Blue Print- Respiratory System

Question 1

Pleural Effusion

Answer 1

Abnormal collection of fluid in the pleural cavity

Question 2

Pleural Effusion (Types of Fluid)

Answer 2

Transudate
Exudate
Purulent (containing pus, empyema)
Chyle (milky fluid of fat and lymph) Sanguineous (bloody)

Question 3

Diagnosis and Treatment of Pleural Effusion

Answer 3

Diagnosis:
Chest radiograph
CT scan

Treatment: directed at the cause of the disorder
Thoracentesis- a procedure to remove fluid/air from lungs
Injection of Sclero agent- solution introduced to pleura to prevent reaccumulation of fluid

Question 4

Pleural Effusion (Transudative)

Answer 4

Occurs due to an increased hydrostatic pressure or low plasma oncotic pressure

E.g., CHF, Cirrhosis, Nephrotic Syndrome, PE, Hypoalbuminemia

LOW in protein and LDH

(Nephrotic syndrome -kidney disorder that causes your body to pass too much protein in your urine.)

Question 5

Pleural Effusion (Exudative)

Answer 5

Occurs due to inflammation and increased capillary permeability

E.g., Pneumonia, Cancer, TB, Viral infection, PE, Autoimmune disease

Question 6

Empyema

Answer 6

Disorder of the Pleura

Pus-filled pockets that develop in the pleural space

Question 7

Atelectasis

Answer 7

The incomplete expansion of a lung or portion of a lung

Question 8

Atelectasis (Causes and Types)

Answer 8

Causes:
Airway obstruction
Lung compression such as that occurs in pneumothorax (complete collapsed lung) or pleural effusion
Increased recoil of the lung due to loss of pulmonary surfactant

Types:
Primary
Secondary

Question 9

Emphysema

Answer 9

Enlargement of air spaces and destruction of lung tissue.

Emphysema is categorized as a type of Chronic Obstructive Pulmonary Disease (COPD)

Types:
Centriacinar- upper lobes
Panacinar- lower lobes

Question 10

Characteristics of Pulmonary Emphysema

Answer 10

Smoking history 
Age of onset: 40-50 years
Often dramatic barrel chest
Weight Loss
Decreased breath sounds
Normal blood gases until late in the disease process
Cor pulmonale only in advanced cases (Right-sided HF) 
Slowly debilitating disease

Question 11

Chronic Obstructive Bronchitis

Answer 11

Obstruction of small airways

COB is categorized as a type of Chronic Obstructive Pulmonary Disease (COPD)

Question 12

Characteristics of Chronic Obstructive Bronchitis

Answer 12

Smoking history 
Age of onset 30-40 years
Barrel chest may be present
Shortness of breath (early symptom)
Rhonchi is often present (Roco) 
Sputum frequent, an early manifestation 
Often dramatic cyanosis
Hypercapnia and hypoxemia may be present
Frequent Cor pulmonale (Right HF) and polycythemia (an increase of RBC) 
Numerous life-threatening episodes due to acute exacerbation

Question 13

Pathophysiology of Chronic Bronchitis

Answer 13

Mucus accumulation 
Mucus plug 
Hyperinflation of alveoli 
Enlarged submucosal gland
Inflammation of epithelium

Question 14

Bronchiectasis

Answer 14

Permanent dilation of the bronchi and bronchioles

Manifestations:
Atelectasis
Obstruction of smaller airways
Diffuse bronchitis 
Recurrent pulmonary infection
Coughing; production of copious amounts of foul-smelling purulent sputum; and hemoptysis
Weight loss and anemia are common

Question 15

Common Respiratory Infections

Answer 15

Common Cold 
Influenza 
Pneumonia 
Tuberculosis
Fungal infections of the lung

Question 16

Tuberculosis

Answer 16

World’s foremost cause of death from a single infectious agent
Causes 26% of avoidable death in developing countries
Lungs are mainly affected
1/3 of world’s population has TB
Drug resistance forms

Question 17

Bacteria Responsible for Tuberculosis

Answer 17

Mycobacterium tuberculosis hominis

• Aerobic
• Has a protective way capsule (think microbio)
• Can stay alive in “suspended animation” for a year (think Disney)

Question 18

Forms of Tuberculosis

Answer 18

M. Tuberculosis hominis (human tuberculosis)

Bovine Tuberculosis

Question 19

M. Tuberculosis hominis (human tuberculosis)

Answer 19

Airborne infection spread by minute nuclei harbored in the respiratory secretions of persons with active tuberculosis

Living under crowded and confined conditions increases the risk for the spread of the disease

Question 20

Bovine tuberculosis

Answer 20

Acquired by drinking milk from infected cows; initially affects the GI tract.

Has been virtually eradicated in North America and other developed countries

Question 21

Diagnostic Tests for Tuberculosis

Answer 21

Tuberculin skin test (TST)
AKA: Mantoux test
Assess duration in 48-72 hours
Reaction >5 (or equal to 5mm) mm considered positive

Interferon-gamma release assays (IGRA’s) (blood test)
Chest x-ray
Bacteriologic studies

Question 22

Clinical Manifestations of Tuberculosis

Answer 22

Latent tuberculosis infection: asymptomatic
Fatigue, weight loss, lethargy, anorexia

A positive skin test is a purified protein derivative (PPD)

Sputum culture, immunoassays, chest radiographs

Question 23

Treatment of Tuberculosis

Answer 23

Isoniazid, rifampin, pyrazinamide, and ethambutol

Drug-resistant bacilli: a combination of at least four drugs to which the microorganism is susceptible, administering for 18 months
(must review drug effectivity in 6 months)