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SWC Heep Respiratory
Respiratory System, Survey Western Clinical Sciences, Heep, Bastyr
| Question | Answer |
|---|---|
| Describe the Basic anatomy of the Respiratory System: | Thoracic cavity Mediastinum Lungs: Right lung has 3 lobes Left has 2 lobes Pleura: Parietal pleura and visceral pleura |
| What are the Respiratory muscles? | internal and external intercostals, diaphragm, SCM and scalene, trapezius, abdominal muscles. |
| What comprises the Upper Airway? | Nasal passages Mouth Pharynx Larynx, vocal cords and epiglottis |
| What comprises the Lower Airway | Trachea Main bronchi Bronchioles Alveolar ducts Alveolar sacs (alveoli/alveolus) |
| Functions of Conductive portion of lung: | Transports air Warms, moisturizes and filters air Mucociliary system |
| Functions of Respiratory portion: | (includes some bronchioles, alveolar ducts and sacs) Gas exchange |
| Types of cells Cells in the Alveolus: | Type I – exchange gas Type II – produce surfactant Macrophages |
| What is spirometry: | Ability to measure lung volumes |
| what are Normal Lung volumes: | Tidal Volume 500 ml Inspiratory reserve volume 3000 ml Expiratory reserve volume 1100 ml Residual volume 1200 ml VC (4600 ml) and TLC (5800 ml) Spirometer |
| What is the normal pH of the blood: | Neutral |
| Describe Metabolic vs. respiratory pH balance: | Respiratory acidosis / alkalosis: change of pH is caused by breathing Metabolic acidosis / alkalosis: change of pH is caused by internal factors |
| Describe Respiratory acidosis / alkalosis: | change of pH is caused by breathing |
| Describe Metabolic acidosis / alkalosis: | change of pH is caused by internal factors |
| Describe effects of Temperature and Oxygen transfer: | Shift to right due to high temp/ high CO2 and low pH Shift to left due to low temp / low CO2 and high pH |
| Define Bradypnea: | slow respiration rate < 12 bpm |
| Define Tachypnea: | rapid (shallow) breathing >18 bpm |
| Define Apnea: | no breathing |
| Define Hyperpnea: | increase in rate and depth of breathing Hyperventilation |
| Define Dyspnea: | shortness of breath (SOB), difficulty breathing or painful breathing. |
| Define Cheyne-Stokes breathing: | periodic apnea |
| What are the complications of Cheyne Stokes breathing: | Congestive heart failure CNS lesion, stroke Normal, adaptation to high altitude |
| Describe age Ranges and Bradypnea: | Age 0-1 year < 30 bpm Age 1-3 years < 25 bpm Age 3-12 years < 20 bpm Age 12 and older < 12 bpm |
| What is an RTI? | Respiratory Tract Infection. |
| What is an URI? | Upper respiratory Infection |
| What is an LRI? | Lower Respiratory tract infection |
| Describe RTI’s | Mostly viruses: self limited common cold to life-threatening pneumonia. Affects upper and lower respiratory tract. URI LRI Some diseases (measles and chicken pox) are contagious through respiration though no presentation in respiratory system. |
| Complications of RTI’s | Can lead to secondary bacterial infection |
| Common pathogens in Respiratory system: | Viral: Rhinovirus, RSV, influenza, adenovirus Bacteria: Staph., Pneumococci Mycobacteria: TB Fungi: Histoplasmosis, blastomycosis Opportunistic organisms: Pneumocystis carinii |
| Describe common cold: | Viral Infection – in cold seasons. |
| Sx of Common Cold: | URI: starts with dryness and stuffiness in nasopharynx, sore throat, ear plugging. Clear watery nose/eye secretion. Fever, chills, body ache, erythema in throat. Usually self-limited (if no bacterial super-infection) – up to 7 days. |
| Tx of common cold: | Tx: no ABx needed, rest, water, steam inhalation, OTC meds. |
| Describe OTC meds for common cold: | Antipyretic Antihistamines: can cause dryness, more cough Decongestant: can cause systemic vasoconstriction – increase BP Use with caution in HTN, Hyperthyroidism, DM. |
| Viruses involved in common cold: | Rhinovirus in cold seasons RSV in winter and spring Para-influenza type 1, 2, 3 Adenovirus and coronavirus: epidemic in winter and spring |
| Describe Sinusitis: | Inflammation/infection of the sinuses. Mostly viral, sometimes bacterial or fungal |
| Describe acute to chronic sinusitis: | Acute (<4 weeks), sub-acute (4 -12 weeks) chronic (> 3 months), recurrent acute (4+/yr) |
| Sx of Sinusitis: | Nasal congestion Purulent nasal discharge Tooth discomfort Facial pain/pressure worse bending forward |
| DDX for acute sinusitis: | Allergic rhinitis and common cold |
| DDX for chronic sinusitis, | more dull pain, HA, PND, chronic cough and bad breath. |
| Tx for Sinusitis: | ABX (antibiotics) treatment, decongestant, expectorants, steaming and saline nasal wash. |
| Complications of Sinusitis: | Facial edema Eye involvement, swelling, pain, pressure Cellulitis: infection of interstitial space Meningitis Intracranial abscess |
| Describe Influenza: | Flu is a viral infection (RNA virus); types A, B |
| Describe Type A Influenza: | Type A is most common and most severe. Can cause epidemics |
| DDX of Influenza: | : common cold, but influenza is a much more severe disease. |
| Is the onset of the Flu Rapid? | Onset very rapid, within 1-3 days. |
| Complications of Influenza: | sinusitis, otitis media, bronchitis, viral/bacterial pneumonia. Can cause URI or LRI. Can progress rapidly to bacterial super-infection and pneumonia, specially in immune deficient and elderly patients and become LRI and pneumonia. |
| Can Influenza cause death? | Can cause death in people > 65 years old. |
| Sx of Influenza: | Fever, sore throat, myalgia, HA, cough, malaise and weakness. Other symptoms like other viral URIs |
| Is nausea and vomiting a symptom of the Flu? | Although nausea and vomiting can be produced, especially in children, these symptoms are more characteristic of the unrelated gastroenteritis, which is sometimes called "stomach flu" or "24-hour flu." |
| Tx of Influenza: | Rest Keep warm Lots of liquid Refer, need antibiotics and life support. |
| Describe Bronchitis: | inflammation of the bronchi or airways, mostly medium sized airways. |
| Acute Bronchitis is: | viral, bacterial |
| Chronic Bronchitis could be: | COPD, caused by smoking or other irritants |
| Sx of Bronchitis: | cough, sputum, SOB, wheezing, occasional fever and fatigue |
| Describe Pneumonia: | lung parenchyma alveoli are inflamed and filled with fluid. Hard to exchange gas |
| Etiology of Pneumonia: | Can be due to: Bacteria, Virus, Fungal, Parasite Idiopathic Chemicals, irritants |
| Define Pneumonia: | Inflammation of the parenchymal structure of the lungs. |
| What causes Non-infectious pneumonia: | fumes and irritants |
| Types of Infectious pneumonia: | Bacterial (typical pneumonia): Strep. pneumoniae Bacterial (atypical pneumonia): Mycoplasma pneumoniae, (atypical bacteria) Other: Candida, viruses, Pneumocystis carinii |
| Predisposing factors of Pneumonia: | Smoking , damage to the ciliated endothelium of the respiratory tract Loss of cough reflex Low immunity |
| Symptoms of pneumonia: | Previous URI/influenza High fever and chills, productive cough, sputum, chest pain and dyspnea, body ache, nausea, fatigue. Feeling of heaviness and consolidation in the chest (lungs). |
| Sx of viral and mycoplasma pneumonia: | cough is dry, hacking and non-productive. |
| Body defense against pneumonias: | Cellular, the macrophages Immunoglobulins: IgA and IgG |
| Difference of Community acquired vs. hospital acquired pneumonia | S. pneumonia = community aquired legionella pneumophilia (gram-negative bacillus). = hospital aquired |
| Describe pneumocystis jirovecii: | PCP. Fungal infection, intracellular in lung cells |
| Who si susceptible to pneumocystis jirovecii: | immunodeficient individuals. Common in AIDS, immunodeficient patients like cancer, radiation, chemotherapy… |
| Sx of pneumocystis jirovecii | High fever, shortness of breath, nonproductive cough, cyanosis. REFERRAL Been treated with ABx: Trimethoprim-sulfamethoxazole (Bactrim) Pentamidine |
| Describe tuberculosis: | Aerobe acid-fast bacillus, called Mycobacterium tuberculinum. |
| Major forms of TB: | 2 major forms of the bacillus: 1) M.T hominis – through airborne droplet nuclei 2) M.T bovis – from cow milk Also Atypical Mycobacterium in north America: M. kansasii M. avium, opportunistic in AIDS |
| Describe Pathogenesis of TB: | Exposure Primary infection granuloma Reactivation Secondary infection Mostly self-limited in the primary stage, forming granuloma in lung. |
| Effects of TB: | Evokes a “hypersensitivity” response in body Tuberculin test (PPD) becomes positive |
| Sx of TB: | If low immunity or reactive: low grade fever, cough, night sweats, anorexia, weight loss. |
| Describ chain of events of TB exposure: | 1) Exposure primary infection: low grade fever, chest pain, sometimes flu like illness, formation of granuloma 2) Reactivation, d/t stress, illness, etc insidious onset of cough, weight loss, fatigue, fever and night sweats, chest pain, hemoptysis |
| Describe fungal infections of the lung: | Histoplasmosis, blastomycosis and coccidiomycosis Are common but seldom serious Similar symptoms to pneumonia and tuberculosis. |
| Describe Lung Cancer: | Leading cause of cancer death in USA 25% of all cancer death due to lung cancer |
| Risk factors of lung cancer: | Smoking (10-30 fold increased risk) Industrial material such as asbestos |
| Describe diagnosis and prognosis of lung cancer: | Usually diagnosed in advanced stage Poor prognosis – 5 year survival is about 15% |
| What are the most common types of lung cancer? | 90% are: Non-small cell lung carcinoma (NSLC) Squamous cell carcinoma Large cell carcinoma Adenocarcinoma Small cell carcinoma (SCLC): 15% Smokers only Invasive, poor prognosis Paraneoplastic properties |
| Describe Manifestations of lung cancer: | Slow growing. Present as chronic bronchitis, or smoking side effects; weight loss, night sweats. Local involvement: pressure or secretionMetastasis: brain, bone and liver Can manifest 6 months to 4 years before tumor detected |
| Describe Paraneoplastic disorders: | Hypercalcemia due to high PTH like peptide Cushing’s syndrome due to ACTH secretion |
| What are the Tools to detect Lung Cancer: | Medical history Imaging: XRay, MRI, CTscan, ultrasound, bronchoscopy. CEA for follow up |
| What are the categories of pulmonary disorders? | Disorders of lung inflation Obstructive Airway Disorders Restrictive Airway Disorders Pulmonary Vascular Disorders Breathing Disorders |
| What physical tests can diagnose Lung cancer, (or at least find something abnormal)? | Breath Sounds: Resonance is Hyper-resonance or Dullness Increased Tactile Fremitus Percussion |
| What are disorders of lung inflation: | Pleural disorders Pleuritis Pneumothorax Pleural effusion Atelectasis |
| Describe the pleura of the lungs: | Double layer membrane: visceral and parietal Pleural cavity/space and serous fluid |
| Describe the negative pressure of the pleura? | Negative pressure in pleural cavity compared to alveolar pressure. This negative pressure keeps the lungs open and resists lung collapse. |
| Causes of Inflammation of the pleura: | viral respiratory infection, pneumonia, direct trauma |
| Sx of Inflammation of the pleura: | Unilateral pain, usually lateral and lower part of chest Pain is stabbing and worse with deep breathing |
| DDx of Inflammation of the pleura: | Musculoskeletal, MI (Myocardial Infarction) |
| Tx of Inflammation of the pleura: | Mostly self limited NSAIDs |
| What are the 3 kinds of Pneumothorax: | Spontaneous Traumatic Tension |
| Symptoms of Pneumothorax: | Acute chest pain, dyspnea |
| Signs of Pneumothorax: | RR increases, HR increases Shallow breathing Asymmetry of chest during breathing Decrease tactile fremitus, absent lung sounds, hyperresonance on percussion |
| Describe causes of Pneumothorax: | Lung diseases - Air enters the pleural space via damaged alveoli. COPD, asthma Pneumonia TB Cancer, metastasis Trauma: Acupuncture, rib fracture |
| What is a pleural effusion? | Accumulation of fluid in the pleural cavity |
| Causes of Pleural effusion: | Due to local or systemic conditions:Trauma to chest, lung cancer, infections like pneumonia or lung abscess, autoimmune conditions (RA and SLE), kidney problems, heart problems (CHF), liver problems. |
| Sx of Pleural effusion: | dyspnea and shifting of the trachea and mediastinum (unilateral). |
| Signs of Pleural effusion: | decreased breath sounds, dullness on percussion, decreased tactile fremitus |
| Define Atelectasis: | Incomplete expansion of the lung. Will cause collapse of lung partial or total. Complication of pneumothorax and pleural effusion. |
| Who is most likely to have Atelectasis: | Primary: in premature infants Secondary or acquired Obstruction of airways or pressure from outside like tumor or pleural effusion or pneumothorax. |
| Symptoms of atelectasis: | reduced lung capacity and pleural inflammation can be present. |
| What are some obstructive airway disorders: | Bronchial Asthma Chronic Obstructive Pulmonary Disease (COPD) Emphysema Chronic bronchitis Bronchiectasis Cystic fibrosis |
| Describe the transition in terms of anatomy of Upper airways to lower airways: | – reduction in the cartilage that supports the wall and increase in smooth muscle. |
| Describe the interaction of the Autonomic nervous system: | Parasympathetic: vagus nerve (CN X), ACh receptors constriction of the airways. Sympathetic and β2-adrenergic receptors dilation of airways. Histamines and IgE constriction |
| Describe Bronchial Asthma: | Chronic inflammation and narrowing of the airways & hyperresponsiveness. Incidence is increasing worldwide |
| Describe the acute and chronic stage of Bronchial Asthma: | Acute stage entails constriction of the airways. Chronic stage entails inflammation and mucus production. |
| Describe pneumohemothorax: | The accumulation of blood in the thoracic cavity (hemothorax) exacerbates the pneumothorax, creating a pneumohemothorax. |
| Etiology of Non allergic Bronchial Asthma: | irritants, infections especially viruses, cold air, exercise, drugs and medication, emotions. |
| Etiology of Allergic Bronchial Asthma: | usually with other allergic symptoms such as GI and skin allergic problems – starts younger age (childhood asthma). Eczema and asthma pattern. Medications: |
| Medications for Acute bronchial asthma: | β2 adrenergic agonist – stimulate β2 receptors and mimic sympathetic bronchodilation (albuterol). Anticholinergics – antagonist of the parasympathetic (ipratropium). |
| Medications for chronic bronchial asthma: | Anti-inflammatory – reduce the inflammation in airways (↓ hyperresponsiveness) Cromolyn and nedocromil stabilize the allergy cells (mast cells); less production of IgE. Steroids – potent antiinflammatory action |
| Describe Asthmatic attack: | acute episode of bronchospasm and constriction. Expiration more difficult than inspiration resulting in air trapped in lungs. |
| Symptoms of Asthmatic attack: | Wheezing and tightness in the chest Cough Dyspnea Exhaustion |
| Signs of Asthmatic attack: | Respiratory distress Cyanosis Drop in BP |
| Describe COPD: | Group of respiratory disorders characterized by chronic and recurrent obstruction of airflow |
| What is the most common cause of COPD: | Most common cause for it is smoking, clinical findings usually absent during early stages, when present disease is already advanced. |
| What are Other risk factors of COPD: | Inhaled toxins Congenital α1-antitripsin deficiency |
| Types of COPD: | Emphysema and chronic bronchitis, asthma |
| Describe Emphysema: | Loss of lung elasticity and abnormal permanent enlargement of air spaces and hyperinflation of lungs. |
| Etiology of Emphysema: | smoking, “α1-antitrypsin” deficiency This is an enzyme that inhibits elastase; which is the enzyme that digests proteins (Elastin) in the lung. (more elastase less Elastin) |
| Describe bronchitis: | Excess mucus excretion into the bronchial tree Simple bronchitis Chronic obstructive bronchitis |
| Sx of Bronchitis: | History of 3 months of cough in 2 consecutive years in the absence of other reasons. |
| Risk factors of Bronchitis: | middle aged men, smoking and recurrent lung infections. |
| Symptoms of Bronchitis: | Cough, respiratory distress, impaired gas exchange, imbalance of perfusion and ventilation leading to hypoxemia. |
| Describe Bronchiectasis: | Thickening and dilation of the major bronchi/bronchioles due damage of the wall secondary to recurrent infection. |
| Describe Cystic Firrosis: | Autosomal recessive genetic disorder Abnormal transport of Cl- and Na+ thick, viscous mucus production |
| Symptoms of Cystic Fibrosis: | Chronic lung disease: thick mucus, productive cough, recurrent infections, COPD Pancreatic exocrine deficiency: digestive problems Elevation of sodium chloride in the sweat |
| Describe Interstitial Lung Disease: | Inflammation and fibrosis in the lungs, resulting in decrease of lung compliance. Affects the supportive collagen and elastic tissue in lungs |
| Describe Sarcoidosis: | An immune system disorder characterized by small inflammatory nodules (granuloma) formation in lungs. |
| Who is most likely to aquire Sarcoidosis: | Most commonly arises in young adults. The cause of the disease is still unknown. |
| What organs can be affected by Sarcoidosis: | Virtually any organ can be affected |
| Symptoms of Sarcoidosis: | Commonly Asx (found on CXR), insidious or acute. Cough, dyspnea, chest pain Fatigue, fever, weight loss |
| What are pulmonary vascular diseases: | Pulmonary embolism Pulmonary hypertension Cor pulmonale |
| Describe Pulmonary embolism: | A blood borne substance lodges in a branch of the pulmonary artery and obstructs blood flow. (embolus) Thrombus, air or fat can be embolus |
| Describe Cor pulmonale: | Right heart failure due to primary pulmonary disease. |
| Describe Obstructive Sleep Apnea (OSA): | Reduced airway size & ↓ neural input airway collapse. Cessation of airflow (apnea) though nose and mouth for ≥ 10 seconds. 5-30 episodes per hour Risk factors for OSA: |
| Symptoms of OSA: | daytime sleepiness, noisy snoring, insomnia, abnormal moving during sleep, morning headache, erectile dysfunction, HTN |
| Describe Hyperventilation syndrome: | Over-breathing and reduction in PCo2 resulting in respiratory alkalosis due to organic problems, drug effects, CNS problems, heat, exercise and emotional states. |
| Sx of Hyperventilation syndrome: | Headache, dizziness, lightheadedness, tingling and numbness in fingers and syncope. |
| Describe Occupational lung disease: | lung diseases due to toxic drugs and radiation and lung diseases of unknown origin as such as sarcoidosis. |
Created by:
bastyr41
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