Week 8 - Respiratory

Question 1

clinical manifestations of repiratory diseases

Answer 1

dyspnea
abnormal breathing patterns
hypo- & hyperventilation
cough
hemoptysis
cyanosis
pain
clubbing
abnormal sputum

Question 2

dyspnea s&s

Answer 2

flaring nostrils
accessory muscle use
retraction of intercostal spaces

Question 3

cheyne stokes

Answer 3

alternating periods of deep and shallow breathing

apnea for 15-60 seconds then rapid resps

Question 4

cheyne stokes results from

Answer 4

injury to brainstem

Question 5

during hypoventilation

Answer 5

co2 removal does not keep up with co2 production an paco2 increases causing hypercapnia, results in respiratory acidosis

Question 6

causes of hypercapnia

Answer 6

1. Depression of resp. centre by drugs
2. Diseases/trauma of the medulla
3. Spinal cord disruption
4. Diseases of neuromuscular junction or respiratory muscles
5. Thoracic cage abnormalities
6. Large airway obstruction
7. Increased work of breathing

Question 7

hypoxemia causes

Answer 7

decreased oxygen content of inspired gas
hypoventilation
diffusion abnormalities
abnormal ventilation-perfusion ratios
pulmonary right-to-left shunt

Question 8

acute cough

Answer 8

resolves within 2-3 weeks, URI

Question 9

chronic cough

Answer 9

more than 3 weeks

postnasal drip, bronchitis

Question 10

hemoptysis

Answer 10

coughing up blood caused from damage to lung parenchyma

Question 11

asthma

Answer 11

chronic inflammatory disease of the airways, morbidity and mortality has risen over last 2 decades

Question 12

asthma patho

Answer 12

Inflammation resulting in hyper-responsiveness of the airways to environmental triggers.
Produces bronchial smooth muscle spasm, edema formation, tenacious mucus production, ->obstruction

Question 13

s&s asthma

Answer 13

Dyspnea, tachypnea
Wheezing on inspiration and expiration
Tachycardia
Circumoral cyanosis
Accessory muscle use
Diaphoresis
Pallor

Question 14

asthma drugs

Answer 14

1st->bronchodilators
2nd->long acting bronchodilators
3rd->anticholinergic agents
4th->inhaled corticosteroids
5th->oral steroids
6th->IV steroids

Question 15

s&s copd

Answer 15

Dyspnea
Cyanosis
Productive cough
Respiratory fatigue
Severe accessory muscle use
Orthopnea

Question 16

chronic bronchitis

Answer 16

Chronic bronchitis is hypersecretion of mucous and productive cough (at least 3 months of the year for at least 2 years)
Patients have decreased exercise tolerance, infection is common

Question 17

emphysema

Answer 17

Abnormal permanent enlargement of gas exchange airways
Obstruction results from changes in lung tissues
Loss of elastic recoil in alveolus and narrowed bronchiole

Question 18

emphysema s&s

Answer 18

Dyspnea on exertion -> marked dyspnea
Little cough and little sputum production
Use of accessory muscles for ventilation
Often very thin
Braces for easier breathing

Question 19

emphysema dx & tx

Answer 19

Pulmonary function tests indicate obstruction to expiratory phase of ventilation
TLC (total lung capacity) may be twice normal
ABG normal until late in disease

Smoking cessation most important tx
Inhaled anticholinergic agents
Relaxation exercises, reconditioning and breathing retraining helpful

Question 20

tuberculosis

Answer 20

Infection of lower respiratory tract caused by mycobacterium tuberculosis, an acid-fast bacillus
Main reason for recent increases is AIDS - very susceptible to respiratory infections
Multidrug-resistant TB now present
Due to not taking medications and mutation of bacteria

Question 21

tb patho

Answer 21

Transmitted in airborne droplets
Inspired bacilli cause pneumonitis (lung inflammation)
Neutrophils and macrophages seal colonies of bacilli into a tubercule
Infected tissues inside tubercule die and form a cheeselike substance (all within 10 days)
May lie dormant for years to whole lifetime
Poor nutritional status, IDDM, long term steroids

Question 22

tb manifestations

Answer 22

Often asymptomatic
Fatigue, weight loss, lethargy, anorexia, low-grade fever in afternoon
Cough- purulent sputum, progresses to hemoptysis
Night sweats, general anxiety

Question 23

croup

Answer 23

Subglottic edema from the infection (in an already narrow airway)
Increased resistance to airflow -> increased work of breathing-> may cause dynamic collapse of upper airway
Watch for rhinorrhea, sore throat, low-grade fever-> seal-like barking cough
Most resolve spontaneously after a few days
If obstruction severe, needs immediate help

Question 24

croup s&s

Answer 24

Sore throat
Low-grade fever
Seal-like, barking cough

Question 25

croup dx & tx

Answer 25

Some controversy over treatment If no stridor, then little treatment Now evidence of value of single dose of steroid with half-life of 36-72 hours Science neither supports or refutes use of mist

Question 26

pneumonia

Answer 26

Infection of the lower respiratory tract | caused by bacteria, viruses, fungi, protozoa, or parasites

Question 27

pneumonia risk factors

Answer 27

elderly, immunocompromised, lung disease, alcoholism, altered consciousness, smoking, intubation, malnutrition, immobilization

Question 28

pneumococcal pneumonia

Answer 28

Best understood pneumoniae Inflammatory response and exudate cause alveolar edema This media causes multiplication of bacteria and spread of infection Phagocytosis takes place in consolidated alveoli Usually infection limited to 1-2 lobes

Question 29

viral pneumonia

Answer 29

Mild and self-limiting Usually sets the stage for another infection (because it provides the perfect environment for bugs to grow) Primary infection = influenza pneumonia Caused by another infection such as chic pox, measles

Question 30

pneumonia s&S

Answer 30

``` cough dyspnea fever chills malaise pleuritic chest pain ```

Question 31

pneumonia dx

Answer 31

Confirmed by chest x-ray Elevated WBC Should do sputum Gram stain and possibly blood cultures

Question 32

lun cancer general info

Answer 32

Arise from epithelium of respiratory tract Considered an epidemic in the U. S. Mortality rate still rising in women, higher even than breast cancer Most common cause is smoking Passive smoking = 30% higher risk Genetic predisposition to lung cancer Also environmental & occupational risk factors

Question 33

lung cancer manifestations

Answer 33

Early symptoms are non-specific Coughing, sputum production, hemoptysis, airway obstruction, pleural effusions Disease usually well advanced before medical advice is sought Only proven reduction method is smoking cessation

Question 34

cystic fibrosis

Answer 34

Autosomal recessive inherited disease In middle of chromosome 7 Gene mutation that results in abnormal expression of cystic fibrosis transmembrane regulator Results in abnormal secretions that obstruct tracts in respiratory, digestive, and reproductive systems Generally affects Caucasians Carriers are healthy

Question 35

cystic fibrosis patho

Answer 35

Autosomal recessive inherited disease In middle of chromosome 7 Gene mutation that results in abnormal expression of cystic fibrosis transmembrane regulator Results in abnormal secretions that obstruct tracts in respiratory, digestive, and reproductive systems Generally affects Caucasians Carriers are healthy

Question 36

cystic fibrosis clinical manifestations

Answer 36

Age of diagnosis 6 mos -> 1 year 10% not diagnosed until after age 10 Respiratory problems - persistent cough or wheeze and recurrent pneumonia GI problems - meconium ilius, failure to thrive, malabsorptive symptoms Males are typically infertile Severity not predictable by genotype, affected siblings may be very different

Question 37

cystic fibrosis dx

Answer 37

Standard test is sweat test CF patients secrete high levels of electrolytes in their sweat sweat chloride concentration > 60 mEq/L

Question 38

4 types of pneumonthorax

Answer 38

Spontaneous Tension Open Secondary

Question 39

pleural effusion

Answer 39

``` Can be fluid - Exudative - Transudative Can be blood - Hemothorax Can be pus - Empyema ```

Question 40

flail chest results from

Answer 40

rib or sternal fractures that disrupt mechanics of breathing

Question 41

pneumothorax

Answer 41

accumulation of air in pleural space

Question 42

tension pneumothorax

Answer 42

trapping of air in pleural space, life threatening

Question 43

pleural effusion

Answer 43

accumulation of fluid in pleural space

Question 44

empyema

Answer 44

presence of pus in pleural space

Question 45

aspiration

Answer 45

passage of fluid and solid particles into lung

Question 46

atelectasis

Answer 46

collapse of alveoli

Question 47

bronchiectasis

Answer 47

inflammatory obstruction of small airways

Question 48

bronchiolitis obliterans

Answer 48

an inflammatory, fibrotic | process that occurs as a complication of lung transplantation.

Question 49

pulmonary fibrosis

Answer 49

excessive amount of connective tissue | in the lung

Question 50

pneumoconiosis

Answer 50

inhalation of dust particles in workplace

Question 51

pulmonary edema

Answer 51

presence of excess water in the lung caused by disturbances of capillary hydrostatic pressure, capillary oncotic pressure, or capillary permeability

Question 52

ALI/ARDS

Answer 52

results from an acute, diffuse inflammatory injury to the alveolocapillary membrane and decreased surfactant production, which increases membrane permeability and causes pulmonary edema and atelectasis

Question 53

acute bronchitis

Answer 53

acute infection or inflammation of the large airways or bronchi; it is usually self-limiting and caused by viruses.