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HSS 3305 > Lecture 13 > Flashcards

Lecture 13 Flashcards

1
Q

Respiratory System Function

A

Respiratory system oxygenates blood and removes carbon dioxide

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2
Q

Circulatory System Function

A

Circulatory system transports gases in the bloodstream

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3
Q

How many lobes are each lung composed of?

A

The right lung has 3 and the left lung has 2

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4
Q

Bronchi

A

Largest conducting tube

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5
Q

Bronchioles

A

Less than 1 mm (thin system of tubes that help conduct air into and out of the lungs)

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6
Q

Terminal bronchioles

A

Located at the terminus of the conducting zone (last of the conducting airflow in lungs)

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7
Q

Respiratory bronchioles

A

Distal to terminal bronchiole with alveoli projecting from walls

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8
Q

Alveoli

A

O2 and CO2 exchange (type
I pneumocytes) have cells that produce surfactant (type II pneumocytes)

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9
Q

Pulmonary Surfactant

A

Produced by type II pneumocytes. Reduces surface tension in the alveoli

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10
Q

Acinus or respiratory unit

A

Functional unit of lung (alveoli)

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11
Q

Ventilation

A

Movement of air into and out of lungs (inspiration and expiration, respectively)

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12
Q

Inspiration

A

Caused by the action of the diaphragm (descends) and intercostal muscles (expand)

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13
Q

Where does gas exchange occur?

A

Gas exchange occurs between alveolar air and pulmonary capillaries

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14
Q

What is Atmospheric pressure at sea level?

A

760 mm Hg

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15
Q

Partial pressure

A

Part of the total atmospheric pressure exerted by a gas

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16
Q

Partial pressure of oxygen (PO2)

A

0.20x760mmHg=152mmHg

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17
Q

Why do gases diffuse among blood, tissues, and pulmonary alveoli?

A

Differences in their partial pressure

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18
Q

Requirements for efficient gas exchange

A

Changes in atmospheric O2 or CO2, Large capillary surface area in contact with the alveolar membrane, Unimpeded diffusion across the alveolar membrane, Normal pulmonary blood flow, and Normal pulmonary alveoli (Impairment of any will result in impaired gas exchange)

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19
Q

Pleura

A

Thin membrane covering lungs (visceral pleura) and internal surface of the chest wall (parietal pleura)

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20
Q

Pleural cavity

A

Potential space between lungs and chest wall

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21
Q

Intrapleural pressure

A

Pressure within pleural cavity (normally less than intrapulmonary pressure), also referred to as negative or subatmospheric pressure

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22
Q

What does the release of the vacuum in pleural space lead to?

A

Lung Collapse (loss of negative pressure)

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23
Q

What can impair lung function when found inside the pleural space?

A

Fluid (inflammatory or hemothorax) or air accumulation (pneumothorax)

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24
Q

Pulmonary Function Tests

A

Tested by measuring volume of air that can be moved into and out of lungs under normal conditions

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25
Q

Vital capacity

A

Maximum volume of air expelled after maximum inspiration – can be used to evaluate progress of chronic disease (emphysema)

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26
Q

One-second forced expiratory volume (FEV1)

A

Maximum volume of air expelled in 1 second – can be used to detect airway narrowing in inflammatory or bronchospasm (Asthma)

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27
Q

Pulse oximeter

A

Measures oxygen saturation in blood

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28
Q

Pneumothorax

A

Escape of air into pleural space due to lung injury or disease (Loss of negative pressure)

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29
Q

Manifestations of Pneumthorax

A

Chest pain, shortness of breath, reduced breath sounds on the affected side, chest x-ray: lung collapse and air in the pleural cavity

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30
Q

Tension pneumothorax

A

Positive pressure develops in the pleural cavity, and air flows through the perforation into the pleural cavity (air flows on inspiration but cannot escape on expiration which causes a build-up of pressure)

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31
Q

Tension Pneumothorax treatment

A

Chest tube is inserted into pleural cavity, left in place until lung heals/re-expands

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32
Q

Atelectasis

A

Collapse of the lung due to obstructive atelectasis or compression atelectasis

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33
Q

Obstructive atelectasis

A

Thick mucus secretions, tumors, foreign object, diaphragm elevates on affected side

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34
Q

Compression atelectasis

A

From external compression of the lung by fluid, air or blood in the pleural cavity, and reduced lung volume and expansion

35
Q

Pneumonia

A

Inflammation of the lung (when exudate reaches the pleural surface), Exudate spreads through the lung, Exudate fills alveoli, Affected lung portion becomes relatively solid (consolidation)

36
Q

Classification of Pneumonia

A

Etiology (cause), anatomic distribution of inflammatory process, and predisposing factors

37
Q

Most common cause of Pneumonia

A

Streptococcus pneumoniae infection

38
Q

Lobar

A

Infection of one or more lobes of lung from bacterial pnemonia

39
Q

Bronchopneumonia

A

Infection of parts of lobes or lobules adjacent to
bronchi by pathogenic bacteria

40
Q

Interstitial or primary atypical pneumonia

A

Caused by virus or Mycoplasma

41
Q

Post-op pneumonia

A

Accumulation of mucus secretions in bronchi

42
Q

Aspiration pneumonia

A

Irritating substance, foreign body, food, vomit, water inhaled

43
Q

Obstructive pneumonia

A

Distal to bronchial narrowing

44
Q

Clinical features of pneumonia

A

Fever, cough, purulent sputum, pain on respiration (if pleura involved), shortness of breath, impaired blood oxygenation, lung consolidation, and elevated WBC

45
Q

SARS (severe acute respiratory syndrome)

A

Highly communicable lower pulmonary infection, Unusual coronavirus first identified in late 2002, last in 2004

46
Q

SARS Manifestations

A

Fever, chills, mild respiratory infection, occasional diarrhea, acute respiratory distress 3-7 days from onset

47
Q

Middle eastern respiratory syndrome (MERS-CoV)

A

First identified in 2012, Infections still occurring – relatively low numbers (2500 total as of Jan 2021 – only 45 cases in 2020), Similar symptoms to SARS, but much more deadly than SARS (35% fatality), Small, isolated outbreaks

48
Q

COVID-10 (SARS CoV2)

A

Genetically similar to SARS Cov1 (83%) with extensive protein homology, Over 200 million cases confirmed with over 4 million deaths, Most (80%) develop mild symptoms, 5% critical and require ventilation support

49
Q

Pneumocystis Pneumonia cause

A

Pneumocystis jiroveci, protozoan parasite of low pathogenicity, Organisms attack and injure alveolar lining, leading to exudation of protein material into alveoli

50
Q

Who does Pneumocystis Pneumonia affect?

A

Affects mainly immunocompromised persons (AIDS patients, patients receiving immunosuppressive drugs, premature infants)

51
Q

Pneumocystis Pneumonia symptoms and diagnosis

A

Thick mucous/sputum too thick to expel creates – non- productive cough, dyspnea, pulmonary consolidation. Diagnosis through lung biopsy, bronchoscopy or from bronchial secretions

52
Q

Usual Interstitial Pneumonia

A

Injury to connective tissue causing fibrosis which tends to be viral or genetic (autoimmune) in origin. Marked by patchy collagen distribution scarring and fibroblast proliferation (slow gradual progress over a period of years)

53
Q

Tuberculosis (TB)

A

Infection from acid-fast bacterium, Mycobacterium tuberculosis transmitted from airborne droplets (Infection begins in lungs but can spread to other parts of the body)

54
Q

Mycobacterium tuberculosis

A

Causes TB; Bacterium has a capsule composed of waxes and fatty substances; resistant to destruction (hard to stain)

55
Q

Granuloma

A

Aggregation of immune cells with central necrosis, indicates development of cell-mediated immunity (TB) - formed as immune cells to attack TB

56
Q

Multinucleated giant cells

A

Bacteria plus fused macrophages and periphery of lymphocytes and plasma cells

57
Q

Caseous Granuloma

A

Fibrous tissue surrounding central cluster of macrophages/giant cells, center region becomes necrotic as granulomatous inflammation progresses – highly characteristic of TB infection

58
Q

Miliary tuberculosis

A

Systemic spread of TB (blood/lymph), Large numbers of organisms disseminated in body when a mass of tuberculous inflammatory tissue erodes into a large blood vessel (AIDS patients and immunocompromised individuals are at risk)

59
Q

Diagnosis of Miliary TB

A

Skin test, detects immune reaction to TB proteins
(Mantoux test) – can detect latent, Chest X-ray, Sputum culture

60
Q

Drug-Resistant Tuberculosis

A

Resistant strains of organisms emerge with failure to complete treatment or premature cessation of treatment (Multi-drug resistant TB (resistant to at least two of the anti-TB drugs) and Extensively drug-resistant TB (no longer controlled by many antituberculosis drugs))

61
Q

Treatment for Drug-Resistant Tuberculosis

A

Tx- combination drug regimen for several months (6-9 months)

62
Q

Acute bronchitis

A

Inflammation of the tracheobronchial mucosa (sore throat common in URTI)

63
Q

Chronic bronchitis

A

From chronic irritation of respiratory mucosa by smoking or atmospheric pollution

64
Q

Bronchiectasis

A

Walls thickened and weakened by chronic inflammation become saclike and fusiform (chronic cough, purulent sputum, and repeated pulmonary infection)

65
Q

Bronchitis and Bronchiectasis treatment

A

Exercise, oxygen therapy, drugs can provide symptom relief, Only effective treatment is surgical resection of affected segments of lung

66
Q

Chronic Obstructive Pulmonary Disease (COPD) anatomic derangements

A

Inflammation and narrowing of terminal bronchioles, Dilation and coalescence of pulmonary air spaces, Loss of lung elasticity; lungs no longer recoil normally following inspiration (caused by chronic irritation: Smoking and inhalation of injurious agents)

67
Q

Pulmonary emphysema

A

Destruction of fine alveolar structure
of lungs with formation of large cystic
spaces which begins in upper lobes and eventually affects all lobes

68
Q

Chronic bronchitis

A

Chronic inflammation of terminal bronchioles; cough plus purulent sputum

69
Q

COPD Pathogenesis

A

Chronic Inflammatory swelling of mucosa, leukocytes accumulate in bronchioles and alveoli, releasing proteolytic enzymes that attack elastic fibers of lung’s structural support, coughing, retention of secretions predisposes to pulmonary infection and impairs gas exchange, Increased susceptibility to respiratory infections

70
Q

COPD Treatment

A

Tx: Promote drainage of bronchial secretions to decrease frequency of pulmonary infections, Bronchodilators, inhaled steroids, oxygen therapy, lung therapy/exercise – lung transplant

71
Q

Antitrypsin

A

Alpha1 globulin; prevents lung damage from lysosomal enzymes (trypsin, fibrinolysin, thrombin) – produced by liver, monocytes (protects lungs from the collateral damage of neutrophils)

72
Q

Alpha1-Antitrypsin Deficiency

A

Deficiency permits enzymes to damage lung tissue, Autosomal dominant (1 mutation milder form of disease compared to double mutation), prone to emphysema development if levels are low, tends to affect lower lobes, causes an absent cough and excessive sputum production, and digestion of connective tissue

73
Q

Bronchial Asthma

A

Spasmodic contraction of smooth wall muscles of bronchi and bronchioles and increased bronchial mucous secretions in response to stimuli, Attacks are often precipitated by allergens: Inhalation of dust, pollens, animal dander, other allergens (Atopy) – type 1 hypersensitivity + stress, exercise, cold, smoke, pollutants and respiratory infection

74
Q

Bronchial Asthma onset

A

Child - typically allergic asthma, Adult - occupational/environmental

75
Q

Bronchial Asthma Treatment

A

Fast acting bronchodilators (Ventolin), long-acting bronchodilators, Long- acting drugs that reduce the reactivity of airways and block release of mediators from mast cells (Corticosteroids, anti-leukotrienes)

76
Q

Neonatal Respiratory Distress Syndrome

A

Progressive respiratory distress soon after birth, inadequate surfactant in lungs which causes alveoli to not expand normally during inspiration and collapse during expiration (most common in premature infants, infants delivered by cesarean section, and infants born to diabetic mothers)

77
Q

Neonatal Respiratory Distress Syndrome treatment

A

Adrenal corticosteroids to mother before delivery and Oxygen and surfactant (delivered by ET tube)

78
Q

Adult Respiratory Distress Syndrome

A

Shock (traumatic or septic) is a major manifestation that causes damage (fall in BP and reduced blood flow to lungs)

79
Q

Treatment of Adult Respiratory Distress Syndrome

A

treat condition that caused shock (infection etc.), oxygen ventilator with slightly increased pressure (aids in diffusion) - High mortality rate 30-40% due to COVID-19

80
Q

Pulmonary Fibrosis

A

Fibrous thickening of alveolar septa from irritant gases, organic and inorganic particles, inflammation, repair post ARDS which makes lungs rigid causing impaired diffusion of gases

81
Q

Pneumoconiosis

A

Lung injury from inhalation of injurious dust or other particulate material (Silicosis, asbestosis (can also cause cancer), cotton fibers, coal dust)

82
Q

Vaping (E-cigarette) Induced Lung Injury

A

Acute severe respiratory distress after vaping: SOB, chest pain – in some cases leading to development of chronic lung disease (syndrome is called EVALI) - similar damages to ARDS (This illness only occurred for a short period of time and mainly in the states)

83
Q

Lung Carcinoma

A

Usually smoking-related neoplasm, Common malignant tumor in both men and women who smoke, lung cancer kills more women then breast cancer

84
Q

Lung Carcinoma Classification, Prognosis, and Treatment

A

Classification (Squamous cell carcinoma and Adenocarcinoma - common, Large and small cell carcinoma (poor prognosis)
Prognosis (depends on stage, age, histology, health, biomarkers, generally poor)
Treatment (Surgery, radiation and chemotherapy for small cell carcinoma and advanced tumors, treatments with specific blocking agents)

HSS 3305 (21 decks)

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