Rsp - Midterm 1 Flashcards
What is Pneumococcal Pneumonia? What does it lead to? What does it release?
-Streptococcus pneumoniae (most common form)
o Has polysaccharide capsule that makes phagocytosis difficult
o Releases toxins that directly damages airway and alveoli
*It is a bacteria so we will treat them with an antibiotic, inflammatory response will lead to red hepatization of lung - bacteria is typically hospital acquired
Lung cancer Risk factors? It is also related to?
- Smoking
- Heavy smokers have a 20-fold greater chance of developing lung cancer than nonsmokers
- Smoking is also related to cancers of the larynx, oral cavity, pancreas, esophagus, and urinary bladder
- Other:
- Second-hand smoke
- Exposure to workplace toxins, radiation, pollution, tuberculosis
What kind of lung disease is Atelectasis?
It’s a restrictive lung disease
In Hypoxemia hypoventialtion happens because? What does it cause in pts who have COPD, are unconscious, or have neurological, muscular or bone diseases that restrict chest movement ?
1.) Hypoventilation happens b/c less O2 available in the alveoli for diffusion
o Can be corrected by ↑rate and ↑depth of breathing
o See above
2.) Hypoventilation causes hypoxemia in Pts who:
o Are unconscious
o Have neurological, muscular or bone diseases that restrict chest movement
o Have COPD
What is Acute Bronchitis? When does it develop? What causes it?
Acute bronchitis is a contagious viral infection that causes inflammation of the bronchial tubes, this narrows the airways.
Acute bronchitis often develops three to four days after a cold or the flu.
Causes - viral or breathing in something that irritates the lungs such as tobacco smoke, fumes, dust and air pollution, can come from a viral infection that weekens our immune system and makes us more susceptible to infections
*longer than 3 months for 2 consecutive years = chronic bronchitis
What is normal V/Q? Abnormal V/Q ratio is the most common cause of?
0.8
- Amount of air that enters alveoli = V (also FiO2)
- The amount of blood going through alveolar capillaries = Q
- Abnormal V/Q ratio is most common cause of hypoxemia
Disorders due to neoplasia can affect what area of the respiratory system?
- Can affect any part of the Respiratory System
- Nose, mouth, nasopharynx, oropharynx
- Larynx
- Lungs
- Focus – Lung Cancer
What is a Pneumothorax?
-Air leaks into the space between your lung and chest wall
- Presence of air or gas in pleural space by rupture in visceral pleura
- Breaches negative air pressure space and disrupts equilibrium
- Lung collapses inwards
- Can be a complete lung collapse or a collapse of only a portion of the lung
What is Chronic Bronchitis (blue bloaters)? What’s it caused by? What is important to keep in mind with chronic bronchitis?
- Hypersecretion of mucous and chronic productive cough for ≥ 3mon/year for 2yrs (consecutive)
(Prevention is important as pathological changes are not reversible)
Caused by:
o Exposure to cigarette smoke, air pollution, infections
* Bronchial Edema
- Increased risk of pulmonary infection
o Bacterial colonization of damaged airway - Increased number of mucous glands
o Hypersecretion of mucous
o Thick, tenacious
Aspiration of Gastric fluid leads to?
pneumonitis
What is passage of fluid and/or solid particles into the lungs called?
What kind of onset does it have?
Aspiration (relatively large amount of material from the stomach or mouth entering the lungs )
rapid onset – fluid breathed into the lungs or airways leading to the lungs, instead of being swallowed into the esophagus and stomach
What is a severe Pneumothorax?
Severe pneumothorax – tracheal deviation away from affected lung
What is classified as a small airway obstruction? What happens here? What do they manifest as?
o Small airway obstruction (asthma, COPD)
↑ ventilatory rate
↓ tidal volume
↑ effort
Prolonged expiration
Audible wheezing
Ventilation?
Ventilation – movement of air in and out of lungs – doesn’t mean that there has been an exchange of oxygen
Tension pneumothorax requires?
Tension needs immediate treatment as each inhalation causes collapse to increase in size
In chronic bronchitis, Chronically high PCO2 diminishes the sensitivity of? What happens because of this?
Central chemoreceptors and they no longer act as primary stimulus for breathing
What is the most common cause of pulmonary edema?
caused by congestive heart failure – left sided heart failure
What is Hyperventilation? What is it caused by? What does it result in?
o Alveolar ventilation exceeds metabolic demands
Lungs remove CO2
↓ PaCO2
* Hypocapnia – When arterial CO2 < 36mmHg
Results in respiratory alkalosis
o Caused by:
Severe anxiety
Acute head injury
Pain
Response to conditions that cause hypoxemia
Examples of pulmonary diseases or injury (super basic from slides)
1.) Hypercapina
2.) Hypoxemia
3.) Acute respiratory Faulure (VQ mismatch)
What is a Adenocarcinoma? Where are they located?
*Arise from glands
-Moderate speed of growth
- Grow peripherally
Pleuritic pain
Account for 35-40% of bronchogenic tumors
*Tumors arise of the peripheral region of pulmonary parenchyma
Also included in this category is bronchioloalveolar cell carcinoma
* Located on the terminal bronchioles and alveoli
Slow growing, unpredictable metastasis pattern
What are the clinical presentations of an Empyema? What are they diagnosed by?
Clinical presentation:
o Cyanosis
o Fever
o Tachycardia
o Cough
o Pleural pain
o Decreased breath sounds over empyema
Diagnosis by:
o Xray
o Thoracentesis
o Sputum culture
Hypoxemia is commonly associated with?
o Compensatory hyperventilation; and
o Resulting respiratory alkalosis
Causes of a pulmonary embolism?
-Usually from blood clots that travel to the lungs from deep veins in the legs
-Fat from the marrow of a broken long bone
-Part of a tumor
-Air bubbles.
What are Squamous cell carcinoma? Common manifestations? Where are they located?
Squamous cell carcinoma associated with smoking and COPD presents with nonproductive cough or hemoptysis, chest pain is late symptom
Grow centrally
Slowest growing
Account for 30% of bronchogenic tumors
Located near the hila and project into bronchi
Tumors are localized and do not metastasize until late disease
Common manifestations:
* Nonproductive cough
* Hemoptysis
* Pneumonia
* Atelectasis
Examples of Asthma triggers?
Asthma triggers: (varies from person to person, we want to educate them on how best to avoid them)
Airborne allergens, such as pollen,dust mites, mold spores, pet dander
What are Neuroendocrine tumors/ Small cell Tumours? What do they produce? Side effects?
o Also known as “Small cell carcinoma”
(Also known as “oat cell”)
o Central origin (hilar and mediastinal)
o Highest correlation with smoking
o Grow rapidly, aggressively
o *Metastasize early, worst prognosis
o *Produce ectopic hormones
Results in paraneoplastic syndrome as first manifestation
– central present at stage IV with poor prognosis
Symptoms mimic side effects of smoking so assessment is not sought out right away – usually well advanced
What is shunting? This happens in? What kind of V/Q does this result in?
Shunt – blood is moving through the lung, but no ventilation - we have a 0 V/Q - (can see this in a collapsed lung)
Example - pulmonary shuntoften occurs when the alveoli fill with fluid, causing parts of thelungto be unventilated although they are still perfused.
-Aveolis has no air movement, de oxygenated high CO2 blood enters the vessle and nothing happens to it on the way through the vessel - Blood that is flowing through the lung that is not exposed to an aveolis containg oxygen
Pulmonary edema caused by left-sided heart failure disease Vs capillary injury which increases capillary permeability?
1.) Commonly caused by left-sided heart disease:
o Left ventricle fails, puts pressure on left side of heart
o Increases pulmonary capillary hydrostatic pressure
o When pressure exceeds oncotic pressure, fluid moves from capillary to interstitial space
o When lymphatic system cannot take up additional fluid, edema happens
2.) Another cause is capillary injury which increases capillary permeability:
o Injury and inflammation cause fluid to leave capillary and into interstitial space
Increases interstitial oncotic pressure
Usually very low
o High interstitial oncotic pressure soon exceeds capillary oncotic pressure
Water moves from capillary and into lung
What is Asthma? What does is cause?
-Chronic inflammatory disorder of bronchial mucosa that causes:
o Bronchial hyper-responsiveness
o Constriction of the airways
o Reversible airflow obstructions
Manifestations of TB?
Manifestations:
o Dyspnea
o Persistent cough
o Bloody sputum
o Pleuritic pain
o Fever
o Night sweats
o Fatigue
Manifestations of Squamous cell carcinoma?
- Often attributed to side effects of smoking
- Once severe enough, disease is often advanced:
-Cough
-Increased sputum
*Hemoptysis
-Atelectasis (due to obstruction)
-Wheezing (narrowed airways)
-Pleuritic chest pain
-Hypoxemia
-Hypercapnia
COVID - 19 quarantine Vs isolation?
Quarantine means restricting activities or separatingpeople who are not illthemselves but may have been exposed to COVID-19. The goal is to prevent spread of the disease at the time when people just develop symptoms.
Isolation means separatingpeople who are illwith symptoms of COVID-19 and may be infectious to prevent the spread of the disease
What are some common causes of a chronic cough?
*classified as chronic if cough persists for longer than 3 weeks
o Caused by:
Postnasal drainage syndrome
Asthma
Eosinophilic bronchitis
Laryngeal hypersensitivity
Gastroesophageal reflux disease
Or not identifiable cause
Chronic bronchitis in smokers
* Lung cancer in smokers
Individuals taking angiotensin-converting enzyme inhibitors for CV disease
What is the goal for a ventilation - perfusion (VQ) scan with pulmonary embolisms?
ventilation–perfusion (VQ)scanis a nuclear medicinescanthat uses radioactive material (radiopharmaceutical) to examine airflow (ventilation) and blood flow (perfusion) in the lungs.
The aim of thescanis to look for evidence of any blood clot in the lungs, called pulmonary embolism (PE)
What is polycythemia?
o Polycythemia (↑RBC) has adequate oxygenation but causes cyanosis
Signs + Symptoms for pulmonary embolism? What can a massive embolus cause?
Sudden onset sharp chest pain, dyspnea, tachypnea, tachycardia, unexplained anxiety
Massive embolus causes severe pulmonary hypertension and shock
Unique breath sounds are are heard over?
Heard over painful aprea (pleural friction rub)
Outcomes of pulmonary embolsim if embolus causes an infection Vs if embolus does not cause an infection?
Embolus does not cause infarction – clot is absorbed circulation returns to normal
Embolus causes infarction – shrinking and scarring occur in affected part of the lung
Where do Squamous cell carcinoma begin to grow?
Usually begins in the bronchial tubes
What is Bronchiolitis? Who do we typically see it in? What population is it more severe in? (upper or lower airway infection)
Acute infection or inflammation of the lower airways
- Common in infants and toddlers
- Due to a viral illness caused by respiratory syncytial virus (RSV)
-Reoccurs – no immunity
-More severe in premature infants or those with underlying pulmonary or cardiac disease
Presents with variable levels of respiratory distress
-Wheezing common, but crackles may be present as well
-Treatment is supportive – NOT antibiotics – viral
Characteristics of Asthma?
Characterized by:
-variable and recurring symptoms
-reversible airflow obstruction
-easily triggered bronchospasms
Pain in chest wall =
*Causes of chest walls pain?
muscle or rib pain
o Excessive coughing
o Rib fractures
o Thoracic surgery
o Inflammation of costochondral junction
What is Status Asthmaticus?
-Status Asthmaticus (Life-threatening asthmatic attack that does not respond to normal treatment)
o Persistent SOB
o Inability to speak in complete sentences
o Agitation, confusion
o Accessory muscle use
o Possible decrease in wheezing
-Acute severe bronchospasm
-Repeated asthma attacks without interruption
-They are not moving ANY air, we will administer bronchodilators to help!
What is hypocapnia? What does it result in? When does it occur?
-Occurs during hyperventilation
- Hypocapnia – When arterial CO2 < 36mmHg
Results in respiratory alkalosis
What is Tonsillitis? What can it cause/develop?
-Infection of the upper airway
-Can cause upper airway obstruction – (can develop an abscess that needs to be drained)
-treated with antibiotics
-recurrent infections can result in a tonsillectomy – not as common now
What is primary TB Vs Secondary TB?
Primary tuberculosis
o Previously unexposed
o Can either go into latency (95%) or can become ill (5%)
Secondary tuberculosis
o Re-activation of first infection
o Another exposure
Perfusion?
delivery of blood to a capillary bed in tissue
What is hypercapnia? When does it occur? What can it result in?
- Hypercapnia – when Arterial CO2 pressure > 44mmHg
Results in respiratory acidosis
-Occurs during hypoventilation
Pain in the chest wall is usually associated with? and caused by?
- Pain is usually localized to part of chest wall
o Unique breath sounds are heard over painful area (pleural friction rub)
o Laughing or coughing makes pain worse
o Commonly from pulmonary infarction (tissue death) from pulmonary embolism - Caused by:
o Pulmonary disorders from pleurae, airways, or chest wall
o Infection/inflammation of parietal pleura (when pleura stretches)
o Infection/inflammation of trachea or bronchi can cause central chest pain
Difficult to distinguish from cardiac pain
o High BP in pulmonary circulation - Pain in chest wall = muscle or rib pain
Poor ventilation of normally-well vented areas of the lungs (low V/Q) is called? It happens in?
This is called shunting
Happens in:
* Atelectasis (lung collapse)
* Asthma from bronchoconstriction
* Pulmonary edema
When blood passes through non-ventilated alveoli, the capillary constricts
* Right-to-left shunt occurs
* Decreases systemic PaO2 and causes hypoxemia
Manifestations of Pneumococcal Pneumonia? What does it start with? What will be found in the assessment?
Start with a viral upper respiratory tract infection
Develop fever, chills, productive or dry cough, malaise, pleural pain
Assessment – pulmonary consolidation, dullness to percussion, inspiratory crackles (the heavier the crackles, the heavier the sputum), increased tactile fremitus, we will have dull purcution
What is Croup? What is it mostly caused by? What kind of cough does it produce?
-Infection of the upper airway
-Interferes with normal breathing – produces barking cough
-Mostly caused by influenza virus & respiratory syncytial virus (RSV) – “steeple” sign – usually short term – acute comes on slower – spasmodic comes on abruptly – humidified air does not improve symptoms
Glucocorticoid steroids, oxygen therapy
Inflammation of the airways (child needs to come into the hospital if they get hypoxic)
Compression atelectasis Vs Absoprtion atelectasis Vs Surfactant imparement?
Compression – external pressure pushing up diaphragm – alveoli collapse
-External pressure (from tumor/fluid/air in pleural space) presses on lung and causes alveoli to collapse
Absorption – less gas enters the alveolus than is removed by uptake by the blood
-Removal of air from obstructed or hypoventilated alveoli or inhaling concentrated O2 or anaesthetic agents
Surfactant impairment – normally surfactant lowers surface tension preventing collapse if there is decreased production or impairment alveoli collapse- Decreased production/inactivation of alveoli surfactant which normally reduces the surface tension in the alveoli
Can be due to premature birth, ARDS, anaesthesia induction, or mechanical ventilation
Risk factors for Asthma?
Risk factors – age of onset of disease (those diagnoses at a younger age will have more serious case), levels of allergen exposure, air pollution, tobacco smoke, recurrent respiratory infections (what they are exposed to), Gastroesophageal reflux disease, Obesity