Which of the following is the appropriate term for inadequate alveolar ventilation in relation to metabolic demands?
A. Hyperpnea
B. Hypoventilation
C. Orthopnea
D. Dyspnea
Hyperpnea is rapid breathing. Orthopnea is difficulty breathing when an individual is lying flat. Dyspnea is difficulty breathing.B.
A person has respirations that are characterized by alternating periods of deep and shallow breathing and apnea. What is the appropriate name for this breathing?
A. Cheyne-Stokes
B. Hypoventilation
C. Kussmaul
D. Hyperpnea
Kussmaul respirations are characterized by an increased ventilatory rate, large tidal volumes, and no expiratory pause. Hypoventilation is inadequate alveolar ventilation. Hyperpnea is rapid ventilation.A
A woman has bulbous enlargement of the distal segments of her fingers. Which disease is associated with this condition?
A. Acute pneumonia
B. Acute myocardial infarction
C. Sickle cell disease
D. Cystic fibrosis
This is actually describing clubbing. There is enlargement of the distal segment of the finger, associated with bronchiectasis, cystic fibrosis, pulmonary fibrosis, lung abscess, and congenital heart disease.D
Which of the following is NOT a cause of hypercapnia?
A. Depression of the respiratory center by drugs
B. Disease of the medulla
C. Large airway obstruction
D. Increased respiratory drive
Causes of hypercapnia include depression of the respiratory center by drugs, diseases of the medulla, abnormalities of the spinal conducting pathways, diseases of the neuromuscular junction or of the respiratory muscles themselves, thoracic cage abnormali
A woman develops excess water in her lungs. What is the most common cause of this condition?
A. Inhalation of toxic gases
B. Heart disease
C. Pulmonary hypertension
D. ARDS
The most common cause of pulmonary edema is heart disease. Toxic gas inhalation, pulmonary hypertension and ARDS are also causes of pulmonary edema, but not the most common.B
Which of the following is NOT true concerning pneumonia?
A. Viral pneumonia is usually mild and self-limiting.
B. The most common community-acquired pneumonia is caused by Streptococcus pneumoniae.
C. Most cases are preceded by an upper respiratory infect
More than half of those hospitalized for pneumonia are older than age 65; mortality from pneumonia is highest in older adults.D
A person has symmetrically dilated airways. Which type of bronchial dilation is this?
A. Saccular
B. Varicose
C. Cylindrical
D. Bronchiectasis
Cylindrical indicates symmetric dilation. Saccular is when the bronchi become large and balloon-like. Varicose is when constrictions and dilations destroy the bronchi. Bronchiectasis is the persistent abnormal dilation of the bronchi.C
Which of the following is TRUE regarding bronchiolitis?
A. In adults, it is usually caused by a virus.
B. It is most common in adults.
C. It is an inflammatory obstruction of the small airways or bronchioles.
D. It is associated with bacterial infection.
Bronchiolitis is most common in children and is caused by a virus. It is seen in adults with chronic bronchitis.C
A 19-year-old man experiences a gunshot wound to the chest. He has an increase in pressure in his chest cavity. Which of the following is NOT an appropriate description for this condition?
A. Tension pneumothorax
B. Spontaneous pneumothorax
C. Secondary p
This pneumothorax is open. Increased pressure indicates tension, and secondary indicates there is a cause such as gunshot or stab wound. Spontaneous pneumothorax is of no known cause.B
A woman has pus in the pleural space. She had a previous respiratory infection. What is the name for this condition?
A. Abscess
B. Consolidation
C. Empyema
D. Transudate
Empyema is the presence of pus in the pleural space and is a complication of respiratory infection. Abscess is a circumscribed area of suppuration and destruction of lung parenchyma. A consolidation is inflamed lung tissue that causes alveoli to fill with
Which of the following is NOT a cause of pulmonary fibrosis?
A. ARDS
B. Tuberculosis
C. Inhalation of harmful substances
D. Upper respiratory infection
Upper respiratory infections do not typically result in pulmonary fibrosis.D
A 63-year-old man presents with a cough and dyspnea. He has been around asbestos. Which chronic condition has been associated with this?
A. Pulmonary edema
B. Pulmonary fibrosis
C. Pneumothorax
D. Pneumonia
The inhalation of inorganic dust particles, silicosis, and asbestos can cause this condition. Asbestos exposure can result in a type of pulmonary fibrosis called asbestosis.B
Which of the following is TRUE regarding ARDS?
A. Most commonly caused by infection
B. Caused by injury to bronchioles
C. Can cause severe pulmonary edema
D. Macrophages not involved in response
The most common cause of ARDS is either sepsis or multiple trauma. Damage is done to the alveolar capillary membrane and causes severe pulmonary edema. Macrophages, neutrophils, complement, and endotoxins are important mediators.C
Which of the following is TRUE regarding asthma?
A. 90% of cases occur during childhood.
B. 10% of cases occur before age 40.
C. The incidence has increased.
D. There is no hereditary pattern.
The incidence of asthma has increased over the past 20 years in the United States, especially in urban areas. Half of cases develop in childhood and another third develops during adulthood. There is a genetic pattern.C
Which of the following is TRUE regarding the pathophysiology of asthma?
A. Inflammation results in airway hyperresponsiveness.
B. IgA is the major factor.
C. The inflammatory process is due to loss of bronchial smooth muscle spasm.
D. There is decreased v
IgE is the major factor. Asthma is caused by increased bronchial smooth muscle spasm and increased vascular permeability.A
Which of the following is TRUE regarding chronic bronchitis?
A. Hypersecretion of mucus
B. Chronic productive cough that occurs for at least 6 months
C. Occurs at least for 5 consecutive years
D. Decreased in smokers
There is hypersecretion of mucus. This mucus is thicker and will "hold on" to embedded bacteria. There is a chronic productive cough that lasts for at least 3 months for at least 2 consecutive years. It is increased up to 20-fold in smokers.A
A person is born with an ?-antitrypsin deficiency. Which of the following conditions will most likely manifest?
A. Asthma
B. Emphysema
C. Pulmonary fibrosis
D. ARDS
Emphysema is bullous disease of the lungs. There is destruction of the alveolar walls without evidence of fibrosis. Individuals with an ?-antitrypsin deficiency have an increased risk because proteolysis in lung tissues is not inhibited.B
Which of the following pathogens is consistent with nosocomial pneumonia?
A. Streptococcus pneumoniae
B. Mycoplasma pneumoniae
C. Haemophilus influenzae
D. Pseudomonas aeruginosa
All of the other choices are community acquired. P. aeruginosa is commonly hospital- or nursing-home acquired.D
A person has been exposed to a contaminated cooling system. A large number of people in the same building have developed pneumonia. The most likely pathogen is which of the following?
A. Legionella pneumophila
B. Streptococcus pneumoniae
C. Mycoplasma pne
Legionella pneumophila is often associated with contaminated water supplies such as cooling systems.A
How is tuberculosis spread from person to person?
A. Sexual contact
B. Air droplet
C. Direct contact
D. It is not transmitted person to person
Tuberculosis is very contagious and is transmitted via air droplet.B
Dyspnea
+Sensation of uncomfortable breathing
+Orthopnea - Hurts when lying down
+Dyspnea when a person is lying down
-Sit them up and lean them forward (tripod)
+Paroxysmal nocturnal dyspnea- lay down to choke - Sit them up on a chair to sleep.
Kussmaul respirations (hyperpnea)
a slightly increased ventilatory rate; large, tidal volumes; and no expiratory pause.
+Too Much Breathing
Cheyne-Stokes respirations
alternating periods of deep and shallow (sometimes not) breathing.
Hypoventilation
Leads to respiratory acidosis
+CO2 Level Goes UP
+HyperCapnia
Hyperventilation
+Leads to respiratory alkalosis
+CO2 Level Goes Down
+HypoCapnia
Cough
+Acute cough
+Chronic cough
Hemoptysis
Coughing up Blood or Bloody Secretions. This indicates a localized abnormality, usually infection or inflammation or a tumor.
Cyanosis
+Cyanosis does not occur until 5 gm of hemoglobin are desaturated.
+Insensitive measure of disease
-Pulmonary disease
-Cardiac disease not a good circulation
-Cold - Winter like symptoms
-Anxiety
Hypercapnia
Too much CO2
Hypoxemia
+Hypoxemia vs. hypoxia
+Ventilation-perfusion abnormalities
-Shunting
How do you know if someone has Acute respiratory failure?
If someone gives the patient O2 it doesn't get any better. The problem isn't that you dont have enough respirtory the problem is your respiratory is failing.
Pulmonary edema
+Excess water in the lungs
+Can't diffuse O2 through the alveolocapillary membrane
What is a list of Restrictive Disorders
+Pulmonary edema
+Atelectasis (collapsed lung)
+Pneumothorax
+Pleural effusion
+Pneumonia
Aspiration
+Passage of fluid and solid particles into lungs
-Right lower lobe most frequent site
Atelectasis
+Compression atelectasis-Caused by external pressure i.e. tumor or fluid/air in pleural space
+Absorption atelectasis- lack of collateral ventilation
Bronchiectasis
+Persistent abnormal dilation of the bronchi
+Cylindrical, saccular, and varicose
Bronchiolitis
+Inflammatory obstruction of the small airways
+Most common in children
+Occurs in adults with chronic bronchitis, a viral infection, or inhalation of toxic gases
Bronchiolitis obliterans
+Late-stage fibrotic disease of the airways
+Can occur with all causes of bronchiolitis
Pneumothorax
+Open pneumothorax
+Tension pneumothorax
+Spontaneous pneumothorax
+Secondary pneumothorax
Pleural effusion
+Transudative effusion- more watery
+Exudative effusion- more gunky
+Pleurisy- pain and you hear the friction rub
+Hemothorax- blood
Empyema
+Infected pleural effusion (there will be pus, oh yes there will be pus)
Abscess formation and cavitation
+Abscess-area of destruction of lung parenchyma
+Consolidation-inflammation = pus and fluid
+Cavitation- absess emptying and cavity formation
Pulmonary fibrosis
Excessive amount of fibrous or connective tissue in the lung
Chest wall restriction
+Compromised chest wall
-Deformation, immobilization, and/or obesity
Flail chest
Instability of a portion of the chest wall
Inhalation disorders
+Exposure to toxic gases
+Pneumoconiosis
-Silicosis
-Coal worker pneumoconiosis (black lung)
-Asbestosis
+Allergic alveolitis
-Extrinsic allergic alveolitis (hypersensitivity pneumonitis
Acute respiratory distress syndrome (ARDS)
+Fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury
+Injury to the pulmonary capillary endothelium
+Inflammation and platelet activation
+Surfactant inactivation
+Atelectasis
ARDS
+Manifestations
-Rapid, shallow breathing
-Respiratory alkalosis
-Dyspnea
-Decreased lung compliance
-Unresponsive hypoxemia
Postoperative respiratory failure
+Atelectasis
+Pneumonia
+Pulmonary edema
+Pulmonary emboli
+Prevention
-Frequent turning, deep breathing, early ambulation, air humidification, and incentive spirometry
Obstructive Disorders
+Asthma
+Chronic bronchitis - Constriction
+Emphysema
-Chronic bronchitis + emphysema = chronic obstructive pulmonary disease (COPD)
+Clinically: dyspnea and wheezing dont give the Patient too much O2
Obstructive Pulmonary Disease
+Airway obstruction that is worse with expiration
+Common signs and symptoms
Dyspnea and wheezing
Chronic bronchitis
Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years
Inspired irritants increase mucus production and the size and number of mucous glands
The mucus is thicker than normal
D
Emphysema
+Abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis
+Loss of elastic recoil - Baggy Lungs
+Centriacinar emphysema
+Panacinar emphysema
+DOE, accessory muscle use, prolonged expi
What are the types of Pneumonia
Community-acquired pneumonia
Streptococcus pneumoniae
Hospital-acquired (nosocomial) pneumonia
Pneumococcal pneumonia
Viral pneumonia
Tuberculosis
+Mycobacterium tuberculosis
+Acid-fast bacillus
+Airborne transmission
+Tubercle formation
+Caseous necrosis
+Positive tuberculin skin test
Acute bronchitis
+Acute infection or inflammation of the airways or bronchi
+Commonly follows a viral illness
+Causes symptoms similar to pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates
Pulmonary embolism
+Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or air bubble
+Pulmonary emboli commonly arise from the deep veins in the thigh
+Triad of Virchow
Venous stasis, hypercoagulability, and injuries to the
Pulmonary hypertension
+Mean pulmonary artery pressure 5-10 mmHg above normal or >20 mmHg
+Classifications
-Pulmonary arterial hypertension
-Pulmonary venous hypertension
-Pulmonary hypertension from a respiratory d-isease or hypoxemia
-Pulmonary hypertension from thrombotic or
Pulmonary Vascular Disease
+Primary pulmonary hypertension
-Idiopathic
+Diseases of the respiratory system and hypoxemia are more common causes of pulmonary hypertension
Pulmonary heart disease
+Right ventricular enlargement
+Secondary to pulmonary hypertension
+Pulmonary hypertension creates chronic pressure overload in the right ventricle
Lip cancer
+Most common form
-Exophytic
+Stages
Laryngeal cancer
+Forms
-Carcinoma of true vocal cords (most common)
-Supraglottic
-Subglottic
Lung Cancer
+Bronchogenic carcinomas
+Most common cause is cigarette smoking
-Heavy smokers have 20 times' greater chance of lung cancer than nonsmokers
-Smoking is related to cancers of the larynx, oral cavity, esophagus, and urinary bladder
+Environmental or occupa
Other Lung Cancers
-Bronchial carcinoid tumors
-Adenocystic tumors (cylindromas)
-Mucoepidermoid carcinomas
-Mesotheliomas