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Alterations of Hematological function in children > PC 604 test 4 > Flashcards

PC 604 test 4 Flashcards

1
Q

Decreased compliance of the lungs

or RESTRICTIVE DISORDERS OF THE LUNG cause..

A

dyspnea, increased respiratory rate and decreased tidal volume

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2
Q

Pulmonary function tests FOR RESTRICTIVE DISORDERS OF THE LUNG

A

decreased forced vital capacity

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3
Q

Restrictive pulmonary disorders affect

A

alveolocapillary membrane and causes decreased diffusion of O2 from alveoli to blood

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4
Q

Acute (adult) Respiratory Distress Syndrome (ARDS) IS…

A

Acute lung inflammation and diffuse alveolocapillary injury

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5
Q

CAUSES OF Acute (adult) Respiratory Distress Syndrome (ARDS)

A

Causes – severe trauma, sepsis, fat emboli, shock, pancreatitis, pneumonia, DIC.etc.

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6
Q

CLINICAL MANIFESTATIONS OF Acute (adult) Respiratory Distress Syndrome (ARDS)

A

• Marked dyspnea, rapid shallow breathing, inspiratory crackles, respiratory alkalosis (because of rapid breathing), decreased lung compliance, hypoxemia that is unresponsive to O2 therapy, diffuse alveolar infiltrates on xray without cardiac disease,
•

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7
Q

PATHOPHYSIOLOGY OF Acute (adult) Respiratory Distress Syndrome (ARDS)

A

MASSIVE PULMONARY INFLAMMATION THAT INJURES THE ALVEOLI/CAPILLARY MEMBRANE AND PRODUCES PULMONARY EDEMA

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8
Q

EXAMPLES OF RESTRICTIVE DISORDERS OF THE LUNG

A

PULMONARY FIBROSIS
INHALATION DISORDERS
ACUTE REPIRATORY DISTRESS SYNDROME

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9
Q

• Much more frequently seen in primary care

A

Obstructive Pulmonary Disorders

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10
Q

• Airway obstruction occurs that is worse on expiration

A

Obstructive Pulmonary Disorders

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11
Q

EXAMPLES OF OBSTRUCTIVE PULMONARY DISORDERS

A

asthma, chronic bronchitis, emphysema

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12
Q

• All cause dyspnea and wheezing, increased work of breathing, ventilation\perfusion mismatch and decreased forced expiratory volume

A

Obstructive Pulmonary Disorders

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13
Q

• Primary cause: Smoking!

A

Obstructive Pulmonary Disorders

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14
Q

• HOW MANY DEATHS FROM COPD IN 2005

A

• Chronic obstructive lung disease was the underlying cause of 1 in 20 deaths in the United States in 2005

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15
Q

COPD DEATHS MORE PREVELANT AMONG MEN OR WOMEN?

A

• Death rates from COPD decreased among men but increased among women, keeping the death rate from COPD about the same overall.

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16
Q

MORE PREVELANT AMONG WHAT RACE?

COPD

A

• COPD deaths are higher among Whites than Blacks or people of other races.

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17
Q

MOST IMPORTANT CAUSE OF COPD..

A

• Smoking is the most important cause of COPD.

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18
Q

WHAT IS SHUNTING IN Acute (adult) Respiratory Distress Syndrome (ARDS

A

• Mismatching of the ventilation to perfusion ratio

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19
Q

EXPLAIN SHUNTING IN Acute (adult) Respiratory Distress Syndrome (ARDS

A
  • Specifically in ARDS we see an inadequate ventilation of well perfused areas of lung
  • Blood supply is undisturbed but the alveoli are inflamed and we get this shunting because of the alveolar function compromise
  • We see hypoxemia
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20
Q

• Remember the increased volume of the left ventricle means there is a backflow to the lungs THIS IS CALLED//

A

PULMONARY EDEMA

LEFT IS LUNG

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21
Q

• THERE IS Excess water in the lungs, the water escapes the capillary and goes into the alveoli IN WHAT DISORDER?

A

PULMONARY EDEMA

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22
Q

WHAT IS THE Most common cause OF heart failure, particularly left heart failure

A

PULMONARY EDEMA

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23
Q

occurs in many lung disorders

AND Occurs in ARDS

A

PULMONARY EDEMA

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24
Q

WHAT ARE SIGNS AND SYMPTOMS OF PULMONARY EDEMA

A

PULMONARY EDEMA
o Inspiratory crackles
o Lungs dull to percussion because there’s increased fluid inside
o Those with severe pulmonary edema would have a pink frothy sputum
o Hypoxemia
o Hypoventilation

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25
PULMONARY EDEMA IS SEEN IN
LEFT SIDED HEART FAILURE AND ARDS | PULMONARY EDEMA
26
A PNEUMOTHORAX IS
Presence or air in the pleural space caused by an opening in the pleura or chest wall.
27
WHEN THERE IS AN OPENING IN THE PLEURA OR CHEST WALL
This destroys the negative pressure that helps the lung recoil after expiration. So the lung collapses
28
WHAT CAN CAUSE OPENINGS IN THE PLEURA?
Spontaneous – bleb Secondary – trauma Open Tension – rupture is one-way valve – air in – collapsing lung and eventually compromising the other lung
29
WHAT ABOUT THE BLEB?
* When the pleura has opened * The lung can have a bleb and the lung tissue where the bleb is opens spontaneously because the wall is a little thinner than the rest of the lung * So we have an area where air is getting into the pleural space but there is no disturbance in the pleura or the chest wall. * Every breath will bring more air into the space * Important to get chest tubes in to get the bleb area repaired or give it a chance to heal
30
WHAT CAUSES A TENSION PNEUMO THORAX?
* rupture occurs and the air inside keeps filling the pleural space causing a severe collapse and eventually it will affect the other lung as well * So every breath in more air goes into the pleura space and cause more collapse so eventually this will compromise both lungs * is one-way valve – air in – collapsing lung and eventually compromising the other lung
31
Inflammatory disorder of airways – reversible
WHAT IS ASTHMA?
32
wHAT AGE GROUPS ARE AFFECTED BY ASTHMA
OCCURS IN ALL AGES
33
HOW MANY GENES HAVE BEEN FOUND TO PLAY A ROLE IS ASTHMA
• Have identified over 20 genes that play a role in asthma either in susceptibility or pathogenesis of asthma
34
WHAT ARE THE RISK FACTORS FOR ASTHMA
family history, allergen exposure, urban living, air pollution, cigarette smoke, recurrent URI from viruses, other atopic disorders IgE mediated
35
CAN ASTHMA OCCUR DUE TO LACK OF EXPOSURE TO INFECTIOUS AGENTS?
YES! • Somehow this affects the immune system in such a way that a child that is too clean, that is never allowed to make mud pies, or play in the dirt or play in the sand, is much more susceptible to asthma
36
CLINICAL MANIFESTATIONS OF ASTHMA
* Between asthma attacks patient is totally asymptomatic * During an attack theres chest constriction, expiratory wheezing, dyspnea, non-productive cough, prolonged expiration, tachycardia and tachypnea * The bronchospasm can become very severe and if it is not reversible we have a condition called status asthmaticus if it’s not reversed
37
• Hypersecretion of mucous and chronic productive cough for at least 3 months of each year X 2 years straight (to be able to diagnose it)
Chronic bronchitis
38
What is the primary cause of chronic bronchitis.
Smoking
39
Dring chronic bronchitis airways are inflammed with
infiltration of neutrophils , macrophages, and lymphocyte into the bronchial walls
40
The • The inflammation of asthma
leads to hyper responsiveness of the airways
41
• If we trace the inflammation of asthma
we see that exposure to an allergen will lead to mast cell degranulation and this will lead to a release of inflammatory mediators practically histamine, interleukins, prostaglandins, leukotryines and nitric oxide
42
When inflammatory mediators are released in asthma what results?
then vasodilation, and an increase in capillary permeability results
43
In asthma eosinophils do what/
• Eosinophils release toxic chemicals that increase the inflammation and the tissue damage
44
When inflammation begins in the tissue
the bronchial smooth muscle will spasm and there will be vascular congestion, edema, thickened mucous, and impaired ciliary function
45
What are cilia?
• Now cilia are little extensions off of the cell membrane that move ad this movement moves away trash and mucous and debris that may gather in the lung
46
• We also see the increased bronchial __________ in asthma.
hyperresponsiveness
47
Chronic Bronchitis is
Hyper-secretion of mucous and chronic productive cough for at least 3 months of each year X 2 years
48
•********* Primary cause of bronchitis is | know this card for the test
• Primary cause is cigarette smoking
49
The pathophysiology of Bronchitis is
• Airway inflammation with infiltration of neutrophils , macrophages, and lymphocyte into the bronchial walls
50
Later in Bronchitis we see
bronchial edema, increase in mucous cells, and the production of a thick tenacious mucous and with this very poor ciliary action with an increase in susceptibility to infection
51
• The air trapping that happens in chronic bronchitis is due to this
hypersecretion of mucous as opposed to asthma where it is more about inflammation
52
PRODUCTIVE COUGH Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: CLASSIC SIGN In Emphysema: LATE IN THE COURSE
53
DYSPNEA Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: LATE IN THE COURSE In Emphysema COMMON
54
WHEEZING Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis:INTERMITTENT In Emphysema MINIMAL
55
HISTORY OF SMOKING Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: COMMON In Emphysema COMMON
56
BARREL CHEST Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: OCCASIONALLY In Emphysema COMMON
57
PROLONGED EXPIRATION Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: ALWAYS PRESENT In Emphysema ALWAYS PRESENT
58
CYANOSIS Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: COMMON In Emphysema UNCOMMON
59
CHRONIC HYPOVENTILATION Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis:COMMON In Emphysema LATE IN THE COURSE
60
POLYCYTHEMIA Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: COMMON In Emphysema LATE IN THE COURSE
61
CORPULMONALE Compare clinical manifestations of Chronic Bronchitis and Emphysema
In Bronchitis: COMMON In Emphysema LATE IN THE COURSE
62
• Don’t get me wrong, there is still inflammation in chronic bronchitis but the primary mechanism of air trapping in chronic bronchitis is
the hyper-secretion of mucous
63
chronic bronchitis is associated with these symptoms
Bronchial edema increase in mucous cells production of a thick tenacious mucous poor cilliary action with an increase in susceptibility to infection.
64
In emphysema air is trapped within the
alveoli
65
The patient with emphysema cannot move air out of the lungs because of
ballooning of the alveoli
66
T/F We do not see fibrosis in emphysema?
True.
67
Primary cause of emphysema is
smoking
68
Besides smoking, name 2 other possible causes of emphysema
air pollution, childhood upper respiratory infections
69
Primary emphysema is an inherited disorder that is
autosomal RESSIVE
70
PRIMARY EMPHYSEMA IS VERY RARE!
YES, IT IS!
71
primary EMPHYSEMA IS A DEFICIENCY OF
• Deficiency of the alpha 1 antripson
72
HOW DOES CIGARETTE SMOKING CAUSE EMPHYSEMA
Cigarette smoking | Inhibits anti protease
73
Inflammation of the lung due to aspiration of stomach juices
PNEUMONITIS
74
Pneumonitis inflammation of
BRONCHIAL TREE
75
WHAT "ACTION" IS LOST IN PNEUMONITIS
CILIARY
76
IF GASTRIC JUICES ENTER THE ALVEOLI WHAT CAN OCCUR
HEMORRHAGIC PNEUMONITIS
77
IN PNEUMONITIS, LUNGS BECOME
STIFF ADND LOOSE SURFACTANT PRODUCTION
78
IS PNEUMONITIS LIFE THREATENING?
YES!!
79
Infection of the lower respiratory tract – 6th leading cause of death in U.S.
PNEUMONIA
80
SEVERE TYPE OF PNEUMONIA IS CAUSED BY
STREPTOCOCCAL PNEUMONIAE
81
STREPTOCOCCAL PNEUMONIAE IS CONSIDERED
COMMUNITY AQUIRED
82
RISK FACTORS FOR STREPTOCOCCAL PNEUMONIAE ARE
``` ADVANCED AGE IMMUNOCOMPROMISED ALCOHOLISM SMOKING DEBILITATING EVENTS ```
83
WALKING PNEUMONIA IS CAUSED BY
MICOPLASM PNEUMONIA
84
NAME 3 ROUTES FOR INFECTION WITH PNEUMONIA
INHALED INFECTION IN THE OROPHARYNX FROM BLOOD BORNE PATHOGEN
85
CLINICAL MANIFESTATIONS OF PNEUMONIA
AN UPPER RESPIRATORY INFECTION FEVER CHILLS PRODUCTIVE COUGH RUST COLORED OR BLOODY SPUTUM
86
WHAT WILL YOU AUSCULTATE IN THE LUNGS WITH THE PNEUMONIA PATIENT?
INSPIRATORY CRACKLES
87
AN INFECTED LUNG IS DULL TO PERCUSSION
YES MAAM, IT SURE IS!
88
THERE IS NO TACTILE FERMENTUS, IS THERE?
YES! YES! THERE IS TACTILE FERMENTUS IN THE INFECTED LUNG.
89
WHAT BACTERIA CAUSES TUBERCULOSIS?
Infection with mycobacterium tuberculosis
90
TUBERCULOSIS
OCCURS IN THE LUNGS IN THE US
91
in other conutries, tuberculosis can appear in other parts of the body due to
unpastuerized milk
92
How is tuberculosis spread
airborne, droplet. Usually lodges in the upper part of the lung
93
What happens when the tuberculine bacteria enters the lungs
• Mild pneumonitis and the bacilli will migrate to the lymph nodes where lymphocytes attack them and initiate an immune response and a cell-mediated response involving macrophages and neutrophils will engulf and isolate the bacilli stopping the spread
94
Tuberculosis may produce a tubercule or
granulomatous lesion. The tissue within the lesion may die.
95
What causes scar tissue within the lung from tuberculosis
encasiation causes the scar tissue
96
Once the bacilli is isolated, the disease process
STOPS CELL MEDIATION HAS CONTAINED THE EXPOSURE.
97
TB may be dormant for a lifetime and occur in response to
decreased immunity or if exposed to more active disease
98
– Active Tuberculosis (Pulmonary that has been around a while) shows symptoms of
• Fatigue, wt loss, lethargy, anorexia, a low grade fever particularly in the evening, cough, that is productive of purulent sputum, night sweats and anxiety (not over night type of reaction, this has been around awhile)
99
• Tuberculosis infection rate has declined in the United States to
4.8 cases per 100,000 population
100
• Hispanics, blacks, and Asians had TB rates
7.3 (Hispanics), 8.3 (blacks), and 19.6 (Asians) times higher than whites in the United States in 2005.
101
• The seven states with the highest incidence of tuberculosis are
California, Florida, Georgia, Illinois, New Jersey, New York and Texas.
102
Acute bronchitis is
• Acute infection or inflammation – usually viral of airways and bronchi – self limiting
103
Acute bronchitis begins with a
cold that "goes to the chest."
104
Clinical manifestations of acute bronchitis
cough,chest pain related to cough
105
Pulmonary embolism
occlusion of the pulmonary vascular bed with an embolism.
106
pulmonary embolism usually originates from
veins of the legs and pelvis
107
pulmonary embolism may be from
blood clots, amniotic fluid, fat from longbone fracture
108
Does an embolism always infarct the lung?
Not always
109
clinical manifestations of DVT
usually non-specific. chest pain, dyspnea, tachypnea, anxiety **check history for DVT
110
Corpulmonale is
right sided heart failure
111
volume backflow of corpulmonale is to the
periphery
112
paroxysmal nocturnal dypnea | PND is a symptom of
lung disease or heart failure

Alterations of Hematological function in children (4 decks)

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