronchitis

Answer 22

type of COPD
cough for 3 months out of the year for 2 consecutive years
hypersecretions (obstruction to inspiration), hypoxia, cyanosis
can’t get air in

Question 23

Emphysema

Answer 23

type of COPD
overdistention of alveoli with trapped air - obstruction to expiration - loss of elastic recoil of alveoli
can’t get air out

Question 24

COPD

Answer 24

smoker, hx of asthma or hyperresponsiveness

by the time detected it is advanced, goal is to slow progression

barrel chest, tripod, inc WOB
prolonged expiration, expiratory wheezing, crackles, tripod positioning

Question 25

OSA - Obstructive Sleep Apnea

Answer 25

most attributed to obesity- structural
intermittent cessation of airflow

sequalae - polycythemia, pulmonary hypertension, cor pulmonale (RSHF)

Question 26

CF

Answer 26

autosomal recessive

impaired chloride transport from CFTR gene mutation - inc NA absorption and water from the airways to the blood - cause mucous to be more viscous and sticky - same process in pancreatic and biliary ducts - leads to chronic infections, poor digestion,

Question 27

Pleural effusion

Answer 27

abnormal collection of fluid in pleural cavity (exudate, transudate, purulent, lymph, sanguieous)

eti: HF, pulmonary infection, neoplasm

Question 28

Empyema

Answer 28

pleural effusion - infection of the pleural cavity results in exudate w/ glucose, proteins, leukocytes

caused by adjacent bacterial PNA, infection, trauma, ruptured lung abscess

Question 29

hemothorax

Answer 29

type of pleural effusion
blood in pleural cavity caused by chest injury or after chest surgery
sx can be sudden and distressing

Question 30

pneumothorax

Answer 30

“collapsed lung” - air in the pleural cavity

Question 31

Spontaneous Pneumo

Answer 31

air present in the pleural space without preceding trauma
tall young men btwn 10-30, rare in over 40

Question 32

traumatic pneumo

Answer 32

penetrating or non-penetrating (fractured ribs) - opening to outside atmosphere, inability to maintain negative pressure - air comes in and builds up in pleural space - compresses lung

Question 33

tension pneumo

Answer 33

intrapleural pressure exceeds atmospheric pressure - life threatening - air can enter but not leave the pleural space - puts pressure on both lungs because air accumulates in pleural space

Question 34

pulmonary edema

Answer 34

increased hydrostatic pressure in pulmonary capillaries causes fluid from blood to diffuse into interstitial tissues

pink frothy sputum

Question 35

Pulmonary hypertension

Answer 35

elevated pulmonary artery pressure

idiopathic, r/t left sided HF, chronic lung disease