respiratory diseases
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| show | Relatively rare disorder of the peripheral nervous system in which flaccid paralysis of the skeletal muscles and loss of reflexes develop in previously healthy pt.
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| show | Mucus accumulation,Airway obstruction,Alveolar consolidation, Atelctasis
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| show | not known. Onset frequently occurs 1-4 weeks after a febrile episode like a upper respiratory or GI illness.
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| signs of GB include? | show 🗑
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| show | in about 85% to 95% of the cases, although approx 40% of might have minor residual symptoms
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| common noncardiopulmonary symptoms of GB? | show 🗑
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| What are Early symptoms of GB: | show 🗑
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| show | diminished breath sounds, crackles and rhonchi
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| show | Plasmapheresis(5 exchanges of 3 L each over 8-10 days is usually adequate.), Infusion of immunoglobulin, Corticosteroids
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| characteristics of GB? | show 🗑
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| show | Chronic disorder of the neuromuscular junction that interferes w/ the chemical transmission of ACH btw the axonal terminal and the receptor sites of voluntary muscles.,Disorder affects the myoneural junction (motor), sensory function not lost
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| major P&S changes for MG? | show 🗑
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| show | cause appears to be related to circulating antibodies of the autoimmune system (anti-ACH receptor antibodies).
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| MG is Most common in? | show 🗑
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| show | often provoked by emotional upset, physical stress, exposure to extreme temp changes, febrile illness, pregnancy
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| diagnosis of MG is based on? | show 🗑
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| show | facial muscle weakness, double vision, difficulty in breathing, talking, chewing or swallowing, muscle weakness in arms and legs, fatigue brought on by repetitive motions, also speech impairment
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| what is Edrophonium test? | show 🗑
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| show | Weakness of striated muscles(ptosis,diplopia,speech impairment,dysphagia), gradual onset,
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| what are first symptoms of MG? | show 🗑
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| show | pt's vital capacity, blood pressure, oxygen saturation, and ABG
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| show | when the pt's clinical data demonstrate impending or acute ventilatory failure.
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| show | It inc the concentration of ACH to compete w/ the circulating anti ACH antibodies, which interfere w/ the ability of ACH to stimulate the muscle receptors
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| how are immunosuppressants used for MG? | show 🗑
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| show | the thymus gland frequently appears to be the source of anti-ACH receptor antibodies- in some pts, muscle strength improves soon after surgery, whereas in others improvement takes months or years.
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| how is Plasmapheresis used for in MG? | show 🗑
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| MG is specifically characterized by? | show 🗑
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| The cause of MG is believed to concern antibodies. It is believed that the antibodies disrupt the chemical transmission of ACH at the neuromuscular junction by? | show 🗑
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| what is seen after the administration of tensilon in a person with MG muscular weakness? | show 🗑
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| show | most popular agents are edrophonium chloride , neostigmine , pyridostigmine
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| how does tensilon work? | show 🗑
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| show | (tensilon),
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| show | (prostigmin)
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| show | (regonol, mestinon)
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| show | Interstitial and intra-alveolar edema and hemorrhage, Alveolar consolidation, Intra-alveolar hyaline membrane, Pulmonary surfactant deficiency or abnormality, Atelectasis
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| show | lungs look heavy and red, beefy or liver like
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| show | Restrictive lung disorder
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| what was ARDS Historically referred to as? | show 🗑
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| in ARDS the intra-alveolar walls become lined w/ a thick, rippled hyaline membrane identical to the hyaline membrane seen in | show 🗑
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| show | contains fibrin and cell debris
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| etiologies of ARDS #1 | show 🗑
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| what is Disseminated-intravascular coagulation? | show 🗑
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| what is Septic shock is caused by | show 🗑
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| what are clinical manifestations of ARDS? | show 🗑
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| what will a chest assessment of ARDS sound like? | show 🗑
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| a mild to moderate ABG of ARDS looks like | show 🗑
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| show | dec pH, inc Paco2, inc Hco3, dec Pao2
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| the chest xray for ARDS shows? | show 🗑
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| what will the mech vent settings be for ARDS? | show 🗑
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| show | dec high transpulmonary pressure, reduce overdistention of the lungs, dec barotrauma
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| etiologies of ARDS #2 | show 🗑
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| show | pulmonary disorders that are all associated w/ pulmonary inflammatory changes
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| CILD rest/obst? | show 🗑
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| show | Fibrotic thickening of the respiratory bronchioles and alveoli, Granulomas, Destruction of the alveoli and adjacent pulmonary capillaries, Honeycombing and cavity formation, Airway obstruction caused by inflammation and bronchial obstruction
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| another name for Extrinsic allergic alveolitis is | show 🗑
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| Extrinsic allergic alveolitis aka hypersensitivity pneumonitis is | show 🗑
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| what is an example of Extrinsic allergic alveolitis? | show 🗑
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| Idiopathic pulmonary fibrosis is a | show 🗑
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| show | acute interstitial fibrosis of the lung, cryptogenic fibrosing alveolitis, hamman-rich syndrome, honeycomb lung, interstitial fibrosis, interstitial pneumonitis
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| show | hyperplasia, desquamation of alveolar type II cells, alveolar spaces are packed w/ macrophages, even distribution of interstitial mononuclear infiltrate. Better prognosis than UIP
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| show | interstitial and alveolar wall thickening caused by chronic inflammatory cells and fibrosis
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| what is seen in severe cases of UIP? | show 🗑
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| who is IPF seen in? | show 🗑
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| show | by open lung biopsy
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| what is Rheumatoid arthritis? | show 🗑
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| How is rheumatoid arthritis a CILD (how does it affect the lungs?) | show 🗑
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| what is the most commonly pulmonary complication associated w/ rheumatoid arthritis? | show 🗑
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| Pleurisy is | show 🗑
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| show | multisystem disorder that mainly involves the joints and skin. Also may cause problems in the kidneys, lungs, nervous system and heart.
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| how many cases of lupus involve the lungs? | show 🗑
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| show | pleurisy w/ or w/o effusion, atelectasis, diffuse infiltrates and pneumonitis, diffuse intersitial lung disease, uremic pulmonary edema, diaphragmatic dysfunction, infections
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| what is the most common pulmonary complication of lupus? | show 🗑
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| show | progressive pulmonary fibrosis of the lung commonly seen in coal miners
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| show | disease of unknown etiology that involves two organ systems- the lungs and the kidneys.
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| how does goodpasture's syndrome affect the lungs? | show 🗑
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| show | glomerulonephritis characterized by the infiltration of antibodies within the glomerular basement membrane
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| good pasture syndrome is usually seen in? | show 🗑
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| show | 15 weeks. About 50% of pts die form massive pulmonary hemorrhage, and about 50% die from chronic renal failure
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| Bronchiolitis obliterans w/ organizing pneumonia- called BOOP is characterized by | show 🗑
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| etiology of BOOP> | show 🗑
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| show | patchy infiltrates of alveolar rather than intersitial involvement
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| show | inc tactile and vocal fremitus, dull percussion, bronchial B.S., crackles
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| what are the chest xray findings? | show 🗑
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| All expiratory maneuver findings (eg FVC, FEV, FEF)? | show 🗑
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| what are the lung volume and capacity findings (eg Vt, RV, FRC)? | show 🗑
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| show | corticosteroids and plasmapheresis
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| what disorders are associated with interstitial inflammation accompanied by granuloma formation? | show 🗑
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| what happens in Severe cases of GB? | show 🗑
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| microscopically what is seen in GB?] | show 🗑
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| show | high antibody titers
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| show | excellent
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| the diagnosis of GB is based on | show 🗑
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| GB is more common in: | show 🗑
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| Non REM sleep- usually begins | show 🗑
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| in non REM sleep During stages 1 and 2 | show 🗑
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| show | ventilation becomes slow and regular. Minute volume is commonly 1 to 2 lpm less. PaCO2 levels are higher (4-8 mm hg), PaO2 levels are lower (3-10 mmhg) and the pH is lower (.03-.05 units)
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| non REM sleep Lasts | show 🗑
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| show | spent in stage 2. person may move into REM sleep at any time though it occurs most often before stage 1 and 2
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| during REM sleep-vent rate | show 🗑
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| show | Bc the muscle tone of the intercostal muscles is low, the neg intrapleural pressure generated by the diaphragm often causes a paradoxical motion of the rib cage;Loss of muscle tone in the upper airway leads to obstructions
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| REM sleep Lasts | show 🗑
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| show | Lengthen and become more frequent toward the end of the night's sleep,Consitutes about 20-25% of the total sleep time, Studies show that it is more difficult to awaken a subject during REM sleep
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| Apnea | show 🗑
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| Sleep apnea is diagnosed in pts who | show 🗑
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| show | during REM sleep and in the supine body position
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| show | Caused by an anatomic obstruction of the upper airway in the presence of continued ventilatory effort.most commonly encountered
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| show | heightened inspiratory efforts during apneic periods, Apneic episodes followed by increasingly desperate efforts to inhale
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| show | snorting sound may be heard at end of apneic periods
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| in OSA's Severe cases | show 🗑
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| OSA Pts usually demonstrate perfectly normal and regular breathing patterns | show 🗑
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| show | in males, esp middle aged men. Approx 1-4% of adult male population appear to be affected.
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| Pickwickian syndrome and OSA | show 🗑
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| Some clinical disorders associated with OSA: | show 🗑
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| show | Chronic loud snoring,Hypertension,Morning headaches,Systemic hypertension,CHF, Nausea,Dry mouth on awakening
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| show | Apnea-related O2 desaturation-4% or greater drop in SpO2;More than 5 obstructive apneas of more than 10 sec per hour of sleep, and one or more of the following: Frequent arousals, Profound bradycardia and/or asystole,Shortened sleep latency
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| show | respiratory centers of the medulla fail to send signals to the respiratory muscles
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| CSA is Characterized by | show 🗑
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| show | the frequency of the apnea episodes is excessive (more than 30 in a 6 hour period)
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| General noncardiopulmonary clinical manifestations of central sleep apnea can be summarized as follows | show 🗑
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| Diagnosis of CSA begins | show 🗑
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| Chest xray, ECG, and echocardiogram helpful in CSA in evaluating the presence | show 🗑
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| Diagnosis and type of sleep apnea is confirmed w/ | show 🗑
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| show | An EEG and electro-oculogram (EOG) to identify sleep stages,Use of monitoring device for airflow in and out of pt's lungs,An ECG ,Impendance pneumography, intercostal electromyography, esophageal manometry,Ear oximetry or transcutaneous oxygen monitoring
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| show | site and severity of pharyngeal narrowing
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| show | History, Exam of the neck and upper airway structures, heart and lungs,Spirometry (FV loops in the erect and supine positions) to assess for extrathoracic airway obstruction , ABG, Hemoglobin and carboxyhemoblogin levels, Nocturnal recording oximetry
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| in sleep apenea, the ABG looks | show 🗑
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| Negative pressure ventilation is used for which type of sleep apnea | show 🗑
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| what is def of Drowning? | show 🗑
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| def of Near drowning? | show 🗑
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| def of Dry drowning? | show 🗑
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| show | glottis relaxes and allows water to flood the TBT and alveoli. When fluid is initially inhaled, the bronchi constrict in response to parasympathetic reflexes- then the patho processes responsible for noncardiogenic pulmonary edema begin
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| If a victim was submerged in unclean water, pathogens and solid material may be aspirated.can lead to | show 🗑
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| show | are the same in fresh water and sea water -both result in reduction in pulmonary surfactant, alveolar injury, atelectasis and pulmonary edema
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| show | Between 6000 and 8000 people drown each year in the US.
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| show | 40% of deaths. Additional 20% of deaths occur in ages between 5 and 20
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| the major P&S changes of near drowning are: | show 🗑
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| show | atelectasis, alveolar consolidation, inc a-c membrane, bronchospasm
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| in near drowning apnea is | show 🗑
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| what are the chest assessment findings of near drowning? | show 🗑
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| show | low pH, high Pa2, low HCO3 (lactic acidosis is common), low Pao2
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| First objective by first responder is to | show 🗑
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| If pt has been submerged for less than 60 mins in cold water, fixed and dilated pupils means | show 🗑
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| show | hypoxemia, hypercapnia, acidosis
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| show | amt of a-c damage-chest xray should be obtained
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| Intubation and mech vent should be performed immediately for anyone | show 🗑
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| For wet drowning, how should ventilation be handled? | show 🗑
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| radiographic deterioration may occur in near drowning pts within | show 🗑
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| show | injury caused by inhalation of hot gases. Usually confined to upper airway-nasal cavity, oral cavity, nasopharynx, oropharynx, larynx
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| show | The remarkable ability of the upper airways to cool hot gases, Reflex laryngospasm, Glottic closure
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| show | Presence of facial burns
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| show | in mucosal edema, vascular congestion, epithelial sloughing, obliterative bronchiolitis, atelectasis, pulmonary edema
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| show | below the level of the larynx, except in the rare instance of steam inhalation.
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| in Early stage (0-24 hours postinhalation)of smoke inhalation injury | show 🗑
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| Smoke inhalation may also cause | show 🗑
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| Intermediate stage (2-5 days postinhalation) | show 🗑
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| Organisms commonly cultured from smoke inhalation injury are | show 🗑
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| Noncardiogenic pulmo edema and ARDS may develop at any time during | show 🗑
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| When chest wall burns are present, situation may be further aggravated by the | show 🗑
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| Late stage (5 or more days postinhalation) | show 🗑
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| Sepsis induced multiorgan failure is primarily cause of death in what stage? | show 🗑
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| show | both
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| show | alveolar fibrosis and chronic atelectasis
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| Obstructive lung disorder- caused by | show 🗑
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| Major patho and structural changes of Thermal injury | show 🗑
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| show | TBT, alveoli: inflammation of TBT, bronchospasm, excessive bronchial secretions and mucus plugging, dec mucosal ciliary transport, atelectasis, alveolar edema and frothy secretions, ARDS, BOOP, alveolar fibrosis, bronchiectasis
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| show | 1. extent and duration of smoke exposure, 2. chemical composition of the smoke, 3. size and depth of body surface burns, 4. temp of gases inhaled, 5. age, 6. pre-existing health status
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| When smoke inhalation injury is accompanied by a full thickness or third degree skin burn, the mortality rate almost | show 🗑
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| First degree (min depth to skin) | show 🗑
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| show | burns in which damage extends through the epidermis and into the dermis but not sufficient enough to interfere w/ regeneration of epidermis. Blisters present. Healing time: 7-21 days.
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| Third degree (full thickness of skin including tissue beneath skin): | show 🗑
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| Principal goals in initial care of smoke inhalation and thermal injuries: | show 🗑
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| Fluid resuscitation w/ ringer's lactate solution is usually initiated according to the parkland formula which is? | show 🗑
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| show | 30-50 ml/hr
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| show | 2-6 mm hg.
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| fluid resuscitation can lead to | show 🗑
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| show | damage may be equal to a third degree burn.
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| show | normal to hairless and depigmented skin w/ texture that is normal, pitted, flat or shiny
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| show | may occur after 21 days or never occur w/o skin grafting if area is large.
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| show | hypertrophic scares (keloids) and chronic degranulation.
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| fluid resuscitation can lead to] | show 🗑
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