Patho Unit 6 Flashcards
part of the neck that is situated immediately posterior to the mouth and nasal cavity and superior to the esophagus, larynx, and trachea.
pharynx
behind the oral cavity
oropharynx
from the internal nares and the soft palate superior to the oral cavity
nasopharynx
covers C4 to C6 of the vertebral column and is inferior to the upright epiglottis and extends to the larynx
laryngopharynx
voice box / where respiratory and digestive passages diverge
larynx
combination of the vocal folds and the spaces in between them
glottis
flap of cartilage located in the throat behind the tongue and over the larynx
epiglottis
part of vagus nerve that innervates most of the larynx
recurrent laryngeal branch
three types of salivary glands
parotid
submandibular
sublingual
cellular metabolism that utilizes oxygen
respiration
action of breathing in and out for air/gas exchange
ventilation
space between the lobes (lungs) that contains the heart, great vessels, and esophagus
mediastinum
hypothetical area that exists for the purpose of describing the area of the LUL that would occupy the same area as the corresponding RML
lingula
name the lobes of the lungs
RUL, RML, RLL, LUL, LLLtrachea in
area over the bifurcation of trachea into the R and L mainstream bronchi and is the location of the second costal cartilage
Angle of Louis / sternal angle
notch above the manubrium
suprasternal notch
lines the thoracic cage
parietal pleura
lines the lung viscera
visceral pleura
excess fluid in the pleural lining
pleural effusion
primary function of the lungs
gas exchange between environmental air and the blood of the body
the movement of air into and out of the lungs
ventilation
movement of gases between air spaces in the lungs and the bloodstream, across the alveolar-capillary membranes
diffusion
movement of blood into and our of the capillary beds of the lungs to the body organs and tissues, allowing CO2 to enter the alveolar air and be breathed our and O2 to leave the alveolar air and enter our bloodstream
perfusion
specialized lung cells that “sweep out” the inhaled particles
ciliated epithelium
specialized cells in the nares, trachea, and large airway that cause reflex sneezes and coughs to help expel foreign particles
irritant receptors
cells where gas exchange takes place
alveoli (alveolus)
anatomical appearance of the alveoli (clusters of berry shaped structures)
pulmonary acinus
type 1 alveolar cells:
provide support
type 2 alveolar cells:
create surfactant
substance that prevents the alveoli from collapsing that has chemical properties to reduce surface tension and protects against pulmonary edema (keeps lungs dry)
surfactant
causes the collapse of alveoli if they are lined with water
Law of LaPlace
major muscle of inspiration that flattens from its bowed position when it contracts creating a negative pressure that passively pulls air into the lungs
diaphragm
2 major muscles of inspiration
diaphragm
intercostal muscles
accessory muscles of inspiration
sternocleidomastoid
scalene muscles
muscles used for forced expiration
internal intercostals
abdominal (rectus) muscles
volume increase in the chest cavity results in ______
inspiration
reflex that causes passive expiration due to the relaxation of the inspiratory muscles
elastic recoil
determined by lung compliance and airway resistance measured with Pulmonary Function Tests
work of breathing
test that measures volume and air flow of the lungs
pulmonary function tests
type of lung disease that interferes with volume of air due to stiffness of the lungs or chest wall and increases the work of breathing
restrictive lung disease
type of lung disease that interferes with the airflow where the airflow is impeded by traveling through a smaller lumen or longer tube
obstructive lung disease
types of restrictive lung diease
sarcoidosis
kyphosis
scleroderma
asbestosis
types of obstructive lung disease
asthma COPD (chronic obstructive pulmonary diease)
pressure that any one gas would exert on the walls of a container if it were the only gas present
partial pressure
sum of all partial pressures of the component of gases in a mixture of gases
total pressure
pressure of the air pressing down on the earth / the sum of the pressure of all gases in air pressing down in a column down on the earth
barometric pressure
percentages of gases in the air
Oxygen - 21%
Nitrogen 78%
Trace gases 1% (includes CO2)
breaths per minute
respiratory rate
amount of gas inspired and expired during normal breathing
tidal volume (VT)
amount of gas that can be inspired in addition to VT
inspiration reserve volume (IRV)
amount of gas that be expired after passive expiration
expiration reserve volume (ERV)
volume of gas that can never be expired and is always present in the lungs
reserve volume (RV)
IRV + ERV + VT + RV =
total lung capacity (at maximal inflation)
ERV + RV = (gas remaining at the end of expiration)
functional residual capacity (FRC)
IRV + ERV + VT = (maximum amount that can be expired from lungs)
vital capacity
portion of the tidal volume that actually reaches the alveoli (VT - dead space D)
alveolar ventilation (AV)
total amount of new air moved into the respiratory passages each minute
VT x RR = 500ml x 12/min = 6L/min
minute respiratory volume
vessel that carries desaturated blood
pulmonary artery
vessel that carries oxygenated blood
pulmonary vein
dissolved oxygen in arterial blood
partial pressure of arterial oxygen (PaO2)
PaO2 low enough to reduce the SaO2 below 90%
hypoxemia
inadequate oxygenation of blood to supply the cells with oxygen
hypoxemia
inadequate oxygen on a cellular level
hypoxia (anoxia)
type of pulmonary function test that measures BOTH volume and airflow that is always ordered with a bronchodilater (BD) challenge
spirometry
basic measurements of spirometry
forced vital capacity (FVC)
forced expiratory volume in 1 second (FEV1)
FEV1/FVC
peak expiratory flow rate (PEF)
maximum amount of gas that can be displaced from the lung during a forced expiration
forced vital capacity (FVC)
maximum amount of air that can be expelled from the lung in 1 second
forced expiratory volume in 1 second (FEV1)
percentage of maximum inspiration that is expired in 1 second
FEV1/FVC
forced expiratory flow rate in the middle of an expiration
peak expiratory flow rate (PEF)
type of pulmonary function test that looks at the expired CO2 over time during expiration phase
capnogram
an area that is getting air from ventilation but is not perfused (occurs in apeces/tops of lungs)
dead space
any time oxygenated blood is mixed with deoxygenated blood ((occurs at bases of lungs)
shunting
nervous system that controls ventilation
ANS
area(s) of the brain that contain the respiratory center
medulla and pons
reflex initiated when lungs are over inflated where respiratory center sends signal to inhibit inspiration and excite expiration
Hering-Breuer reflex (stretch reflex)
the fact that there is excess oxygen circulating as an oxygen buffer on hemoglobin
hemoglobin buffer mechanism
regular respiratory reflexes
cough
sneeze
hiccup
rare, progressive, autoimmune disease that leads to hardening and tightening of the skin and connective tissues (initially dry patches of skin that get thicker and harder and progress to internal organs in some patients
scleroderma
etiology of scleroderma
overproduction of collagen along with localized inflammation
common abnormal curvature of the spine that usually begins at the onset of puberty and worsens during the rapid growth phase of the adolescent
scoliosis
extrinsic restrictive condition that is the most common congenital deformity of the anterior chest that causes decreased space in the chest cavity of the lungs to expand and cardiac compression or shifting with the restriction of stroke volume
pectus excavatum
inflammatory lung disease (obstructive) that is a chronic inflammatory disorder of the airways with bronchial hyperresponsiveness to a variety of stimuli causing brochoconstriction, recurrent episodes of wheezing breathlessness, chest tightness, and coughing
asthma
type of asthma caused by sensitization to allergens and contributing factors include respiratory infections, infant prematurity, air pollution, and exposure to smoking
atopic asthma
type of asthma that is assumed to be due to environmental exposure
occupational asthma (irritant induced asthma)
disease that most asthma patients have that induces brochospasm
gastroesophogeal reflux disease (GERD)
handheld meter for patient self use to determine the peak expiratory flow rate (PEF)
peak flow meter
condition that includes chronic bronchitis and emphysema that is characterized by a midlife onset of slowly progressive symptoms (dyspnea, chronic cough and sputum) woth smoking as the most common risk factor
chronic obstructive pulmonary disease (COPD)
how is the severity staged in COPD
spirometry
type A COPD (means trapping air)
caused by a stiff lungs that have lost elastic recoil and cause a slow airway collapse on exhalation and trap air in the lungs.
emphysema
type B COPD, more common, can develop in anyone with enough bronchial irritation, may be barrel chested, clubbed fingers, low weight, stooped posture, pursed lips, accessory muscle use when breathing
chronic bronchitis
increased pressures in pulmonary blood vessels resulting in areas of hypoperfusion and hyperperfusion, can be idiopathic, drug induced, or mountain sickness. dysregulation of low sensitivity to low CO2 in the brain or dysregulation of pulmonary circulation upon exposure to hypoxia
primary pulmonary hypertension
RV enlargement due to lung disease produces secondary pulmonary artery hypertension that results in clinical picture of RHF
Cor Pulmonale Secondary to Pulmonary Hypertension
compression of the superior vena cava that may include tracheal narrowing, and/or obstruction of the pulmonary arteries or veins. usually associated with bronchogenic carcinoma, lymphoma, or thrombus. Presents with dyspnea, cough, orthopnea, swelling of the trunk, nasal stuffiness, jugular vein distension, horner syndrome, paralysis of vocal cords, paralysis of phrenic nerve
Superior Vena Cava Syndrome (SVCS)
when foreign substances are inhaled into the lungs, caused by a swallowing dysfunction or some other inability to control wallowing
aspiration
aspiration of a bolus while swallowing
direct aspiration
aspirations of refluxed foods from the stomach that enters the esophagus and then the lung
indirect aspiration
aspiration that occurs in utero or during birth passage in the amniotic fluid after 34 weeks GA. baby is cyanotic, tachypnic, tachycardic, has nasal flaring and intercostal retractions
meconium aspiration
aspiration of water (unless laryngospasm keeps water out) with severe hypoxia.
near drowning
unilateral absence of breath sounds, wheezing, hemoptesis, recurrent pneumonia, stridor, coughing, apnea, inimproving croup, hyperinflated obstructed lung. usually occuring in children due to swallowing objects
tracheal foreign body (TFB)
airspace disease and consolidation that may be bacterial or viral where airspaces are filled with bacteria or other microorganisms AND exudate
pneumonia
type of pneumonia that is classical pneumococcal pneumonia with the entire lobe consolidated and air bronchograms are common
lobar pneumonia
viral or mycoplasma, latter starts perihilar and can become confluent and or patchy as the disease progresses, no air bronchograms
interstitial pneumonia
follows gravitational flow of swallowed contents, imparied consciousness, post anesthesia, alcoholics, debilitated, demented
aspiration pneumonia
type of pneumonia where microbes (including strep pneumoniae, H. influenzae, Chlamidia pneumoniae, mycoplasma pneumoniae, staph aureus, respiratory viruses, endemic fungi…) that is often called walking pneumonia (has cough, fever, purulet sputum, chest pain, shaking chill)
Community Acquired Pneumonia (CAP)
after one week of hospital stay and there is a new CXR infiltrate
Nosocomial (hospital acquired) pneumonia
abnormal and permanent dilation (ectasia) pf bronchi or lower airways that can be acquired or congenital and can be focal or diffuse
bronchiectasis
secondary to prior pneumonia that has walled off, usually caused by a prior aspiration or infection behind an obstructed bronchus. almost always clears with correct antibiotics over 2-3 weeks
lung abscess
purely pediatric condition AKA acute infectious laryngotracheobronchitis that sounds like a barky cough with inspiratory stridor with respiratory distress
croup
pediatric diagnosis: small airway inflammation and RSV posistive, common in first 2 years of life. usually in spring or fall and may trigger future asthma
pediatric bronchiolitis
organizing pneumonia that has granulation tissue in the distal air spaces
Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
usually pediatric diagnosis, presents as high fever, respiratory distress, dysphagia, muffled voice, sit erect and drool, swollen epiglottis. EMERGENCY. prepared to intubate
epiglottitis
infection of the middle ear with acute onset, presence of a middle ear effusion, and signs of middle ear inflammation. most frequent diagnosis in a febrile child. presents with otalgia, fever, tinnitus, vertigo, draining ear, and child pulling at ear
acute otitis media (AOM) (middle ear infection)
looks like bubble behind the eardrum, eardrum may be retracted, may be a black horizontal line across the TM if middle ear is partially full of fluid, may be caused by reduced barometric pressure (plane ride), may contribute to hearing loss or tinnitus symptoms
serous otitus media (SOM)
can be caused by Streptococcal (group A beta-hemolytic strep), diphtheric, or gonococcal microbes, but only 15% is caused by group A strep. it is mostly viral
pharyngitis
viral or bacterial, edema, erythema, purulent exudate from crypts. swelling in tonsillar pillars
tonsillitis
inflammation and/or infection of one or more paranasal sinuses, occurs with the obstruction of the normal drainage mechanism. occuring for < 3 weeks
acute bacterial sinusitis
length of time to be considered chronic sinusitis
> 3 months
complication of direct orbital trauma where bacteria reaches the orbit via wall of infected sinus or gains entry from the outside due to a trauma
orbital cellulitis
airborne mycobacterial infection, usually of the lungs, causing cough, weight loss, night fevers, fatigue, hemptysis, and is acutely infectious. Tested for by placing a PPD
tuberculosis (TB)
immune incompetence form cancer, HIV, immune suppressing drugs, or severe illness
anergy
lung cannot inflate completely due to fluid being in the pleural cavity and taking up the lung space. can be aquired or congenital (infectious or noninfectious)
pleural effusion
removal of fluid by drainage (may require placement of chest tube for continuous drainage
thoracentesis
air in the potential space between the visceral and parietal pleura
pneumothorax
accumulation of blood within the chest (usually in the pleural space) usually due to to trauma
hemothorax
collection of pus in the pleural space
empyema
describes how far cancer has spread anatomically, and tissue invasion
staging
part of pathology report that describes a macro view. naked eye description as it is received in the lab
gross description
part of pathology report that describes the findings of the cells after all of the fixation and processing has been completed
microscopic description
leading cause of cancer death and second most commonly diagnosed cancer (excluding skin cancer) among both men and women in the US
lung cancer
type of cancer associated with asbestos exposure, that arises from mesothelial cells (usually in pleura, but also in the peritonium, pericardium, and testes. very aggressive and usually fatal
pleural mesothelioma
clot in the vein that can lead to a traveling clot
deep vein thrombosis (DVT)
traveling clot
venous thromboembolism
when a venous thromboembolism ends up in the lungs
pulmonary embolism
prediction charts for diagnosis pulmonary empbolism
Wells Prediction Rule
Geneva Test
name some tests for diagnosing pulmonary embolism
Dimer test ABGs BNP EKG ultrasound capnography x-ray Ct scan angiogram
condition where fluid is in the lungs to to an injury or infection. prevention of gas exchange causes hypoxemia, dyspnea, CXR infiltrates, and decreased pulmonary compliance (EMERGENCY)
pulmonary edema and ARDS (Acute Respiratory Distress Syndrome)
when airway pressure is maintained above atmospheric pressure at the end of exhalation by means of impedance (valves), in order to increase the volume of gas remaining in the lungs at the end of expiration, improving gas exchange
positive end-expiratory pressure ventilation (PEEP)
pulmonary edema that occurs after the removal of an airway obstruction
post-obstructive pulmonary edema (POPE)
condition where hypoxemia drives minute ventilation inducing respiratory alkalosis and low CO2 to the brain, develops after ascending 1000 feet in 24 hours.
acute mountain sickness (AMS)
two complications from acute mountain sickness that are caused if at the altitude for too long where fluid gets into the lungs and/or the brain
high altitude pulmonary edema (HAPE)
high altitude cerebral edema (HACE)
