With Pulmonary Fibrosis: 1. An unknown antigen triggers ___ & ___ lymphocytes. 2. B and T Cells activate ____. 3. Activated ____ recruit Neutrophils and activate _____. 4. _____ lay down collagen and _____ tissue 5. _____ release oxidant _____. 6. Excess fibrin deposition results in stiff, _____ lungs.

1. B and T 2. Macrophages 3. macrophages, fibroblasts 4. Fibroblastas, connective 5. Neutrophils, proteases 6. noncompliant

Fibrotic interstitial Lung Disorders include: 1. Diffuse ____ lung disease 2. Sarcoidosis 3. Hypersensitivity _____ 4. _____ Lung Disease

1. interstitial 3. Pneumonitis 4. Occupational

N339 Exam 5: Respiratory Disorders Flashcards by Ryan Liberty

What are two types of Fibrotic Interstitial Lung Diseases?

Diffuse Intersitial Lung Disease (Restrictive lung disease)
Sarcoidosis

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With _____ tissue becomes fibrotic and restricts the contraction of the lungs.

fibrotic interstitial lung disease

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Diffuse Interstitial Lung Disease is also known as?

Diffuse Intersittial Pulmonary Fibrosis

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Diffuse Interstitial Lung Disease is characterized by and related to?

characterized by Inflammation and thickening of the alveolar interstitium. “scarring down tissue”

Related to an immune reaction that begins with injury to the alveolar epithelial or capillary endothelial cells, leading to infiltration by immune cells.

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Excess fibrin deposits from Diffuse Interstitial lung disease result in ? (6)

stiff, noncompliant lungs
Decreased vital capacity
decreased tital volume
decreased function residual capacity
decreased diffusion capacity
increased respiratory rate to compensate for tidal volume.

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What are the most common patient complaints with Diffuse Interstitial lung disease? what is the contributing factor?

Progressive Dyspnea
Non-productive cough
SOB

Smoking

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With Pulmonary Fibrosis:

An unknown antigen triggers ___ & ___ lymphocytes.
B and T Cells activate ____.
Activated ____ recruit Neutrophils and activate _____.
_____ lay down collagen and _____ tissue
_____ release oxidant _____.
Excess fibrin deposition results in stiff, _____ lungs.

B and T
Macrophages
macrophages, fibroblasts
Fibroblastas, connective
Neutrophils, proteases
noncompliant

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Type II pneumocytes usually release ____.

2. With pulmonary fibrosis, ____ of type II pneumocytes occurs b/c of the inflammatory process.

Surfactants

2. deactivation

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With pumonary fibrosis, increased connective tissue causes poor _____. Additionally, since type II pneumocytes are deactivated, surfactant ____ results in alveoli that can’t ____.

diffusion.
decrease
stay open

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Treatment of pulmonary fibrosis (diffuse interstitial lung disease) centers on administration of drugs to depress immune system activity, such as ____.

corticosteroids

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Fibrotic interstitial Lung Disorders include:

Diffuse ____ lung disease
Sarcoidosis
Hypersensitivity _____
_____ Lung Disease

interstitial
Pneumonitis
Occupational

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Sarcoidosis is ____ or chronic of unknown cause but ____ cause is likely.

acute

immunologic

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Sarcoidosis is characterized by development of multiple _____ of 1-2mm in diameter that affect _____ organs but most commonly the _____ and lung tissue.

granulomas
multiple
lymph nodes

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Sypmtoms of Saroidosis include:

dyspnea
fever
enlarged lymph nodes

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Hypersensitivity Pneumonitis is caused by exposure of lung tissue to inhaled _____ agents. This leads to a type ____ hypersensitivity reaction (ie ___ ___ complexes)

organic
III
antigen-antibody

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What organic agents cause hypersensitivity Pneumonitis?

Mold
Bird Poop
Fungal Infections

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In advanced cases of Hypersensitivity Pneumonitis, ____ lung changes occur (_____ lesions and _____ alveolar walls)

fibrotic
granulomatous
thickened

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Symptoms of Hypersensitiviity Pneumonitis include?

Fever
Chills
Malaise
Dyspnea
Dry cough
Tachypnea

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Occupational Lung Disease is caused by inhalation of ____ substances (toxic gases) and foreign particles.

Inorganic

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An example of Occupational Lung Disease caused by inhalation of inorgaic dust particles is _____.

Pneymoconiosis

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3 major types of ocuupational lung Pneumoconiosis include? and what is source of particles?

anthracosis: coal dust
silicosis: inhaling sand (sandblasting community)
asbestosis: wall insulation

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With Occupational lung disease, lung ____ occurs as disease progresses. In late stage, ____ occurs (i.e. can’t get enough oxygen to support perfusion to the body).

fibrosis

hypoxemia

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Common Atmosheric Pollutants that contribute to lung disease include? (5)

Carbon monoxide (cars)
Sulfar oxides (factories)
Photochemical oxidants (byproduct of hydrocarbon exposure, ozone etc)
Cigarette smoke (nicotine)
Particulate Matter (factories)

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What is the common pathology with exposure to atmospheric pollutants?

They all paralyze the mucociliary escalator.

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What are two types of Atelectatic Disorders?

1. Acute Respiratory distress Syndrome (ARDS) | 2. Infant Respiratory Distress Syndrome

ARDS is characterized by damage to the ____-capillary membrane and has a mortality rate of ___%. Because of _____, patients that recover may have continued respiratory problems.

alveolar 50 scarring

ARDS is associated with? (5)

1. Severe trauma 2. Sepsis (40% of cases) 3. Aspiration of gastric acid (30% of cases) 4. Fat emboli syndrome (from fractured long bone) 5. Shock (any cause of)

Characteristic findings of ARDS: 1. Injury to ____ 2. Changes in Alveolar ____ 3. Injury to _____ circulation 4. Disruption of oxygen ____ and utilization

1. alveoli 2. diameter 3. pulmonary 4. transport

With injury to Alveoli in ARDS, injury includes? (3)

1. direct injury to wall 2. aspiration of gases 3. indirect shock

With changes in alveolar diameter and ARDS, decrease in diameter occurs b/c?

inactivation of surfactant

What are symptoms of ARDS?

1. severe hypoxemia 2. decreased lung compliance 3. decreased functional residual compliance 4. diffuse alveolar infiltrates 5. non-cardiogenic pulmonary edema (not from heart failure)

Does oxygen therapy help ARDS patients?

No: can’t exchange gas thru alveolar walls due to hyaline membrane. Plus, capillary wall endothelial is thickened.

What are 4 conditions in whcih ARDS can develop?

1. Aspiration 2. Drugs, Toxins, Therpeutic Agents 3. Infections 4. Trauma and Shock

What are two events that can cause Aspiration leading to ARDS?

Near drowning and Aspiration of gastric contents

What are 4 types of chemicals that can lead to ARDS?

1. heroin 2. Inhaled gases (ex smoke or ammonia) 3. Oxygen 4. Radiation

What are 3 types of infections that can lead to ARDS

Gram negative septicemia | Bacterial and viral infections

What are 3 types of trauma or shock that cause ARDS

Burns Fat embolism Chest Trauma

What are 3 major pathophysiologic processes associated with ARDS?

1. Non-cardiogenic pulmonary edema 2. atelectasis from lack of surfactant 3. fibrosis from inflammatory deposition of proteins.

With ARDS, increased ____ of the pulmonary vasculature and flooding of the alveoli with proteinaceous fluid, leading to the development of protein-rich pulmonary ____. The acute lung injury triggers the____ to activate the complement system and to initiate _____ sequestration in the lung

permeability edema immune system neutrophil

Pathologenesis of ARDS: Triggering agents has effect on vasculature (I.e. 1). Causes (2) due to inflamm response. With increased permeability, dumping of (3) cause non-cardiogenic edema. At same time, infection everywhere, activate alveloar macrophage that kick out (4), recruits (4), injures alveolar cap walls, leave cap bed, goes to alveolus. All released in alveolus cause damage, slough off of Type I (5). Type II hypertrophy become (6). All cellular debris and protein rich fluid forms (7) that lines inside of alveolus. Now alveolus begins to (8). Surfactant/exudate now referred to as (9) memrane. Oxygen that does get thru from capillaries can’t get into alveolus.

1. Alveolar Capillary 2. dilation 3. plasma proteins 4. cytokines, neutrophils 5. alveolar cells 6. inactivated 7. exudate 8. collapse 9. hyaline

Surfactant normally decreases _______in small alveoli and prevents them from ____.

surface tension | collapsing

Infant Respiratory Distress Syndrome (IRDS) is also known as _____.

hyaline membrane disease

IRDS is caused by a lack of ____ that causes formation of ____ membrane.

surfactant | hyaline

IRDS occurs in ___% of infants born before 30 weeks who are not treated with _____. Also occurs in __% of infants born after ___ weeks. IRDS is more common in ____.

``` 30% corticosteroids 5% 34 weeks C-Sections ```

The Primary cause of IRDS is lack of _______leading to increased alveolar tension and decreased______.

pulmonary surfactant | lung compliance

The secondary cause of IRDS is ____ of pulmonary blood supply becuase of thick ____ walls.

Immaturity | Endothelial

With IRDS, ______ is needed to fill infants lungs with air.

mechanical ventilation

Symptoms of IRDS include? (4)

nasal flaring expiratory grunt thoracic retraction rapid shallow respiration

Typcially, IRDS is avoided because cortisol and _____ of vaginal delivery ___ maturation of type II alveoloar cells.

stress | enhances

What are the two types of Pleural space disorders?

1. Pneumothorax | 2. Pleural Effusion

What is pneuomothorax?

Accumulation of air in the pleural space that creates atmospheric pressure and does not allow the lung to expand.

What are general signs of pneumothorax?

Tachycardia Dulled or absent breath sounds SOB with chest pain on effected side.

What are 3 types of pneumothorax?

1. Spontaneous (primary0 2. Secondary 3. Tension Pneumothorax

A ____ is caused by a rupture on the surface of the lungs and air goes into the pleural cavity.

Spontaneous or Primary pneumothorax

What increases the risk of a spontaneous pneumothorax?

cigarette smoking

A _____ pneumothorax occurs as a result of prexisting pulmonary disease.

Secondary

Secondary pneumothorax results in? (4)

Asthma, emphysema, CF, Infectious diseases (TB or pneumonia) and interstitial lung disease

A ____ pneumothorax is caused by an external lesion from trauma. Air accumulates in the pleural cavity and pushes the ____ toward the mediastinum (_____) and the ____ shifts. Air is able to enter the pleural space but cannot escape on _____.

``` tension lung heart trachea exhalation ```

True or False: Tension and Spontaneous pneumothorax are not medical emergencies.

False.

Tension Pneumothorax will present with? (5))

1. Tachycardia 2. Hypotension 3. Tracheal shift 4. Compression of the vena cava 5. Possibe tracheal tear

Compression of the vena cava is neck vein ____ or Kussmauls sign.

distention

_____ is an accumulation of fluid in the pleural cavity.

Pleural Effusion

What are 5 types of fluid that can cause a pleural effusion?

1. Transudates 2. Exudates 3. Empyema 4. hemothorax 5. Chylothorax

1. Transudates associated with Pleural Effusion are ___ in protein. 2. Associated with severe ____, cirrhosis with ___; ____ syndrome or ____.

1. low 2. heart failure 3. ascites (fluid build up in abdomen) 4. nephrotic 5. myxedema (hypothyroidism)

Exudates associated with Pleural Effusion are ___ in protein. They are caused by? (6)

1. High | 2. Malignancies, Infections, Pulmonary Embolism, Sarcoidosis, Post MI syndrome, Pancreatic disease.

Causes what type of fluid? 1. Malignancies, 2. Infections, 3. Pulmonary Embolism, 4. Sarcoidosis, 5. Post MI syndrome, 6. Pancreatic disease.

Exudate

Empyema associated with Pleural effusion is?

Pus from pleural infection

Hemothorax associated with pleural effusion is?

Blood from chest trauma

Chylothorax associated with pleural effusion is?

leakage of lymph following trauma

General manifestations of Pleural Effusion include? (4)

1. Dyspnea 2. Cough 3. Pleuritic Pain 4. Diminished breath sounds and dullness to percussion over effected area.

What are 5 neuromuscular disorders that may lead to respiratory disorders?

1. Poliomyelitis 2. Amyotrophic Lateral Scoliosis (ALS) 3. Muscular Dystrophies 4. Gullain-Barre Syndrome 5. Myasthenia Gravis

With the neuromuscular disorder Poliomyelitis, what virus is responsible?

Poliovirus

With Poliomyelitis, the poliovirus attacks ____ neurons in the spinal cord (grey matter) and the ___.

motor | brain

ALS is a ____ disease of the NS. It involves both upper and ____ motor neurons. The ___ muscle fails and patients have a ___ prognosis.

degenerative lower diaphragm poor

Muscular Dystrophies are progressive loss of ___ cells with developing muscle ____. The muscle disintegrates with each ____. MD is passed from ____ to sons.

muscle weakness contraction mothers

Guillain-Barre Syndrome is presumed to be an _____ disorder characterized by ______ of peripheral nerves. Progresses from foot to head in a ____ path. Most patients get put on _____. "C3, C4, C5, keep ____ alive"

``` immunologic demyelination ascending respirators diaphragm ```

Myasthenia Gravis causes _____ destruction of _____ receptors of neuromuscular juctions leading to progressive ____ weakness. It affects lungs and the ____.

autoimmune acetylcholine muscle diaphragm

Chest wall deformities lead to respiratory disorders because they limit chest _____.

expansion

Chest wall deformities associated with respiratory disorders include? (4)

1. Kyphoscoliosis 2. Ankylosing Spondylitis 3. Flail Chest 4. Disorders of Obesity

Kyphoscoliosis includes both kyphosis and ___. ___ is a hunchbacked appearance resulting in forward ____. Scoliosis causes ___ curvature deformity.

Scoliosis Kyphosis flexion lateral

______ is a chronic inflammation of the site of ligamentous insertion into the spine or sacroliliac joints. ___ atttachements harden and the chest can't ___.

Ankylosing Spondylitis Rib expand

_____ results from multiple rib fractures as a result of trauma to the chest

Flail chest

Obesity may be associated with _____ and airway _____.

hyperventilation | obstruction

Build up of fat in the mediastinum and around the trachea causes obsturction of aiway most often when supine. Causing _____ sleep ___.

obstructive sleep apnea

Infection or Inflammation of the lung associated with respiratory disorders includes what 3 disorders or syndromes?

1. Pneumonia 2. Severe Acute Respiratory Syndrome (SARS) 3. Pulmonary Tuberculosis

Pneumonia is an ____ reaction in the alveoli and _____ of the lung that is usually caused by an infection agent.

Inflammatory | Interstitium

infectious agents that cause pneumonia include? (4)

1. Bacteria 2. Viruses 3. Fungi 4. Mycoplasmids

True or False: Mycoplasmids can reproduce independently.

True

Manifestations of Pneumonia include?

Hemoptysis (bloody cough)

Symptoms of Pneumonia are variable and include? (4)

Fever cough headache malaise

SARS is a severe form of ____ occuring in Asia. It is caused by the ______ and spread via ____ infection.

pneumonia coronavirus (SARS-CoV) Droplet

Symptoms of SARS include: 1. fever 2. ____ 3. headache 4. _____ cough 5. dyspnea

myalgias | non productive

SARS has a mortality rate of ___% and there is no current definitive ____.

10% | treatment

Pulmonary Tuberculosis (TB) is caused by ________, contracted by _____, ____ or ingestion of ____. TB causes a Type __ immune response.

``` Mycobacterium tuberculosis droplet inhalation bacterium IV ```

TB affects all organ systems but most commonly afects the _____ and lymph nodes.

lungs

TB is managed by _____ over a course of 9-_ months for ___ disease.

antibiotics 12 active

What are two types of TB?

primary and | secondary (reactivating)

Primary TB is the _____ infection and is usually clinically _____. TB may lay ____ for years before _____.

initial silent dormant reactivation

Secondary TB or ______, occurs when the patients immune system becomes _____.

Reactivation | impaired

Clinical features of TB include: 1. low grade ___ 2. cough 3. ____ sweats 4. fatigue 5. weight ____ 6. Malaise 7. Anorexia 8. ____ cough is common

1. fever 3. night 5. loss 8. chronic

____ TB is disseminated form of TB that can affect many ____ including the GI, ___, spleen and ____.

Miliary organs liver CNS

Multidrug-resisitant strains of TB account for 15% of cases and are especially _____ with a 70-___% fatality rate.

dangerous | 90%

Tuberculosis Pathogenisis (Primary): 1. inhalation of Mycobacterium tuberculosis. 2. Cell-mediated _____response 3. If inhale enough of the bacteria, ____ inflammatory response 4. ____ complex is formed 5. If no treatment: healed ____ lesion occurs.

2. hypersensitivity 3. Granulomatous 4. Ghon 5. dormant

Granulomatous (walled-off areas of inflammatory cells and bacteria) become ___ and _____, forming tubercles, which are the hallmark of tuberculosis.

fibrotic and calcified | Ghon

Secondary: 6: since ______ immunity occurred with primary infection, ____ occurs with weak immune system. 7. Get large cell-mediated response and _____ in Ghon complex are released which leads to ____ or disseminated TB and ____TB.

6. cell mediated, reactivation | 7. bacteria, progressive, miliary

With Secondary TB, ___ occurs because the Ghon complex breaks up.

Cavitation