mod 6 Flashcards
is a protective reflex that helps clear the airways by an explosive expiration. Inhaled particles, accumulated mucus, inflammation, or the presence of a foreign body initiates the cough reflex by stimulating the irritant receptors in the airway.
cough
-The cough reflex consists:
-Inspiration
-closure of the glottis and vocal cords
-contraction of the expiratory muscles
-reopening of the glottis, > forceful expiration that removes the offending matter.
Resolves within 2 to 3 weeks of the onset of illness or resolves with treatment of the underlying condition.
acute cough
Persisted for more than 3 weeks, although 7 or 8 weeks may be a more appropriate timeframe because acute cough and bronchial hyperreactivity can be prolonged in some cases of viral infection.
chronic cough
In persons who smoke, this is the most common cause of chronic cough
chronic bronchitis
-a subjective experience of breathing discomfort that is comprised of qualitatively distinct sensations that vary in intensity
-It is often described as breathlessness, air hunger, shortness of breath, labored breathing, and preoccupation with breathing.
-Pulmonary disease, or many other conditions such as pain, heart disease, trauma, and anxiety.
dyspnea
-Reduced oxygenation of arterial blood (reduced Pao2),
-Respiratory alterations
hypoxemia
-reduced oxygenation of cells in tissues
-may be caused by alterations of other systems as well.
hypoxia
-a bluish discoloration of the skin and mucous membranes caused by increasing amounts of desaturated or reduced hemoglobin (which is bluish) in the blood.
cyanosis
-Slow blood circulation in fingers and toes
-Most often caused by poor circulation resulting from intense peripheral vasoconstriction, such as that observed in persons who have Raynaud disease, are in cold environments, or are severely stressed.
-Best observed in the nail beds.
peripheral cyanosis
-the expectoration of blood or bloody secretions.
-Indicates infection or inflammation that damages the bronchi (bronchitis, bronchiectasis) or the lung parenchyma (pneumonia, tuberculosis, lung abscess)
hemoptysis
-to confirm the site of bleeding.
bronchoscopy and ct scan
the selective bulbous enlargement of the end (distal segment) of a digit (finger or toe)
clubbing
infection of the pulmonary parenchyma
pneumonia
Normal lung defenses of pneumonia
- cough reflex, reflex closure of the glottis
- tracheobronchial mucociliary transport
- alveolar macrophages
- inflammatory immune system response
SEASONAL FLU (INFLUENZA A & B)
Most common cause of pneumonia in children
<10% in adults
General Pneumonia Triad (WHO)
-fever
-tachycardia
-tachypnea
-most common bacterial pneumonia
Streptococcus pneumoniae
-sudden onset bronchopneumonia
Staphylococcus aureus
-most common atypical pneumonia; “walking pneumonia”
-at risk: young adults (especially 5-15 years old)
Mycoplasma pneumoniae
-at risk:: alcoholics
Klebsiella pneumoniae
-at risk: patients on immunosuppressants (e.g. transplant recipients) or chemotherapy, AIDS when CD4 count < 200
Pneumocystis carinii
-inhalation of aerosolized droplets from close contacts
- The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria becomes sick.
mycobacterium tuberculosis
-development of granulomatous reactions in the lungs, +/– local spread to lymph nodes and hematogenous to distant
organs (extrapulmonary TB, e.g. kidneys, bone)
primary TB
reactivation of dormant organisms and proliferation in aging/immunocompromised patients
secondary/post-primary TB
-reactivation of dormant organisms in immunocompromised patients;
-early systemic symptoms:
omalaise, fever, sweats, anorexia, weight loss
post-primary TB
-post-primary dissemination of multiple tiny granulomas in immunocompromised patients):
ofever, anemia, splenomegaly, meningitis
Miliary TB
-nonspecific lower lobe calcified infiltrates, hilar and paratracheal node enlargement, pleural effusion
primary TB
-cavitation in apical regions and posterior segment of upper lobe and/or superior segment of the lower lobes +/– calcification
post-primary TB
-uniformly distributed, very fine nodules (like seeds) throughout
Miliary TB
fungus is usually destroyed if patient is _______
-immunocompetent
usually resolves spontaneously in the immunocompetent
acute cryptococcosis
intense pulmonary granulomatous reaction with hematogenous spread to brain causing fatal meningoencephalitis if not treated; immunocompromised patients at risk
chronic cryptococcosis
HEAVILY ASSOCIATED WITH SMOKING
-characterized by progressive development of airflow limitation that is irreversible/minimally reversible
CHRONIC OBSTTRUCTIVE PULMONARY DISEASE
-dilatation and destruction of air spaces distal to the terminal bronchiole without obvious fibrosis
-decreased elastic recoil of lung parenchyma causes decreased expiratory driving pressure, airway collapse, and air trapping
Emphysema
typical form seen in smokers
primarily affects upper lung zones
centriacinar (respiratory bronchioles predominantly affected)
responsible for less than 1% of emphysema cases
primarily affects lower lobes
panacinar (respiratory bronchioles, alveolar ducts, and alveolar sacs affected)
-Chronic cough and sputum production on most days for at least 3 consecutive months in 2 successive years
-Obstruction due to narrowing of the airway lumen by mucosal thickening and excess mucus
Usually due to smoking but air pollution increasingly important
Chronic Bronchitis
-A chronic Inflammatory Disorder of the Airways > Episodic, Reversible Constriction.
asthma
-Rapid Immune Reaction to a Previously-Sensitized Antigen > Mast-Cell/Basophil Degranulation > Release Inflammatory Mediators >
Type 1 Hypersensitivity Reaction
-Vasodilation & inc Permeability (Bronchial edema)
-Smooth Muscle Spasm (Bronchoconstriction)
-Epithelial Damage > dec Mucociliary Function > Mucus Accumulation.
Initial (Early) Phase:
-Immune-Mediated Epithelial Damage
-Dec. Mucociliary Function > Accumulation of Mucus
Late Phase
Status Asthmaticus
Acute Asthma
Inhaled Corticosteroids (Budesonide or Fluticasone) Or Inhaled Antimuscarinic (Ipratropium Bromide) – If ICS-Intolerant.
Mild Asthma prevention
o LABA + Inhaled Corticosteroid Combinations
Symbicort [Budesonide + formoterol] or Seretide [Fluticasone + Salmeterol]
Moderate Asthma prevention
Oral Leukotriene Inhibitors (Singulair [Montelukast])
Severe Asthma prevention
