Term
| what are the four lung volumes? |
|
Definition
|
|
Term
| what are the four lung capacities? |
|
Definition
|
|
Term
| what is the usual way RV is measured? |
|
Definition
helium dilution, using the formula C1He(V1)=C2He(V1+V2)
V2=FRC |
|
|
Term
| the pressure generated by respiratory muscles is made up of what two pressues? |
|
Definition
| P(elastic) and P(resistance) |
|
|
Term
| what is transpulmonary pressure? |
|
Definition
| P(L) is that pressure difference b/t the inside the lung and that immediately outside the lung |
|
|
Term
| what is P(L) when breathing? |
|
Definition
| P(L)=P(elastic) + P(resistance) |
|
|
Term
| what is P(L) when not breathing? |
|
Definition
|
|
Term
| What is compliance and what is its relationship to elastance? |
|
Definition
| A measure of the distensibility of the lungs and chest wall. It is inversely proportional to elastance i.e. the more compliant the lung, the less stiffness(elastic recoil) it has |
|
|
Term
| What value is equal to the slope of the P-V curve? |
|
Definition
|
|
Term
|
Definition
| This is the differences in the changes of the P-V curves for inhalation compared to exhalation. HOW volume changes is different. This is due in most part to surfactant. |
|
|
Term
|
Definition
| a secretion of type 2 pneumocytes that decreases the surface tension at the beginning of inspiration but increases surface tension as the surface area increases. |
|
|
Term
| What is infant respiratory distress syndrome? |
|
Definition
| When either a premature infant has not yet begun to make surfactant or there is a congenital absence of surfactant production. Can lead to neonatal atelectasis. |
|
|
Term
| Which part of the lung (apex or base) has the lowest P(L)? Upon inspiration, which part fills with more air and why? |
|
Definition
| the base. The base also fills with more air upon inspiration due to the affect of gravity. The apex is already mostly filled with air and expanded, thus further compliance is low. The bases are not expanded and thus much more compliant. |
|
|
Term
| How does surfactant interact with the Law of LaPlace? |
|
Definition
This allows lungs to keep a relatively constant pressure as they expand. In order to do this, tension must also increase. The Law of LaPlace is as follows:
P=(2T)/R |
|
|
Term
| How can some pathologies such as obesity and ascities cause a (+) pleural pressure at lung volumes below FRC? What mechanisms try to overcome this? What is a symptom of abnormally high pleural pressure? |
|
Definition
| At lung volumes below FRC, some alveoli have pleural pressure greater than atm pressure and will not expand unless the pleural pressure decreases. Obese/edematous people have increased abdominal pressure and thus increased pleural pressure. This might cause (+) pleural pressure during regular tidal breathing and lead to hypoxemia. Pts must overcome this with deeper breathing. |
|
|
Term
| what two forces are balanced at FRC volume? |
|
Definition
| when the expansion of the chest wall is exactly balanced by the elastance of the lung. |
|
|
Term
| Is the intrapleural pressure at FRC (+), (-), or 0? |
|
Definition
|
|
Term
|
Definition
| when the lung or chest wall is punctured/ruptured and the intrapleural pressure = atm pressure. This balance of (-) intrapleural pressure is lost and the lung collapses while the chest wall expands |
|
|
Term
| what happens to FRC with emphysema? |
|
Definition
| it increases due to increased compliance |
|
|
Term
| what happens to FRC with fibrosis? |
|
Definition
| it decreases due to decreased compliance |
|
|
Term
| in dynamic lung mechanics, what two types of flow describe air movement? |
|
Definition
| laminar and turbulent flow |
|
|
Term
| what law describes laminar flow? |
|
Definition
Poiseuille's Law:
V=[(P)(piR^4)]/(8nl) |
|
|
Term
| what law describes turbulent flow? |
|
Definition
|
|
Term
| What causes decreased alveolar pressure upon inspiration? |
|
Definition
|
|
Term
| as the segmentation generations of airways increases in number, what happens to air velocity and laminar flow? |
|
Definition
air velocity decreases
laminar flow increases |
|
|
Term
| which airways have the highest resistance overall? |
|
Definition
|
|
Term
| When does one use effort-dependent exhalation? |
|
Definition
| at the beginning of forced exhalation |
|
|
Term
| when is exhalation effort-independent? What property is the primary reason for this? |
|
Definition
| the latter part of forced exhalation because as the lung volume decreases no matter how much effort exerted, one cannot increase the rate of flow. This is due to dynamic compression of the airways. |
|
|
Term
| does dynamic compression begin earlier or later in an emphysema patient? |
|
Definition
|
|
Term
| Why does emphysema cause lung hyperinflation? What is this called? What capacity does a chronic emphysema patient approach. |
|
Definition
| there is decreased elastance (increased compliance) and pts must breathe at an overall higher lung volume to be able to force air out of lung, called dynamic hyperinflation. As the years progress they approach TLC. |
|
|
Term
| Is emphysema obstructive or restrictive? What is the primary characteristic of this? |
|
Definition
| obstructive. FEV1 is decreased, FEV1/FVC is decreased. Expiratory time is increased. |
|
|
Term
| What happens if an emphysema pt is hyperventilating? |
|
Definition
| They are not able to fully expire their tidal volume and the beginning of each new inhalation begins at a higher and higher volume. |
|
|
Term
| How does severe obstructive disease cause hypotension? How would you treat this patient? |
|
Definition
| lungs overdistended, high intrathoracic pressure, decr. venous return. Give them a narcotic or paralyzing agent to stop respirations while supporting them with mechanical ventilation. |
|
|
Term
| What two pressures make up alveolar pressure? |
|
Definition
| elastic recoil pressure + pleural pressure |
|
|
Term
| what is the equal pressure point? |
|
Definition
| when elastic recoil is negligible, the pleural pressure squeezing on the lung = pressure inside the airway |
|
|
Term
| formula for partial pressure of a gas? |
|
Definition
|
|
Term
| what is the A-a gradient? |
|
Definition
| the alveolar-arterial gradient is the difference b/t the partial pressure of O2 in alveoli vs. arterial circ. |
|
|
Term
| what is the formula for PAO2? (hint: notice the capital "A") |
|
Definition
|
|
Term
| once you have determined the PAO2, how do you determine the PaO2 in a normal pt? |
|
Definition
| use a gradient subtraction, and subtract the following formula from PAO2: 2.5+0.21(age in years) |
|
|
Term
| Name the 5 causes of hypoxia? |
|
Definition
1)high altitude (aka decr. PO2 of inspired air)
2)hypoventilation
3)ventilation/perfusion mismatch: if V/Q < 1 this indicates a ventilation problem. If V/Q is > 1 this indicates a perfusion problem.
4) shunt (anatomic and physiologic)
5) disorders of Hb (CO poisoning or severe anemia) |
|
|
Term
| what are the 3 causes or hypercapnia? |
|
Definition
1) incr. production of CO2
2) decr. minute ventilation
3) incr. dead-space ventilation |
|
|
Term
| what is the formula for PaCO2? |
|
Definition
| PaCO2 = (kVCO2)/[Ve(1-Vd/Vt)] |
|
|
Term
| what is the most common cause of incr. CO2 production? |
|
Definition
|
|
Term
| what are 3 likely causes of increased dead-space ventilation? |
|
Definition
| emphysema, ARDS, pulmonary embolism |
|
|
Term
| What is the formula for Ve (minute ventilation)? |
|
Definition
|
|
Term
| Name 3 causes of chest wall disease that decr. chest wall expansion and thus decr. Ve |
|
Definition
| kyphoscoliosis, morbid obesity, emphysema |
|
|
Term
| what drugs can cause decr. Ve? |
|
Definition
|
|
Term
| what NMJ diseases/conditions can cause decr. Ve? |
|
Definition
| myasthenia gravis, Eaton-Lambert, tetanus, botulism |
|
|
Term
| what neuron diseases can cause decr. Ve? |
|
Definition
| polio, ALS, trauma, Guillain-Barre (watch for symptoms of ascending paralysis), critcal illness polyneuropathy |
|
|
Term
| what brain diseases can cause decr. Ve? |
|
Definition
|
|
Term
| what is the formula for O2 carrying capacity of the blood? |
|
Definition
| CaO2 = 1.34*[Hb g/dL]*sat.Hb + (.003*PO2) |
|
|
Term
| what 5 factors cause a left shift in the oxyHb dissociation curve? |
|
Definition
decr. PCO2
incr. pH
decr. temperature
decr. 2,3-DPG
CO poisoning |
|
|
Term
| what 4 factors cause a right shift in the oxyHb dissociation curve? |
|
Definition
incr. PCO2
decr. pH
incr. temperature
incr. 2,3-DPG |
|
|
Term
| what is the formula for O2 delivery? |
|
Definition
| DO2 = CaO2*cardiac output = CaO2*HR*SV |
|
|
Term
| normal oxygen delivery is approximately 1L O2 per minute. How much of this is used by the tissues? |
|
Definition
|
|
Term
| how can one supply an incr. O2 demand? |
|
Definition
| incr. cardiac output, incr. O2 release from Hb, redistribute blood flow |
|
|
Term
| Give 3 reasons why tobacco became such a health problem |
|
Definition
| mass cigarette production, fear of TB incr. cigarette use, incr. in overall life expectancy |
|
|
Term
| know some of the major non-neoplastic diseases attributable to smoking |
|
Definition
| CHD, CVA, COPD, PVD, infant mortality, spontaneous pneumothorax, DIP, RBILD (100% attributable to smoking), UIP, macular degeneration, AAA |
|
|
Term
| what fraction of lifetime smokers die from a smoking-related death? |
|
Definition
|
|
Term
| what fraction of lifetime smokers die from lung cancer |
|
Definition
|
|
Term
| what fraction of all cancer deaths are attributable to smoking? |
|
Definition
|
|
Term
| what fraction of total U.S. deaths due to smoking? |
|
Definition
|
|
Term
| why are cigarettes more harmful than cigars? |
|
Definition
| cigars have an alkaline pH that allows nicotine absorption via the oral mucosa. Cigarettes must be inhaled. |
|
|
Term
| List the stages of behavior change in smoking cessation |
|
Definition
use (precontemplation)
contemplation of change
action (attempt to quit)
abstinence
relapse? |
|
|
Term
| list the four A's of healthcare provider actions for a smoker |
|
Definition
| ask, advise, assist, arrange (follow-up) |
|
|
Term
| What is bupropion's role in cessation? |
|
Definition
| reduces desire to smoke for about 40% of smokers |
|
|
Term
| What is varenicline's role in cessation? |
|
Definition
| blocks the nicotine receptor |
|
|
Term
| true or false? As the number of tactics increase, the likelihood of quitting smoking decreases |
|
Definition
|
|
Term
| What % of smokers begin at age 21? by age 14? |
|
Definition
|
|
Term
| The average smoker loses how many years of life? The average smoker who dies loses how many years of life? |
|
Definition
|
|
Term
| What are the 3 MAJOR features ESSENTIAL to the dx and Rx of asthma? |
|
Definition
1) variable airflow obstruction that is often reversible with a bronchodilator
2) airway inflammation
3) increased bronchial responsiveness to stimuli (i.e. BHR, AHR) |
|
|
Term
| Upon pulmonary fxn tests, what values are characteristic of asthma? |
|
Definition
decr. FEV1/FVC
decr. FEV1
decr. PEFR
incr. expiratory time |
|
|
Term
| what are some other objective values of asthma? |
|
Definition
hyperinflation
incr. RV
incr. FRC
incr. TLC
incr. compliance
unequal V/Q distribution |
|
|
Term
| What would happen to the A-a gradient at high altitude? |
|
Definition
|
|
Term
| what would happen to the A-a gradient in physiologic or anatomic shunt? |
|
Definition
|
|
Term
| an asthmatic event is usually asymptomatic until what percentage drop in FEV1? |
|
Definition
| 30-50% Because of this, as an attack subsides, a patient still probably needs treatment to return airflow to normal. |
|
|
Term
| What are the potential contributors to airflow obstruction in asthma? |
|
Definition
1) acute bronchoconstriction (IgE or non-IgE, exercise, cold air, etc.)
2) eosinophil and lymphocyte infiltration/activation, mast cell activation
3) airway edema from incr. leakage and airway swelling which limits airflow
4) chronic mucus plug formation from thick, tenacious secretions
5) airway remodeling |
|
|
Term
| an exaggerated bronchoconstrictor response to a variety of stimuli is called what? how is it evaluated? |
|
Definition
| bronchial hyperresponsiveness (BHR). Tested by attempting to induce airflow obstruction in response to non-immunologic stimuli. It is quantified by identifying the amt of histamine or methacholine required to induce a 20% fall in FEV1. This is called the PC20 |
|
|
Term
| What is the key abnormality in asthma? |
|
Definition
|
|
Term
| describe the role of eosinophils in asthma |
|
Definition
incr. no. in airways
mildly incr. in blood
releases mediators (MBP, ECP, EPO) which cause degraulation of basophils and mast cells |
|
|
Term
| describe the role of mast cells in asthma |
|
Definition
usually an incr. state of activation, not an incr. no.
IgE on surface cross-linked by allergen, release of preformed mediators histamine and eosinophil chemotactic factor
newly formed mediators via 5-lipoxygenase pathway including leukotrienes (like LTC4). Effects include brochoconstriction, edema formation, mucus secretion, eosinophil attraction
newly generated cytokines IL4(B-cells), IL5(eosinophils), TNF-alpha(vascular endothelium) |
|
|
Term
| describe the role of lymphocytes in asthma |
|
Definition
| found in incr. no. and incr. state of activation in asthmatics. Usually Th2 helper cells that amplify the growth and/or activity of eosinophils and mast cells. |
|
|
Term
| describe the role of macrophages in asthma |
|
Definition
| found in airways and alveoli, process and present foreign Ag to lymphocytes. Overall questionable role in asthma |
|
|
Term
| Describe some neurogenic mechanisms thought to be associated with asthma |
|
Definition
increased alpha-adrenergic and decr. beta-adrenergic activity
also, neuropeptide involvement:
substance P-incr. mucus and microvascular permiability
VIP-normally relaxes airways but is degraded much faster in asthma
neurokinin A-potent bronchoconstrictor |
|
|
Term
| describe the early asthmatic response |
|
Definition
w/i 15 min and ends w/i an hour
purely bronchospastic
inhibited by B2-agonists and cromoglycate
no change in BHR |
|
|
Term
| describe the late asthmatic response |
|
Definition
w/i 5-8 hrs and may last 24+ hrs.
can be triggered by allergens, viral infxns, or ozone
airways narrowing due to inflammation, edema, mucus hypersecretion, SM narrowing
prevented by corticosteroids and cromoglycate
increased BHR for several days |
|
|
Term
| what are some of the major triggers of an asthmatic attack? |
|
Definition
| allergens, exercise, cold dry air, viral infxns, S02, air pollution including ozone, stress, GERD |
|
|
Term
| what are some of the major risk factors for asthma? |
|
Definition
| genetics, atopy, resp. infxns, passive smoking, occupational exposure |
|
|
Term
| what are some of the major symptoms of an asthmatic attack? |
|
Definition
| chest tightness, cough, wheezing, dyspnea with variable frequency of recurrance |
|
|
Term
| what are some of the major signs of an asthmatic attack? |
|
Definition
| none, tachypnea, wheezing, prolonged exp. phase, cough, accessory muscle use, severe attack (judged by resp. rate > 30, pulse > 120, pulsus paradoxus > 15 mmHg, PEFR < 100 L/min, mental status changes, ABG abnormalities |
|
|
Term
| what causes V/Q mismatch in asthma pts? What causes a decr. PaCO2? |
|
Definition
| unequal airflow obstruction and mucus plugging. decr. PaCO2 due to hyperventilation |
|
|
Term
| What are the primary symptoms of interstitial lung disease? |
|
Definition
| dyspnea, dry cough, fatigue |
|
|
Term
|
Definition
| VELCRO rales, clubbing, pulmonary HT w/ a loud S2 (a result of hypoxemia, capillary obliteration, decr. vessel distensibility), right ventricular failure, cyanosis |
|
|
Term
|
Definition
x-ray with incr. interstitial markings (reticular, nodular, or reticulonodular)
small lung vol.
enlarged hilar/mediastinal nodes (specific for sarcoid, hypersen. pneumonitis, berylliosis)
CT shows ILD better than CXR |
|
|
Term
|
Definition
pattern of findings typical of a restrictive disease
small lung volumes (TLC, FRC, VC)
reduced DLCO
flow rates normal or incr.*
*sarcoid the exception b/c some pts have obstruction with restriction due to granulomatous inflammtion of the airways. |
|
|
Term
| Why might one see an enlarged liver upon PE for ILD? |
|
Definition
| jaundice and enlargement due to passive congestion. May also see ascites and peripheral edema |
|
|
Term
| Does hypoxemia of ILD worsen with exercise? |
|
Definition
| YES, due to worsened V/Q mismatch. obstructive diseases don't do this. |
|
|
Term
| are blood tests helpful for a dx of ILD? |
|
Definition
|
|
Term
| what are some of the main characteristics of sarcoidosis? What can improve overall symptomatology? |
|
Definition
enlarged hilar and mediastinal lymph nodes
hepatoslenomegaly
uveitis
erythema nodosum (painful red bumps on shins)
elevated ACE
possible obstruction on PFTs
Rx w/ prednisone |
|
|
Term
| what are some of the main characteristics of hypersensitivity pneumonitis? What is the primary treatment? |
|
Definition
4-8 hrs post-exposure
sudden fever and dyspnea
hypoxemia
interstitial lung x-ray
remove pt from exposure, Rx w/ prednisone |
|
|
Term
| inorganic fibrogenic dust can also cause pulmonary fibrosis. What is the most fibrogenic dust that causes a NODULAR pattern in the upper lobes? What is another dust that causes a LINEAR pattern in the lower lobes? What part of pt hx is MOST important? |
|
Definition
silica
asbestos
occupational |
|
|
Term
| Name 3 collagen vascular diseases that have pulmonary fibrosis as one feature as well as the treatment for that condition. |
|
Definition
rheumatoid arthritis--corticosteroids
scleroderma--cyclophosphamide
polymyositis, dermatymyositis, SLE--corticosteroids |
|
|
Term
| What are common characteristics of all the idiopathic interstitial pneumonias? |
|
Definition
alveolar involvement, surrounding the airways--fibrosis and/or cellular infiltration into alveolar wall and alveolar space.
restrictive, decr. lung vol., incr. attenuation of breathing |
|
|
Term
| describe UIP. what treatment is pt advised to seek? |
|
Definition
the most common, with fibrosis of interstitium and infiltration of PMNs and macrophages.
seek transplant |
|
|
Term
| describe DIP. what treatment is pt advised to seek? |
|
Definition
macrophages in alveolar lumen, and most pts are cigarette smokers.
Rx with steroids and smoking cessation |
|
|
Term
|
Definition
| cellular behavior resembles DIP, but fibrotic behavior resembles UIP |
|
|
Term
| describe RBILD. what is treatment? |
|
Definition
| a mild disease found exclusively in smokers. must cease smoking. |
|
|
Term
| describe BOOP. how do you treat? |
|
Definition
| assoc. w/ drug reactions, infxous pneumonias, toxic inhalations, and connective tissue diseases. Usually responds to steroids. |
|
|
Term
| do CELLULAR or FIBROTIC dominant ILDs respond better to treatment? |
|
Definition
| cellular. There is no effective treatment for UIP. |
|
|
Term
| what are the four key points about ILD treatment? |
|
Definition
1) identify cause and prevent further exposure if possible
2) suppress alveolitis if inflammation present by using prednisone and sometimes cyclophosphamide
3) avoid hypoxemia by providing O2
4) prevent infxn using pneumococcus and influenza vaccines, and reduce exposure to sick contacts |
|
|
Term
| how many deaths worldwide/year due to lung cancer? |
|
Definition
|
|
Term
| how does the no. of new lung cancer dx relate to number of lung cancer deaths? |
|
Definition
|
|
Term
| what % of lung cancers can be attributed to smoking? |
|
Definition
|
|
Term
| if a lifelong smoker quits before the age of 50, what % do they decrease their risk of dying in the next 15 years? |
|
Definition
|
|
Term
| two major categories of lung cancer? |
|
Definition
|
|
Term
| why is it a problem that pts are SYMPTOMATIC at initial presentation of lung caner? |
|
Definition
| because symptoms don't usually present until late in disease process |
|
|
Term
| what are symptoms related to the primary tumor in lung cancer? |
|
Definition
| cough, dyspnea, hemoptysis, wheezing, pneumonia, chest pain |
|
|
Term
| what are some symptomatic clues of metastatic lung cancer? What are some other less common clues of lung carcinoma? |
|
Definition
hoarseness (recurrent laryngeal nerve) or diaphragm paralysis (phrenic nerve)
pleural effusion or pericardial effusion, both of which cause dyspnea.
can also obstruct blood vessels as seen with SVC syndrome when pts present with upper extremity and/or facial swelling |
|
|
Term
| two common areas of spread beyond the chest for lung cancer include what? |
|
Definition
| bone pain from metastatic lesions, abnormal liver blood enzymes from lesions' spread to liver |
|
|
Term
| 10% of pts with small cell lung cancer have spread to what organ? what symptoms likely? |
|
Definition
| the brain, w/ headaches, imbalance, seizures, etc. |
|
|
Term
| what clues should a physician look for upon PE for lung cancer? |
|
Definition
clubbing
acanthosis nigricans
erythema multiforme
most impt!---enlarged lymph nodes |
|
|
Term
describe a lung paraneoplastic syndrome
give a few examples and the type of cancer assoc. |
|
Definition
due to potential metabolic or secretory effects of lung cancer, sometimes the initial symptom
hypercalcemia--PTHrp (non-small)
Cushing's--ACTH (small)
hyponatremia--SIADH (small) |
|
|
Term
| non-small cell carcinoma has four subtypes. what are they? |
|
Definition
squamous
adenocarcinoma (including bronchioloalveolar)
large cell
mixed |
|
|
Term
| radiographic findings for squamous cell carcinoma |
|
Definition
|
|
Term
| radiographic findings for large cell carcinoma |
|
Definition
| peripheral and large mass |
|
|
Term
| radiographic findings for small cell carcinoma |
|
Definition
| large central/hilar mass and rapid growing |
|
|
Term
| radiographic findings for regular adenocarcinoma |
|
Definition
|
|
Term
| radiographic findings for bronchoalveolar adenocarcinoma |
|
Definition
| nodule/mass that appears pneumonic or interstitial |
|
|
Term
| what is the simplest way to dx lung cancer? |
|
Definition
| cytology of expectorated sputum |
|
|
Term
| What are the 3 components of tumor staging? |
|
Definition
tumor size
lymph node involvement
presence of metastasis |
|
|
Term
| what stages are NOT treated with surgery? |
|
Definition
|
|
Term
| How would you stage a symptomatic lung cancer with that has lymph nodes on the opposite side of the chest (+) for tumor? is it operable? If untreated, what is the median survival time for this cancer? |
|
Definition
| node would be N3, so staging would be IIIB and inoperable. px 4-5 mo. of life remaining |
|
|
Term
| What is the 5-yr survival rate of all types and stages of lung cancer? |
|
Definition
|
|
Term
| What stage of NON-SMALL cell lung cancer would most likely receive surgical resection w/ post-op chemotherapy but usually not radiation therapy? What stage would radiation be added to surgery and chemo? |
|
Definition
|
|
Term
| All small cell lung cancers receive what treatment? |
|
Definition
| chemotherapy +/- radiation therapy with rare consideration for surgical resection |
|
|
Term
|
Definition
| an inherited tendency to develop IgE-mediated allergic diseases such as rhinitis, asthma, and eczema |
|
|
Term
| what is the freq. of dual response allergic reactions? |
|
Definition
|
|
Term
| What are the typical symptoms of rhinitis? |
|
Definition
| sneezing, watery rhinorrhea, congestion, and pruritis of the nasopharynx and eyes |
|
|
Term
| what is time of onset of rhinitis after exposure to foreign substance? |
|
Definition
|
|
Term
| Upon intradermal injection, the same substance that causes rhinitis should cause what reaction? |
|
Definition
|
|
Term
| what are the two broad categories of allergens? |
|
Definition
seasonal windborne pollens
perennial dusts |
|
|
Term
| what are the 5 primary functions of the nose? |
|
Definition
| olfaction, resonation, air conditioning (heating, humidification, filtration), local production of IgE/IgA, and ciliary-mucus transport |
|
|
Term
| what ANS branch controls mucus production? |
|
Definition
|
|
Term
| upon degranulation, what are some of the major mediators released from mast cells/basophils? |
|
Definition
| histamine, heparin, tryptase, prostaglandin D2, leukotriene B4, leukotriene C4, platelet activating factor, bradykinin |
|
|
Term
| The mediators of allergic rhinitis produce some or all of these effects: |
|
Definition
incr. mucus
SM contraction
vagal stimulation
vasodilation
chemoattraction
neutrophil activation |
|
|
Term
| How are the symptomatic effects of rhinitis multiplied? Think pathophys... |
|
Definition
| The mediators open the mucosal intercellular tight jxns, allowing more Ag penetration and binding to IgE. |
|
|
Term
| What cells are involved in the early allergic rhinitis response? |
|
Definition
|
|
Term
| what cells are involved in the allegic rhinitis late response? |
|
Definition
| basophils, eosinophils, and neutrophils |
|
|
Term
| what mediators are involved in the allergic rhinitis early response? |
|
Definition
| histamine, PGD2, LTC4, bradykinin |
|
|
Term
| what mediators are involved in the allergic rhinitis late response? |
|
Definition
| histamine, LTC4, bradykinin |
|
|
Term
| Is the allergic rhinitis EARLY or LATE response characterized by nasal mucosa hypersensitivity? |
|
Definition
|
|
Term
| what are 3 non-specific tests of allergic response? |
|
Definition
| nasal swab for eosinophils, blood eosinophil count, elevated serum IgE |
|
|
Term
| what are two specific tests for allergic rhinitis? |
|
Definition
intradermal skin test
RAST (IgE specific to Ag) |
|
|
Term
| list some of the treatments for allergic rhinitis |
|
Definition
| avoidance, antihistamines (H1-blockers), nasal/oral decongestants (alpha-agonists, anticholinergics), nasal corticosteroids, disodium cromoglycate |
|
|
Term
| what is the ddx of nasal congestion and rhinorrhea? |
|
Definition
1) allergic rhinitis
2) infectious rhinitis
3) non-allergic rhinitis (including vasomotor rhinitis and medicamentosa rhinitis) |
|
|
Term
| Is there a specific Rx for the late response of allergic rhinitis? |
|
Definition
| sometimes nasal corticosteroids can BLOCK the late response and improve the early response |
|
|
Term
|
Definition
| an autosomal recessive disorder w/ progressive mucous obstruction beginning in small airways |
|
|
Term
| what is the approx. incidence of CF in the population? what is the carrier rate? |
|
Definition
1/2500
3-4% (or about 1/20) |
|
|
Term
| what % of infants with CF are born with meconium ileus? |
|
Definition
|
|
Term
| what ethnic group has the highest incidence of CF? |
|
Definition
|
|
Term
| What gene mutation accounts for about 70% of all abnormal CF genes? This genetic mutation also predicts significant involvement of what other two organs? |
|
Definition
delta-F508
pancreas and GI |
|
|
Term
| the delta-F508 mutation specifically blocks the CFTR in what way? |
|
Definition
| prevents it from being processed and transported to the apical membrane |
|
|
Term
| What % of CF pts are homozygous for delta-F508? |
|
Definition
|
|
Term
| What is the normal function of CFTR? |
|
Definition
| an ion channel that facilitates/regulates transport of intracellular Cl- ions across the apical membrane of epithelial cells |
|
|
Term
| what happens with an abnormal/absent CFTR? |
|
Definition
1) apical membrane of epithelial cell impermeable to chloride
2) sodium (Na+) flux into cells doubles
3) H2O follows Na+ |
|
|
Term
| How do dehydrated secretions in CF cause problems? |
|
Definition
| impair cilia fxn and decr. mucous clearance which promotes bacterial colonization |
|
|
Term
| What cells dominate CF inflammation? How does this further complicate CF? |
|
Definition
PMNs
when PMNs breakdown, they release their DNA which can significantly incr. the viscosity of mucous |
|
|
Term
| what is the major test for dx of CF? What value indicates a positive test? |
|
Definition
| the sweat chloride test is the GOLD STANDARD test for CF. 60 mEq/L or more of Cl- indicates a positive test. Less than 40 mEq/L is normal |
|
|
Term
| review the pathophys. for complications of cystic fibrosis |
|
Definition
| mucous obstruction ---> colonization, infxn, inflammation ---> airway edema, incr. mucus, incr. inflammation ---> mucus plugging, bronchiectasis, lobar atelectasis, emphasematous cysts (cysts can lead to pneumothorax) ---> severe cough in areas of bronchial hypertrophy can lead to bronchial artery tearing and hemorrhage (hemoptysis) ---> chronic hypoxia, pulmonary HT, cor pulmonale |
|
|
Term
| What are the major clinical presentation of CF? |
|
Definition
persistent respiratory problems (cough, recurrent pneumonia, CXR abnormalities)
malnutrition
steatorrhea
meconium ileus |
|
|
Term
| What are the treatments for the pulmonary issues related to CF? |
|
Definition
| anti-inflammatory agents, antibiotics, mucolytics, bronchodilators, chest physiotherapy |
|
|
Term
| What are the treatments for the pancreatic issues related to CF? |
|
Definition
| pancreatic enzyme replacement |
|
|
Term
| What are the treatments for the GI issues related to CF? |
|
Definition
125%-150% daily recommended calories
supplement fat-soluble vitamins ADEK |
|
|
Term
|
Definition
| absence of airflow at nose and mouth |
|
|
Term
|
Definition
| absence of oronasal flow lasting longer than two resp. cycles in with continued respiratory effort |
|
|
Term
|
Definition
| cessation of resp. effort lasting at least two resp. cycles |
|
|
Term
| what is the fxn of the dorsal resp. group? |
|
Definition
|
|
Term
| what is the fxn of the pneumotactic center? |
|
Definition
| inhibits the DRG, controls rate and pattern of breathing |
|
|
Term
| what is the fxn of the ventral respiratory group? |
|
Definition
| has control over inspiration and expiration, but specifically expiration using abdominal muscles during times of high respiratory need |
|
|
Term
| where are the central chemoreceptors located and what do they respond to? |
|
Definition
| located near the ventral medulla and sense increased [H+] in the CSF |
|
|
Term
| What is the most important factor in central ventilation control? |
|
Definition
|
|
Term
| What are the peripheral chemoreceptors and what do they respond to? What is their function? |
|
Definition
carotid and aortic bodies, respond to decreases in arterial O2 and pH as well as increased PCO2.
fxn to incr. respiratory rate |
|
|
Term
| What 9 factors could lead to dysfxn of central control of breathing? |
|
Definition
1)prematurity
2)absence of resp. fxn when sleeping (Ondine's)
3) metabolic disease (electrolyte, MCAD)
4) congenital abnormalities (chiari, meningomyelocele, hydrocephalus, achondroplasia)
5) toxic drug exposures
6) chronic hypoxemia
7) seizures
8) infection
9) trauma |
|
|
Term
| What 4 factors could lead to dysfxn of peripheral control of breathing? |
|
Definition
1) lung disease
2) neuromuscular disease
3) upper airway disease/obstruction
4) GER |
|
|
Term
| define apnea of prematurity |
|
Definition
a > 20 sec. respiratory pause, or a shorter pause assoc. with bradycardia or cyanosis, in the preterm infant with no other identifiable etiology.
**must EXCLUDE other diagnoses FIRST before you can say apnea of prematurity** |
|
|
Term
| incidence of apnea of prematurity? |
|
Definition
| 84% of those infants born with a weight < 1000 grams |
|
|
Term
| etiology of apnea of prematurity is thought to stem from a combination of what four things? |
|
Definition
immature central respiratory drive
immature brainstem
upregulation of inhibitory NTs
increased % of REM sleep |
|
|
Term
| does apnea of prematurity predispose an infant for SIDS? |
|
Definition
|
|
Term
| by what age does apnea of prematurity usually resolve? |
|
Definition
|
|
Term
| in apnea of prematurity what is the primary consequence of a bradycardic event? |
|
Definition
| dramatic decrease in cerebral blood flow |
|
|
Term
| apnea of prematurity does predispose to what condition? |
|
Definition
| spastic diplegia (a type of cerebral palsy) |
|
|
Term
| what are four different therapies for apnea of prematurity? |
|
Definition
tactile stimulation
methylxanthines
assisted ventilation
home monitoring |
|
|
Term
| sudden infant death syndrome is the death of an infant unexplained by what three things? |
|
Definition
unexplained by
1) history
2) autopsy
3) circumstances of death |
|
|
Term
| what are some non-specific but characteristic findings in an infant who died of SIDS upon autopsy? |
|
Definition
intrathoracic petachiae (75%)
histologic evidence of minor resp. infxn and thus incr. IL1/IL6 (majority)
histologic evidence of prior hypoxic events
persistence of HbF
astroglial proliferation
brainstem abnormalities
metabolic disorders |
|
|
Term
| how many infants die each year of SIDS in the U.S.? |
|
Definition
|
|
Term
| increased risk of SIDS is associated with what epidemiological factors? |
|
Definition
| young mother, poor, prenatal smoking, prenatal drug use, low birth weight, etc. |
|
|
Term
| what are some appropriate therapies/interventions to prevent SIDS? The incidence of SIDS decreases by what % with supine sleep? |
|
Definition
supine sleep, no smoking, avoid overdressing newborn, good prenatal care
75% drop in incidence with supine sleep |
|
|
Term
| define an apparent life threatening event (ALTE) |
|
Definition
| episode of combo of apnea, color change, change in muscle tone, choking, and/or gagging |
|
|
Term
| what are risk factors for ALTE? |
|
Definition
prenatal smoking
maternal drug use
young maternal age
prone infant sleep |
|
|
Term
| what are the major causes of ALTE? |
|
Definition
seizure
GER
MCAD
infection
cardiac arrhythmias
toxins
child abuse |
|
|
Term
| what is the best overall intervention for ALTE? |
|
Definition
treat etiology(ies)
know infant CPR
supine sleep |
|
|
Term
| Why is the prone sleeping position more hazardous? |
|
Definition
1) increased diaphragm thickness which impairs strength and adds work, compromising infant's ability to respond in a stressful situation
2) laryngeal chemo reflex (with decr. breathing, decr. swallowing, and decr. exp. w/ prone position when fluid is in the pharyxn; perhaps due to the unstable position/relationship of the epiglottis to the larynx at this stage of development |
|
|
Term
| What are the 5 stages of embryonic development of the newborn lungs and their appropriate time of gestation? |
|
Definition
embryonic 4-6 weeks
pseudoglandular 7-16 weeks
canalicular 17-28 weeks
saccular 29-35 weeks
alveolar 36 weeks to 8 years |
|
|
Term
| describe the sequence of basic lung embryologic development |
|
Definition
ant. foregut bud
mainstem bronchi
23 generations of branching
__________________________________
simultaneous development and branching of vascular system, with proximate capillaries and acini forming about the same time (22-23 weeks) |
|
|
Term
| what stage will a congenital diaphragmatic hernia most likely form? |
|
Definition
| pseudoglandular, when the diaphragm is normally supposed to close |
|
|
Term
| What is a Bochdalek hernia? What are some of the developmental consequences? |
|
Definition
| if the four muscles that fuse to form the diaphragm don't, usually left-sided. With access to thoracic cavity, the guts, spleen, and/or stomach can herniate and also result in intestinal malrotation |
|
|
Term
| explain the transition from fetal vasculature to normal infant vasculature upon birth. what happens if the pulmonary vascular resistance doesn't drop |
|
Definition
| O2-blood shunted through foramen ovale and ductus arteriosis upon first breaths, gaseous lung expansion, decreased pulmonary vascular resistance increased bloodflow to pulmonary circuit, pressure incr. in left atrium, foramen ovale closes O2 stimulates closure constriction of ductus arteriosus **if pulmonary vascular resistance doesn't decr., shunt will remain open and child can become hypoxemic** |
|
|
Term
| What is a potential treatment if a newborn has alveolar hypoxia? |
|
Definition
| administer NO for diffusion to arterial smooth muscle to cause relaxation which relieves constriction of the vascular bed |
|
|
Term
| What are the two main causes of hypoxemia due to diaphragmatic hernia in a newborn? |
|
Definition
alveolar hypoxia (treatable)
incomplete vascular development (non-treatable) |
|
|
Term
| What is extracorporal membrane oxygenation (ECMO)? |
|
Definition
| Take blood from right atrium, remove CO2, add O2, and deliver it back to newborn |
|
|
Term
| Why is pulse-ox higher in a newborn of a certain PO2 vs. an adult with the same PO2? |
|
Definition
| due to HbF and it's incr. affinity for O2 with a left-shift on the O2-Hb dissociation curve |
|
|
Term
| Why does a baby in RDS have retractions? |
|
Definition
| due to the decreased compliance of the lung, it is easier to bring some of the chest wall inward |
|
|
Term
| How does surfactant help alveolar opening upon inspiration and prevent alveolar collapse on expiration? |
|
Definition
| the surfactant has a polar head and hydrophobic tail that allows repelling of other molecules at the beginning of inspiration by reducing the attractive forces b/t the molecules responsible for surface tension, but also prevents collapse upon expiration because the molecules don't want to be too close to one another |
|
|
Term
| what is the cause of bronchopulmonary displasia (BPD)? |
|
Definition
| iatrogenic ventilation of the newborn |
|
|
Term
| what is the clinical definition of chronic lung disease in premature babies? |
|
Definition
| the need for O2 + an abnormal CXR in a baby at or beyond 36 weeks post-conceptional age |
|
|
Term
| What are the clinical risks for BPD? |
|
Definition
effects of the ventilator: positive pressure, the O2 itself, and increased time of use
the effects of prematurity: increased prematurity |
|
|
Term
| Why is giving molecular O2 to a pre-term infant damaging? |
|
Definition
| because the pre-term infant is antioxidant deficient |
|
|
Term
| What are the two bad things oxygen radicals do? |
|
Definition
direct damage to lipid membranes, proteins, and DNA
provoke expression of inflammatory genes |
|
|
Term
|
Definition
| a sterile mixture of amniotic fluid, bile, sloughed intestinal cells, mucous, blood, etc. that gets into the fetal intestine |
|
|
Term
| what are some of the consequences of meconium aspiration syndrome? |
|
Definition
ball-valving upon ventilation
inflammation
surfactant inactivation (due to bile)
pulmonary hypertension--alveolar hypoxia and systemic stress |
|
|
Term
| is airway cephalad or caudad in children? |
|
Definition
|
|
Term
| what is the narrowest portion of the airway in children 8 years and younger? adults? |
|
Definition
|
|
Term
| What is stridor and what causes it? |
|
Definition
| the most common feature of upper airway disease in infants and children with an abnormal sound due to upper airway obstruction usually upon inspiration |
|
|
Term
| what is the cause of epiglottitis? what are the symptoms? |
|
Definition
usually due to H.flu infection.
rapid onset, w/ fever, drooling, occasionally stridor and retractions |
|
|
Term
| what is the cause of viral croup? what are common symptoms? |
|
Definition
aka laryngotracheitis, commonly caused by parainfluenza virus.
slow onset, low grade fever, barking cough, common stridor/retractions |
|
|
Term
| what is the cause of bacterial tracheitis? What are the common symptoms? |
|
Definition
bacterial infection (MCC is s. aureus) of the trachea sometimes following a viral URI
slow onset, high fever, barking cough, stridor/retractions |
|
|
Term
| What is the most common cause of stridor in infants? |
|
Definition
|
|
Term
| What are the four causes of airway narrowing? |
|
Definition
infectious
dynamic
fixed airway
airway foreign body(ies) |
|
|
Term
| an intrathoracic airway obstruction is defined by what? |
|
Definition
|
|
Term
| an extrathoracic airway obstruction is defined by what? |
|
Definition
|
|
Term
| what is the most common deposition site for a small foreign body? |
|
Definition
| the right lower lobe bronchus |
|
|
Term
| what would lead one to suspect foreign body aspiration? |
|
Definition
| a sudden, unexplained, chronic cough |
|
|
Term
| What are some symptoms that healthy people experience upon breathing polluted air? |
|
Definition
| burning eyes, sore throat, headache, nausea, cough, substernal discomfort |
|
|
Term
| List the types of people most susceptible to air pollution |
|
Definition
| babies, elderly, chronic lung disease, chronic heart disease |
|
|
Term
| What individuals are most susceptible to carbon monoxide? |
|
Definition
| those with coronary heart disease who may experience angina pectoralis |
|
|
Term
| Who is most susceptible to respiratory irritants and poor air quality? |
|
Definition
| those with asthma and chronic bronchitis |
|
|
Term
| What four types of evidence were used to convince scientists that air pollution damages health? |
|
Definition
air pollution exposure
animal exposure
human volunteer exposure
epidemiological studies |
|
|
Term
| What two major adult diseases are caused by environmental tobacco smoke? |
|
Definition
| lung cancer and coronary heart disease |
|
|
Term
| What childhood diseases are more likely in a home with environmental tobacco smoke? |
|
Definition
| lung cancer, asthma, bronchitis, pneumonia, otitis media |
|
|
Term
| What effect can radon have on the occupants of a home? Why test for radon? |
|
Definition
| A radon test is REALLY easy to do, and radon in homes accounts for 10,000 lung cancer deaths each year. |
|
|
Term
| what is building associated illness? |
|
Definition
| when a specific disease strikes people present in a building that harbors a disease-causing agent (like a faulty furnace or contaminated ventilation system) |
|
|
Term
| what is sick building syndrome? |
|
Definition
| when a substantial number of people who spend time in a building are bothered by symptoms but no specific disease can be diagnosed. |
|
|
Term
| what are some of the known carcinogens? |
|
Definition
| asbestos, uranium, arsenic, nickel, coke oven emissions, chloromethyl ethers, chromates, radiation |
|
|
Term
| what are the 3 major types of responses of the lung to occupational exposures? |
|
Definition
| neoplastic, parenchymal, airway |
|
|
Term
The parenchymal response's primary effect is in what part of the respiratory tract?
what are the 3 types of parenchymal responses? |
|
Definition
the acinus
fibrogenic dusts, granulomatous, and hypersensitivity pneumonitis |
|
|
Term
| what are three major occupational dusts that cause a fibrogenic parenchymal response? |
|
Definition
|
|
Term
| What occupational granulomatous disease is indistinguishable from sarcoidosis? |
|
Definition
|
|
Term
|
Definition
| chronic disease with dyspnea and variable cough/sputum production, along with airflow obstruction that demonstrates little reversibility and is slowly progressive |
|
|
Term
| define chronic bronchitis. how is the disease characterized? |
|
Definition
| cough/sputum production for 3 mo./yr for 2 consecutive years. The disease is characterized by symptoms with a pathologic correlate |
|
|
Term
| define emphysema. how is the disease characterized? |
|
Definition
abnormal permanent enlargement of airspace distal to terminal bronchiole w/ destruction of alveolar walls.
characterized by pathology with a symptomologic correlate (dyspnea) |
|
|
Term
| What % of cases of COPD are due to cigarettes? |
|
Definition
|
|
Term
| a MAJORITY of smokers with COPD experience what two symptoms, with a MINORITY experiencing what two additional symptoms? |
|
Definition
increased mucus production and cough
airflow obstruction and dyspnea |
|
|
Term
|
Definition
stands for
body-mass index
obstruction
dyspnea
exercise
used to give a prognosis and probability of survival to COPD patients |
|
|
Term
| What is the result of an alpha-1 antitrypsin deficiency? What % of COPD pts have this deficiency? |
|
Definition
a genetic defect when there is not enough hepatic production of anti-elastase which protects the lung from the effects of elastase released by neutrophils.
elastase digests alveolar walls
4% of COPD pts |
|
|
Term
| an FEV1 of 35-49% of predicted would have what COPD classification? How would you rate the symptoms? |
|
Definition
| FEV1 indicates MODERATE disease, symptoms continuous but not very limiting |
|
|
Term
| What would you see on a PE for COPD? |
|
Definition
wheezing on auscultation
bronchitis--wet cough (wheezing blue bloaters)
emphysema--over distended lungs/chest (pursed lip pink puffers) |
|
|
Term
| in a pt with COPD with symptoms resembling that more of emphysema, would would their labs look like? |
|
Definition
decr. FEV1
low DLCO
low but acceptable PO2
low-normal pCO2 |
|
|
Term
| in a pt with COPD with symptoms resembling that more of chronic bronchitis, would would their labs look like? |
|
Definition
decr. FEV1
normal DLCO
unacceptably low PO2
incr. PCO2 |
|
|
Term
| Do most smokers develop clinically significant airflow obstruction? |
|
Definition
|
|
Term
| During normal tidal breathing, a pt with emphysema may actually reach what value on the flow-volume curve? |
|
Definition
| PEFR, hence the pursed lips |
|
|
Term
| What causes obstruction in bronchitis? |
|
Definition
| secretions, edema, and inflammation in the conducting zones |
|
|
Term
| What causes obstruction in emphysema? |
|
Definition
| decr. elastic recoil and decr. radial support in the respiratory zone leading to airway collapse |
|
|
Term
| Is emphysema a perfusion or ventilation problem? |
|
Definition
| Mostly a perfusion problem, b/c some air is going to tissue that is poorly perfused |
|
|
Term
| Is chronic bronchitis a perfusion or ventilation problem? |
|
Definition
| a ventilation problem, b/c some blood flow is going to tissue that is poorly ventilated |
|
|
Term
| What are the 5 steps of management of COPD? |
|
Definition
1) smoking cessation (5 As: ask, advise, assist, assess, arrange)
2) preserve and protect remaining function (anticholinergic bronchodilators)
3) rehabilitation and exercise
4) supplemental O2 if PO2 < 55 mmHg
5) surgery (volume reduction or lung transplant) |
|
|
Term
| What makes up the alveolar fluid barrier? In what two ways can this barrier be breached? |
|
Definition
low permeability, type 1 epithelial cells.
Fluid will pass through this barrier if 1) the rate of fluid filtration exceeds the lymphatic capacity to drain that fluid away, or 2) the peribronchovascular cuff cannot sequester anymore fluid |
|
|
Term
| Via what emergency relief mechanism do the lungs protect themselves from edema during times of crisis? |
|
Definition
| peribronchovascular cuffing--allows the lung to accept from fluid during these times |
|
|
Term
| What transporters in type 1 alveolar cells aid fluid movement across the alveolar epithelium? |
|
Definition
|
|
Term
| In what direction is the pressure gradient in the lungs to protect against edema formation? |
|
Definition
|
|
Term
| What are the three types of pulmonary edema and what part of Starling's equation is affected in each? |
|
Definition
cardiac (incr. hydrostatic pressure)
non-cardiac osmotic (decr. osmotic pressure)
non-cardiac microvascular (incr. diffusion constant) |
|
|
Term
| What are some common causes of cardiac pulmonary edema? |
|
Definition
aortic/mitral valve failure
hypertensive crisis
left heart failure
arrhythmic (atrial fib., etc. leading to decr. filling of left vent. during diastole and backup of fluid) |
|
|
Term
| What are a couple uncommon causes of cardiac pulmonary edema? |
|
Definition
pericarditis
myocardial tumors (myxomas) |
|
|
Term
| upon reaching severe cardiac pulmonary edema (i.e. alveolar flooding) what are some characteristics? |
|
Definition
decr. compliance due to saturated interstitium
incr. work to breathe w/ diaphoresis, wheezing
right to left shunt, w/ severe hypoxia (cyanotic)
incr. dead space ventilation and incr. PaCO2 due to hypoxic vasoconstriction |
|
|
Term
| non-cardiac osmotic pulmonary edema usually doesn't cause edema alone but can exacerbate another form of edema. What is the primary cause of this type of edema? |
|
Definition
| hypoalbuminemia that allows more fluid to flow to interstitium, usually due to either poor nutrition or incr. IV fluids |
|
|
Term
| What are the 5 causes of bronchiectasis? |
|
Definition
CF (MCC in United States)
infections (TB is MCC worldwide, adenovirus, S.aureus, H.flu)
bronchial obstruction (tumor, etc.)
ciliary dyskinesia
allergic bronchopulmonary aspergillosis (ABPA) |
|
|
Term
| What is damaged in non-cardiogenic microvascular pulmonary edema? |
|
Definition
| the lung capillary endothelium |
|
|
Term
| How would an MI of the left ventricle cause event WORSE pulmonary edema in a pt w/ preexisting microvascular injury? |
|
Definition
| increased left atrial pressure, which incr. lung water even more than in solely cardiac edema |
|
|
Term
| Why would you see a high transpulmonary pressure with microvascular lung injury? |
|
Definition
| there would be increased edema fluid, causing a severe compromise of lung compliance (also due to abnormal surfactant) and tissue oxygenation due to shunt |
|
|
Term
| poor oxygenation causes hypoxic vasoconstriction of lung tissue that is not being ventilated. this, in turn, causes what kind of defect? |
|
Definition
| dead-space ventilation (air is entering respiratory airways but is unable to diffuse because of edema fluid AND because blood flow has now been directed away from this section of lung |
|
|
Term
|
Definition
| a noncardiogenic pulmonary edema resulting from acute alveolar-capillary damage that is due to direct lung injury or systemic disease |
|
|
Term
| What are some risk factors for ARDS? |
|
Definition
infection (most common, usually bacterial sepsis)
aspiration
trauma
drugs (like heroin)
smoke inhalation
acute pancreatitis
DIC
amniotic fluid embolism/fat embolism |
|
|
Term
| What is the pathogenesis of ARDS? |
|
Definition
| 1) acute damage to alveolar capillary walls, which in the case of sepsis is bacterial release of LPS 2) recruitment of alveolar macrophages which also secrete chemotactic cytokines to neutrophils 3) neutrophils transmigrate into alveoli and cause damage to both capillary endothelial cells alveolar epithelium by release of oxygen radicals and elastase 4) this causes incr. fluid flow to alveolar space. Damaged type 1 cells unable to expel fluid due to loss of ENaC, CFTR, and AQP2. *SEVERE HYPOXEMIA* |
|
|
Term
| What is the reaction of type 2 pneumocytes in ARDS? |
|
Definition
| they attempt repair with actin filaments but end up pulling cells apart more (stress fibers) which allows more fluid to move into interstitium. |
|
|
Term
| What are some of the dx symptoms of pulmonary edema? |
|
Definition
| dyspnea, tachypnea, accessory muscle use, cyanosis, crackles, wheezing w/ incr. exp. phase |
|
|
Term
| How would you assess lung fluid? |
|
Definition
CXR
pulseox, ABG
measure compliance
right heart catheterization |
|
|
Term
| What is the therapy for pulmonary edema? |
|
Definition
supplemental O2
give diuretic to decr. intravascular volume
treat underlying cause
treat infection
mechanical ventilation
PEEP
admin. inhaled NO |
|
|
Term
| Why is a pt with ARDS very SLOW to respond to supplemental O2? |
|
Definition
| due to extensive intrapulmonary shunting |
|
|
Term
| Why would you use PEEP for treatment of ARDS? |
|
Definition
| because of damage to the type 2 pneumocytes resulting in a decrease in surfactant production |
|
|
Term
| Where and when do you usually hear stridor? |
|
Definition
| over the central airways upon inspiration |
|
|
Term
| Where and when do you usually hear wheezing? |
|
Definition
| in the distal airways upon expiration |
|
|
Term
| Name some of the anatomic structures/growths that can cause infant wheezing |
|
Definition
intrinsic: tracheomalacia, tracheoesophageal fistula, inflammation (croup/aspiration)
extrinsic: mediastinal lymphadenopathy, masses, cysts |
|
|
Term
| Name some of the pulmonary causes of infant wheezing |
|
Definition
| asthma, bronchiolitis, respiratory illness, GER, CF, foreign body, bronchopulmonary dysplasia, TB, ciliary dyskinesia |
|
|
Term
| Name some non-pulmonary causes of infant wheezing |
|
Definition
| salicylate poisoning, CHF, viral myocarditis |
|
|
Term
| what is the most common cause of RTIs among children and infants worldwide? |
|
Definition
|
|
Term
| If RSV causes a RTI in infants, what are some of the common diagnoses? |
|
Definition
| "common cold," croup, pneumonia, central/obstructive apnea, bronchiolitis |
|
|
Term
| describe bronchiolitis in a child < 2 y.o. |
|
Definition
tachypnea, chest retractions, wheezing, air trapping on CXR
+/- fever, cyanosis, severe resp. distress |
|
|
Term
| If RSV causes a URTI in infants, what are some of the common symptoms? |
|
Definition
| nasal congestion with rhinorrhea, otitis, inflamed mucosa, low/moderate fever |
|
|
Term
| If RSV causes a LRTI in infants, what are some of the common symptoms? |
|
Definition
| cough, tachypnea, incr. WOB, irritability, malaise, anorexia, apnea, wheezing, crackles, resp. distress |
|
|
Term
| What are some labs that one would order for a wheezing infant? |
|
Definition
CXR checking for hyperinflation, atelectasis, pneumonia
CBC, ABG (esp. for hypoxemia)
RSV rapid Ag test
viral culture |
|
|
Term
| Would a child with bronchiolitis and an O2sat < 95% need hospital admission? |
|
Definition
|
|
Term
| what are pathophysiologic end effects of RSV? |
|
Definition
airway edema, mucosal necrosis and sloughing, decr. cilia, mucus hypersecretion
can lead to total obstruction--atelectasis
can lead to partial obstruction--air trapping
this would also lead to a V/Q mismatch |
|
|
Term
| what is the most effective way to prevent the spread of RSV? |
|
Definition
HAND WASHING.......
.......duh |
|
|
Term
| what is proper therapy for RSV bronchiolitis? |
|
Definition
| supplemental O2, IV fluids, bronchodilators |
|
|
Term
| what is proper prevention for RSV bronchiolitis? |
|
Definition
again, HAND WASHING.
but also, RSV IgG preps for very high-risk patients |
|
|
Term
| what are positive predictors of asthma development? |
|
Definition
freq. wheezing in 1st 3 years of life,
+ 1 of 2 major criteria (parental asthma and/or eczema) AND/OR 2 of 3 minor criteria (allergic rhinitis and/or wheezing when not sick and/or eosinophilia) |
|
|
Term
|
Definition
an infectious exudative inflammation of the distal portions of the lung (terminal airways, alveolar spaces, and interstitium)
the inflammation usually involves hyperemia, incr. vascular periability, and an exudate |
|
|
Term
| what are the four routes of pneumonia inoculation? |
|
Definition
airborne pathogen
aspiration of oropharyngeal secretions
hematogenous bacteremia
direct extension to lungs |
|
|
Term
| what are the anatomic defenses to pneumonia? |
|
Definition
respiratory filtering
laryngeal competence (impaired by seizures, altered mental status, problems with swallowing)
cough (1st line) (impaired by stroke, paralysis)
mucociliary transport (impaired by smoking, viral infection, CF, ciliary dyskinesia) |
|
|
Term
| How do alveolar macrophages and PMNs protect against pneumonia? |
|
Definition
phagocytose inhaled bacteria (less effective against aspiration bolus)
IgA, IgG, compliment, and opsonins aid phagocytosis |
|
|
Term
| What different bacteria are able to circumvent normal defenses and which take advantage of impaired defenses? |
|
Definition
virulent bacteria are able to circumvent normal defenses (pneumococcus, mycoplasma)
less virulent bacteria are less common causes of pneumonia but can take advantage of weakened defenses (enteric gram (-) aerobes, anarobes) |
|
|
Term
| What 3 scenarios would allow for the development of a pneumonia? |
|
Definition
defense defect
virulent organism exposure
overwhelming inoculum |
|
|
Term
| in febrile pts with new pulmonary infiltrates ____ to ____ % have no identifiable pathogen |
|
Definition
|
|
Term
| What make viruses more capable of infection? |
|
Definition
| able to bypass arbitrary anatomic barriers and can invade all parts of respiratory tract |
|
|
Term
| is the primary problem in most pneumonia obstruction or restriction? |
|
Definition
| restrictive due to airspace and interstitial exudates that decr. lung compliance in all parts |
|
|
Term
| What are the major alterations in pneumonia and what causes them? |
|
Definition
gas exchange alterations
due to alveolar flooding which decreases ventilation, causing shunt and hyperventilation of good tissue
due to the poor ventilation of some lung tissue, that tissue undergoes hypoxic vasoconstriction which brings an area of poor ventilation back into V/Q balance to limit systemic hypoxemia |
|
|
Term
| what are the clinical features of classic pneumonia? |
|
Definition
(pneumococcus)
sudden chills
fever
cough
rusty sputum
pleuritic chest pain
crackles
consolidation
lobar airspace disease |
|
|
Term
| What are the clinical features of atypical pneumonia? |
|
Definition
(mycoplasma)
gradual fever
dry, irritating cough
myalgia, headache
crackles
wheezes
diffuse, patchy infiltrates |
|
|
Term
| What are the diagnostic criteria of pneumonia? |
|
Definition
1) a new radiographic infiltrate
+
1 major symptom (cough, fever, sputum)
+
2 minor symptoms (leukocytosis, dyspnea, pleuritic chest pain, consolidation) |
|
|
Term
| What is the most common symptom of elderly with pneumonia? |
|
Definition
MALAISE
mental status changes
fever less common
no resp. symptoms common |
|
|
Term
| What is the best treatment regimen for pneumonia? |
|
Definition
supplmental O2
hydration
pain relief
use epidemiological, hx, and PE considerations for best ANTIBIOTIC Rx |
|
|
Term
| What are some ways one can identify the causative agent of a pt's pneumonia? |
|
Definition
examine sputum
blood culture
serologic/Ag testing |
|
|
Term
| Does mortality have a (+) or (-) correlation with respiratory rate in the cause of pneumonia? |
|
Definition
|
|
Term
| what are some complications of pneumonia? |
|
Definition
lung abscesses
empyema
bronchiectasis
dissemination |
|
|
Term
| What are some symptoms of aspiration pneumonia and likely agents? |
|
Definition
gradual fever
productive, foul cough
weight loss
crackles
pleural effusion
abscesses
commonly anaerobes and mixed flora etiology |
|
|
Term
| describe tuberculosis and some characteristics of the mycobacterium |
|
Definition
chronic pneumonia w/ possible caseous necrosis and granuloma formation
it is an obligate aerobe that prefers the apecies of the lungs with a high cell wall lipid content , is slow-growing, and acid-fast. |
|
|
Term
What % of the U.S. population is infected with TB?
What % of the world population is infected with TB? |
|
Definition
|
|
Term
| list some pts who are predisposed to getting TB |
|
Definition
HIV(+)
crowded conditions w/o adequate healthcare
old, very young
diabetics, alcoholics, drug addicts |
|
|
Term
| describe the pathophys. of TB transmission and course |
|
Definition
infected person coughs/sneezes
aerosol transmission inhaled by another
droplet nuclei deposition in lungs
distal airway deposition
replication
lymphatic/hematogenous spread
spreads to areas w/ high O2 tension (e.g. the lung apex, renal cortex, spine (Pott's), cervical nodes)
6-8 wk post-infxn T-cell mediated rxn
type IV reactive skin test (PPD +)
infxn walled off
97% become healed or dormant
3% active TB |
|
|
Term
| describe some characteristic symptoms of primary TB |
|
Definition
decr. immune competence
severe pneumonia unresponsive to abx
pleurisy, effusion
can manifest extrapulmonarily as meningitis, pericarditis, miliary, and renal TB
upon CXR/CT/autopsy, may see Ghon complex |
|
|
Term
| describe some characteristic symptoms of reactivation TB |
|
Definition
breakdown of site of previous infxn
caseous necrosis
malaise, fever (FUO), sweats, weight loss (consumption)
cough, sputum, hemoptysis, chest pain
radiographic infiltrates in upper zone with possible cavitation(s) |
|
|
Term
| what is the ddx for symptoms that present similarly to TB? |
|
Definition
chronic bronchitis
cancer
pneumonia
fungal disease |
|
|
Term
| What is the preliminary dx test for TB? How could you confirm that dx? |
|
Definition
(+) smear for acid-fast bacillus
confirm with (+) sputum culture, abscess aspiration, node bx, blood, urine |
|
|
Term
| Pathologic findings in TB are all PRESUMPTIVE until getting what (+) test result? |
|
Definition
|
|
Term
| What drug therapy is best for treatment of TB? |
|
Definition
| combos of INH, RIF, ETH, PZA with prolonged directly observed therapy |
|
|
Term
| What are the best methods of TB INFECTION prevention? |
|
Definition
immunization (not in United States)
patient identification and isolation
(-) pressure hospital room and mask |
|
|
Term
| What are the best methods of TB DISEASE prevention? |
|
Definition
INH daily for 6 mo. decr. lifetime risk
treat infected ppl at high risk for developing disease
treat ppl w/ recent exposure to confirmed active case
treat new PPD+ |
|
|
Term
| What are some symptoms of allergic bronchopulmonary aspergillosis (ABPA)? |
|
Definition
| asthma-like, mucus plugging, bronchiectasis |
|
|
Term
| Where would you see an aspergilloma? |
|
Definition
| a fungus ball in a sarcoid/TB cavity |
|
|
Term
| Who is at highest risk for aspergillus? Best treatment? |
|
Definition
neutropenic pts
need multiple abx |
|
|
Term
| What is the usual treatment for the mycoses? |
|
Definition
| amphotericin B or one of the "conazoles" |
|
|
Term
| Where do you find histoplasmosis? coccidiomycosis? blastomycosis? |
|
Definition
Ohio and Mississippi River valleys
U.S. Southwest
Southeastern U.S. |
|
|
Term
| How does the short process of the malleus appear with otitis media? |
|
Definition
| more prominent causing TM retraction |
|
|
Term
| How does the handle of the malleus appear with otitis media? |
|
Definition
| more horizontal w/ TM retraction |
|
|
Term
| When is the long process of the incus visible? |
|
Definition
| only when the TM is transparent and healthy |
|
|
Term
| What does the Weber Test test? |
|
Definition
| sensorineural heaing loss variations b/t the ears |
|
|
Term
| What does the Rinne Test test? |
|
Definition
| tests to see if hearing loss is conductive or sensorineural |
|
|
Term
| What are symptoms and treatment of cerumen impaction? |
|
Definition
ear fullness, hearing loss
suction, water irrigation, curetting |
|
|
Term
| What are characteristics of exostoses? |
|
Definition
bony protuberances of ear canal which prevent visualization of TM, a history of cold water swimming
surgery only when symptomatic |
|
|
Term
| What are symptoms and treatment of auricular perichondritis? |
|
Definition
otalgia, swelling, tender, trauma
pseudomonas aureoginosa is the MCC
give abx, incise, drain |
|
|
Term
| What are symptoms and treatment of auricular folliculitis? |
|
Definition
very painful, S. aureus infxn of hair follicle
if abscess, incise, drain
oral abx |
|
|
Term
| What are symptoms and treatment of bacterial otitis externa? |
|
Definition
aspergillus (black) or candidiasis (white)
local cleaning, mycostatin, lotrimin, acetic acid
avoid water |
|
|
Term
| What are symptoms and treatment of necrotizing otitis externa? |
|
Definition
a life-threatening pseudomonas infxn
CN paralysis (VII, IX, X, XI, XII)
otalgia, purulent frainage, granulation tissue
canal debridement, systemic abx, control underlying factor |
|
|
Term
| What is the MCC of malignant tumors of the ear canal? What are some symptoms associated? |
|
Definition
squamous cell carcinoma
pain and facial paralysis in advanced stages
ulcerated mass in ear |
|
|
Term
| What are symptoms and treatment of bullous myringitis? What is the MCC? |
|
Definition
severe otalgia, bullae on TM
clean, instill local abx drops
oral erythromycin
MCC is mycoplasma pneumonia |
|
|
Term
What are symptoms and treatment of actue otitis media?
What is the MCC? |
|
Definition
usually post-URI and the 2nd most common childhood disease (75% of kids have 3 AOMs by age 7)
severe otalgia, fever, hearing loss, erythematous bulging TM, bloody, purulent fluid if TM rupture
typanostomy tube insertion, analgesics, abx, myringotomy and drainage
MCC is strep. pneumoniae |
|
|
Term
| What are symptoms and treatment of otitis media w/ effusion? |
|
Definition
serous or mucoid fluid accumulates in middle ear, the MCC of hearing loss in children
conductive hearing loss, retracted TM, amber-colored TM, decr. mobility, prominent blood vessels
likely post-AOM, barotrauma, patulous e.tube
MCC is strep. pneumoniae
does not respond to abx, but Rx is abx, steroids, myringotomy w/ tubing |
|
|
Term
| What are symptoms and treatment of a cholesteatoma? |
|
Definition
cystic structure w/ keratinizing squamous epithelium from TM extending towards middle ear and mastoid cavity.
tissues of cholesteatoma wall have enzymes that can dissolve bone
purulent ear drainage, TM perferation, hearing loss, pain, dizziness, facial paralysis
treatment: tympanomastoidectomy and local cleaning |
|
|
Term
| What are some complications of supperative ear disease (AOM or cholesteatoma) |
|
Definition
bony erosion, damage of preformed pathways like the oval/round windows, labyrinthine system
extracrainial: subperiosteal abscess (acute mastoiditis)
intracranial: meningitis (the MCC of intracranial complications due to OM); brain abscess (MCC of death due to OM) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| a surgical reconstruction of the TM with or without repair to the ossicles |
|
|
Term
| what is the ratio of head and neck cancer in men vs. women? |
|
Definition
|
|
Term
| what are the 2 primary causes of head and neck cancer? How would you describe their effect if used together? |
|
Definition
tobacco and alcohol
synergistic |
|
|
Term
| oral carcinoma is much more common in what group? |
|
Definition
| heavy drinkers, regular smokers |
|
|
Term
| What virus has been identified in premalignant and malignant lesions of the mouth and throat? |
|
Definition
|
|
Term
| 1/3 of patients when carcinoma of the lip work in what type of environment? which lip is most common? which type of cancer is most likely? |
|
Definition
outdoor occupation
lower lip
squamous cell ca. |
|
|
Term
| What sexually transmitted infection increases the chance for lip cancer development? |
|
Definition
syphilis
(formation of lip chancre, increased cell division, increased chance for cancerous mutation) |
|
|
Term
What type of epithelium covers the respiratory tract from the larynx to the respiratory bronchioles?
*What is the one exception? |
|
Definition
pseudostratified columnar epithelium
*the vocal cords covered by non-keratinizing squamous epithelium |
|
|
Term
| What type of epithelium covers the respiratory tract from the larynx to the respiratory bronchioles? |
|
Definition
|
|
Term
| What 3 histologic traits do premalignant oropharyngeal tumors demonstrate? |
|
Definition
hyperkeratosis
hyperplasia
dysplasia |
|
|
Term
| Head and neck cancers are predominately of what cell type? |
|
Definition
|
|
Term
| What traits are common in the appearance of squamous cell carcinoma? |
|
Definition
exophytic
ulcerative
infiltrative
verrucous |
|
|
Term
| What does evidence of perineural carcinoma invasion indicate? |
|
Definition
| more extensive local and regional disease w/ a worse prognosis |
|
|
Term
| What does evidence of vascular carcinoma invasion indicate? |
|
Definition
| much higher probability of metastasis |
|
|
Term
| Why would someone with a cancer causing changes in their voice have a better cancer px? |
|
Definition
| because they would present earlier for laryngeal cancer, thus better options for treatment |
|
|
Term
| What is the most common site of metastasis for laryngeal carcinoma? |
|
Definition
| the jugular digastric lymph nodes |
|
|
Term
| What is the most common site of metastasis for oral carcinoma? |
|
Definition
| submandibular/submental nodes |
|
|
Term
| How is a PET scan useful in cancer dx? |
|
Definition
to search for an unknown primary tumor
or
to evaluate recurrent tumor
or
to define distant metastases |
|
|
Term
| difficulty swallowing can be characteristic of what cancer location? |
|
Definition
pharyngeal or hypopharyngeal, but also commonly a metastatic neck node
(if a neck node, this significantly worsens prognosis) |
|
|
Term
| Which type of tumors of the head do not seem to be affected by cigarette smoking or tobacco use? |
|
Definition
|
|
Term
| What would be the primary treatment for a laryngeal cancer? |
|
Definition
| targeted radiotherapy to preserve the functions of the larynx such as speaking |
|
|
Term
| What is the primary treatment for early/solitary tumors of the head and neck? |
|
Definition
surgery*
as long as the surgery would not compromise function of an important structure |
|
|
