Pulmonary Diseases Flashcards
Oxygen is ______ ______ in blood
poorly soluble
The high oxygen needs of complex internal organs are met by a soluble protein that binds oxygen rapidly, reversibly, and with a high storage capacity. What is this protein called?
hemoglobin!
What is hemoglobin? Talk about its subunits, what it contains, and what its capable of
hemoglobin is a complex tetramer of 1 alpha and 2 beta polypeptide chains, each of which contains a heme group with an iron atom in the ferrous form (Fe+2) at its center capable of binding to molecular oxygen
Each molecule of hemoglobin can bind ____ oxygen molecules
4
Blood oxygen content is the sum of…..
dissolved oxygen and oxygen bound to hemoglobin
oxygen bound to hemoglobin is the product of…..
Hint: 3 things
1) oxygen-carrying capacity
2) hemoglobin conc.
3) hemoglobin saturation (SO2)
Inflation of the lungs must overcome 3 opposing forces. What are they?
1) elastic recoil (including surface forces)
2) inertia of the respiratory system
3) resistance to airflow
Increased elastic forces predominate in 2 common disorders. Name them
1) diffuse parenchymal fibrosis
2) obesity
Most of the resistance in normal breathing arises from what?
medium-sized bronchi and not in smaller bronchioles
What is bronchoconstriction?
abnormal narrowing of the airways
The volume of gas in the lungs is divided into ______ and ________
volumes, capacities
Lung volumes are primary. What does this mean?
they do not overlap each other
What is tidal volume (VT)?
the amount of gas inhaled and exhaled with each resting breath
What is residual volume (RV)?
the amount of gas remaining in the lungs at the end of a maximal exhalation
Lung capacities are composed of _____ lung volumes
2+
What is vital capacity (VC)?
the total amount of gas that can be exhaled after a maximal inhalation
The vital capacity and the residual volume together constitute the _____
_______ ________, or the total amount of gas in the lungs at the end of a maximal inhalation
total lung capacity (TLC)
The vital capacity and the residual volume together constitute the total lung capacity (TLC), or the total amount of gas in the lungs at the end of a maximal inhalation
What is the functional residual capacity (FRC)?
the amount of gas in the lungs at the end of a resting tidal breath
The lungs inflate and deflate _______ in response to changes in pleural pressure
passively
Control over respiration lies in control of what muscles?
striated muscles, specifically the diaphragm, intercostals, and abdominal wall change the pleural pressure
The breathing muscles are under what type of NS control?
automatic and voluntary control!
What is the main lung function?
gas exchange (exchanging O2 for CO2)
Lungs see blood from 2 sources. What are they?
1) pulmonary circulation
2) bronchial circulation
What is the pulmonary circulation pathway?
blood is going from RV to drop off CO2 and pick up O2
What does RV do in pulmonary circulation?
RV pumps blood to the lungs for gas exchange and returns to left side of heart (and repeat)
How does pulmonary circulation differ from systemic circulation?
pulmonary circulation has much lower pressure and resistance than systemic
this is because pulmonary vessels have less smooth muscle in the vessel walls = less pressure+resistance
_______ arterioles are very sensitive to hypoxia, and so they have strong autoregulation. Additionally, they are sensitive to alveolar PO2
pulmonary arterioles
If there is low O2 in the area, are pulmonary arterioles going to dilate or constrict?
vasoconstrict
What’s the purpose of pulmonary capillaries? Why does vasoconstriction make sense when there is low O2 in the area regarding to this function?
gas exchange!
If there’s no O2 in the alveoli, then theres no reason to vasodilate
What happens where there’s low O2 in the alveoli (for pulmonary circulation)?
will vasoconstrict until it reaches alveoli w/ oxygen
autoregulation in the pulmonary system is ________ than the rest of body
opposite
bronchial circulation is NOT for…..
gas exchange
What is bronchial circulation?
blood supply of conducting airways
Where do bronchial arteries branch from?
aorta
Most lung tumors are fed by the _______ arteries
bronchial
Love you, don’t kill me for this flashcard
bronchial ______ drain the lungs, and empty into the _____ atrium by the ______ vein and then into the _____ atrium by ______ veins
1) veins
2) right (atrium)
3) azygous (vein)
4) left (artium)
5) pulmonary (veins)
T/F:
There is never 100% oxygenated blood, theres always a mix. This is why there is drainage into both L/R atriums
true
pulmonary valve is approx ____cm below lung apex
20
T/F:
pulmonary valve location of pressure is necessary to blood flow
true
R ventricle generates pulmonary arterial pressure of ____ mmHg
15
Blood vessels in pulmonary circulation have less smooth muscle than systemic vessels and the apex of lungs is far above the pulmonary valve. What does this mean for pulmonary vessels and lungs?
the pulmonary vessels and lungs are subject to gravity
Gravity does not have any effect on lungs when? What does this mean?
supine
all air is perfused equally in the lungs
When pt is erect, gravity exerts a downward force and causes decreased pressure above the heart by ____ mmHg for each cm of vertical distance
1
With gravity and pt upright, pulmonary blood flow is lowest at the _____ of lung, also known as zone ___
apex, zone 1
With gravity and pt upright, pulmonary blood flow is highest at the _____ of lung, also known as zone ___
base, zone 3
Zone 1 has more or less blood flow than zone 2?
less blood flow than zone 2
T/F:
The blood capillaries are closed in zone 1
true!!!!
Why are the blood capillaries closed in zone 1 of the lung model?
GRAVITY
What helps keep the capillaries closed in zone 1 of the lung model?
alveolar pressure
Compre PA, Pa, and PV for zone 1 of the lung model
PA > Pa > PV
What is PA?
alveolar pressure
What is Pa?
arteriole pressure
What is PV?
venous pressure
When is PA > Pa > PV normal? When is this detrimental?
PA > Pa > PV is perfectly normal for average person in zone 1 of lung model, but this can be detrimental for person with injury, trauma, disease, etc.
Zone 2 has less or more blood flow than zone 3?
less blood flow than zone 3
T/F:
the capillaries are closed in zone 2 of lung model
FALSE- they are partially open/closed in zone 2 (not fully closed like in zone 1)
Which zone is blood flow medium flow?
zone 2
Compre PA, Pa, and PV for zone 2 of the lung model
Pa > PA > PV
Compre PA, Pa, and PV for zone 3 of the lung model
Pa > PV > PA
Which zone of the lung model has full capillary blood flow?
zone 3
Zone 3 is below the pulmonary valve. What does this mean for blood flow?
Blood flow is highest here
What is the only organ in body that is subject to gravity?
the lungs
T/F:
Ideally, there should be mixture of oxygenated and deoxygenated blood
FALSE It’s the opposite
there ideally SHOULDN’T be a mixture
Systemic circulation is not always….
100% saturated with oxygen
What is venous admixture?
mixture of oxygenated and deoxygenated blood
What are the 2 main causes for venous admixture?
1) shunts (anatomic or physiologic)
2) low ventilation/ perfusion (VA/Q) ratio
What are shunts?
where venous blood bypasses exchange of the lungs and goes from one side of heart to the next
What are the 2 types of shunts?
anatomic and physiologic shunts
What is an example of an anatomical shunt? What happens here?
atrial septal defect
this is an opening between the R/L atrium that shouldn’t be there and blood will leak through the hole
T/F:
Physiological shunts are ALWAYS due to some kind of disease
true!!!!!!!!!!!
What are some factors affecting rate of diffusion through a cell membrane?
1) lipid solubility
2) molecular size
3) conc. gradient
4) membrane surface area
5) composition of lipid bilayer
What is Fick’s law of diffusion?
the rate of diffusion depends on:
1) SA
2) conc. gradient
3) membrane permeability
In patients with emphysema, the alveoli are destroyed. What does this mean for gas exchange?
less surface area for gas exchange
In patients with fibrotic lung disease, what happens to the alveoli and lungs?
thickened alveolar membrane slows gas exchange
loss of lung compliance may decrease alveolar ventilation
What is the difference between emphysema and fibrotic lung disease?
in emphysema the alveoli walls break down, this means that decreased alveoli= decreases SA + gas exchange
In fibrotic lung disease, you’re not losing alveoli, but the walls of alveoli are thickening. The alveoli should be simple squamous epithelium, but thats getting replaced with fibrotic tissue. This decreases membrane permeability and diffusion
Is V/Q ratio autoregulated?
yes
If ventilation decreases in a group of alveoli, P(CO2) ________ and P(O2) _________. Blood flowing past those alveoli does not get oxygenated
increases, decreases
Ventilation is no longer matched with perfusion. What is this called?
V/Q mismatch
arterioles are ________ vessels
resistance
What happens to arterioles during V/Q mismatch caused by under-ventilated alveoli?
arterioles vasoconstrict and shunt blood to other alveoli that are filled with oxygen
Lungs have approx 500 million alveoli, so if a couple are infected with pneumonia or something else what happens?
no biggie, body will fight off infection, pt wont die from it if just a few are infected
this is because the arterioles can vasoconstrict and shunt blood to other alveoli that are filled with oxygen/ healthier
T/F:
When you have a V/Q mismatch, not all alveoli are ventilated, but you have normal blood flow
TRUE!
What is the V/Q ratio for a V/Q mismatch caused from under-ventilated alveoli?
V/Q ratio = 0
What is normal V/Q ratio?
V/Q ratio = 1
Is a high V/Q or V/Q greater than 1, also considered a V/Q mismatch?
YES
What does a high V/Q ratio mean?
low perfusion relative to its ventilation
impaired perfusion, not enough blood
What causes a high V/Q ratio of V/Q greater than 1?
hypotensive states or a partial obstruction of pulmonary blood vessels present in pulmonary embolism
Low perfusion with normal alveoli, means what for V/Q ratio?
high V/Q ratio!
If a pt has a pulmonary embolism what happens to the lungs and body?
air in alveolus will not change, they will still have oxygen, but nothing is there to pick up the oxygen so there is a lack of gas exchange
more CO2 = body will undergo hyperventilation to try to compensate
Why do V/Q ratios matter?
good measure of pulmonary function + health
How do you test pt’s V/Q ratio?
use radioactive tracers while scanning lungs
How many primary bronchi are there?
2
As bronchioles get smaller and smaller towards the bottom of the lungs, ______ increases (generally speaking)
resistance
(Beth do not overthink this)
T/F:
Medium sized bronchi are the airways with the highest resistance
true!!!!!
Terminal respiratory units- look at them as units, not as individual bronchioles. They are all the same size, so _______ and ________ are decreased here because of the huge cross-sectional area of ALL bronchioles
pressure and resistance
Why are medium sized bronchi the ones with the most resistance?
because they’re the last airways that are interpreted as “individuals” as opposed to a whole unit of bronchioles
The numbers increase in SA for all terminal bronchioles that pressure is divided between all of them (compensation), this results in…..
less resistance in smaller airways just because there are SO many
What is the main function of alveoli?
gas exchange
How many alveoli are there per lung?
300-500 million
Each alveolus is moistened w/ a thin film of alveolar fluid that creates _______ ________
surface tension
Alveolar fluid that is coating alveoli is primarily _______
water
Alveoli are always on point of collapse because of _______ _______
surface tension
Surface tension is counteracted by what? Where is it synthesized and released from?
surfactant
surfactant is synthesized and released by type 2 pneumocytes
What is surfactant composed of?
combination of proteins and phospholipids
What is the Law of LaPlace?
pressure is greater in the smaller bubble
If 2 bubbles have the same surface tension, the smaller bubble will have higher pressure
What does surfactant do?
reduce surface tension in lungs
Is there the same amount of surfactant everywhere in the lungs?
No, the smaller alveoli have more surfactant, which equalizes the pressure between large and small alveoli
Surfactant has 3 functions. What are they?
1) promotes alveolar stability
2) increase compliance of lungs
3) help keep lungs dry
What law is under surfactants function for alveolar stability? What does this mean?
Law of LaPlace (P=2T/R)
surface tension will be the same in both bubbles, but pressure is higher in smaller one
surfactant counteracts/decreases surface tension to equalize pressure along all the alveoli
smaller alveoli have more pressure and surface tension, so they will be covered with more surfactant than larger alveoli
surfactant gives alveolar stability bc it equalizes pressure
Surfactant increases lung compliance. What does this mean?
lungs have a lot of elastic tissue
main component of elastic tissue is that it can recoil (like a rubberband)
surfactant decreases surface tension in alveoli and makes it more easier to breathe bc alveoli are not collapsed in
surfactant makes lungs more compliant and this means that lungs can expand much easier than w/o surfactant
Define lung compliance
amount of pressure necessary to inflate the lungs to a given volume
Surfactant helps to keep lungs dry. Explain this
surfactant decreases pressure and maintains the same pressure across all alveoli, so this also decreases the pressure gradient between alveoli and the interstitium
decrease pressure gradient= NO fluid in the alveoli and this keeps lungs dry
surfactant helps to decrease pressure gradient between alveoli and interstitial fluid
T/F:
In a normal lung at rest, pleural fluid keeps the lung adhered to the chest wall
true!
Healthy lungs are subject to 2 equal and opposite forces at rest. What are they?
1) compliance (trying to expand)
2) elastic recoil (elastance- trying to make lungs smaller)
Generally speaking, what is the function of muscles?
to contract
What happens to the lung when you inhale?
they expand!
compliance ________ w/ age due to the deposition of connective tissue
decreases
Lungs are filled w/ elastic tissue. What is the function of elastic tissue?
to recoil
What do the 2 forces do to the lung pressure? What is this pressure called and where is it?
they generate neg. pressure in the intrapleural space
this is known as intrapleural pressure (PPI)
this is pressure between the parietal and visceral pleura
P(PI) = -3mmHg
What is the atmospheric pressure in mmHg, atm, and in relation to lungs at rest?
760 mmHg
1 atm
0 (in relation to lungs at rest)
If something breaches the pleural space, such as a stabbing, what happens?
air will rush in until it equalizes and lungs will lose negativity (-3mmHg)
this will cause lungs to collapse because neg. pressure helps keep lungs open
air flowing into lung = pneumothorax
The amount of oxygen that the blood carries depends on…..
hemoglobin saturation
What is oxygen saturation?
measure of the number of occupied oxygen binding sites
How many heme(s) are there on 1 Hb molecules?
4 (each heme will allow oxygen to bind to it)
What does 100% saturation mean?
each hemoglobin is carrying 4 oxygens
Where do you see 100% saturation in the body?
arterial blood
What does it mean if one heme is not carrying oxygen?
its not fully saturated
Where do you see 75% saturation in the body?
venous blood
What does 75% saturation mean?
not every hemoglobin molecule is 3/4 (75%), this is just an average of all the hemoglobins
some can be 1/4, 2/4, 3/4, 4/4, but overall average is 75% saturation
Venous blood has less than _____mmHg of O2
40
Venous blood follows the pressure gradient to get 100 mmHg at the alveoli. What happens next?
venous blood will equilibrate to 100 mmHg (from its original 40) as it passes the lungs and turns into arterial blood
On the dissociation curve, the plateau starts at….
60 mmHg
At 60 mmHg, hemoglobin is ______ saturated
90%
T/F:
Arterial blood goes to cells and drops off 1 molecules of oxygen, as it drops it off, the hemoglobin affinity decreases for oxygen. Oxygen will be able to unload and continue to do so until no oxygen is left. Blood will circle back around and get more oxygen and repeat
true!!!!
sorry idk how to make this into better flashcard
More CO2= more _______ environment
acidic
Metabolism generates what 3 things that can affect the lungs/oxygen affinity?
1) CO2
2) heat
3) 2.3 DPG
What 3 things decrease Hb affinity for oxygen and will have oxygen unload easily?
1) heat
2) CO2
3) acid
How does temp. affect lungs/oxygen affinity?
increase temp = hemoglobin loses its affinity for O2, dissociation curve will shift to right, and O2 is unloaded
What is an example of a time temp. will change and affect lungs/oxygen affinity?
strenuous exercise
muscle temp. can increase by approx. 3 degrees Celsius, which will help hemoglobin unload more oxygen
How does P(CO2) affect lungs/oxygen affinity?
CO2 binds to the globin part of Hb (DOES NOT BIND TO HEME)
more CO2= more Hb loses its affinity for oxygen and curve will shift to right, and oxygen is unloaded
When you produce CO2 in the body, it dissolves in water. What does this produce?
carbonic acid
What happens with carbonic acid in the body?
it quickly disassociates because its a weak acid
it will dissociate into H ion and bicarbonate ions
Whenever you produce CO2, you’re also generating what?
H+ ions in the body, which creates an acidic environment
An acidic environment with CO2 means what?
the dissociation curve will shift to R with more H+ ions, and this is known as bohr effect
What is the equation Roop said to never forget?
CO2 + H20 ->/<- H2CO3 ->/<- H+ +HCO3-
What do H+ ions do to hemoglobin?
stabilize deoxygenated form of Hb
more H+ = more R shift = Bohr effect
What effect does 2,3 DPG have on the lungs and oxygen affinity?
more 2,3 DPG = more stabilization of the deoxygenated form of Hb = more Hb loses affinity for oxygen and curve shifts to R, and unload O2
Where is 2,3 DPG (diphosphoglycerate) abundant?
in RBCs
2, 3 DPG is another byproduct of ________
metabolism
A decrease in 2, 3 DPG, H+ ions, temp., or CO2 results in what?
dissociation curve will shift to left, hemoglobin affinity increases for O2, and Hb holds on tightly to O2
T/F;
Maternal and fetal hemoglobin have different oxygen-binding properties
true
What chains does HbA have?
2 alpha, 2 beta chains
What chains does HbF have?
2 alpha, 2 gamma chains
What do the gamma chains do for HbF?
gamma chains enhance ability of HbF to bind oxygen in low oxygen environments like the placenta
At 30% mmHg of O2, HbF is….
85% saturated (even at a low oxygen level!)
At 30% mmHg of O2, HbA is…..
55% saturated
HbF has a much higher affinity for O2 than ______
HbA
HbF changes to HbA after how many days of birth?
approx 120 days (like RBCs)
T/F: carbonic acid is not strictly regulated in body
FALSE
it is strictly regulated
Why is carbonic acid strictly regulated in body?
CNS needs to maintain plasma pH/pH of arterial blood at 7.35-7.45
this should never change in a healthy person
Effect of acid on plasma pH is estimated by the…
Henderson- Hasselbach (HH) eq
decreased CO2 with increased pH means….
alkalosis
increased CO2 with decreased pH
acidosis
For respiratory acidosis, retaining CO2 means that plasma CO2 _____
increases
For respiratory acidosis, alveolar hyperventilation causes what?
plasma CO2 to increase
In respiratory acidosis, alveolar hyperventilation can be due to…
hint: 5 things
1) respiratory depression due to certain drugs/alcohol
2) increased airway resistance (ex: asthma)
3) decreased gas exchange
4) muscle weakness (ex: muscular dystrophy)
5) COPD (includes emphysema + chronic bronchitis)
What is the most common cause of CO2 retention/ alveolar hyperventilation?
COPD (includes emphysema + chronic bronchitis)
Respiratory acidosis has a number of things that are elevated. What are they?
high CO2, H+ ions, and bicarbonate ions
How does the body compensate with respiratory acidosis?
kidneys will excrete more H+ ions and reabsorb more bicarbonate ions
this will decrease pH with increased bicarbonate ion levels
What drug causes more respiratory depression than any other medication?
morphine
respiratory alkalosis is the _________ of respiratory acudosis
opposite
For respiratory alkalosis, decreased CO2 results in _________ H+ ions and bicarbonate ions
decreased
T/F:
Respiratory acidosis is much less common than respiratory alkalosis
False! Respiratory acidosis is way more common
What is the most common reason for respiratory alkalosis?
hyperventilation
For respiratory alkalosis what happens with CO2?
blowing off more CO2, but not making anymore CO2, so it decreases
What is the most common medical cause for respiratory alkalosis?
artificial ventilation
What is the treatment for hyperventilation?
breath into brown paper bag to bring back/recycle CO2 and reverse the alkalosis
What is the compensation in the body for respiratory alkalosis?
kidneys will reabsorb H+ ions and secrete bicarbonate ions
Do COPD patients have a harder time inhaling or exhaling?
exhaling
What happens to elastic tissue in COPD patients?
they lose that elastic tissue, so they don’t have good recoil
What do COPD pts have to do to feel better with breathing?
tripod position and forcefully blow air out
COPD includes chronic bronchitis. What makes breathing hard here?
huge mucus production, which will lead to decreased oxygen intake
What is a “medical” name for patients with chronic bronchitis from COPD?
blue bloaters
this is because they tend to have cyanotic lips, nails, etc.
COPD includes emphysema. What makes breathing hard here?
they lost elastic recoil/elastic tissue
so they have to use accessory muscles to breath out
they tend to hyperventilate w/ expiration
What is a “medical” name for patients with emphysema from COPD?
pink puffers
What are some tests you can run for pulmonary problems?
hint: there’s 7
1) spirometry (monitor pt lung volumes)
2) ABG (arterial blood gases)
3) C&S (culture & sensitivity)
4) pulse oximeter
5) bronchoscopy (look at lesion or take biopsy)
6) exercise tolerance test (monitor resp. ability)
7) x-ray (for pneumonia and TB)
What is ABG (arterial blood gases) checking the lungs for?
oxygen, carbon dioxide, and hydrogen ion levels
tests for hypoxemia and hypoxia!
What are some S&S of respiratory disease?
hint: 6 things
1) sneezing
2) hypoxemia (low oxygen in blood)
3) hypoxia (low oxygen in tissues)
4) coughing
5) sputum
6) pleural pain
What is sneezing typically caused from?
reflex due to irritant in nasal mucosa/URT, or inflammation
What is hypoxemia?
low oxygen in blood
What is hypoxia?
low oxygen in tissues
What can hypoxia be caused from?
Hint: 4 things
1) low RBCs/hemoglobin
2) hemorrhage (low blood flow )
3) thrombus (blocks blood flow)
4) CO poisoning (can cause anemia hypoxia)
What is the coughing center of the brain?
medulla
What is coughing typically due to?
irritant or nasal drip
What does yellowish/green sputum typically mean?
bacterial infection
What is hemoptysis?
blood in sputum
What does rusty sputum (deep red/brown color) typically mean?
pneumococcal pneumonia
What does thick sticky sputum typically mean?
asthma or CF
What is pleural pain?
pleura is infected or inflamed
can mimic pain of heart attack
center of chest pain (not on L side like with the heart)
What is hypoxic hypoxia?
low arterial P(O2)
What are some typical cases for hypoxic hypoxia?
hint: 4 things
1) high altitude
2) alveolar hypoventilation
3) decreased lung diffusion capacity
4) abnormal V/Q ratio
What is anemic hypoxia?
decreased total amount of oxygen bound to hemoglobin
What are some typical cases for anemic hypoxia?
hint: 3 things
1) blood loss
2) anemia (low Hb or altered HbO2 binding)
3) CO poisoning
What is ischemic hypoxia?
reduces blood flow
What are some typical cases for ischemic hypoxia?
1) heart failure (whole body hypoxia)
2) shock (peripheral hypoxia)
3) thrombosis (hypoxia in a single organ)
What is histotoxic hypoxia?
failure of cells to use O2 because cells have been poisoned
What are some typical cases for histotoxic hypoxia?
cyanide and other metabolic poisons
What organ does hypoxia affect first? How does it compensate?
brain (very dependent on O2)
comp=
1) tachycardia (try to generate more blood)
2) increase bp to try to move more blood
3) increase in EPO + RBCs (too many RBCs can also lead to polycythemia)
What is EPO and where is it synthesized?
hormone needed for RBC production and it is synthesized in the kidneys
Define eupnea
normal quiet breathing/normal rate of respiration, 12-18 bpm
What is hyperpnea? Ex of when this can happen?
increased respiratory rate and/or volume in response to increased metabolism
ex: exercise
What is hyperventilation? Ex of when this can happen?
increased respiratory rate and/or volume without increased metabolism
ex: emotional hyperventilation or blowing up a balloon
What is hypoventilation? Ex of when this can happen?
decreased alveolar ventilation
ex: shallow breathing, asthma, restrictive lung disease
What is tachypnea? Ex of when this can happen?
rapid breathing usually increased respiratory rate w/ decreased depth
ex: panting
What is dyspnea? Ex of when this can occur?
difficulty breathing (a subjective feeling sometimes described as “air hunger”)
ex: hard exercise
What is apnea? Ex of when this can happen?
cessation of breathing
ex: voluntary breathing-holding, depression of CNS control centers
What is kussmaul’s respiration?
its a form of hyperventilation, shows up in metabolic acidosis
breath fast and deep
What are the 4 types of breath sounds we learned?
1) rales
2) stridor
3) wheezing
4) rhonchi
What are rales breath sounds?
crackling sounds as air is mixing w/ secretions in the lungs
deeper sounds as air is mixing w/ mucus
What are stridor breath sounds?
high-pitched sound, usually due to blockage or obstruction in upper airways
What are wheezing breath sounds?
whistling sounds, usually due to blockage or obstruction in lower airways
What is orthopnea?
difficulty breathing while laying down
What is paroxysmal nocturnal dyspnea?
SOB while sleeping (will wake you up!), will feel better sitting up
If pt is waking up in the middle of the night w/ SOB it can be due to…..
L sided congestive heart failure
What is the most common URT infection?
common cold (infectious rhinitis)
What is common cold (infectious rhinitis) caused by?
a virus, usually be a rhinovirus
How contagious is the common cold (infectious rhinitis)?
very contagious in first few days
Is common cold (infectious rhinitis) self-limiting?
yes
For common cold (infectious rhinitis), mucus membranes of nasal mucosa and pharynx can become inflamed. What does this result in?
headache and sore throat, sometimes it can spread even further and develop into bronchitis or laryngitis
What is the treatment for common cold (infectious rhinitis)?
acetaminophen and/or decongestants
Strep throat (pharyngitis) is caused by what?
Streptococcus that invades tissues that are already inflamed
How do you confirm strep throat (pharyngitis)?
w/ a throat culture
What are the S&S with strep throat (pharyngitis)?
severe fever, pain, sore throat
How do you treat strep throat (pharyngitis)?
antibiotics
Sinusitis is what type of infection?
usually a bacterial infection that goes along w/ cold or allergies
What is sinusitis?
infection of the sinuses
Where is sinusitis found?
frontal, ethmoid, sphenoid, and maxillary sinuses
What happens to the sinuses in sinusitis?
sinuses are filled w/ mucus (can cause headache or face pain)
What is sinusitis caused from?
streptococcus or pneumococcus
What is the treatment for sinusitis?
decongestants and/or analgesics
What is the medical name for croup?
laryngotracheobronchitis
What age group is croup common in?
babies/ children 1-2 y/o
How does croup start? What happens after?
starts as URT infection, but then mucosa of larynx and trachea become inflamed and this obstructs the airways
What is the clinical presentation of croup?
barking cough and stridor breath sounds
Is croup self limiting?
yes
What are the treatments for croup?
humidifiers
severe cases: put baby on oxygen
What are the 2 types of LRT infections we learned about?
1) bronchiolitis (RSV)
2) pneumonia
What is another name for bronchiolitis?
respiratory syncytial virus infection (RSV)
Where does bronchiolitis (RSV) come from?
myxovirus
What age group is bronchiolitis (RSV) commonly seen in?
children, especially before the age of 1
T/F:
72% of all bronchiolitis (RSV) cases are caused by RSV myxovirus
true!
Who is more susceptible to bronchiolitis (RSV)?
babies living in homes w/ smokers
What happens to the body w/ bronchiolitis (RSV)? S&S?
inflammation of small bronchi and bronchioles, so this causes edema and excess mucus production in small airways, and in severe cases obstruction
S&S:
-wheezing
-stridor
-fever
-dyspnea
Is bronchiolitis (RSV) self-limiting?
yes
How are severe cases of bronchiolitis (RSV) treated?
oxygen
pneumonia can be a primary infection, but usually it is a _________ infection
secondary
When does pneumonia usually occur?
when cilia is damaged in the respiratory airways
cilia is unable to move secretions, so fluid accumulates in the lungs
What are the pneumonia classifications based on agent/microbe?
1) viral pneumonia
2) fungal pneumonia
3) bacterial pneumonia
What are the pneumonia classifications based on anatomy?
1) bronchopneumonia (diffuse throughout lungs)
2) lobar pneumonia (affect 1-2 lobes)
3) interstitial pneumonia/ alveolar septae (between all the connective tissues of lungs)
What are the pneumonia classifications based on how it was acquired?
1) nosocomial infection
2) community infection
What are some common risk factors for pneumonia?
1) HIV infection
2) organ/bone marrow transplant pt
3) COPD
4) smoking
5) structural lung disease
6) alcoholism
7) injection drug abuse
8) environmental or animal exposure
9) nosocomial
10) post influenza
What is another name for lobar pneumonia?
pneumococcal pneumonia
What is lobar pneumonia/pneumococcal pneumonia caused by?
strep pneumoniae
What is the 1st stage of lobar pneumonia/pneumococcal pneumonia?
congestion
this is where the alveolar walls are inflamed and eventually they will thicken
thick = disrupts flow of oxygen
What is the 2nd stage of lobar pneumonia/pneumococcal pneumonia?
consolidation
alveoli are filled w/ inflammatory material neutrophils, RBCs, and fibrin will form solid masses in alveoli (RBCs os why there is red/rusty colored sputum)
macrophages will come in a phagocytosis all the material in the alveoli
What happens if all the inflammation continues in lobar pneumonia/pneumococcal pneumonia stage 2?
it can cause pleurisy, which is inflammation of pleural membranes
If the infection is not treated/resolved in lobar pneumonia/pneumococcal pneumonia stage 2, what happens?
it can cause empyema, which is infection of pleura where there is pus in the pleural cavity
this can be severe bc it interferes with the neg. pressure you should have in the lungs
What are the treatments for lobar pneumonia/pneumococcal pneumonia ?
1) antibiotics (penicillin)
2) fluids replacement
3) vaccine (pneumococcal vaccine is recommended for elderly)
Where is bronchopneumonia typically found?
throughout the lungs, but it usually is found in the inferior parts more than anywhere else
What is bronchopneumonia caused by?
multiple strains of bacteria
What happens if bronchopneumonia is not treated/resolved?
it will spread to alveoli and affect oxygen diffusion
What is the most noticeable sign with bronchopneumonia?
yellowish/green sputum
What is another name for interstitial pneumonia?
primary atypical pneumonia (PAP)
What type of pneumonia is interstitial pneumonia/PAP
can be a viral pneumonia or mycoplasmic pneumonia
If interstitial pneumonia/PAP is a mycoplasmic pneumonia, what is it caused by?
mycoplasma pneumoniae
If interstitial pneumonia/PAP is a mycoplasmic pneumonia, what age group is it most prevalent in?
young adults
If interstitial pneumonia/PAP is a mycoplasmic pneumonia, what is its severity/contagious level?
not very serve or contagious
If interstitial pneumonia/PAP is a mycoplasmic pneumonia, what is the treatment?
antibiotics such as erythromycin or tetracycline
If interstitial pneumonia/PAP is a viral pneumonia, what is it caused by?
influenza A or B, or RSV
Is interstitial pneumonia/PAP as a viral pneumonia self limiting?
yes
If interstitial pneumonia/PAP is a viral pneumonia, what does it affect in the body?
interstitium of lungs, NOT the alveoli (so in this case, you won’t have a problem w/ diffusion of oxygen)
If interstitial pneumonia/PAP is a viral pneumonia, what is the treatment?
antibiotics such as erythromycin
What does SARS stand for?
severe acute respiratory syndrome
When was SARS identified?
2003
What is SARS?
a coronavirus, known as SARS-CoV
its an RNA virus
(now we also have SARS-CoV2 from 2020)
Where is SARS found geographically?
primarily in the east
What is SARS incubation period?
2-7 days
What is the clinical presentation of SARS?
-first started w/ flu-like symptoms
-then developed diarrhea
-then a cough (congestion spread throughout lungs)
-hypoxia was possible (pt need respirator)
-lymphopenia and thrombocytopenia
For SARS, respiratory distress was fatal for _____ of patients, and _____ of all deaths were the elderly (60+ y/o)
10%, 50%
Where is TB on the rise?
nationally and in Florida
T/F:
1-2% of all TB cases are resistant to multiple antibiotics
TRUE
What is TB caused by?
mycobacterium tuberculosis
it is a slow growing bacillus bacteria w/ a cell wall
What is the function of the cell wall on the TB bacterium?
the cell wall prevents immune system from penetrating it
TB is primarily a ______ disease, but can spread to other areas of body
lung
What is the 1st stage of TB (primary infection)?
this is long i apologize in advance
1) inhale bacterium and it gets into lungs
2) causes inflammatory response where macrophages will come and phagocytosis it
3) some macrophages will go to lymph nodes and cause type 4 hypersensitivity rxn
4) pts w/ high resistance:
-macrophages, lymphocytes, and neutrophils will come in a create a granuloma (surround the microbes)
-inside the granuloma is a tubercle, which is the active bacteria
-Ghon complexes= fibrous material surround granulomas and calcify
-necrosis occurs in the center of granuloma (caseation necrosis) because the center is so far from nutrients
4) pts w/ low resistance will get the active infection
What is the 2nd stage of TB (secondary or reinfection)?
If pt is once again exposed to microbe or for some reason resistance decreases, the tubercles will become reactivated and multiply
then it will break through Ghon complexes and spread throughout the lungs and becomes contagious!
Who is extremely susceptible to TB?
anyone taking biologics bc your immune system is suppressed
