1
Q
signs and symptoms of pulmonary disease
- _____ and _____
- pulmonary disease is associated with many sings and symptoms, and their specific characteristics often help in identifying the underlying disorder. the most common characteristics are _____ and _____
hemoptysis abnormal sputum cyanosis chest pain clubbing altered breathing patterns hyperventilation hypoventilation
A
dyspnea
cough
dyspnea
cough
2
Q
sings and symptoms of pulmonary disease dyspnea -subjective sensation of \_\_\_\_\_ -severe dyspnea --\_\_\_\_\_ of the nostrils --use of \_\_\_\_\_ of respiration --retraction of the \_\_\_\_\_
- dyspnea on exertion
- -_____ with activity
- _____: sitting up in a forward leaning position generally relieves which breathing
- -orthopnea is generally relieved by _____ in a _____ or supporting the upper body on _____
A
uncomfortable breathing flaring accessory muscles intercostal spaces SOB orthopnea sitting up forward leaning posture several pillows
3
Q
signs and symptoms of pulmonary disease
hypoventilation
-_____ is inadequate in relationship to the _____
-leads to _____ from _____
-is caused by _____, _____, or altered neurologic control of _____
A
alveolar ventilation metabolic demands respiratory acidosis hypercapnia/high CO2 levels airway obstruction chest wall restriction breathing
4
Q
signs and symptoms of pulmonary diseases hyperventilation -\_\_\_\_\_ exceeds the \_\_\_\_\_ -leads to \_\_\_\_\_ from \_\_\_\_\_ -is caused by \_\_\_\_\_, \_\_\_\_\_, or severe \_\_\_\_\_
A
alveolar ventilation metabolic demands respiratory alkalosis hypocapnia/low CO2 levels anxiety head injury hypoxemia
5
Q
clubbing
- clubbing is the selective _____ of the end (_____) of a _____ and is commonly associated with diseases that interfere with _____ such as:
- -_____, _____, _____, _____, and _____
A
bulbous enlargement distal segment digit oxygenation bronchiectasis cystic fibrosis pulmonary fibrosis lung abscess congenital heart disease
6
Q
conditions caused by pulmonary disease or injury
hypoxemia vs hypoxia
-PaO2: oxygenation of _____
-PAO2: the amount of oxygen in the _____
- the _____ is a measure of the difference between the alveolar concentration of oxygen and the arterial concentration of oxygen. it is used in diagnosing the source of _____
- measurement helps isolate the location of the problem as either _____ (within the lungs) or _____ (somewhere else in the body)
A
arterial blood alveoli alveolar-arterial gradient hypoxemia intrapulmonary extrapulmonary
7
Q
reduced oxygenation of cells in tissues
A
hypoxia
8
Q
reduced oxygenation of arterial blood (reduced _____), is caused by respiratory alternation
A
hypoxemia
PaO2
9
Q
conditions caused by pulmonary disease or injury hypoxemia vs hypoxia
- _____: or reduced oxygenation of arterial blood (reduced PaO2) is caused by _____
- _____ of _____ through the _____ is impaired if the alveolocapillary membrane is _____ or if the surface area available for _____ is _____
- _____ and _____ cause hypoxemia by the mechanism of abnormal _____, as occurs with _____ (tissue swelling) and _____ (formation of fibrous lesions), _____ the time required for _____ across the _____ membrane so bottom line point this causes of impairing _____
A
hypoxemia respiratory alternation diffusion oxygen alveolocapillary membrane thickened diffusion decreased pulmonary edema pulmonary fibrosis thickness pulmonary edema pulmonary fibrosis increases diffusion alveolocapillary alveolocapillary membrane diffusion
10
Q
pleural abnormalities pleural effusion -presence of \_\_\_\_\_ in the \_\_\_\_\_ -\_\_\_\_\_ effusion --is \_\_\_\_\_ and diffuses out of the \_\_\_\_\_
- _____ effusion
- -is less _____ and contains high concentrations of _____ and _____
A
fluid pleural space transudative watery capillaries exudate watery white blood cells plasma proteins
11
Q
exudative effusion
- exudative effusion contains high concentrations of _____
- exudative effusion may occur in response to an _____
- the presence of a _____ can trigger exudative effusion
- exudative effusion is a result of _____
A
white blood cells
inflammatory process
malignant cancer
increased capillary permeability
12
Q
pleural abnormalities
empyema
-infected _____
-_____ in the _____: causes pulmonary infections (_____, _____), infected _____
clinical manifestations
-_____, _____, _____ (rapid heart rate), _____, and _____
treatment
- administration of _____
- drainage of the _____ with a _____
- severe cases: _____, instillation of _____, or _____ (_____) injected into the _____
A
pus pleural space pneumonia abcesses wounds cyanosis fever tachycardia cough pleural pain antimicrobial medications pleural space chest tube ultrasound-guided pleural drainage fibrinolytic agents deoxyribonuclease DNase pleural space
13
Q
restrictive lung diseases
- restrict the _____
- the lungs are unable to _____ normally, diminishing the amount of _____ that can be _____
obstructive lung diseases
- affect _____
- _____ into and out of the lung is _____. increased resistance to air flow caused by _____
A
lung volume expand gas inspired gas flow airflow obstructed narrowing of airways
14
Q
CXR abnormalities terms
- _____ and _____: air trapping in the _____ and _____
- _____ or _____: _____ of lung tissue
- _____ or _____: cavities
- _____: nodules
A
asthma and emphysema alveoli airways pneumonia pulmonary edema consolidation accesses or tuberculosis lung cancer
15
Q
restrictive lung disorders
- aspiration
- _____
- bronchiectasis, bronchitis
- _____
- inhalational disorders
- pneumoconiosis
- allergic alveolitis
- _____
- _____
A
atelectasis
pulmonary fibrosis
pulmonary edema
acute respiratory distress syndrome
16
Q
atelectasis
-a loss of _____ caused by _____ of _____ and subsequent collapse of part of the _____
etiology:
- obstructive (e.g. _____)
- non obstructive- _____
- pneumothorax
- surfactant deficiency
- _____ (_____)
- asbestosis
A
lung volume deflation alveoli lung tumor pleural effusion postoperative within 72 hours of surgery
17
Q
atelectasis
- _____ of _____
- compression atelectasis
- -_____ on the _____
- absorption atelectasis
- -gradual absorption of _____ from _____ or _____
- surfactant impairment
- -_____ production or inactivation of _____
clinical manifestations
-_____, _____, _____, and _____
- treatment: _____
- -_____
A
collapse lung tissue external compression lung air obstructed hypoventilated alveoli decreased surfactant dyspnea cough fever leukocytosis prevention deep breathing
18
Q
_____ supine left lung _____ in _____
A
atelectasis
reduced
volume
19
Q
restrictive lung disorders
pulmonary fibrosis
-excessive amount of _____ or _____ in the _____
-_____: no specific cause
–clinical manifestations: increasing _____ on _____
- treatment
- -_____; combined treatment with _____ drugs; _____ drugs such as (_____ and _____), interferon, and _____ agents; _____
A
fibrous connective lung idiopathic dyspnea exertion corticosteroids cytotoxic antifibrotic N acetylcysteine pirfenidone anticoagulant lung transplantation
20
Q
restrictive lung disorders
pulmonary edema
-excess _____ in the lung from disturbances of _____, _____, or _____
-most common cause of pulmonary edema: _____
-clinical manifestations: _____, _____, _____, and increased work of _____
A
water capillary hydrostatic pressure capillary oncotic pressure capillary permeability left-sided heart disease dyspnea orthopnea hypoxemia breathing
21
Q
pulmonary edema
-perihilar, _____ shadow of _____ or _____ appearance. the hatched lines are the _____ (_____ which represent prominent _____ vessels)
A
interstitial opacities butterfly bat wings septal lines kerley lines interlobular lymphatic
22
Q
kerley b lines
- these are _____ lines at the lung _____. these lines represent _____ which are usually less than 1 cm in length and parallel to one another at _____ to the _____
- they are located peripherally in contact with the _____, but are generally absent along _____
- they may be seen in any zone but are most frequently observed at the _____ at the _____ on the PA radiograph
A
short parallel periphery interlobular septa right angles pleura pleura fissural surfaces lung bases costophrenic angles
23
Q
restrictive lung disorders ARDS -\_\_\_\_\_ (ALI) or \_\_\_\_\_ (ARDS) --is a \_\_\_\_\_ form of \_\_\_\_\_ characterized by \_\_\_\_\_ and \_\_\_\_\_ --injury to the \_\_\_\_\_ --increased \_\_\_\_\_ --inflammation --\_\_\_\_\_ --edema and atelectasis
A
acute lung injury acute respiratory distress syndrome fulminant respiratory failure acute lung inflammation diffuse alveolocapillary injury pulmonary capillary endothelium capillary permeability surfactant inactivation
24
Q
ARDS pathophysiology
- in acute respiratory distress syndrome (ARDS), _____ and _____ fill with _____ as a result of inactivation of _____ and the impairment of _____
- _____ release inflammatory mediators such as _____, _____, _____, and _____
A
alveoli respiratory bronchioles fluid surfactant type II alveolar cells neutrophils proteolytic enzymes oxygen-free radicals prostaglandins leukotrienes platelet activating factor
25
obstructive pulmonary diseases
| name the 4
asthma
chronic bronchitis
emphysema
chronic bronchitis plus emphysema equals chronic obstructive pulmonary disease (COPD)
26
obstructive pulmonary disease
- airway obstruction is worse with expiraton
- disease requires _____ to _____ a _____
more force
expire
volume of air
27
asthma
- pathophysiology
- -episodic attacks of bronchospasm, bronchial inflammation, mucosal edema, and increased mucous production
- early asthmatic response
- -_____ (_____), may contribute to the pathophysiologic characteristics of asthma
- -_____ that are produced by asthma:
- -_____
- -_____
- -_____
- -_____
- late asthmatic response
- begins 4-8 hours after the early response
- chemotactic recruitment of lymphocytes, eosinophils, and neutrophils occurs
- -the release of _____ contributes to _____
- clinical manifestations
- -_____ and _____, _____, _____, and _____
```
immunoglobulin E IgE
inflammatory mediators
histamine
bradykinin
leukotrienes
prostaglandins
toxic neuropeptides
increased bronchial hyper responsiveness
inspiratory
expiratory wheezing
dyspnea
nonproductive cough
tachypnea
```
28
chronic bronchitis
_____- _____ is more severe
-hypersecretion of mucus and chronic productive cough that lasts at least 3 months of the year and for at least 2 consecutive years
pathophysiology:
-the production of _____ associated with chronic bronchitis is due to _____ in _____
clinical manifestations:
- _____
- _____ and _____
- _____ (_____) becomes _____
- polycythemia
- decreased FEV1
treatment
-_____: disease _____ can be _____
```
blue bloaters
hypoxia
mucus
increased
goblet cell size
decreased exercise tolerance
wheezing
shortness of breath
productive cough
smokers cough
copious
smoking cessation
progression
halted
```
29
emphysema
_____, _____ breathing, _____
-abnormal permanent _____ of the _____ accompanied by the _____ of the _____ without _____
-loss of _____
-primary emphysema: inherited deficiency of the enzyme _____
-secondary emphysema: _____: main cause
--air pollution, occupational exposures, and childhood respiratory infections: possible contributors
clinical manifestations:
-include _____, _____ on _____, use of _____, and _____ with _____
treatment:
-the initial step in the management of emphysema: _____
```
pink puffer
pursed lip
barrel chest
enlargement
gas-exchange airways
destruction
alveolar walls
obvious fibrosis
elastic recoil
a1-antitrypsin
cigarette smoke
unexplained weight loss
dyspnea
exertion
accessory muscles
tachypnea
prolonged expiration
smoking cessation
```
30
emphysema
_____ means that it is filled with more air than usual. this is a common finding in someone with _____. the hyperinflation also causes the _____
lateral chest xray: the _____ of the _____ are significantly _____. the thorax can be described as a _____
```
hyper inflated lungs
chronic obstructive pulmonary disease (COPD)
flattened diaphragms
domes
diaphragm
flattened
barrel chest
```
31
```
lung infections
pneumonia
-infection of the _____
-responsible for more disease and death than any other infection
-community-acquired pneumonia: _____
-health-care associated pneumonia
-hospital-acquired (_____) pneumonia
-ventilator-associated pneumonia
```
lower respiratory tract
streptococcus pneumoniae
nosocomial
32
```
pneumonia
community acquired (CAP)
-_____
-_____
-_____
```
streptococcus pneumoniae
H. influenza
moraxella catarrhalis
33
```
pneumonia
ventilator-associated (VAP)
-_____
-_____
-_____
```
```
pseudomonas
staphylococcus aureus (MRSA)
klebsiella
```
34
```
pneumonia
health care associated (HCAP)
_____
_____
_____
```
```
pseudomonas
staphylococcus aureus (MRSA)
klebsiella
```
35
```
pneumonia
hospital acquired (HAP)
-has the greatest _____
-_____
-_____
-_____
```
mortality
pseudomonas
staphylococcus aureus (MRSA)
klebsiella
36
pneumonia
routes of infection
-_____
-most common route of _____ is via _____ of _____
aspiration
lower respiratory tract infection
aspiration
oropharyngeal secretions
37
streptococcus pnemoniae
- streptococcus pneumonia
- -ALI, resulting in _____ and _____, causes _____
- -_____ creates a medium for the multiplication of _____ and aids in spreading infection into adjacent portions of the lung
- -involved lobe undergoes _____
- -four phases:
1. _____
2. _____
3. _____
4. _____
```
inflammatory cytokines
cells
alveolar edema
edema
bacteria
consolidation
consolidation
red hepatization
gray hepatization
resolution
```
38
pneumonia
_____ pneumonia
-is seasonal; usually mild and self limiting
-can set the stage for a secondary bacterial infection
-most common form: _____
viral
| influenza
39
pneumonia
- clinical manifestations:
- for streptococcus pneumonia look for _____ of _____ preceded by an _____, followed by _____, _____ (_____ or _____)
treatment:
- bacterial pneumonia: _____
- viral pneumonia: _____ alone, unless _____ is present
```
rapid onset
shaking chills
upper respiratory infection
fever pleuritic chest pain
productive cough
yellow-ish green
rust
antibiotics
supportive therapy
secondary bacterial infection
```
40
tuberculosis
pathophysiology:
-isolation of _____ by enclosing them in _____ and surrounding the _____ with _____
bacilli
tubercles
tubercles
scar tissue
41
tuberculosis
how the body walls off the bacilli
-in tuberculosis, the body walls off the bacilli in a tubercle by stimulating _____ that activate _____
-in defense, _____ and _____ release _____, which inhibits the replication of the _____ and stimulates more _____ to attack the _____. _____ can also activate _____
```
apoptotic infected macrophages
cytotoxic t cells
macrophages
lymphocytes
interferon
microorganism
macrophages
bacterium
apoptotic infected macrophages
cytotoxic t cells
```
42
tuberculosis
| a patchy dense _____ can be seen in the _____
infiltrate
| left upper lobe
43
acute bronchitis
- is an acute infection or inflammation of airways or bronchi; commonly follows a _____
- causes symptoms similar to _____ but does not demonstrate _____ and _____
- clinical manifestations:
- -_____ occurs in paroxysms and is aggravated by _____, _____, or _____
- treatment:
- -rest, _____, humidity, and _____ (codeine)
```
viral illness
pneumonia
pulmonary consolidation
chest infiltrates
nonproductive cough
cold
dry
dusty air
aspirin
cough suppressant
```
44
pulmonary embolus causes alveolar dead space
-a pulmonary embolus that impairs _____ to a segment of the _____ results in an area where _____ are _____ but not _____, which causes _____
```
blood flow
lungs
alveoli
ventilated
perfused
alveolar dead space
```
45
aging and the pulmonary system
- loss of _____
- _____ of the _____
elastic recoil
stiffening
chest wall
