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Pathophysiology > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Primary function of the respiratory system

A

gas exchange

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2
Q

ventilation

A

movement of air between the atomosphere and the respiratory portion of the lungs.
Inspiration and expiration

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3
Q

perfusion

A

flow of blood through the lungs

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4
Q

diffusion

A

transfer of gases between the air filled spaces in the lungs and the blood

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5
Q

Muccociliary blanket

A

mucus produced by the epithelial cells in the conducting airways

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6
Q

conducting airways

A

through which air moves as it passes between the atmosphere and lungs

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7
Q

Respiratory tissues of the lungs

A

where gas exchange takes place

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8
Q

Inspiration

A

innnervated by the diaphragm. phrenic nerve roots from c4. people who lose function require mechanical ventilation

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9
Q

accessory muscles to inspiration

A

scalene and sternocleidomastoid muscles. scale -first two ribs. sternocleidomastoid: raise the sternum to increase the rise of the chest

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10
Q

Lobes of the lungs

A

3 in the right, 2 in the left.

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11
Q

Hyaline cartilage in the bronchi

A

surrounds the lumina of the bronchi, and replace the c shaped cartilage rings. two layers of smooth layers of muscles spiraling in opposite directions.
The cartilage gradually decreases as there is an increase in smooth muscle and elastic tissue. by the time the bronchioles are reahced, there is no cartilage present.

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12
Q

Bronchiospasms

A

narrowing of the bronchioles and impairs airflow

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13
Q

tidal volume

A

volume of air inspired of exhaled with each breath.

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14
Q

Inspiratory reserve volume

A

max amt of air that can be inspired

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15
Q

Expiratory reserve volume

A

max that can be exhaled

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16
Q

Residual volume

A

always remains in the lungs, approx 1200 ml

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17
Q

Forced vital capacity

A

full inspiration to total lung capacity followed by forceful maximal expiration

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18
Q

Maximum voluntary ventilation

A

volume of air a person can move in and out of the lungs during max effort lasting for 12-15 seconds

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19
Q

Forced expiratory vital capacity

A

full inspiration, forceful max expiration

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20
Q

forced expiratory volume

A

expiratory volume achieved in a given time period

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21
Q

forced inspiratory vital flow

A

resp response during rapid max inspiration

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22
Q

FEV1.0

A

FEV that can be exhaled in 1 second. used to diagnose obstructive lung disorders

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23
Q

Factors affecting alveolar capillary gas exchange

A

surface area available, thickness of the alveolar-capillary membrane, partial pressure of alveolar gases, solubility and molecular weight of the gas

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24
Q

Oxygen Dissociation curve

Right

A

rightward shift means that a higher PO2 is required to achieve similar level of hemoglobin saturation compared to the baseline. dec affinity, inc temp, inc 2,3 DPA, inc Pco2, dec pH

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25
Q

Oxygen Dissociation Curve LEft

A

less po2 can achieve a higher hemoglobin saturation compared to the baseline. a higher affinity for oxygen. dec temp, dec pco2, dec 2,3 DPA, inc pH.

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26
Q

Chemoreceptors: Central and Peripheral

A

Central: extremely sensitive to pco2, an increase in pco2 inc ventilation and peaks within a minute
Peripheral: carotid and aortic bodies. little control over ventilation until po2 drops below 60. hypoxia is main drive for ventilation

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27
Q

Pacemaker center

A

pneumotaxic center, apneustic center

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28
Q

CO2 Narcosis

A

people with chronically elevated levels of PCO2 no longer have a response to the stimulus for increased ventilation, but rely on stimuls of decrease in PO2 levels.

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29
Q

Dyspnea

A

subjective. shortness of breath.
observed in: primary lung diseases (pneumonia, asthma, emphysema), heart disease (pulmonary congestion), neuromuscular disorders (myasthenia gravis and muscular dystrophy)

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30
Q

Lower Respiratory infections mortality

A

most deadly communicable disease. tb is the most.

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31
Q

Viruses and respiratory infections

A

most frequent cause, range from self limited cold to life threatening pneumonia

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32
Q

Factors affecting signs and symptoms of respiratory tract

A

function of the structure involved, severity of the infectious process, persons age and general health status.

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33
Q

Transmission of the common cold

A

direct mucus membrane contact by fingers picking up the virus from contaminated surfaces and carrying it to the nasal membranes and the eyes

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34
Q

Acue bacterial rhinosinusitis

A

symptoms that worsen after 5-7 days or persist beyond 10 days, or symptoms that are out of proportion of those usually associated with a viral upper resp tract infection

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35
Q

Sinus films

A

do not differentiate between bacterial from viral

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36
Q

Rhinosinusitis: the need for medical attention

A

facial swelling over the involved sinus, abnormal extraocular movements, protrusion of the eyeball, periorbital edema, or changes int he mental status may indicate indtracranial complications

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37
Q

Influenza Viruses

A

type A: most common type. can infect multipe species. either Hemaglutanin and neuraminidase.

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38
Q

Antigenic Shift

A

major genetic rearrangement in either antigen, may lead to epidemic or pancdemic

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39
Q

antigenic drift

A

population mostly protected by cross reacting antibodies

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40
Q

influenza

A

more contaigous than bacterial resp infections. inhalation of droplet nuclei. people become infectious 1 day before symtoms, and remain infectious through approx 1 week after illness onset.

41
Q

Influenza infections

A

uncomplicated upper resp infection, viral pneumonia, and resp viral infection followed by a bacterial infeciton.

42
Q

Reyes Syndrome

A

fatty liver with encephalitis. rare complication of influenza in young children who have been given aspirin

43
Q

Pneumonia

A

caused by infectious agents and noninfectious agents aspirated into lungs

44
Q

Classification of pneumonia

A

according to source of infection, immune status of the host, according to organism, anatomic location

45
Q

Atypical pneumonia

A

caused by viral and mycoplasma infections that involve the alveolar septum and the interstitium of the lung. variety of agents. M. pneumoniae, and mycoplasm infections

46
Q

lobar pneumonia

A

consolidation of a part or all of a lung lobe

47
Q

bronchopneumonia

A

patchy consolidation involving more than 1 lobe

48
Q

community pneumona

A

infections from organisms found in the community. bacterial or viral. S. pneumoniae

49
Q

hospital acquired pneumonia

A

second most common cause of HAI, mortality of 30-50%. most are bacterial. many have antibiotic resistance

50
Q

Tuberculosis

A

macrophage directed attack, has an outer waxy capsule that makes it more resistant, can persist in old necrotic and calcified lesions and remain capable of reinstating growth. strict aerobes. upper lobe or upper parts of the lower lobes of the lung

51
Q

Primary TB

A

form of the disease that develops in previously unexposed and unsensitized people.

52
Q

TB cell mediated immunity

A

sesults in the development of gray white circumscribed granulomatous lesion, Ghon focus, that contains tb modified macrophages and immune cells

53
Q

Ghon Complex

A

combination of the primary lung lesion and lymph node granulomas

54
Q

PPD

A

hypersensitivity. Type IV. cell mediated.
Quantiferon TB gold test is used to detect active and latent TB by measuring interferon y , which is part of the cell mediatedimmune response to TB

55
Q

Goals of TB treatment

A

eliminate the tubercle from the infected person while avoiding emergence of significant drug resistance. treatment often needs multiple drugs for long periods of time.

56
Q

Small cell lung cancers

A

highly malignant, tend to infiltrate widely, disseminate early in their course, rarely resectable. brain metastases are particularly common and may provide first evidence. associated with several types of paraneoplastic syndrome

57
Q

non small cell lung cancer

A

squamos cell carcinomas, adenocarcinoma, and large cell.

58
Q

Clinical manifestations of lung cancers:

A

:paraneoplastic manifestations: endocrine, neurologic and connective tissue.
all type has the ability to synthesize bioactive products and produce paraneoplastic syndromes. may result of hormonal production.
Most common sites of metastases: brain, bone and liver
for staging and treatment: divided into small and nonsmall, almost all small have metastasized at the time of diagnosis.

59
Q

repiratory distress syndrome

A

most common causes of resp disease in premies. lack of surfactant. dysfunction and no diffusion. right after birth. higher in preterm male infants, white infants, infants of diabetic mothers.

60
Q

Bronchopulmonary dysplasia

A

chronic lung disease that develops in premies who were trated with long term mechanical ventilation. present if dependent after gestation. fibrotic process of the lungs does not get better.

61
Q

surfactant deficiency

A

lungs collapse between breaths. infants have to work harder. noncompliant areas become still. hyaline membrane forms inside the alvoli as protein and fibrin rich fluids are pulled into the alveolar space .
Central cyanosis is a prominent sign.

62
Q

Bronchiolitis

A

Sx of viral upper resp infection. lower resp tract symptoms including persistent cough, tachypnea, and increased work of breathing later follow

63
Q

Hypoxemia

A

reduction in arterial blood o2 levels which is considered a pa02 less than 95.
inadequate o2 in the air, disease of resp system. dysfuntion of the neuro system, alterations in circultory function

64
Q

hemoglobin saturation with po2 of 60

A

90%

65
Q

mild hypoxemia

A

metabolic acidosis, inc hr, peripheral vasoconstriction, diaphoresis, inc in blood pressure, slight impairment of mental performance

66
Q

Chronic hypoxemia

A

insidious in onset and attributed to other causes. inc ventilation, pulmonary vasoconstriction, inc production of red blood cells, cyanosis. people with anemia are less likely to exhibit cyanosis.

67
Q

Hypercapnia

A

increase in the carbon dioxide content of the arterial blood.
four Factors contribute to:
alteration in carbon dioxide production, disturbance in the gas exchange function of the lungs, abnormalities in function of the chest wall and respiratory muscles, and changes in neural control of respiration

68
Q

Pleura: outer parietal layer

A

lines pulmonary cavities and adheres to the thoracic wall.

69
Q

Pleura: inner visceral pleura

A

covers the lung and is adherent to all its surfaces. continous with the parietal pleura at the hilum of the lungs. thin layer of fluid separates the two

70
Q

Causes of disorders of lung inflations

A

compression of the lung by an accumulation of fluid in the intrapleural space, complete collapse of an entire lung, collapse of a segment of the lung

71
Q

Pleural effusion

A

abnormal collection of fluid in the pleural cavity.
hydrothorax: srous fluid.
can be uni or bilateral. hydro is usually CHF.
Parapneumonic effusions: common. largely bacterial infections. empyema. infection in the pleural cavity.
Hemothorax: blood in the pleural cavity

72
Q

Pneumothorax

A

presence of air in the pleural space. causes partial or complete collapse of the affected lung.

73
Q

Spontaneous pneumo

A

air filled blister of the lung surface ruptures.

hypothesized. primary: healthy people. Secondary: underlying lung disease (emphysema)

74
Q

Traumatic Pneumo

A

caused by penetrating or nonpenetrating injuries.

75
Q

Tension Pneumo

A

occurs when the intrapleural pressure exceeds atmospheric pressure. impairs resp and cardiac function.
lifethreatening, shift in the mediastinum to the opposite side of the chest, dec in venous return and reduced CO.

76
Q

Atelectasis

A

incomplete expansion of a lung or portion of a lung
Primary: present at birth.
Secondary: later in life.
complete obstruction of an airway is followed by the absorption of air from the dependent alveoli and collapse of that portion of the lung

77
Q

Pleuritis

A

pleuisy. inflammation of the pain.

78
Q

Parasympathetic nervous system

A

airway constriction, increased glandular secretion. bronchoconstrictor. vagal control

79
Q

Sympathetic

A

Beta adrenergic receptors. broncodilator. airway relaxation, blood vessel constriction, and inhibition of glandular secretion

80
Q

Asthma

A

chronic disorder of the airways that causes episodes of airway obstruction, bronchila hyperresponsiveness, and airway inflammation.
wheezing, breathlessness, chest tightness, and a cough that is often worse at night.
common denominator is an exaggerated hyperresponsiveness to a variety of stimuli.

81
Q

Treatment of asthma

A

first line in treatment is inflmmatory controller drug that would include inhaled corticosteroids. Quick relief medicaitons such as short acting beta two adrenergic agonists relax bronchila smooth muscle and provide promt relief of symtpoms.

82
Q

COPD

A

chronic and recurrent obstruction of airflow in the pulmonary airways. most common cause is smoking. chornic cough, sputum production, dyspnea, and a history of exposures of risk factors

83
Q

Causes of COPD

A

chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis

84
Q

Emphysema

A

enlargement of air spaces and destruction of lung tissue. smoking, barrel chest, dec breath sounds, normal blood gases cor pulmonale only in advanced cases. pink puffer.

85
Q

chronic obstructive bronchitis

A

increased mucus production, obstruction of small airways, and a chronic productive cough. smoking, barrel chest, SOB, rhonchi, sputum. clinical diagnosis requires a history of chronic productive cough for at least 3 consecutive months in at least 2 consecutive years

86
Q

Cor pulmonale

A

right sided heart failure with peripheral edema.

venous congestion, peripheral edema, SOB, and a productive cough

87
Q

Bronchiectasis

A

permanent dilation of the bronchi and bronchioles, secondary to persisting infection or obstruction

88
Q

Cystic Fibrosis

A

autosomal recessive disorder involving fluid secretion in the exocrine glands and the epithelial lining of the respiratory, GI, and reproductive tracts. caused by mutations in a single gene.

89
Q

Cystic Fibrosis manifestations

A

accumulation of viscid mucus in the bronchi, impaired muccociliary clearance, and lung infection. pancreatic function is often abnormal. malabsorption and malnutrition. sweat test for chloride.

90
Q

Diffuse interstitial lung diseases

A

diverse group of lung disorders that produce similar inflammatory and fibrotic changes in the insterstitium or inter alveolar septa of the lung. stiff and noncompliant. restrictive lung disorders.

91
Q

occupational lung diseases

A

require comprehensive personal and family hsitory, with emphasis on exposure. primary treatment is removing the agent, suppressing the inflammatory response, and preventing progression of the disease, and supportive therapy

92
Q

Pulmonary embolism

A

blood borne substance lodges in a branch of the pulmonary artery and obstructs blood flow. may consist of a thrombus air that has been introduced, fat in a large fracture, or amniotic fluid that enters maternal circulation

93
Q

Manifestations of pulmonary embolism

A

: depends on the size and location of the obstruction. chest pain, dyspnea, and inc RR most frequenct signs

94
Q

d-Dimer testing

A

measurement of plasma d-dimer, a degreatation product of coagulation factors that have been activated as the result of thromboembolic event.
Helical CT angiography requires adinistation of an intravenous radiocontrast medium. sensitive for the detection of emboli in the proximal pulmonary arteries.

95
Q

Pulmonary hypertension

A

elevation of pressure within the pulmonary circulation, may be acute or chronic. can be due to changes in the arterial wall, or it may occur as a secondary condition.
Defined as persistent elevation in pulmonary artery pressure with normal left V pressures differentiating it from left sided heart failure.

96
Q

ARDS

A

injury and increased permeability of the alveolar capillary membrane allow fluid, protein, cellular debris, platelets, and blood cells to move out of the vascular compartment and enter the interstitium and alveoli.
Causes: aspiration, trauma, sepsis, pancreatitis, metabolic events.
Rapid onset of resp distress within 12-18 hours of initiating event an increase in RR, and signs of R failure. marked hypoxemia occurs
assisted ventilation using high concentrations of oxygen my be required to correct

97
Q

respiratory failure

A

failure in gas exchange due to either heart or lung failure or both.
Acute failure is manifested by varying degrees of hypozemia and hypercapnia. resp fialure conventionally defined by an arterial po2 less than 50 mm or an arterial pco2 50 or more, or both

98
Q

Treatment of respiratory failure

A

establish an airway, bronchodialtors, antibiotics, adequate o2, supportive measures, ensure adeuqate o2 of vital organs, usually by mechanical ventilation

Pathophysiology (11 decks)

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