Pathology Test 3 Lecture 3 First Half

Front 1

3 main portions of the respiratory system:
_- Humidifies, warms, cleans
Nasal cavities, sinuses, pharynx, tonsils & larynx
_-Trachea, bronchi & bronchioles
_-Air sacs and primary lobules (acini)

Back 1

Upper airway
Lower airway
Terminal alveoli

Front 2

_- lung disease were pt. gets accumulation of mucus in their lungs (accumulation in the _)

Back 2

Cystic fibrosis
lower airway

Front 3

Pulmonary system function:
-
-
-

Back 3

Temperature regulation- exhalation
Hormone secretion
Gas exchange- O2 CO2

Front 4

Pulmonary System Function:
_ —ability to move air in & out of the lungs via a pressure gradient
Patho—of the airways, lungs, chest wall & diaphragm affects _
_ —gas exchange that supplies O2 to the blood & body tissues & removes CO2
Patho—of the lungs & CV system, as well as the peripheral tissues affects _

Back 4

Ventilation xs 2
Respiration xs 2

Front 5

How do we help ppl cough- _

Back 5

put them in supine and then push their stomach upward

Front 6

ventilation steps:
1. inspiration begins w/contraction of the _ and _ muscles
2. _flattens & descends, increasing _ length
3. _muscles raise ribs & sternum up & outward, increasing the _ surface area
4. _increase results in decreased _ in pleural cavity & alveoli & airways
5. as ribs & diaphragm moves, attached_ pulls adhering _ and _ along with it
6. as _ moves outward, the elastic lungs expand with it, resulting in a _in air _into the lungs
7. at this point, atmospheric pressure is _ intra-alveolar pressure, SO air flows from _ to _
8. normal expiration—_ and _muscles relax, leading to a _ in thorax size
9. this _, along with natural _ of alveoli, results in increased _ pressure (_atmospheric pressure)
10. so air flows_ of the alveoli into the atmosphere. Quiet expiration is a _process & does not require _. Forced inspiration or expiration does

Back 6

diaphragm & external intercostal
diaphragm
thoracic cavity
external intercostal
thorax
thorax
pressure
pleura
visceral pleura & lungs
visceral pleura
decrease
pressure
>
atmosphere to alveoli
diaphragm & external intercostal
decrease
decrease
elastic recoil
intraalveolar
>
out
passive
energy

Front 7

Exhale is a_ process (usually), use the _ to do forced expiration

Back 7

passive
rectus abdominal

Front 8

Uses what muscles?
Inspiration:
Expiration:

Back 8

SCM, scalenes, pectoralis minor & serratus anterior.
abdominals & intercostals

Front 9

-If they have an inspiratory problem those muscle will be _ during inspiration

Back 9

predominant

Front 10

-putting your hands on your knees makes it _ for the upper inspiratory muscles so they can breath better. To_after exercise is better bc a lot of the blood flow is in your legs.

Back 10

closed chain
keep moving

Front 11

Pulmonary Dz:
_ —common condition caused by pulmonary dz or injury. Caused by respiratory alterations or CV compromise. Can lead to-> _ (this is the _ part)
_—decrease of O2 to body tissue. Can occur anywhere in the body caused by an alteration in other systems & may not be related to changes in the pulmonary system. Partial pressure of < 80 mmHg (=90% SaO2) is _. (and this is the _ part)

Back 11

Hypoxemia
hypoxia.
blood
Hypoxia
hypoxia
oxygen

Front 12

hypoxia only precedes hypoxemia with _

Back 12

One exception hypoxia precedes hypoxemia with CO2 poison

Front 13

Hypoxemia causes: mechanism/common clinical causes:
_ Asthma, Chronic bronchitis, Pneumonia
_High altitude,Low O2 content,
Suffocation
_Lack of neuro center stim of respiratory center, Oversedation, Drug overdose,Neuro damage,COPD
_Emphysema, Fibrosis, Edema
_ ARDS, Hyaline membrane disease, Atelectasis

Back 13

-Ventilation/perfusion mismatch
-Decreased O2 content
-Hypoventilation
-Alveolocapillary diffusion abnormality
-Pulmonary shunting

Front 14

_ S and S
_ normal
_mod. tachycardia, possible onset of respiratory distress, DOE
_malaise, lightheaded, nausea, vertigo, impaired judgement, incoordination, restlessness
_marked confusion, cardiac dysrhythmias, labored respiration
_cardiac arrest, decreased renal blood flow, decreased urine output, lactic acidosis, lethargy, LOC

Back 14

hypoxemia
80-100
60-80
50-60
35-50
25-35

Front 15

when puls ox drops below _ S and S begin. if the numbers are even lower we need to have _ on the pt

Back 15

90
oxygen

Front 16

S and S _

Cough
Dyspnea
Chest pain
Cyanosis
Clubbing
Altered breathing patterns

Back 16

pulmonary dz

Front 17

Occurs frequently in healthy people. A persistent dry _ may be the result of a tumor, congestion, or hypersensitive airways (allergies).

Back 17

cough

Front 18

A productive cough w/ _ may indicate infection, WHEREAS a productive cough w/ _ (stuff that is _) is nonspecific & indicates airway irritation.

Spitting up _ is the next level of _

Back 18

purulent sputum
nonpurulent sputum
clear
blood
Sputum

Front 19

_ indicates a patho condition such as infection, inflammation, abscess, tumor or infarction.

Back 19

Hemoptysis

Front 20

_ SOB usually indicates hypoxemia but can be from emotions, esp. fear & anxiety.
factors contributing: _

Back 20

dyspnea
orthopnea

Front 21

_—fluid shifts to the lungs, interferring w/gas exchange. Supine & prone positioning exerts pressure on the diaphragm from abdo contents.

Back 21

Orthopnea

Front 22

_ Usually localized to chest region over the lung fields (ant chest, side or back). May radiate to neck, upper traps, costal margins, thoracic areas, scapula or shoulder.

Back 22

chest pain

Front 23

_ Pleural irritation is sharp local pain aggravated by respiratory motions. Pain reduced by _. (putting pressure on it, by ones-self)

Back 23

chest pain
autosplinting

Front 24

If a rib is fractured can _their rib so they can breath while you treat them

Back 24

autosplint

Front 25

_— bluish discoloration in oral mucous membranes, lips & conjunctivae & is most often associated w/ R to L shunts & pulmonary dz.

Back 25

Central cyanosis

Front 26

_—decreased perfusion to extremities, nail beds & nose & is commonly caused by cold temps, anxiety, heart failure or shock.

Back 26

Peripheral cyanosis

Front 27

_- fits under a vessel Dz problem

Back 27

Raynaud’s

Front 28

clinically detected cyanosis:
Depends on _ & amount of circulating _.
Oxygen saturation in _cyanosis is usually decreased whereas arterial saturation may be normal in _.
In _, vasoconstriction w/decreased blood supply & perfusion rather than unsaturated blood is the underlying cause of symptoms.

Back 28

oxygen saturation
hemoglobin
central
peripheral cyanosis
peripheral cyanosis

Front 29

_Thickening & widening of the terminal phalanges of fingers & toes. Recognized by loss of angle between nail & nail bed.
Schamrath method—if a diamond shape, then no clubbing. Index finger is then inspected

Back 29

clubbing

Front 30

normal values for clubbing:
Normal _ degrees
Curved nail _ degrees or less
Early clubbing: _ degrees and the nail base feels _ to palpation.

Back 30

160
160
180
spongy

Front 31

_—fluid shifts to the lungs, interferring w/gas exchange. Supine & prone positioning exerts pressure on the diaphragm from abdo contents.

Back 31

Orthopnea

Front 32

_ Usually localized to chest region over the lung fields (ant chest, side or back). May radiate to neck, upper traps, costal margins, thoracic areas, scapula or shoulder.

Back 32

chest pain

Front 33

_ Pleural irritation is sharp local pain aggravated by respiratory motions. Pain reduced by _. (putting pressure on it, by ones-self)

Back 33

chest pain
autosplinting

Front 34

If a rib is fractured can _their rib so they can breath while you treat them

Back 34

autosplint

Front 35

_— bluish discoloration in oral mucous membranes, lips & conjunctivae & is most often associated w/ R to L shunts & pulmonary dz.

Back 35

Central cyanosis

Front 36

_—decreased perfusion to extremities, nail beds & nose & is commonly caused by cold temps, anxiety, heart failure or shock.

Back 36

Peripheral cyanosis

Front 37

_- fits under a vessel Dz problem

Back 37

Raynaud’s

Front 38

clinically detected cyanosis:
Depends on _ & amount of circulating _.
Oxygen saturation in _cyanosis is usually decreased whereas arterial saturation may be normal in _.
In _, vasoconstriction w/decreased blood supply & perfusion rather than unsaturated blood is the underlying cause of symptoms.

Back 38

oxygen saturation
hemoglobin
central
peripheral cyanosis
peripheral cyanosis

Front 39

_Thickening & widening of the terminal phalanges of fingers & toes. Recognized by loss of angle between nail & nail bed.
Schamrath method—if a diamond shape, then no clubbing. Index finger is then inspected

Back 39

clubbing

Front 40

normal values for clubbing:
Normal _ degrees
Curved nail _ degrees or less
Early clubbing: _ degrees and the nail base feels _ to palpation.

Back 40

160
160
180
spongy

Front 41

Gasping inspiration followed by short expiration

Back 41

apneustic

Front 42

Fast deep breaths interspersed w/abrupt pauses in breathing

Back 42

biots respiration

Front 43

Repeated cycle of deep breathing followed by shallow breaths or no breathing (bad sign)

Back 43

cheyne-stokes

Front 44

Discontinuous low-pitched sounds heard mostly during inspiration that indicated secretions in peripheral airways (if you hear this follow it up with precussions )

Back 44

crackles/rales

Front 45

Distressing dyspnea w/increased resp. rate, increased depth of respiration, panting, & labored respiration typical of air hunger

Back 45

kussmaul's respiration

Front 46

Anterior chest flattening w/excessive flaring of the lower ribs in supine

Back 46

lateral-costal breathing

Front 47

All or part of the chest wall falls in during inspiration, may be abdo expansion during exhalation; reverse breathing.

Back 47

paradoxical breathing

Front 48

Shrill harsh sound heard during inspiration in presence of laryngeal obstruction

Back 48

stridor

Front 49

High pitched continuous whistling sound, usually w/expiration & related to bronchospasm or other constriction of the airways.

Back 49

wheezing

Front 50

_ Common feature of all types is an inflammatory response to an offending organism or agent.

Back 50

pneumonia

Front 51

_ susceptible-> Older people, infants, bedridden or people w/altered consciousness are more susceptible
Mostly _ is preceded by a Upper Respiratory Infection, mostly viral in nature.

Back 51

pneumonia
pneumonia

Front 52

lung infections- _ -Causes: bacteria, virus, fungus, mycoplasma infection, inhalation of toxic chemicals or aspiration.
It is a leading cause of death in the US.
~30% are _, ~50% are_.

Back 52

pneumonia
bacterial
viral

Front 53

types of pneumonia:
-_
-_ Histoplasmosis, coccidioidomycosis, bastomycosis are limited to specific geographic areas
-_Bronchial walls become edematous & infiltrated w/WBC’s. The bronchial epithelium sloughs off & prevents mucociliary clearance
-_ _ get to the alveolar surfaces, WBC’s & fixed macrophages assist with clearing out _

Back 53

aspiration
fungal
viral
bacterial
bacteria
bacteria

Front 54

_ s and s depends on the type
Sudden & sharp pleuritic chest pain aggravated by chest motion
Hacking productive cough (rusty, green) {bacteria}
Dyspnea
Tachypnea (rapid resp associated w/fever) accompanied by decrease of chest excursion on the affected side
Cyanosis
HA
Fever & chills (bacteria)
Generalized aches & myalgia that may extend to the thighs & calves (viral)
Fatigue

Back 54

pneumonia

Front 55

_: Hypercapnea—build up of CO2 in blood.
Specifically, paCO2 is > 45 mmHg. (amount of CO2 in the arteries)
Cause can be anything that alters lung fx.

Back 55

pulmonary dz

Front 56

_ Declined but coming back due to HIV
Etiology—bug can live on a table for weeks!
Pathogenesis—primary infection->hypersensitivity of T cells develops. Secondary infection is reactivation.

Back 56

TB

Front 57

_ S and S

Fatigue, malaise, anorexia, weight loss, low grade fevers, night sweats, frequent productive cough, dull chest pain

Back 57

TB

Front 58

_ Hyperplasia of mucous glands & goblet cells of endothelium (excess amount of mucus)
Causes– smoking & urban pollution
Pathogenesis—excess mucous caused by smoking

Back 58

bronchiti

Front 59

_3 months of excessive mucous over 2 consecutive years

Back 59

chronic brochitis

Front 60

_ s and s
Persistent cough w/production of sputum (worse in AM & PM than @ mid-day)
Reduced chest expansion
Wheezing
Fever
Dyspnea
Cyanosis
Pulmonary edema

Back 60

bronchitis

Front 61

blue bloaters

Back 61

bronchitis

Front 62

progression from bronchitis to _

Back 62

CHF

Front 63

_ patients are usually on O2, short walk gets them out of breath

Back 63

bronchitis

Front 64

Emphysema & Bronchitis (go together like a horse & carriage...which leads to _..leads to _)
95% are due to _

Back 64

COPD
CHF
smoking