Term
| How is the pulmonary system like the kidney system? |
|
Definition
| Both involved in blood pH adjustment |
|
|
Term
|
Definition
1. Lymph (protects body from foreign insult)
2. Baths the lungs (helps keep lungs open) |
|
|
Term
| Name some actions/features of the lungs that attribute to it's immune system |
|
Definition
lymphatic system enters at hilum
cilia
coughing
mucus
phagocytosis
|
|
|
Term
Purpose of surfactant (Type II)
|
|
Definition
| Keeps alveoli from collapsing and makes it easier for them to open during breathing |
|
|
Term
| Why does the pulmonary capillary system respond to oxygen levels in alveoli and blood more than it responds to blood pressure? |
|
Definition
| Because the capillary system is a low pressure system |
|
|
Term
| How is the negative air pressure that is responsible for respiration created? |
|
Definition
Contraction of diaphragm, flattening and downward motion.
Increases volume of thoracic cavity, thus creating negative pressure.
Air is drawn in to equalize this pressure. |
|
|
Term
| What must happen in the alveoli to expel extra air from the lungs? |
|
Definition
| the air pressure inside them must be increased above ambient pressure, done using accessory muscles. |
|
|
Term
| Which respiratory rate is classified as bradypnea? |
|
Definition
|
|
Term
| Which respiratory rate is classified as Tachypnea? |
|
Definition
|
|
Term
| Name 3 aspects of the autonomic nervous system that control breathing rate |
|
Definition
Respiratory centers in medulla
Sympathetic Activity
Parasympathetic Activity |
|
|
Term
| The substance that has the most influence on central chemoreceptors is.... |
|
Definition
|
|
Term
| The substance that has the most influence on peripheral chemoreceptors is..... |
|
Definition
|
|
Term
| How do high CO2 blood levels affect breathing? |
|
Definition
| Increased rate and depth of breathing |
|
|
Term
| Name 3 types of mechanoreceptors and their locations |
|
Definition
Stretch Receptors in the chest wall and airways
J receptors in juxtacapillary regions of lung periphery
Irritant receptors in airways
|
|
|
Term
| What function do the J receptors in the juxtacapillary regions in the lung periphery have? |
|
Definition
| keep match between areas with good blood flow and alveoli perfusion |
|
|
Term
| Name the 2 most common signs of lung disease |
|
Definition
|
|
Term
| What is the most common cause of chronic cough worldwide? |
|
Definition
|
|
Term
T/F
Pulmonary disease causes a lot of pain in the chest |
|
Definition
| False, no pain receptors in lung tissue |
|
|
Term
| Name 3 conditions (excluding heart dz) that may cause chest pain (lung related dz) |
|
Definition
Pleural disease
Pulmonary Vascular disease
Musculoskeletal pain |
|
|
Term
| What is the most common way to diagnose pulmonary emboli and arteriovenous malformations |
|
Definition
|
|
Term
|
Definition
| Pulmonary function testing where the patient breathes into an apparatus and their inspiratory and expiratory rates are measured. |
|
|
Term
|
Definition
| Volume of air inspired and expired with normal breathing |
|
|
Term
| IRV-Inspiratory Reserve Volume |
|
Definition
| Extra air volume which can be brought into lungs with effort |
|
|
Term
| ERV-Expiratory Reserve Volume |
|
Definition
| Extra air that can be expired forcefully |
|
|
Term
|
Definition
|
|
Term
| Vital Capacity + Reserve Volume=? |
|
Definition
|
|
Term
| FRC, Functional Residual capacity |
|
Definition
| Amount of air remaining in lungs at end of normal expiration |
|
|
Term
|
Definition
| Volume of air in lungs even after the most forceful expiration |
|
|
Term
| Name 4 arterial blood gases that the body regulates very closely |
|
Definition
|
|
Term
How can one determine the cause of acidosis ( decreased blood pH)?
|
|
Definition
| Evaluation of blood gases can determine if the problem is metabolic or respiratory |
|
|
Term
| Explain how hypoventilation results in acidosis |
|
Definition
Hypoventilation causes carbon dioxide to build up in the blood
This causes reactions that increase formation of H+ and HCO3. The bicarbonate is excreted by the kidneys and the hydrogen is left behind, causing a decrease in pH. |
|
|
Term
| Explain the proportions of arterial blood gases in acidosis caused by the respiratory system |
|
Definition
| Carbon dioxide will be high in the blood, causing the 'reaction' to shift to produce high amounts of carbonic acid and H+. The kidneys take care of the excess carbonic acid, but the hydrogen remains, decreasing blood pH. |
|
|
Term
| Explain the proportions of arterial blood gases in acidosis caused by changes in metabolism |
|
Definition
| Body compensates with increased breathing rate, so carbon dioxide and bicarbonate levels are low to normal, hydrogen and other metabolic acids build up. |
|
|
Term
| What are some metabolic causes of acidosis |
|
Definition
Decreased kidney function
Shock
Diabetes
Cardiac Arrest |
|
|
Term
| Which part of respiration is most affected by obstructive pulmonary disease? |
|
Definition
| The passive process of exhalation |
|
|
Term
| Which category of lung disease is characterized by decreased lung capacity due to reduced expansion |
|
Definition
| Restrictive pulmonary disease |
|
|
Term
| Name 4 systemic conditions discussed in class that have ocular and pulmonary effects |
|
Definition
Tuberculosis
Sarcoidosis
Histoplasmosis
Collagen Vascular Disorders |
|
|
Term
| What are some common problems caused by pulmonary disease meds |
|
Definition
Optic atrophy
Glaucoma
Cataract
Blurred Vision
Tear Effects |
|
|
Term
| Pulmonary disease can increase the risk of which ocular diseases |
|
Definition
Glaucoma
ARMD
Retinal vascular changes
Optic nerve head changes |
|
|
Term
| Describe the changes in Vital capacity, Residual Volume, and TLC caused by Obstructive Pulmonary dz |
|
Definition
Decreased VC
Increased RV
TLC is the same, may even grow |
|
|
Term
| How does the high RV in obstructive dz cause poor gas exchange |
|
Definition
High RV means the diaphragm is flatter after expiration, decreasing ability to change volume of lungs.
This results in poor gas exchange |
|
|
Term
| Name 3 types of chronic LOWER respiratory dz discussed in class |
|
Definition
Asthma
COPD
Cystic fibrosis |
|
|
Term
|
Definition
Emphysema
Chronic Bronchitis |
|
|
Term
| What is one of the main reasons asthma does not qualify as COPD |
|
Definition
COPD gets progressively worse with time.
Asthma causes structural changes to a certain point and then progression stops |
|
|
Term
| Asthma is associated with which type of hypersensitivity? |
|
Definition
|
|
Term
| What cell type do asthmatics have much more of than non-asthmatics? |
|
Definition
They have 10x more mast cells
(Lung tissue has the highest amount of mast cells in the body as it is) |
|
|
Term
| What combines with mast cells to release histamines, prostaglandins, tryptase and leukotrienes? |
|
Definition
|
|
Term
| Exposure to allergens or other attack initiators produces what substances in the asthmatic? |
|
Definition
IgE
Eosinophils (activation) |
|
|
Term
| Mediators such as histamines, prostaglandins, tryptase and leukotrienes have what sort of effects on lung tissue |
|
Definition
bronchospasm
Mucosal Edema
Mucus hypersecretion |
|
|
Term
| Explain the pathway of remodeling in asthma that starts with activated eosinophils |
|
Definition
Eosinophils release proteins toxic to the epithelium and cause chronic injury.
The body attempts to protect the injured tissue by increasing goblet cell number.
Toxic proteins are deposited in basement membrane causing thickening |
|
|
Term
| Explain Airway hyperreactivity |
|
Definition
Hyperplasia of smooth muscle allows it to contract more easily with decreased number of beta receptors
|
|
|
Term
| Name 2 categories of meds used to treat asthma |
|
Definition
Bronchodilators
Anti-inflammatories |
|
|
Term
| What is the agent of choice for treatment of mild asthma? |
|
Definition
| Beta-2 selective adrenergicreceptor agonists |
|
|
Term
| Why are beta 2 selective agrenergic receptor agonists never used as sole therapy for chronic asthmatics? |
|
Definition
| They have little to no anti-inflammatory action |
|
|
Term
| Name 2 mechanisms by which beta-2 selective adrenergic receptor agonists treat asthma |
|
Definition
Prevent or relieve bronchospasm
Prevent Mast cell degranulation |
|
|
Term
| Why is inhalation the preferred method of delivery of beta2 selective adrenergic agonists to treat asthma? |
|
Definition
| Inhalation decreases side effects because it sends the medication directly where it needs to go. |
|
|
Term
| Acronym for fast acting rescue drugs (asthma tx) |
|
Definition
SABA
short acting beta2 agonists |
|
|
Term
| Name 3 asthma fast acting rescue drugs and their mechanism |
|
Definition
Albuterol
Levalbuterol
Metaproterenol
Beta 2 agonists |
|
|
Term
| Onset and duration of SABA drugs |
|
Definition
15-30 min onset
last 4-6 hours |
|
|
Term
| Name 2 LABA drugs (asthma tx) |
|
Definition
|
|
Term
| Name 5 adverse effects of adrenergic bronchodilators |
|
Definition
Skeletal muscle tremors
Headache
Cough/dry throat
Upper resp infection
Paradoxical bronchospasm |
|
|
Term
| Explain why anticholinergics are used to treat asthmatics |
|
Definition
They prevent contraction of airway smooth muscle
Prevent mucus secretion |
|
|
Term
Anticholinergics
fast or slow onset? |
|
Definition
|
|
Term
| Name 2 anticholinergics used to treat asthma |
|
Definition
Ipratropium bromide
Tiotropium |
|
|
Term
3 SE of anticholinergics in asthma tx
|
|
Definition
Blurred vision
headaches
dizziness |
|
|
Term
| What are the most effective agents for long term control of moderate to severe asthma |
|
Definition
|
|
Term
| Why are glucocorticoids often combined with beta agonists? |
|
Definition
| because they have no direct effect on smooth muscle of the airway |
|
|
Term
| What is the purpose of the spacer in aerosol glucocorticoids |
|
Definition
Only 20% of inhaled steroids actually get to the lung.
Makes it so the large particles deposit on the walls of the spacer rather than the mouth, thus less is absorbed into the system |
|
|
Term
| Name 4 aerosol glucocorticoids |
|
Definition
Beclomethasone
Triamcinolone
Flunisolide
Budesonide |
|
|
Term
| What is one advantage of the powdered glucocorticoids over aerosol? |
|
Definition
| Do not require the hand-breath coordination necessary for taking aerosol. |
|
|
Term
| Name 1 powdered glucocorticoid |
|
Definition
| Mometasone furoate (Asmanex) |
|
|
Term
| Name some common adverse effects of glucocorticoids |
|
Definition
Osteoporosis
Impaired wound healing
Increased risk of infection
Hypertension
Decreased growth in children
Edema
Ulcers
Psychoses
Cushings-like syndrome
Oral Candidiasis |
|
|
Term
| Name 2 ocular conditions whose risk is increased when taking glucocorticoids |
|
Definition
|
|
Term
| More risk for adverse effects with oral or inhaled forms of glucocorticoids? |
|
Definition
|
|
Term
| Name 4 conditions with which caution should be taken when prescribing inhaled glucocorticoids |
|
Definition
Parasitic infection
TB (active or inactive)
Ocular herpes simplex
Increased IOP |
|
|
Term
Montelukast, zafirlukast and zileuton
which drug type? |
|
Definition
|
|
Term
| Name a reason why it may be a good thing to add a leukotriene inhibitor to a pts asthma regimen? |
|
Definition
| Taking this may mean they need a lower dose of corticosteroid |
|
|
Term
| What aspect of asthma do leukotriene inhibitors help with, the inflammation or the remodeling? |
|
Definition
|
|
Term
Leukotriene inhibitors
Immediate or nonimmediate use? |
|
Definition
| Not useful for immediate bronchodilation |
|
|
Term
| Mast cell stabilizers- acute management or long term? |
|
Definition
| Long term, not direct bronchidilators |
|
|
Term
| Name a mast cell stabilizer |
|
Definition
|
|
Term
Why do mast cell stabilizers have so few adverse effects
|
|
Definition
|
|
Term
| Approx how long doe sit take to determine efficacy of mast cell stabilizers |
|
Definition
|
|
Term
| Which drug is a monoclonal antibody that interferes with IgE activity in asthma by binding with it? |
|
Definition
|
|
Term
| Describe Alair Bronchial thermoplasty |
|
Definition
a device is installed through nose or mouth into lungs
radiowaves are used to heat smooth muscle, decreasing thickness and hyperresponsiveness |
|
|
Term
| Why is aspirin contraindicated in asthma patients? |
|
Definition
| Aspirin blocks the prostaglandin side of the arachidonic acid pathway, causing an increase in leukotrienes and subsequent inflammation. |
|
|
Term
| Daily use of which common medication increases risk of chronic lower respiratory disease by 75% |
|
Definition
|
|
Term
| What is often the first symptom of COPD? |
|
Definition
|
|
Term
| Which disease is characterized by enlargement of air spaces due to destruction of the alveolar walls? |
|
Definition
|
|
Term
| What is the most common cause of emphysema? |
|
Definition
|
|
Term
| What can happen when the bullae weaken and rupture? |
|
Definition
| Pneumothorax --> sudden death |
|
|
Term
| Why might the bronchioles collapse upon expiration in Emphysema? |
|
Definition
| as the large bullae form there is loss of elastic recoil, which causes the bronchioles to collapse |
|
|
Term
Pink Puffer
Which disease? |
|
Definition
|
|
Term
| Why do emphysema patients tend to purse their lips? |
|
Definition
| This narrows the airway, decreasing the air that gets out of the lips, keeping more air in the alveoli, making it easier to 'reinflate' them during the next breath in. Also keeps the alveoli from collapsing. |
|
|
Term
Pt is thin, tends to sit with hands on knees, always pursing their lips, breath fast and short
Which dz is this indicative of? |
|
Definition
|
|
Term
| Why might emphysema patients have low pCO2 in their blood? |
|
Definition
| Because the CO2 leaves the lungs easier than oxygen comes in |
|
|
Term
| Persistent, productive cough on most days for at least 3 consecutive months in 2 consecutive years |
|
Definition
|
|
Term
| Why is polycythemia a sign of chronic bronchitis? |
|
Definition
| The body attempts to distribute the low amounts of oxygen better by increasing the number of red blood cells. |
|
|
Term
| Why do chronic bronchitis patients 'wheeze' |
|
Definition
| they wheeze on expiration due to the excess mucus which narrows the airway |
|
|
Term
| Why do chronic bronchitis patients 'crackle' |
|
Definition
| due to edema in the lung tissue |
|
|
Term
| Three characteristics of the lungs of a chronic bronchitis pt |
|
Definition
Inflammation of the airways
hypertrophy of large airway mucous glands
Hypersecretion of mucus |
|
|
Term
| Pink puffers are to emphysema as "____________________" are to chronic bronchitis |
|
Definition
|
|
Term
| At some point, chronic bronchitis patients reach CO2 narcosis and no longer struggle with breathing, why is this? |
|
Definition
| They have reached chronically high levels of CO2 that disrupt brain function, making them very happy (narcosis). Also, their chemoreceptors have been 'reset' to accept these high levels of CO2 so they no longer attempt to fix the problem with tachypnea. |
|
|
Term
| Describe some of the ocular manifestations of chronic bronchitis |
|
Definition
Decreased VA (esp night)
Decreased color vision
Transient visual obscurations
|
|
|
Term
| What are the 5 A's of smoking cessation? |
|
Definition
ASK
ADVISE
ASSESS
ASSIST
ARRANGE |
|
|
Term
Drug used in treatment of COPD, low therapeutic index, a phosphodiesterase inhibitor, only used in severe, end stage dz.
|
|
Definition
| Theophylline (non selective) |
|
|
Term
| Name 2 adverse effects of theophylline |
|
Definition
|
|
Term
| Which Phosphodiesterase inhibitor is selective for PDE 4 and is contraindicated in children? |
|
Definition
|
|
Term
| In addition to asthma treatments, how is COPD treated? |
|
Definition
Oxygen therapy
Antibiotics
Immunizations
Surgery |
|
|
Term
Name 2 types of surgery used to treat COPD (primarily emphysema)
|
|
Definition
Bullectomy
Volume Reduction Surgery |
|
|
Term
| Multi system disease associated with abnormal chloride transport of epithelial cells, resulting in reduced chloride and increased sodium |
|
Definition
|
|
Term
| What causes thick, viscous mucus in cystic fibrosis? |
|
Definition
Impaired secretion of Cl into airway lumen causes increased Na reabsorption into cells.
Water follows the Na into the cells, causing the secretions to be thick and viscous |
|
|
Term
| Most cystic fibrosis patients die of pulmonary failure secondary to ________________ |
|
Definition
|
|
Term
| What other systemic problems arise from cystic fibrosis? |
|
Definition
Poor fat digestion
Malabsorption of carbs and proteins
Infertility
Cirrhosis |
|
|
Term
| Which cystic fibrosis treatment makes sputum less viscous and easier to clear? |
|
Definition
| Pulmozyme (dornase alpha) |
|
|
Term
| What treatment method is considered to be the main reason for increased life span for cystic fibrosis patients? |
|
Definition
|
|
Term
| Name 2 medications used as inhaled antibiotics in cystic fibrosis |
|
Definition
High Dose Tobramycin
Aztreonam |
|
|
Term
| How do cystic fibrosis patients avoid development of resistance when using inhaled antibiotics like TOBI |
|
Definition
| They u se for 28 days then stop for 28 days then repeat |
|
|
Term
| What are some CF treatments in addition to antibiotics? |
|
Definition
Bronchodilators
Nutritional support (due to the dz's affect on the pancreas)
7% sodium chloride (water follows it into lung tissue, softening it)
Ibuprofen
Genetic therapy
Lung transplant |
|
|
Term
| Cystic fibrosis medication that treats a specific CF mutation |
|
Definition
|
|
Term
| What risks are involved with treating CF patients with ibuprofen? |
|
Definition
Kidney damage
GI bleeding |
|
|
Term
| What is happening structurally in obstructive sleep apnea? |
|
Definition
| In sleep, there is complete collapse of the upper airway |
|
|
Term
| Gold standard in OSA diagnosis |
|
Definition
| Nocturnal Polysomnography (sleep lab) |
|
|
Term
| What is monitored in a sleep lab? |
|
Definition
Eye movements
Chest wall monitors
Electromyogram
Electroencephalogram
Electrocardiogram
Oximetry
nasal/oral air flow |
|
|
Term
| What medical conditions are associated with OSA? |
|
Definition
HTN
Obesity
emotional problems
DM
Cardiovascular dz
|
|
|
Term
| How does OSA affect diabetics? |
|
Definition
Increases their risk of retinopathy, esp macular edema
|
|
|
Term
| Nonsurgical treatments of OSA |
|
Definition
Weight loss
Tongue retaining
mandibular adjustment
tennis balls
compression stockings
Medications
CPAP
Oropharyngeal exercises |
|
|
Term
|
Definition
Constant Positive Airway Pressure
Mask blows air to keep airway open |
|
|
Term
| What are some surgical options for treatment of OSA |
|
Definition
Uvulopalatopharyngoplasty (UPPP)
Jaw surgery
Tracheostomy |
|
|
Term
| Name 3 types of infiltrative lung disease |
|
Definition
Pneumoconiosis
Collagen Vascular Disease
Sarcoidosis |
|
|
Term
| Name 3 Chest Wall Abnormalities |
|
Definition
Kyphoscoliosis
Obesity
Respiratory muscle fatigue |
|
|
Term
Briefly describe infiltrative lung dz
|
|
Definition
Diffuse lung injury and inflammation
fibrosis of alveoli, stiffening of septae
restriction of stretching
Difficulty inhaling |
|
|
Term
| Lung disease from inhalation of inorganic dust that leads to lung fibrosis |
|
Definition
|
|
Term
| Which is the 'most important type' of pneumoconiosis in US? |
|
Definition
|
|
Term
Specify how asbestos may affect the lungs
|
|
Definition
pleural effusion
progressive pulmonary fibrosis
malignant mesotheliomas of pleura and peritoneum |
|
|
Term
| What is the most prevalent occupational disease in the world? |
|
Definition
|
|
Term
| Sarcoidosis is a multisystem disorder, what three systems were starred in the notes? |
|
Definition
| Pulmonary, Ocular, Dermatologic |
|
|
Term
| What is the mOST COMMON ocular manifestation of sarcoidosis? |
|
Definition
|
|
Term
| Name some common ocular manifestations of sarcoidosis |
|
Definition
Anterior Uveitis
Granulomas in lids, iris and retina
Conjunctivitis
Lacrimal gland inflammation
Retinal vasculitis
ONH edema
|
|
|
Term
| Describe respiratory symptoms/signs of sarcoidosis |
|
Definition
Dry cough
Dyspnea
Paratracheal/hilar adenopathy
Infiltrates and fibrosis |
|
|
Term
| Name 2 tests for sarcoidosis whose results could also be indicative of TB |
|
Definition
|
|
Term
| What is the DEFINITIVE test in diagnosis of Sarcoidosis |
|
Definition
|
|
Term
| What are the 3 elements required for diagnosis of Sarcoidosis? |
|
Definition
Clinical history and X ray consistent with dz
exclusion of other dz
granuloma biopsy |
|
|
Term
As the TB test is to Tuberculosis, this test is to Sarcoidosis,
but is much more difficult to make the sample that is injected. |
|
Definition
|
|
Term
| What is the most common cause of death in sarcoidosis patients? |
|
Definition
|
|
Term
| How does acute versus chronic onset affect prognosis of Sarcoid? |
|
Definition
| Acute has better prognosis |
|
|
Term
| Describe the different prognoses of Sarcoid |
|
Definition
1/3-spontaneous remission
1/3 stable
1/3 progress (10% to severe pulmonary fibrosis) |
|
|
Term
| What meds may be used to treat sarcoid? |
|
Definition
Anti-inflammatories
Immune modulating meds for severe cases (methotrexate, cyclosporine etc.) |
|
|
Term
| Tremendous bending of the spine results in reduced lung volume and increased chest wall stiffness, allowing collapse of alveoli. |
|
Definition
|
|
