mod 6

Question 1

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.

Answer 1

cough

Question 2

-The cough reflex consists:

Answer 2

-Inspiration
-closure of the glottis and vocal cords
-contraction of the expiratory muscles
-reopening of the glottis, > forceful expiration that removes the offending matter.

Question 3

Resolves within 2 to 3 weeks of the onset of illness or resolves with treatment of the underlying condition.

Answer 3

acute cough

Question 4

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.

Answer 4

chronic cough

Question 5

In persons who smoke, this is the most common cause of chronic cough

Answer 5

chronic bronchitis

Question 6

-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.

Answer 6

dyspnea

Question 7

-Reduced oxygenation of arterial blood (reduced Pao2),
-Respiratory alterations

Answer 7

hypoxemia

Question 8

-reduced oxygenation of cells in tissues
-may be caused by alterations of other systems as well.

Answer 8

hypoxia

Question 9

-a bluish discoloration of the skin and mucous membranes caused by increasing amounts of desaturated or reduced hemoglobin (which is bluish) in the blood.

Answer 9

cyanosis

Question 10

-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.

Answer 10

peripheral cyanosis

Question 11

-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)

Answer 11

hemoptysis

Question 12

-to confirm the site of bleeding.

Answer 12

bronchoscopy and ct scan

Question 13

the selective bulbous enlargement of the end (distal segment) of a digit (finger or toe)

Answer 13

clubbing

Question 14

infection of the pulmonary parenchyma

Answer 14

pneumonia

Question 15

Normal lung defenses of pneumonia

Answer 15

• cough reflex, reflex closure of the glottis
• tracheobronchial mucociliary transport
• alveolar macrophages
• inflammatory immune system response

Question 16

SEASONAL FLU (INFLUENZA A & B)

Answer 16

Most common cause of pneumonia in children

<10% in adults

Question 17

General Pneumonia Triad (WHO)

Answer 17

-fever
-tachycardia
-tachypnea

Question 18

-most common bacterial pneumonia

Answer 18

Streptococcus pneumoniae

Question 19

-sudden onset bronchopneumonia

Answer 19

Staphylococcus aureus

Question 20

-most common atypical pneumonia; “walking pneumonia”
-at risk: young adults (especially 5-15 years old)

Answer 20

Mycoplasma pneumoniae

Question 21

-at risk:: alcoholics

Answer 21

Klebsiella pneumoniae

Question 22

-at risk: patients on immunosuppressants (e.g. transplant recipients) or chemotherapy, AIDS when CD4 count < 200

Answer 22

Pneumocystis carinii

Question 23

-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.

Answer 23

mycobacterium tuberculosis

Question 24

-development of granulomatous reactions in the lungs, +/– local spread to lymph nodes and hematogenous to distant
organs (extrapulmonary TB, e.g. kidneys, bone)

Answer 24

primary TB

Question 25

reactivation of dormant organisms and proliferation in aging/immunocompromised patients

Answer 25

secondary/post-primary TB

Question 26

-reactivation of dormant organisms in immunocompromised patients;
-early systemic symptoms:
omalaise, fever, sweats, anorexia, weight loss

Answer 26

post-primary TB

Question 27

-post-primary dissemination of multiple tiny granulomas in immunocompromised patients):
ofever, anemia, splenomegaly, meningitis

Answer 27

Miliary TB

Question 28

-nonspecific lower lobe calcified infiltrates, hilar and paratracheal node enlargement, pleural effusion

Answer 28

primary TB

Question 29

-cavitation in apical regions and posterior segment of upper lobe and/or superior segment of the lower lobes +/– calcification

Answer 29

post-primary TB

Question 30

-uniformly distributed, very fine nodules (like seeds) throughout

Answer 30

Miliary TB

Question 31

fungus is usually destroyed if patient is _______

Answer 31

-immunocompetent

Question 32

usually resolves spontaneously in the immunocompetent

Answer 32

acute cryptococcosis

Question 33

intense pulmonary granulomatous reaction with hematogenous spread to brain causing fatal meningoencephalitis if not treated; immunocompromised patients at risk

Answer 33

chronic cryptococcosis

Question 34

HEAVILY ASSOCIATED WITH SMOKING
-characterized by progressive development of airflow limitation that is irreversible/minimally reversible

Answer 34

CHRONIC OBSTTRUCTIVE PULMONARY DISEASE

Question 35

-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

Answer 35

Emphysema

Question 36

typical form seen in smokers
primarily affects upper lung zones

Answer 36

centriacinar (respiratory bronchioles predominantly affected)

Question 37

responsible for less than 1% of emphysema cases
primarily affects lower lobes

Answer 37

panacinar (respiratory bronchioles, alveolar ducts, and alveolar sacs affected)

Question 38

-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

Answer 38

Chronic Bronchitis

Question 39

-A chronic Inflammatory Disorder of the Airways > Episodic, Reversible Constriction.

Answer 39

asthma

Question 40

-Rapid Immune Reaction to a Previously-Sensitized Antigen > Mast-Cell/Basophil Degranulation > Release Inflammatory Mediators >

Answer 40

Type 1 Hypersensitivity Reaction

Question 41

-Vasodilation & inc Permeability (Bronchial edema)
-Smooth Muscle Spasm (Bronchoconstriction)
-Epithelial Damage > dec Mucociliary Function > Mucus Accumulation.

Answer 41

Initial (Early) Phase:

Question 42

-Immune-Mediated Epithelial Damage
-Dec. Mucociliary Function > Accumulation of Mucus

Answer 42

Late Phase

Question 43

Status Asthmaticus

Answer 43

Acute Asthma

Question 44

Inhaled Corticosteroids (Budesonide or Fluticasone) Or Inhaled Antimuscarinic (Ipratropium Bromide) – If ICS-Intolerant.

Answer 44

Mild Asthma prevention

Question 45

o LABA + Inhaled Corticosteroid Combinations
Symbicort [Budesonide + formoterol] or Seretide [Fluticasone + Salmeterol]

Answer 45

Moderate Asthma prevention

Question 46

Oral Leukotriene Inhibitors (Singulair [Montelukast])

Answer 46

Severe Asthma prevention