EXAMS 2 Flashcards
1
Q
Cardiac output
A
stroke volume X heart rate
2
Q
stroke volume
A
preload, afterload, contractility
the volume of blood pumped during every contraction of the heart. anytime your heart beats, how much blood is pumped
3
Q
Pulmonary
A
both ventilation and perfusion needed for gas exchange (a V/Q mismatch if either is inadequate)
4
Q
Tissue oxygenation
A
need above plus normal capillary flow, acid-base, normal O2 content, electrolytes, temperature
5
Q
what is V/Q mismatch
A
when part of your lungs receives oxygen without blood flow or blood flow without oxygen. eg choking
6
Q
When the heart beats too rapidly,
A
it pumps less efficiently
7
Q
systemic circulation
A
blood supply to all body functions
8
Q
pulmonary circulation
A
circulation of blood between the heart and lungs
9
Q
pressure between pulmonary and systemic circulation
A
pulmonary has lower pressure (18mmHg) than systemic circulation (90mmHg)
10
Q
what happens to our aveolis when we breathe out
A
When we breathe in and out, our aveolis don’t completely close cus of surfactant. Babies are not born with this.
11
Q
Primary gas exchange units
A
alveoli
12
Q
alveolocapillary membrane
A
space between the aveoli and RBC.
aveoli has to be in close contact with the RBC.
fluid filling in those spaces due to infections like pneumonia will lead impairment f GAS EXCHANGE
13
Q
what is hypercapnia
A
too much CO2 in bloodsteam by inadequate breathing
14
Q
two types of insufficient exchange of gasses
A
Hypoxemia = low oxygen content = Hypercapnia = too much CO2 in blood
15
Q
neurological system
A
the cns and the respiratory center in the brain regulates how we breathe
16
Q
how does Chronic hypoxemia adapt
A
Chronic hypoxemia adapt by having increased ventilation
chronic hypoxemia aslso lead to the increase in production of RBC
17
Q
peripheral vasoconstriction?
A
mild hypoxemia
METABOLIC ACIDOS
= lack of oxygen can lead to conusion or mental problems
18
Q
pulmonary vasoconstriction
A
chronic hypoxemia. example is chronic hypoxemia is cyanosis.
19
Q
what is dyspnea
A
difficultiy breathin
20
Q
what is Hyperventilation
A
fast breahting to compensate for the lost of oxygen
as a result, theres less CO2 = respiratory alkaylosis
21
Q
difference between Hypoxema and hypoxia
A
hypoxemia is low oxygen content in the blood
hypoxia means low oxygen content in bodily tissues.
22
Q
common portal of viruses
A
nasal mucosa and conjunctional surfaces of the eyes
23
Q
types of influenza vaccinations
A
trivalent inactivated influenza (INJECTION)
- live, attenuated influenza vaccine (INTRANASALY)
24
Q
what is pneumonia
A
respiratory disorders involving inflammation of lung structures (ALVEOLI and BRONCHIOLES)
25
type A influenzas
- most common
- CAN AFFECT MULTIPLE PEOPLE
- CAUSES MOST SEVERE DISEASES
26
subtypes of TYPE A influenza
hemagglutin (H) and neuraminidase (N)
SURFACE ANTIGENS
27
infectious agents causing pneumonia
bacteria and viruses
28
non infectious agents that causes pneumonia
gastric secretions that end up in the lungs
29
factors that facilitates development of pneumonia
- exceedingly virulent organism
- a large inoculum (culture)
- impaired host defense. whether they are immunocompromised of immunocompetent
30
classifications of pneumonia
- according to the source of the infection. where you get the infection from, hospial or community
- according to the immune system of the host. weak immune system most likely to expericne severe reactions
31
what is tuberculosis
commonly affects the lungs. worlds foremost cause of death from a single infectious agent
CAN AFFECT BRAINS, KIDNEYS AND BONES AS WELL
32
myobacterium tuberculosis
virus that causes tuberculosis.
has a waxy capsule which makes it get harder to get rid off.
CAN STAY ALIVE IN ANIMATED SUSPENSION FOR YEARS
33
forms of tuberculosis
mycotuberclosis horminis also known as human TB
- congested areas
- Airborne infection spread by minute droplet nuclei harbored in the respiratory secretions of persons with active tuberculosis
bovine tuberculosis
- Acquired by drinking milk from infected cows; initially affects the gastrointestinal tract
- has been virtually eradicated
34
respiratory disorders in children
upper airways infections
- Viral croup
- Spasmodic croup
- Epiglottis
lower airways infections
- Acute bronchiolitis
35
Impending Respiratory Failure in Infants and Children
- Rapid breathing
- Exaggerated use of the accessory muscles
- Retractions
- Nasal flaring
- Grunting during expiration
36
what is pleura effusion
abnormal accumulation of fluid in the pleural cavity
37
parietal pleura
lines the thoracic wall and superiror aspect of the diaghphram
38
visceral pleura
covers the lungs
39
pleura cavity
spaces between two layers and contains thing layer of seorus fluid
FLUID PREVENTS FRICTION
40
causes of lung cancer
primary: lung tumors 95%
secondary via mestastasis
smoking
asbestos = fibers from workplaces
41
treatment of tuberculosis
combination of drugs and can take up to 18 months.
positive tuberculin doesnt idifferentiate past, latent or active disease
42
what is chylothorax
lymphatic fluid formed in digestive system acummulates in the pleura
- treat conservatively with meds, surgery or pleurodesis
43
what is atelectasis
partial collapse of the lung due to alveolis being surpressed
lung compression that occurs in pneumothroax or pleura effusion
atelectasis can also be incomplete expansion of the lungs
44
what is emyema
pus in the cavity
45
what is pneumothorax
collapse of the lung due to increase pressure of the pleura cavity
46
what is spontaneous pneumothorax
occurs when an airfilled blister on the lung surface raptures
47
what is traumatic pneumothorax
- any trauma that penetrates the penetrates the lungs from outside. can be gunshot, blow
CAN BE PENETRATING (gunshot OR NON PENETRATING (blow)
48
what is tension pneumothorax
occurs when the intrapleural pressure exceeds atmospheric pressure. basicaaly when there is odee pressure in the lungs as compaired to outside
49
what is primary atelecatasis
failure of the lung to expand fully at birth
50
what is secondary atelectasis
- develops in neontal period or later in life PNEUMOTHORAX
51
what is hemothorax
blood in the pleura space. can be drained with chest tube
52
types of fluids in pleural effusion
transudate = low proteins= high hydrostatic pressure/low oncotic pressure
exudates = high protein= inflammation and CAPILLARY PERMEABILITY
- chyle
- blood
53
what is thoracentesis
removal of fluid or air from around the lungs
54
what is asthma
affects the airways of the lungs not necessarily the lungs
55
what is dyspnea
difficulty breathing
56
majority cause of asthma
- majority of asthma are due to environemental factors
57
what is status asthmaticus
BRONCHOSPAMS not reversed by unsual measures = life threatning
58
omnious signs of impending death
silent chest (no audible air movement) and PaCO2 greater than 70mmHg
59
Chronic Obstructive Airway Disease
- Inflammation and fibrosis of the bronchial wall
- Hypertrophy of the submucosal glands
- Hypersecretion of mucus
- Loss of elastic lung fibers
Impairs the expiratory flow rate, increases air trapping, and predisposes to airway collapse
60
Alveolar tissue
Decreases the surface area for gas exchange
61
Loss of elastic lung fibers
Impairs the expiratory flow rate, increases air trapping, and predisposes to airway collapse
EMPHYSEMA
62
atopy
genetic tendency to develop allergic reaction
63
Pulsus paradoxus
when youre having an active attack of asthma and theres not pulses
64
polycythemia
refers to an increase in RBC in the body
65
what is Cystic Fibrosis
An autosomal recessive disorder involving fluid secretion in the exocrine glands and the epithelial lining of the respiratory, gastrointestinal, and reproductive tracts = not just lungs. GI tract, respiratory tracts
66
cause of cystic fibrosis
Mutations in a single gene on the long arm of chromosome 7 that encodes for the cystic fibrosis transmembrane regulator (CFTR), which functions as a chloride (Cl−) channel in epithelial cell
67
manifestations of cystic fibrosis
- Pancreatic exocrine deficiency
- Pancreatitis
- Elevation of sodium chloride in the sweat
- Excessive loss of sodium in the sweat
- Nasal polyps
- Sinus infections
- Cholelithiasis
68
what are Diffuse Interstitial Lung Diseases
A diverse group of lung disorders that produce similar inflammatory and fibrotic changes in the interstitium or interalveolar septa of the lung
69
types of Diffuse Interstitial Lung Diseases
- Sarcoidosis
- The occupational lung diseases
- Hypersensitivity pneumonitis
- Lung diseases caused by exposure to toxic drugs
70
what is Pneumoconioses
The inhalation of inorganic dusts and particulate matter
71
Occupational Lung Diseases
- Pneumoconioses
- Hypersensitivity diseases
- Byssinosis
72
Hypersensitivity diseases of occupational lung diseases
The inhalation of organic dusts and related occupational antigens
73
what is byssinosis
cotton workers; has characteristics of the pneumoconioses and hypersensitivity lung disease
74
development of pulmonary embolism
A blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flow
75
types of pulmonary embolism
- Thrombus: arising from DVT
- Fat: mobilized from the bone marrow after a fracture or from a traumatized fat depot
- Amniotic fluid: enters the maternal circulation after rupture of the membranes at the time of delivery = after delivering a baby, amniotic fluid can end up in the blood. Rare but can occure
76
Cor Pulmonale
- Right heart failure resulting from primary lung disease and long-standing primary or secondary pulmonary hypertension
- Involves hypertrophy and the eventual failure of the right ventricle
- Manifestations include the signs and symptoms of the primary lung disease and the signs of right-sided heart failure.
77
Acute Respiratory Distress Syndrome
A number of conditions that produces pathologic lung changes that include diffuse epithelial cell injury with increased permeability of the alveolar–capillary membrane
78
causes of acute respiratory distress syndrome
- Aspiration of gastric contents
- Major trauma (with or without fat emboli)
- Sepsis secondary to pulmonary or nonpulmonary infections
- Acute pancreatitis
- Hematologic disorders
- Metabolic events
- Reactions to drugs and toxins
79
Impaired ventilation
- Upper airway obstruction
- Weakness of paralysis of respiratory muscles
- Chest wall injury
80
Impaired diffusion
- Pulmonary edema
| - Respiratory distress syndrome
81
causes of respiratory failure
- impaired ventilation
- impaired matching or ventilation and perfusion
- impaired diffusion
82
Tracheostomy
Surgically created stoma (opening) used to
- Establish a patent airway
- Bypass an airway obstruction
- Facilitate secretion removal
- Permit long-term mechanical ventilation
- Facilitate weaning from mechanical ventilation
83
Types of Chronic Obstructive Pulmonary Disease
- emphysema
| - chronic obstructive bronchitis
84
what is emphysema
- Enlargement of air spaces and destruction of lung tissue
| - Types: centriacinar and panacinar
85
what is chronic obstructive bronchitis
Obstruction of small airways
86
what is Bronchiectasis
Permanent dilation of the bronchi and bronchioles
- secondary to persisting infection or obstruction
87
manifestations of bronchiectasis
- atelectasis = partial collapse of the lungs
- Obstruction of the smaller airways
- Diffuse bronchitis
- Recurrent bronchopulmonary infection
- Coughing; production of copious amounts of foul-smelling, purulent sputum; and hemoptysis
- Weight loss and anemia are common.
88
what is hemoptysis
spitting pf blood originated from lungs or bronchial tubes
89
wha makes up the blood basics
Blood is composed of formed elements and plasma.
- Formed elements
- Plasma
- Serum
- Hematocrit
90
Functions of the hematopoietic system include
transport, communication, temperature, defense, and clotting.
91
Red cells are produced in the..........
red bone marrow after birth
Until 5 years of age, almost all bones produce red cells to meet growth needs; after 5 years, bone marrow activity gradually declines.
After 20 years, red cell production takes place mainly in the membranous bones of the vertebrae, sternum, ribs, and pelvis.
92
The heme molecule is converted......
to bilirubin and transported to the liver.
93
The red blood cell life span
- The red blood cell has a life span of approximately 120 days.
- It is broken down in the spleen.
- The degradation products (iron and amino acids) are recycled
94
Regulation of erythropoiesis
is through erythropoietin (EPO) that stimulates bone marrow to increase RBC production in response to low oxygen
95
oxygen-binding component of hemoglobin.
iron
96
Erythropoiesis requires
- requires vitamin B12 (cobalamin), folate (folic acid) and iron.
Folate and Vitamin B12 are required for DNA synthesis.
97
what is Thrombopoiesis
- the process of forming platelets.
Platelets are derived from fragmentation of megakaryocytes and are important in hemostasis.
98
what is Thrombopoietin
is a growth hormone released from the liver that stimulates thrombopoiesis
99
thrombocytopenia may give rise to
purpura and petechiae (rash or spots due to bleeding).
100
Exposure of these stem cells to environmental cues (hormones, growth factors)
may give rise to many types of cells
| Lineages
101
Bilirubin
The heme unit is converted to bilirubin.
Bilirubin is insoluble in plasma and attaches to plasma proteins for transport. ( UNCONJUGATED )
Removed from the blood by the liver and conjugated with glucuronide to render it water soluble
(Conjugated)
Jaundice
102
Red blood cell count (RBC)
Measures the total number of red blood cells in 1 mm3 of blood
103
Percentage of reticulocytes
normally approximately 1%)
104
Hemoglobin
grams per 100 mL of blood
Measures the hemoglobin content of the blood
105
Hematocrit TEST
Measures the volume of red cell mass in 100 mL of plasma volume
106
Polycythemias
Too many RED BLOOD cells
107
Normal number of cells with altered components
Sickle Cell
108
Too few RED BLOOD cells
Anemias
109
anemia size
Identified by terms that end in “-cytic”
Macrocytic, microcytic, normocytic
110
Hemoglobin content
- Identified by terms that end in “-chromic”
| - Normochromic and hypochromic
111
The classification of anemia usually based on?
the size of the rbc, mcv and MCH, normocytic, microcytic, and macrocytic, but it does not mean bigger size is better.
112
what is Pernicious anemia
- Caused by a lack of intrinsic factor made by the gastric parietal cells and is required for vitamin B12 absorption
- Results in vitamin B12 deficiency
113
Pernicious anemia neurological manifestations due to nerve demyelination
Weakness, paresthesias of feet and hands, ↓ vibratory and position senses, ataxia, muscle weakness, and impaired thought processes
114
increasing dietary cobalamin (vitamin B12) pernicious anemia
Increasing dietary cobalamin does not correct this anemia if intrinsic factor is lacking or if there is impaired absorption in the ileum
115
what is folic acid?
- Folic acid is required for DNA synthesis
| - RBC formation and maturation
116
Folic Acid Deficiency
Common causes are Dietary deficiency
- Malabsorption syndromes
- Increased requirement (i.e., pregnancy)
- Alcohol abuse and anorexia
Loss during hemodialysis
Gluten is a protein found in wheat, rye, and barley. It may also be in other products like vitamins and supplements, hair and skin products, toothpastes, and lip balm.
117
what is celiac disease (genetic)
Celiac disease is an immune disease in which people can't eat gluten because it will damage their small intestine. If you have celiac disease and eat foods with gluten, your immune system responds by damaging the small intestine.
Treatment is a diet free of gluten.
118
folic acid deficiency serum folate level
Serum folate level is low but vit b12 is normal
| We can treat them by replacement therapy or eat the food with larger amount of folic acid
119
most common type of anemia
Iron Deficiency Anemia
```
Nutritional iron deficiency
Metabolic or functional deficiency
Progression of iron deficiency causes:
Brittle, thin, coarsely ridged, spoon-shaped nails
A red, sore, painful tongue
```
120
Normocytic anemia:
Acute and chronic Blood Loss
Anemia resulting from blood loss may be caused by either acute or chronic problems
Acute blood loss occurs as a result of sudden hemorrhage
121
When acute blood loss is more gradual
- the body maintains its blood volume by slowly increasing the plasma volume, but then the number of RBCs is significantly diminished
Consequently, blood transfusions (packed RBCs) may be needed if the blood loss is significant.
122
When anemia exists after acute blood loss...
When anemia exists after acute blood loss, dietary sources of iron will probably not be adequate to maintain iron stores.
Therefore oral or parenteral iron preparations are administered
123
Some causes of chronic blood loss:
- Bleeding ulcer
- Hemorrhoids
- Menstrual and postmenopausal blood loss
124
Blood Transfusion complications
Not linked into one baseline hemoglobin level but recommended for HCT < 30
- Fluid overload
- Blood-borne infection
- Exposure to donor leukocytes
125
Acute hemolytic transfusion reaction
Incompatibility
Hypothermia – ventricular dysrhythmias
126
what is Sickle Cell Disease
Inherited structural abnormality in the hemoglobin
- Crystal-like, elongated, rigid cell causes occlusion in the microcirculation
- Sickling in response to cold, dehydration, hypoxia, infection, and acidosis
127
Treatment of Sickle Cell Crisis
- Oxygen administration
- Aggressive intravenous fluid hydration
- Prompt treatment of infection with broad-spectrum antibiotics
RBC transfusions are not usually required
- Pain control with around-the-clock narcotics
- Folic acid supplementation
- Hydroxyurea
- Hematopoietic stem cell transplantation (HSCT) is promising towards finding a cure for Sickle Cell Disease
128
Polycythemia Vera
A condition in which the red blood cell mass is increased.
129
Relative polycythemia
results from a loss of vascular fluid and is corrected by replacing the fluid
130
Primary polycythemia
a proliferative disease of the bone marrow with an absolute increase in total red blood cell mass accompanied by elevated white cell and platelet counts
131
Secondary polycythemia
is caused by other disease processes that induce hypoxia. For these, the underlying cause is treated. These include: chronic heart and lung disease, living at high altitude, sleep apnea
132
RBCs and platelets are formed
in the marrow and released into circulation.
133
lifespan of WBC
The life span of WBCs is relatively short; constant renewal is necessary to maintain normal blood levels.
Conditions that decrease availability of stem cells or hematopoietic growth factors produce a decrease in WBCs.
134
Leukopenia deficiency of leukocytes
Neutropenia
| Granulocytopenia
135
Aplastic anemia
Anemia, thrombocytopenia, and agranulocytosis
136
RBCs and platelets are formed in the
the marrow and released into circulation.
137
whats is Infectious Mononucleosis
Self-limited lymphoproliferative disorder
138
Causes and Characteristics
| of infectious mononucleosis
- Caused by the B-lymphocytotropic EBV, a member of the herpes virus family; transmitted in saliva
- Characterized by fever, generalized lymphadenopathy, sore throat, and the appearance in the blood of atypical lymphocytes and several antibodies
- Highest incidence in adolescents and young adults
Treatment is symptomatic and supportive.
139
Neoplastic Disorder of Hematopoietic and Lymphoid Origin
Represent the most important of the white cell disorders
140
Hodgkin disease
Reed-Sternberg cells are present.
141
Reed-Sternberg cells are derived
from B lymphocytes
142
Non-Hodgkin disease
Reed-Sternberg cells are not present.
143
Symptoms of Hodgkin Disease
- Stage A
Lack constitutional symptoms
- Stage B (40% of persons with Hodgkin disease)
Significant weight loss, fevers, pruritus, or night sweats
ADVANCED STAGES
- Fatigue and anemia
- Liver, lungs, digestive tract, and CNS may be involved.
144
Categories of Non-Hodgkin Lymphomas
- Low-grade lymphomas
Predominantly B-cell tumors
- Intermediate-grade lymphomas
Include B-cell and some T-cell lymphomas
```
- High-grade lymphomas
Largely immunoblastic (B cell), lymphoblastic (T cell), Burkitt, and non-Burkitt lymphomas
```
145
what are Leukemias
Malignant neoplasms arising from the transformation of a single blood cell line derived from hematopoietic stem cells
146
Lymphocytic leukemias
lymphocytes
147
Myelocytic leukemias
granulocytes
| monocytes
148
chronic leukemias
Malignancies involving the proliferation of well-differentiated myeloid and lymphoid cells
149
Types of chronic leukemia
- Chronic lymphocytic leukemia (CLL)
| - Chronic myelogenous leukemia (CML)
150
```
Acute lymphocytic (lymphoblastic) leukemia (ALL)
Chronic lymphocytic leukemia (CLL)
```
- Both involve immature lymphocytes and their progenitors in the bone marrow, the spleen, lymph nodes, CNS, and other tissue.
151
Acute myelogenous (myeloblastic) leukemia (AML)
Chronic myelogenous leukemia (CML)
Both involve the pluripotent myeloid stem cells in bone marrow and interfere with the maturation of all blood cells.
152
Factors Affecting the Likelihood of Achieving Remission
- Age (most significant prognostic variable)
- Type of leukemia
- Stage of the disease at time of presentation
153
Multiple Myeloma definiation
A plasma cell dyscrasia characterized by expansion of a single clone of immunoglobulin-producing plasma cells and a resultant increase in serum levels of a single monoclonal immunoglobulin or its fragments
154
Main sites involved
| in multiple myeoma
- The bones and bone marrow
- Proliferation and activation of osteoclasts that lead to bone resorption and destruction
- Pathologic fractures
- Hypercalcemia
