respiratory disorder Flashcards
1
Q
rhinorrhea upper/lower
A
upper
2
Q
cause of rhinorrhea
A
increased production of mucus> congestion
increased secretion from lacrimal glands draining into the nasal cavity
exposure to cold air
3
Q
rhinitis upper/lower
A
upper
4
Q
rhinitis
A
inflammation of nasal mucosa spreads from nose to throat to chest
5
Q
rhinitis results
A
sinusitis
via spreading inflammation to tear ducts and paranasal sinuses, causing blockage of sinus passageway
6
Q
types of rhinitis
A
allergic and non allergic
7
Q
non allergic rhinitis caused by
A
air pollution, smoke, strong odor
8
Q
explain allergic rhinitis reaction
ex. pollen
A
pollen binds to the b receptor> b cell differentiate into plasma cell>plasma cells make IgE antibodies> attaches to mast cell and basophils via the constant region of IgE antibody
When 2nd exposure, IgE binds tothe variable region of pollen> degranulation of mass cell>release of histamine & inflammatory mediators> congestion&leakiness of capilaries
9
Q
sinus infection caused by
A
germs growing in the accumulated mucous
10
Q
sinus headaches caused by
A
pressure change
11
Q
3 types of lung receptor
A
stretch receptors, irritant receptors, juxtacapillary receptors
12
Q
stretch receptors located at
A
smooth muscle layer
13
Q
stretch receptors responds to
A
changes in pressure in airway
14
Q
irritant receptor located at
A
between airway and epithelial cells
15
Q
irritant receptor respond to
A
noxious gases, dust, cold air
16
Q
juxtacapillary receptors located at
A
alveolar wall
17
Q
juxtacapillary receptor senses
A
congestion
18
Q
cough reflex
A
primary defense mech for respiratory syst
19
Q
cough reflex receptors located at
A
throat and trachebronchial wall
20
Q
cough reflex process
A
vagus nerve transmits signal to the medulla > leads to rapid large inspiration of air, forceful contraction of abdominal and expiratory muscle
21
Q
2 general cause of respiratory dysfunction during spirometry
A
restrictive lung disease, obstructive lung disease
22
Q
restrictive lung disease
A
decrease in total lung capacity from structural or functional lung changes
difficulty expanding lungs
23
Q
obstructive lung disease
A
increase in airway resistance
24
Q
restrictive lung disease causes TLC and forced expiration to
A
decrease
> 80% FEV1/FVC ratio
25
restrictive lung disease examples
pulmonary fibrosis, sarcoidosis
26
pulmonary fibrosis
accumulation of fibrous tissues in the lungs when alveoli are damaged
27
cause of pulmonary fibrosis
inhalation of small particles
(fine needles)
the problem gets bigger when try to remove them
28
lung tissue, vital capacity, forced expiration in obstructive lung disease
lung tissue, vital capacity normal, forced expiration reduced
FEV1/FVC <70%
29
obstructive lung disease example
asthma, bronchiectasis, bronchitis, COPD
30
4 other conditions affecting respiratory function
1. diseases affecting diffusion of O2 and CO2
2. reduced ventilation due to mechanical failure
3. failure of adequate pulmonary blood flow
4. V/Q abnormalities
31
Edema
thickening of the respiratory membrane leading to inadequate gas exchange and oxygen deprivation
32
emphysema
decrease in surface area due to thickening of respiratory membrane
33
obstructive sleep apnea
chronic disorder of intermittent cessation of breathing during sleep
34
cause of obstructive sleep apnea
partial/complete collapse of the UPPER airway
35
risk factor of obstructive sleep apnea
age, male, obesity, cranio facial and upper airway abnormalities, nasal congestion
36
symptoms of obstructive sleep apnea
snoring, fatigue, restless sleep, awakening with chocking and gasp, nightmare, changes in mood, cognitive deficits, headache, GERD
37
obstructive sleep apnea treatment
wt loss, continuous positive airway pressure
38
developmental lung disorder and infection in children
sudden infant death syndrome, neonatal respiratory distress syndrome, bronchiolitis, croup
39
sudden infant death syndrome
etiology unknown, happens to infant under one
40
neonatal respiratory distress syndrome
alveolar collapse due to decreased surfactant in premature babies
41
process of neonatal respiratory distress syndrome
decreased surfactant & immature lung structure > decreased lung compliance>atelectasis (airway collaspe)>hypoxia
42
hypoxia can lead to
1. pulmonary vascular constriction > pulmonary hypertension>decreased pulmonary perfusion
2. increased pulmonary capillary permeability>movement of capillary fluid into alveoli>hyaline membrane formation > shedding of dead cells
43
neonatal respiratory distress syndrome symptoms
cyanosis, flaring nostrils, tachypnea, tachycardia, grunting sounds with breathing, poor feeding, chest retractions
44
bronchiolitis
bronchioles swell and get congested
45
cause of bronchiolitis
respiratory syncytial virus
46
symptom of bronchiolitis
cyanosis, wheezing, intercostal retraction, fever (bc it's a infection), coughm tachypnea
47
croup
inflammation of the larynx and subglottic airway
48
cause of croup
viral URI (parainfluenza virus type 1)
49
hallmark sign of croup
barking cough, stridor on inspiration/expiration,fever,drooling, tachypnea
50
croup occurs at
trachea causing epiglottis to narrow ("steeple sign")
51
treatment of croup
depends on severity
oral hydration, calming down, moist air
drugs: steroids(dexamethasone), epinephrine
intubation when serious
52
infection of respiratory system
acute respiratory distress syndrome, corona virus, bronchitis, pneumonia, tuberculosis, ghon complex,
53
acute respiratory distress syndrome
acute abnormalities of both lungs, rapidly progressing inflammatory lung injury: pro-inflammatory cytokines, increased pulmonary permeability
54
acute respiratory distress syndrome cause
due to septic shock, penumonia, aspiration of gastric content, vomit, overdose of ASA/cocaine/opioids
55
acute respiratory distress syndrome leads to
diffuse alveolar damage, hypoxia
56
symptoms of acute respiratory distress syndrome
cyanosis, dyspnea, flaring nostrils, tachypnea, tachycardia, diaphoresis, use of accessory respiratory muscle
57
progression of corona virus (severe acute respiratory syndrome)
SARS-CoV>MERS-CoV>SARS-CoV-2
58
SARS-CoV-2
single stranded positive sense RNA virus
59
entry receptor of SARS-CoV-2 and why does that matter
ACE2 receptor, it has widespread distribution: vascular endothelial cells, oral and nasal mucosa and nasopharynx, kidneys, cardiac myocytes, lungs including alveolar epithelial cells, GIT including small intestine and the liver, brain
60
T/F
Covid is not just a respiratory virus bc it attaches to anything that has ACE 2 recpetor
True
61
effect of covid 19
direct cytotoxic effect
when meet cell, dead
62
covid virus binding with ACE 2 receptor with TMPRSS2 leads to (RAAS system)
ACE2 receptor breaking down angiotensin 2 > increased angiotensin 1-7> binds to Mas-R>vasodilation
63
TMPRSS2
modifies spike protein so covid virus binds better with the ACE receptor
64
decrease number of ACE 2 receptor leads to
vasoconstriction
65
inflammatory pathway of covid virus
shedding ACE2 receptor from the cell surface
66
thromboinflammation of covid virus
virus+endothelial cell > activate factor 3, decrease fibrinolysis, increase thrombin production >formation of clot> Q(perfusion) decrease
67
dysregulated immune response of covid virus
neutrophil causes
1. NET(neutrophil extracellular trap)> histone +free DNA> activate instrinsic pathway>coagulation
2. ROS> inactivate surfactant> risk of alveoli collaspe increas, shedding of alvoli type 1 cell, leukotriene&MMP activated &release > destruction of alveoli
68
sign of severe Covid
lung ground glass opacities and consolidation on chest X-ray or CT
drop in PO2
increased levels of IL-6
increased C-reactive protein levels and erythrocyte sedimentation rate
elevated fibrinogen and d-dimer levels
development of a cytokine storm
69
consequences of severe covid
pneumonia, sepsis, lung damage, heart damage, coagulation abnormalities: sepsis-induced coagulopathy, microvascular thrombosis, macrovascular arterial and venous thrombosis
70
mechanism of coagulation abnormalities
complement activation, NET components of cell-free DNA and histones activate the intrinsic pathway of coagulation , inhibition of fibrinolysis by increasing the activity of PAI-1, damage of endothelial cells leads to inflammation, apoptosis, release of tissue factor and platelet aggreagation
71
post covid syndrome also called
long haulers
72
multisystem inflammatory syndrome in associated with covid
mostly child, symptoms develop after the infection, can lead to chock and multiple organ failure, similar to Kawasaki disease,
interferon doesn't do its job and interleukins level increase
73
bronchitis
inflammation of lining of bronchi
74
cause of acute bronchitis
virus causing URI, bacteria
75
symptoms of bronchitis
cough, production cough, SOB, chest tightness
76
pneumonia
inflammation of lung parenchyma including alveoli and bronchioles, fluid accumulation in the alveoli
77
cause of community-acquired pneumonia
bacteria (pneumococcus/mycoplasma)
78
lobar
affects an entire lobe of the lung
79
bronchopneumonia
patchy distribution over more than one lobe
80
atypical pneumonia
viral and mycoplasma infections of the alveolar septum or interstitium (중요, typically inside the lumen not interstitium)
81
nosocomial pneumonia
병원 드러버서 걸린 거
82
cause of tuberculosis
mycobacterium tuberculosis hominis
83
mycobacterium tuberculosis hominis
aerobic, protective waxy capsule, spread by droplets from respiratory secretion of infected pts, can stay alive in "suspended animation" for yrs
84
initial tb infection
macrophages begin a cell-mediated immune response, resulting in a granulomatous lesion/ghon focus containing: macrophages, t cells, inactive tb bacteria > activate cell mediated T cell > delayed type 4 immune response
85
secondary tb infection
reinfection or reactivated tb > progressive or disseminated tb
86
ghon complex
nodules in lung tissue and lymph nodes, caseous necrosis, calcium may deposit in the fatty area of necrosis, visible on x-rays
87
tb vaccine
if you take a PPD test, the result is always positive
88
latent tb infection
no symptoms, but positive on the test, should consider treatment for latent TB infection to prevent TB disease
89
disorder of the pleura
pneumothorax, pleural effusion
90
pneumothorax (lung collapse)
caused by equalization of the intrapleural pressure with the intrapulmonary pressure > transpulmonary pressure keeps the airways open
91
pneumothorax leads to
trauma, infection (TB, pneumonia), lung cancer
92
symptoms of pneumothorax
sudden chest pain, sob
93
risk factor for pneumothorax
males, pre-existing lung disease, smoking, FH or prior history, mechanical ventilation
94
types of pneumothorax
tension, open
95
tension pneumothorax
air enters pleural cavity through wound on inhalation, cannot leave on exhalation
들어올 순 있는데 나갈 수가 없음
more severe
96
open pneumothorax
air enters pleural cavity through the wound on inhalation and leaves on exhalation
너무 자유롭게 들낙
97
pleural effusion
fluid in the pleural cavity
98
pleural effusion includes
hydrothorax, empyema, hemothorax
99
Hydrothorax
serous fluid occur with inflammatory condition ex. inflammatory disease
100
Empyema
pus, caused by bacterial infection, need antibiotics
101
Hemothorax
blood, caused by trauma/cancer
102
bronchial obstructive disorders
atelectasis, asthma, copd, emphysema, chronic bronchitis
103
atelectasis
incomplete expansion of a lung or portion of the lung
104
cause of atelectasis
bronchial obstruction: mucus, foreign object, tumor, enlarged lymph node
105
asthma
chronic inflammatory disorder of the airways
106
asthma characterized by
recurring symptoms of reversible airway obstruction, bronchial hyperresponsiveness and bronchospasm, increased mucus secretions and release of inflammatory mediators
107
treatment for asthma
beta2 agonist bronchodilator (albuterol) to reduce symptoms
but need to take care of the inflammation
108
atopy
genetic predisposition for the development of IgE-mediated response to allergens, strongest predisposing factor for asthma development
109
adult onset asthma
atopy, family history, occupational exposure to chemicals, viral infections, cig, environmental pollution, premature birth
110
inflammatory cells/mediators involved with asthma
neutrophils, lymphocytes, mast cells, macrophages, eosinophil recruitment
111
neutrophil w/ asthma
severe sudden onset fatal asthma, occupational asthma, in smokers
112
lymphocytes ( T helper cell) w/ asthma
release cytokines that modulate eosinophil adherence, migration, and activation
113
Mast cell w/ asthma
IgE-mediated release of histamine and leukotrienes> airway remodeling: irreversible changes that result through chronic yrs of inflammation
114
Macrophages w/ asthma
release of inflammatory mediators like leukotrienes
115
eosinophil recruitment w/ asthma
causes epithelial cell damage, mucus hypersecretion, increased smooth muscle reactivity
116
asthmatic bronchioles
lumen clogged up w/ mucus, contraction of the smooth muscle
117
pulmonary function monitoring
PRFR: peak expiratory flow rate
118
mild intermittent asthma
less than 2x per week
need rescue inhaler
119
mild persistant asthma
more than 2x per week but less than one a day, need rescue inhaler
120
moderate persistant asthma
need rescue inhaler and ICS
121
severe persistent asthma
can't talk
122
difference between COPD and asthma
beta 2 agonist is not used for COPD
123
COPD
trouble exhaling, frequent pulmonary infection, mostly caused by smoking, air trapping > can't properly oxygenate
124
type of COPD
emphysema, chronic obstructive bronchitis, bronchiectasis
125
emphysema
enlargement of air spaces and destruction of lung tissue
V&Q both affected
126
chronic obstructive bronchitis
obstruction of small ariways
only V affected>mismatch
127
bronchiectasis
infection and inflammation destroy smooth muscle in airways > permanent dilation, multiple chronic lung infection, hard to exhale
128
general mechanism of COPD
inflammation & fibrosis of the bronchial wall
1. hypertrophied mucous glands > productive cough
2. loss of alveolar tissue > decreased surface area for gas exchange
3. loss of elastic lung fibers > airway collapse, obstructed exhalation, air trapping
129
emphysema
loss of lung elasticity, enlargement of distal terminal bronchial airways (decreased surface area), destruction of alveoli and capillary beds (V&Q affected) , hyperinflation of lungs (increased TLC), dry cough,
130
emphysema inflammation caused by
inhaled irritants, increased infiltration of neutrophils, macrophages, CD8+ T-cells
131
neutrophil w/ emphysema
secrete proteases: trypsin & elastase, MMPs (matric metalloproteases) > result in breakdown of elastin and connective tissue
132
alpha- antitrypsin in emphysema
inactivates the trypsin before it can damage the alveoli > if don't have it then alveolar damage
133
chronic bronchitis
chronic irritation of airways due to increased number of mucous cells and mucus gland enlargement, mucus hypersecretion, bronchial edema
productive cough
fibrosis and smooth muscle hypertrophy
134
pink puffers
emphysema
135
why is emphysema pink puffers
increase respiration to maintain oxygen levels, dyspnea, increased ventilatory effort, use accessory muscle
match VQ
136
blue bloaters
bronchitis
137
why is bronchitis blue bloaters
cannot increase respiration enough to maintain oxygen level, cyanosis and polycythemia, cor pulmonale
VQ mismatch
138
low levels of O2
hypoxia
139
high CO2 levels
hypercapnia
140
secondary pulmonary hypertension
elevation of pulmonary venous pressure, increase pulmonary blood flow, pulmonary vascular obstruction, hypoxemia
141
primary pulmonary hypertension
blood vessel walls thicken and constrict
142
cor pulmonale
right-sided heart failure secondary to pulmonary disease
143
cor pulmonale leads to
decreased lung ventilation, increased workload on the right heart, decreased oxygenation, kidney releases erythropoietin>more RBCs made> polycythemia makes blood more viscous, increased workload on the heart
144
cystic fibrosis
recessive disorder in chloride transport proteins
145
cystic fibrosis leads to
high conc of NaCl in the sweat, less Na and water in respiratory mucus in pancreatic secretion > mucus is thicker > obstructs airways and obstructs the pancreatic and biliary duct 너무 찐득해서 CFTR channel로 나가질 못함
146
health problems with cystic fibrosis
gallstones > gallbladder needs to be removed, can't digest fats (bc no adipose) and vit ADEK
147
3 types of lung cancer
squamous cell carcinoma, adenocarcinoma, small cell carcinoma
148
squamous cell carcinoma
centrally located in the lungs, arises in bronchial epithelium, strongly associated with smoking, intraluminal growth pattern, result in obstruction, hemptysis
149
adenocarcinoma originates at
peripheral lung area derived from mucus-producing glands (aggressive)
150
small cell carcinoma contains
lymphocyte-like cells that originate in the primary bronchi > rapid doubling time
grows in the wall NOT lumen
151
characteristic of small cell carcinoma
highly metastatic, starts in central airway and infiltrates submucosa, less likely to cause obstruction than squamous cell carcinoma
