question

The primary function of the respiratory system is _____.

answer

gas exchange

question

Functionally, the respiratory system can be divided into two parts: the ____ airways through which air moves as it passes between the atmosphere and the lungs, and the ____ tissues of the lungs, where gas exchange takes place.

answer

conducting, respiratory

question

The ____ airways consists of the nasal passages, mouth and pharynx, larynx, trachea, bronchi, and bronchioles.

answer

conducting

question

The air we breathe is _____, _____, and _____ as it moves through the conducting airways.

answer

warmed, filtered, moistened

question

The _____ produced by the epithelial cells in the conducting airways forms a layer that protects the respiratory system by entrapping dust, bacteria, and other foreign particles that enter the airways.

answer

mucus

question

The vocal folds and the elongated opening between them are called the _____.

answer

glottis

question

The walls of the trachea are supported by horseshoe- or C-shaped rings of _____ cartilage, which prevent it from collapsing when the pressure in the thorax becomes negative.

answer

hyaline

question

Each primary bronchus, accompanied by the pulmonary arteries, veins, and lymph vessels, enters the lung through a slit called the ____.

answer

hilum

question

Each _______ is supplied by a branch of a terminal bronchiole, an arteriole, the pulmonary capillaries, and a venule.

answer

pulmonary lobule

question

The _____ are the terminal air spaces of the respiratory tract and the actual sites of gas exchange between the air and the blood.

answer

alveoli

question

The pulmonary circulation arises from the _____ artery and provides for the gas exchange function of the lungs.

answer

pulmonary

question

Particulate matter entering the lung is partially removed by _____ vessels, as are the plasma proteins that have escaped from the pulmonary capillaries.

answer

lymphatic

question

It is _____ stimulation, through the vagus nerve, that is responsible for slightly constricted smooth muscle tone in the normal resting lung.

answer

parasympathetic

question

Stimulation of the _____ nervous system causes airway relaxation, blood vessel constriction, and inhibition of glandular secretion.

answer

sympathetic

question

The pressure exerted by a single gas in a mixture is called the _____.

answer

partial pressure

question

Air moves between the atmosphere and the lungs because of a _____.

answer

pressure difference

question

The pressure in the pleural cavity is called the _____ pressure.

answer

intrapleural

question

The ____ maneuver is used to study the cardiovascular effects of increased intrathoracic pressure on peripheral venous pressures, cardiac filling and cardiac output, as well as poststrain heart rate and blood pressure responses.

answer

Valsalva

question

Lung _____ refers to the ease with which the lungs can be inflated.

answer

compliance

question

The _____ is the volume of air inspired (or exhaled) with each breath.

answer

tidal volume (TV)

question

The maximum amount of air that can be inspired in excess of the normal tidal volume (TV) is called the _____, and the maximum amount that can be exhaled in excess of the normal TV is the ____.

answer

inspiratory reserve volume (IRV), expiratory reserve volume (ERV)

question

The ____ is the amount of air a person can breathe in beginning at the normal expiratory level and distending the lungs to the maximal amount.

answer

inspiratory capacity

question

The _____ equals the inspiratory reserve volume (IRV) plus the tidal volume (TV) plus the expiratory reserve volume (ERV) and is the amount of air that can be exhaled from the point of maximal inspiration.

answer

vital capacity

question

The _____ is the amount of air that is exchanged in 1 minute.

answer

minute volume

question

_____ ventilation refers to the total exchange of gases between the atmosphere and the lungs; ____ ventilation is the exchange of gases within the gas exchange portion of the lungs.

answer

Pulmonary, alveolar

question

Even at low lung volumes, some air remains in the alveoli of the lower portion of the lungs, preventing their ____.

answer

collapse

question

____ refers to the air that is moved with each breath but does not participate in gas exchange.

answer

Dead space

question

Both dead air space and shunt produce a ____ of ventilation and perfusion.

answer

mismatching

question

Although the lungs are responsible for the exchange of gases with the external environment, the ____ transports gases between the lungs and body tissues.

answer

blood

question

____ carries about 98% to 99% of oxygen in the blood and is the main transporter of oxygen.

answer

Hemoglobin

question

Oxygen binds ____ with the heme groups on the hemoglobin molecule.

answer

cooperatively

question

Hemoglobin's affinity for oxygen is influenced by ____, _____, concentration, and body _____.

answer

pH, carbon dioxide, temperature

question

Carbon dioxide is transported in the blood in three forms: as _____ (10%), attached to _____ (30%), and as _____ (60%).

answer

dissolved carbon dioxide, hemoglobin, bicarbonate

question

The pacemaker properties of the respirator center result from the cycling of the two groups of respiratory neurons: the ____ center in the upper pons and the ____ center in the lower pons.

answer

pneumotaxic, apneustic

question

The automatic regulation of ventilation is controlled by input from two types of sensors or receptors: _____ and _____ receptors.

answer

chemoreceptors, lung

question

The _____ content in the blood regulates ventilation through its effect on the pH of the extracellular fluid of the brain.

answer

carbon dioxide

question

____ is a subjective sensation or a person's perception of difficulty in breathing that includes the perception of labored breathing and the reaction to that sensation.

answer

Dyspnea

question

Define Mediastinum

answer

Space between lungs that contains heart, blood vessels, lymph nodes, nerves and the esophagus.

question

Define Elastic recoil

answer

The ability of elastic components of the lung to recoil to their original position.

question

Define Epiglottis

answer

Routes liquids and foods into the esophagus.

question

Define Type I pneumocytes

answer

Form part of respiratory membrane

question

Define Angiogenesis

answer

Formation of new blood vessels

question

Define Mucociliary blanket

answer

Mucus lining of the conducting airways

question

Define Alveolar pressure

answer

Pressure inside the airways and alveoli

question

Define Brush Cells

answer

Act as receptors that monitor the air quality of the lungs

question

Define Tracheobronchial

answer

The trachea, bronchi, and bronchioles

question

Define Type II pneumocytes

answer

Synthesize pulmonary surfactant

question

Put these respiratory structures in anatomic order: a. Nasopharynx b. Trachea c. Epiglottis d. Alveoli e. Respiratory bronchiole f. Intrapulmonary bronchus g. Extrapulmonary bronchus

answer

1. Nasopharynx 2. Epiglottis 3. Trachea 4. Extrapulmonary bronchus 5. Intrapulmonary bronchus 6. Respiratory bronchiole 7. Alveoli

question

Describe the pleura and explain its function.

answer

The pleural membrane lines the thoracic cavity and encases the lungs. The outer parietal layer lines the pulmonary cavities and adheres to the thoracic wall, the mediastinum, and the diaphragm. The inner visceral pleural closely covers the lung and is adherent to all its surfaces. It is continuous with the parietal pleura at the hilum of the lung, where the major bronchus and pulmonary vessels enter and leave the lung. A thin film of serous fluid separates the two pleural layers, allowing the two layers to glide over each other and yet hold together so there is no separation between the lungs and the chest wall.

question

Describe the events of the respiratory cycle.

answer

During inspiration, the size of the chest cavity increases, the intrathoracic pressure becomes more negative, and air is drawn into the lungs. The diaphragm is the principal muscle of inspiration. When the diaphragm contracts, the abdominal contents are forced downward and the chest expands from top to bottom. The external intercostal muscles, which also aid in inspiration, connect to the adjacent ribs and slope downward and forward. When they contract, they raise the ribs and rotate them slightly so that the sternum is pushed forward; this enlarges the chest from side to side and from front to back. The scalene muscles elevate the first two ribs, and the sternocleidomastoid muscles raise the sternum to increase the size of the chest cavity. Expiration is largely passive. It occurs as the elastic components of the chest wall and lung structures that were stretched during inspiration recoil, causing air to leave the lungs as intrathoracic pressure increases. When needed, the abdominal and the internal intercostal muscles can be used to increase expiratory effort.

question

What is the function of the pulmonary surfactant?

answer

Pulmonary surfactant forms a monolayer with its hydrophilic surface binding to liquid film on the surface of the alveoli and its hydrophobic surface facing outward toward the gases in the alveolar air. This monolayer interrupts the surface tension that develops at the air-liquid interface in the alveoli, keeping them from collapsing and allowing equal inflation.

question

What is the mathematical formula used to describe the diffusion of gas across the respiratory membrane?

answer

Gas diffusion in the lung is described by the Fick law of diffusion. The Fick law states that the volume of a gas diffusing across the membrane per unit time is directly proportional to the partial pressure different of the gas, P1 - P2, the surface area, SA, of the membrane, and the diffusion coefficient, D, and is inversely proportional to the thickness, T of the membrane.

question

In the clinic, what type of blood is used for blood gas measurements and why?

answer

Arterial blood is commonly used for measuring blood gases. Venous blood is not used because venous levels of oxygen and carbon dioxide reflect the metabolic demands of the tissues rather than the gas exchange function of the lungs.

question

What causes us to cough?

answer

Coughing is a neurally mediated reflex that protects the lungs from accumulation of secretions and from entry of irritating and destructive substances. It is one of the primary defense mechanisms of the respiratory tract. The cough reflex is initiated by receptors located in the tracheobronchial wall; these receptors are extremely sensitive to irritating substances and to the presence of excess secretions. Afferent impulses from these receptors are transmitted through the vagus to the medullary center, which integrates the cough response.

question

What diagnostic tests should a doctor order to confirm a diagnosis of generalized hypoxia?

answer

Blood gas and pulmonary function test should be ordered.

question

The lungs are the working structures of the respiratory system and they have several functions. What are the functions of the lungs?

answer

Produce heparin and convert angiotensin I to angiotensin II.The lungs are the functional structures of the respiratory system. In addition to their gas exchange function, they inactivate vasoactive substances such as bradykinin; they convert angiotensin I to angiotensin II. They also serve as a reservoir for blood storage. Heparin-producing cells are particularly abundant in the capillaries of the lung, where small clots may be trapped.

question

Bronchial blood vessels have several functions. They are warm and humidify incoming air as well as distribute blood to the conducting airways and the supporting structures of the lung. What is it that make bronchial blood vessels unique in the body?

answer

They can undergo angiogenesis.The bronchial blood vessels are the only ones that can undergo angiogenesis (formation of new vessels) and develop collateral circulation when vessels in the pulmonary circulation are obstructed, as in pulmonary embolism. The development of new blood vessels helps to keep lung tissue alive until the pulmonary circulation can be restored. The blood in the bronchiole blood vessels is unoxygenated, so they neither carry oxygen-rich blood to the lung tissues nor participate in gas exchange. Bronchiole blood vessels drain blood into the bronchial veins.

question

Define Alveolar pressure

answer

Pressure inside the airways and alveoli of the lungs

question

Define Intrapleural pressure

answer

Pressure in the pleural cavity

question

Define Transpulmonary pressure

answer

The difference between the intraalveoli and intrapleural pressures

question

Define Intrathoracic pressure

answer

The pressure in the thoracic cavity.

question

What does the equation C =ΔV/ΔP stand for?

answer

Lung compliance. Specifically, lung compliance, C, describes the change in lung volume, ΔV, that can be accomplished with a given change in respiratory pressure, ΔP; thus, C = ΔV/ΔP.

question

An 82-year-old man with chronic obstructive pulmonary disease (COPD) is at the clinic for a regular check-up. Because of his diagnosis, the nurse would expect his respiratory rate under normal circumstances to be what?

answer

Less than or greater to 18 to 20 bpm. The work of breathing is determined by the amount of effort required to move air through the conducting airways and by the ease of lung expansion, or compliance. Expansion of the lungs is difficult for persons with stiff and noncompliant lungs; they usually find it easier to breathe if they keep their tidal volume low and breathe at a more rapid rate (e.g. 300 x 20 = 6000 mL) to achieve their minute volume and meet their oxygen needs. In contrast, persons with obstructive airway disease usually find it less difficult to inflate their lungs but expend more energy in moving air through the airways. As a result, these persons take deeper breaths and breathe at a slower rate (e.g. 600 x 10 = 6000 mL) to achieve their oxygen needs. People with COPD do not have hyperpneic breathing under normal conditions.

question

Our ability to oxygenate the tissues and organs of our bodies demands on our ability to ventilate, or exchange, gases in our respiratory system. The resultant distribution of ventilation or the areas of the body open to the exchange of gases in our respiratory system depends on what?

answer

Effects of gravity and body position.The distribution of ventilation between the apex and the base of the lung varies with body position and the effects of gravity on intrapleural pressure. Intrapleural pressure impacts the distribution of ventilation, not intrathoracic or alveolar pressures.

question

Alveolar oxygen levels directly impact the blood vessels in the pulmonary circulation. In a person with lung disease, there is vasoconstriction throughout the lung, causing a generalized hypoxia. What can prolonged hypoxia lead to?

answer

Pulmonary hypertension and increased workload on the right heart. Generalized hypoxia occurs at high altitudes in persons with chronic hypoxia due to lung disease, and cause vasoconstriction throughout the lung. Prolonged hypoxia can lead to pulmonary hypertension and increased workload on the right heart.

question

When there is a mismatching of ventilation and perfusion within the lung itself, insufficient ventilation occurs. There is a lack of enough oxygen to adequately oxygenate the blood flowing through the alveolar capillaries, creating a physiologic shunt. What causes a physiologic right-to-left shunting of blood in the respiratory system?

answer

Destructive lung disease or heart failure.Physiologic shunting of blood usually results from destructive lung disease that impairs ventilation or from heart failure that interferes with movement of blood through sections of the lungs. Obstructive lung disease, pulmonary hypertension, and regional hypoxia usually do not cause the physiologic shunting of blood.

question

Blood transports both oxygen and carbon dioxide in a physically dissolved form to the tissues and organs of the body. It is the measurements of the components of the gases in the blood that are used as indicators of the body's status by health care workers. Why is it commonly the blood in the arteries that is measured for its components rather than the blood in the veins?

answer

Venous blood measures the metabolic demands of the tissues rather than the gas exchange function of the lungs. In the clinical setting, blood gas measurements are used to determine the partial pressure of oxygen (PO2) and carbon dioxide (PCO2) in the blood. Arterial blood commonly is used for measuring blood gases. Venous blood is not used because venous levels of oxygen and carbon dioxide reflect the metabolic demands of the tissues rather than the gas exchange function of the lungs.

question

Respiration has both automatic and voluntary components that are sent to the respiratory center of the brain from a number of sources. What physiologic forces can exert their influence on respiration through the lower brain centers?

answer

Fever, Pain, and Emotion.The automatic and voluntary components of respiration are regulated by afferent impulses that are transmitted to the respiratory center from a number of sources. Afferent input from higher brain centers is evidenced by the fact that a person can consciously alter the depth and rate of respiration. Fever, pain, and emotion exert their influence through lower brain centers.

question

There are several actions the body makes to initiate a cough. Put these actions into the correct order. a. Elevation of intrathoracic pressures b. Rapid opening of glottis c. Closure of glottis d. Rapid inspiration of large volume of air e. Forceful contraction of abdominal and expiratory muscles

answer

1. Rapid inspiration of large volume of air 2. Closure of glottis 3. Forceful contraction of abdominal and expiratory muscles 4. Elevation of intrathoracic pressures 5. Rapid opening of glottis

question

Dyspnea is defined as an uncomfortable sensation or difficulty in breathing that is subjectively defined by the client. Which of the following disease states is not characterized by dyspnea? a. Pneumonia b. Emphysema c. Myasthenia gravis d. Multiple sclerosis

answer

Multiple sclerosis. Dyspnea is observed in at least three major cardiopulmonary disease states: primary lung diseases, such as pneumonia, asthma, and emphysema; heart disease that is characterized by pulmonary congestion; and neuromuscular disorders, such as myasthenia gravis and muscular dystrophy that affect the respiratory muscles. Dyspnea is not an identified component of multiple sclerosis.

question

____ are the most frequent cause of respiratory tract infections.

answer

Viruses

question

Viral infections can damage ____ epithelium, _____ airways, and lead to secondary ____ infections.

answer

bronchial, obstruct, bacterial

question

The common cold is a viral infection of the ____ respiratory tract.

answer

upper

question

Outbreaks of colds due to ____ are most common in early fall and late spring.

answer

rhinoviruses

question

____ are popular over-the-counter treatments for colds because of their action in drying nasal secretions.

answer

Antihistamines

question

___ refers to inflammation of the nasal passages, and sinusitis as inflammation of the ____ sinuses.

answer

Rhinitis, paranasal

question

The lower ____ content in the sinuses facilitates the growth of organisms, impairs local defenses and alters the function of immune cells.

answer

oxygen

question

Host antibodies to ____ and _____ prevent or ameliorate infection by the influenza virus.

answer

hemagglutinin, neuraminidase

question

The influenza viruses can cause three types of infections: an uncomplicated _____ respiratory infection, _____ pneumonia, and a respiratory viral infection followed by a _____ infection.

answer

upper, viral, bacterial

question

Because influenza is so highly contagious, prevention relies primarily on ______.

answer

vaccination

question

Avian strains of the influenza virus do not usually contain outbreaks of disease in humans unless a ____ of the virus genome has occurred within an intermediate mammalian host such as a pig.

answer

reassortment

question

The term ____ describes inflammation of parenchymal structures of the lung, such as the alveoli and the bronchioles.

answer

pneumonia

question

____ refers to consolidation of a part or all of a lung lobe; and ____ signifies a patchy consolidation involving more than on lobe.

answer

Lobar pneumonia, bronchopneumonia

question

Hospital-acquired, or _____, pneumonia is defined as a lower respiratory tract infection that was not present or incubating on admission to the hospital.

answer

nosocomial

question

The term ____ host usually is applied to persons with a variety of underlying defects in host defenses.

answer

immunocompromised

question

____ disease is a form of bronchopneumonia; infection normally occurs by acquiring the organism from the environment.

answer

Legionnaire

question

The primary atypical pneumonias are caused by a variety of agents, the most common being ____ pneumonia.

answer

mycoplasma

question

____ is the world's foremost cause of death from a single infectious agent.

answer

Tuberculosis

question

Mycobacteria are similar to other bacterial organisms except for an outer ____ that makes them more resistant to destruction.

answer

waxy

question

_____ tuberculosis is a form of the disease that develops in previously unexposed, and therefore unsensitized, persons.

answer

Primary

question

The most frequently used screening methods for pulmonary tuberculosis are the _____ tests and chest _____.

answer

tuberculin skin, x-rays

question

____ is caused by the dimorphic fungus Histoplasma capsulatum and is one of the most common fungal infections in the United States.

answer

Histoplasmosis

question

____ respiratory infections produce pulmonary manifestations that resemble tuberculosis.

answer

Fungal

question

The number of Americans who develop lung cancer is decreasing, primarily because of a decrease in _____.

answer

smoking

question

Cigarette smoking causes more than ____ cases of lung cancer.

answer

80%

question

____ are aggressive, locally invasive, and widely metastatic tumors that arise from the epithelial lining of major bronchi.

answer

Lung cancers

question

The ____ are small, round to oval cells that are approximately the size of a lymphocyte and grow in clusters that exhibit neither glandular nor squamous organization.

answer

small cell lung cancers (SCLCs)

question

The _____ include squamous cell carcinomas, adenocarcinomas, and large cell carcinomas.

answer

non-small cell lung cancers (NSCLCs)

question

____ is characterized by inspiratory strider, hoarseness, and a barking cough.

answer

Croup

question

By the ____ weeks of gestation, sufficient terminal air sacs are present to permit survival of the premature infant.

answer

25th to 28th

question

Define SCLCs

answer

Highly aggressive lung cancer

question

Define Typical pneumonias

answer

Result from infection by bacteria

question

Define Stridor

answer

Audible crowing sound during inspiration

question

Define Anergy

answer

False-negative tuberculin skin tests

question

Define Hemagglutinin

answer

Attachment protein that allows the influenza virus to enter epithelial cells in the respiratory tract.

question

Define squamous cell

answer

Carcinoma is associated with the paraneoplastic syndromes that produce hypercalcemia.

question

Define Paraneoplastic syndrome

answer

Symptoms that develop when substances released by some cancer cells disrupt the normal cell function.

question

Define Atypical pneumonias

answer

Facilitates influenza viral replication and release from the cell.

question

Define neuraminidase

answer

Viral and mycoplasma infection.

question

Define Reye syndrome

answer

Fatty liver with encephalitis.

question

How is the cold virus spread?

answer

The fingers are the greatest source of spread, and the nasal mucosa and conjunctival surface of the eyes are the most common portals of entry of the virus. The most highly contagious period is during the first 3 days after the onset of symptoms, and the incubation period is approximately 5 days. Cold viruses have been found to survive for more than 5 hours on the skin and hard surfaces, such as plastic countertops. Aerosol spread of colds, through coughing and sneezing, is much less important than the spread by fingers picking up the virus from contaminated surfaces and carrying it to the nasal membranes and eyes.

question

How does the influenza virus reinfect someone? How is it so contagious?

answer

Contagion results from the ability of the influenza A virus to develop new HA and NA subtypes against which the population is not protected. An antigenic shift, which involves a major genetic rearrangement in either antigen, may lead to epidemic or pandemic infection. Lesser changes, called antigenic drift, find the population partially protected by cross-reacting antibodies.

question

What is a common complication of influenza (usually of the elderly or those with cardiopulmonary disease)?

answer

Viral pneumonia occurs as a complication of influenza. It typically develops within 1 day after onset of influenza and is characterized by rapid progression of fever, tachypnea, tachycardia, cyanosis, and hypotension. The clinical course of influenza pneumonia progresses rapidly. It can cause hypoxemia and death within a few days of onset. Survivors often develop diffuse pulmonary fibrosis.

question

What type of pneumonia results from inhalation or aspiration of nasopharyngeal secretions during sleep?

answer

The lung below the main bronchi is normally sterile, despite frequent entry of microorganisms into the air passages by inhalation during ventilation or aspiration of nasopharyngeal secretions. Bacterial pneumonia results due to loss of the cough reflex, damage to the ciliated endothelium that lines the respiratory tract, or impaired immune defenses. Bacterial adherence also plays a role in colonization of the lower airways. The epithelial cells of critically and chronically ill persons are more receptive to binding microorganisms that cause pneumonia. Other clinical risk factors favoring colonization of the tracheobronchial tree include antibiotic therapy that alters the normal bacterial flora, diabetes, smoking, chronic bronchitis and viral infection.

question

What are the pathophysiologic stages of pneumococcal pneumonia infection?

answer

During the first stage, alveoli become filled with protein-rich edema fluid containing numerous organisms. Marked capillary congestion follows, leading to massive outpouring of polymorphonuclear leukocytes and red blood cells. Because the first consistency of the affected lung resembles that of the liver, this stage is referred to as the red hepatization sage. The next stage involves the arrival of macrophages that phagocytose the fragmented polymorphonuclear cells, red blood cells, and other cellular debris. During this stage, which is termed the gray hepatization stage, the congestion has diminished but the lung is still firm. The alveolar exudate is then removed and the lung returns to normal.

question

How is Mycobacterium tuberculosis hominis spread?

answer

Mycobacterium tuberculosis hominis is an airborne infection spread by minute, invisible particles called droplet nuclei that are harbored in the respirator secretions of persons with active tuberculosis. Coughing, sneezing, and talking all create respiratory droplets; these droplets evaporate, leaving the organisms, which remain suspended in the air and are circulated by air currents. Thus, living under crowded and confined conditions increases the risk for spread of the disease.

question

Describe the pathogenic mechanisms of Mycobacterium tuberculosis hominis.

answer

Inhaled droplet nuclei pass down the bronchial tree without settling on the epithelium and are deposited in the alveoli. Soon after entering the lung, the bacilli are phagocytosed by alveolar macrophages, but resist killing, because cell wall lipids of the M. tuberculosis block fusion of phagosomes and lysosomes. Although the macrophages that first ingest M. tuberculosis cannot kill the organisms, they initiate a cell-mediated immune response that eventually contains the infection. As the tubercle bacilli multiply, the infected macrophages degrade the mycobacteria and present their antigens to T lymphocytes. The sensitized T lymphocytes, in turn, stimulate the macrophages to increase their concentration of lytic enzymes and ability to kill mycobacteria. When released, these lytic enzymes also damage lung tissue. The development of a population of activated T lymphocytes and related development of activated macrophages capable of ingesting and destroying the bacilli constitutes the cell-mediated immune response.

question

How is lung cancer categorized?

answer

Lung cancer is classified as squamous cell lung carcinoma, adenocarcinoma, small cell carcinoma, and large cell carcinoma.

question

What causes the varied manifestations of lung cancer?

answer

The manifestations of lung cancer can be divided into three categories: 1. Those due to involvement of the lung and adjacent structures. 2. The effects of local spread and metastasis. 3. Nonmetastatic paraneoplastic manifestations involving endocrine, neurologic, and connective tissue function.

question

What is the result of the absence of surfactant in premature infants?

answer

Pulmonary immaturity, together with surfactant deficiency, lead to alveolar collapse. The type II alveolar cells that produce surfactant do not begin to mature until approximately the 25th to 28th week of gestation; consequently, many premature infants are born with poorly functioning type II alveolar cells and have difficulty producing sufficient amounts of surfactant. Without surfactant, the large alveoli remain inflated, whereas the small alveoli become difficult to inflate, resulting in respiratory distress syndrome.

question

Mr. Jones, who is 68 years old, presents to the clinic with lack of appetite and weight loss of 30 pounds over the past 6 months. He has a history of chronic, nonproductive cough; shortness of breath, which is worse on exertion; and wheezing. He tells the nurse that he is now coughing up "bloody stuff", and he wants to know what is wrong with him. When asked about pain he says, "I get heartburn once in awhile, but the pain is dull instead of burning." Routine laboratory work is ordered and the only abnormal finding is hypercalcemia. The suspected diagnosis is squamous cell cancer of the lung. What diagnostic tests would the nurse expect to be ordered?

answer

Diagnostic tests for squamous cell cancer of the lung include chest radiography, bronchoscopy, cytologic studies (Papanicolaou [Pap] test) of the sputum or bronchial washings, percutaneous needle biopsy of lung tissue, Scalene lymph node biopsy, computed tomographic scans, MRI studies, ultrasonography to locate lesion and evaluate the extent of the disease, and poistron-emission tomography, a noninvasive alternative for identifying metastatic lesion in the mediastinum or distant sites.

question

Mr. Jones, who is 68 years old, presents to the clinic with lack of appetite and weight loss of 30 pounds over the past 6 months. He has a history of chronic, nonproductive cough; shortness of breath, which is worse on exertion; and wheezing. He tells the nurse that he is now coughing up "bloody stuff", and he wants to know what is wrong with him. When asked about pain he says, "I get heartburn once in awhile, but the pain is dull instead of burning." Routine laboratory work is ordered and the only abnormal finding is hypercalcemia. The suspected diagnosis is squamous cell cancer of the lung. Mr. Jones wants to know how is cancer will be treated. The nurse knows that treatments are available. Which treatments are used for squamous cell (NSCLC) cancer of the lung?

answer

Treatments used for squamous cell (NSCLC) cancer of the lung include surgery for the removal of small, localized NSCLC tumors; radiation therapy, a definitive or main treatment modality for palliation of symptoms; and chemotherapy, often using a combination of drugs. Often, a combination of these treatments are used.

question

A 23 year old woman goes to the drug store to buy a medication to ease the symptoms of her cold.Her friends have told her to buy a medication with an antihistamine in it to help dry up her runny nose and make it easier to breath. The woman talk with the pharmacist, who has known her for many years. The pharmacists recommends that this young woman not buy a cold medication with a decongestant in it. Why would he do that?

answer

Client has a history of hyperthyroidism. Decongestant drugs (i.e. sympathomimetic agents) are available in over-the-counter nasal sprays, drops, and oral cold medications. These drugs constrict the blood vessels in the swollen nasal mucosa and reduce nasal swelling. Rebound nasal swelling can occur with indiscriminate use of nasal drops and sprays. Oral preparations containing decongestants may cause systemic vasoconstriction and elevation of blood pressure when given in doses large enough to relieve nasal congestion. They should be avoided by persons with hypertension, heart disease, hyperthyroidism, diabetes mellitus, or other health problems.

question

The early stages of influenza pass by as if the infection were any other viral infection. What is the distinguishing feature of an influenza viral infection that makes it different from other viral infections?

answer

Rapid onset of profound malaise. One distinguishing feature of an influenza viral infection is the rapid onset, sometimes in as little as 1 to 2 minutes, of profound malaise.

question

Influenza A subtype H5N1 has been documented in poultry in both East and Southeast Asian Countries. This form of Avian flu (bird flu) is highly contagious from bird to bird, but rarely is passed from human to human. There is a large amount of concern that the H5N1 strain might mutate, making it easier to be passed from human to human, carrying with it a high mortality rate. What is the main concern if the H5N1 strain does mutate?

answer

Initiation of a pandemic. Recently, a highly pathogenic influenza A subtype H5N1 was found in poultry in East and Southeast Asian Countries. Although the H5N1 strain is highly contagious from one bird to another, the transmission from human to human is relatively inefficient and not sustained. The result is only rare cases of person-to-person transmission. Most cases occur after exposure to infected poultry or surfaces contaminated with poultry droppings. Because infection in humans is associated with high mortality, where exists considerable concern that H5N1 strain might mutate and initiate a pandemic.

question

Community-acquired pneumonia can be categorized according to several indexes. What are these indexes?

answer

Radiologic findings, Age, Presence of coexisting disease. Community-acquired pneumonia may be further categorized according to risk of mortality and need for hospitalization based on age, presence of coexisting disease, and severity of illness using physical examination findings and laboratory and radiologic findings.

question

An immunocompromised host is open to pneumonia from all types of organisms. There is, however, a correlation between specific types of immunologic deficits and specific invading organisms. What organisms is most likely to cause pneumonia in an immunocompromised host with neutropenia and impaired granulocyte function?

answer

Staphylococcus aureus. Neutropenia and impaired granulocyte function, as occurs with leukemia, chemotherapy, and bone marrow depression, predispose to infections caused by S.aureus, Aspergillus, gram-negative bacilli, and candida.

question

Elderly people are very susceptible to pneumonia in all its varieties. The symptoms the elderly exhibit can be very different than those of other age groups who have pneumonia. What signs and symptoms are elderly people with pneumonia less likely to experience than people with pneumonia in other age groups?

answer

Marked elevation in temperature. Pleuritic pain, a sharp pain that is more severe with respiratory movements, is common. With antibiotic therapy, fever usually subsides in approximately 48 to 72 hours, and recovery is uneventful. Elderly persons are less likely to experience marked elevations in temperature; in these persons, the only sign of pneumonia may be a loss of appetite and deterioration in mental status.

question

Tuberculosis is a highly destructive disease because the tubercule bacillus activates a tissue hypersensitivity to the tubercular antigens. What does the destructive nature of tuberculosis cause in a previously unexposed immunocompetent person?

answer

Caseating necrosis and cavitation.The pathogenesis of tuberculosis in a previously unexposed immunocompetent persons is centered on the development of a cell-mediated immune response that confers resistance to the organism and development of tissue hypersensitivity to the tubercular antigens. The destructive nature of the disease, such as caseating necrosis and cavitation, results from the hypersensitivity capabilities of the tubercule bacillus. Tuberculosis does not have rapidly progressing pulmonary lesions, nor does it have purulent necrosis or purulent pulmonary lesions.

question

Coccidioidomycosis is a pulmonary fungal infection resembling tuberculosis. Less severe forms of the infection are treated with oral antifungal medications. For persons with progressive disease, what is the drug of choice?

answer

IV amphotericin B. The oral antifungal drugs itraconazole and fluconazole are used for treatment of less severe forms of infection. Intravenous amphotericin B is used in the treatment of persons with progressive disease. Long-term treatment is often required. BCG is an attenuated strain of live tubercle vaccine.

question

Non-small cell lung cancers (NSCLCs) mimic small cell lung cancers (SCLCs) through their abilities to do what?

answer

Synthesize bioactive products and produce paraneoplastic syndromes.The NSCLCs include squamous cell carcinomas, adenocarcinomas, and large cell carcinomas. As with the SCLCs, these cancers have the capacity to synthesize bioactive products and produce paraneoplastic syndromes. NSCLCs do not neutralize bioactive syndromes. In addition, they neither synthesize ACTH nor produce panneoplastic syndromes.

question

Premature infants who are treated with mechanical ventilation, mostly for respiratory distress syndrome, are at risk for developing bronchopulmonary dysplasia (BPD), a chronic lung disease. What are the signs and symptoms of BPD?

answer

Rapid and shallow breathing and chest retractions. The infant with BPD often deomnstrates a barrel chest, tachycardia, rapid and shallow breathing, chest retractions, cough, and poor weigh gain.

question

Identify where epiglottis occurs in the respiratory tract of children: upper airway or lower airway.

answer

Upper airway.

question

Identify where acute bronchiolitis occurs in the respiratory tract of children: upper airway or lower airway.

answer

Lower airway

question

Identify where asthma occurs in the respiratory tract of children: upper airway or lower airway.

answer

Lower airway

question

Identify where spasmodic croup occurs in the respiratory tract of children: upper airway or lower airway.

answer

Upper airway

question

Identify where laryngotracheobronchitis occurs in the respiratory tract of children: upper airway or lower airway.

answer

Upper airway

question

What is the underlying cause of respiratory failure in a child with bronchiolitis?

answer

The child with bronchiolitis is at risk for respiratory failure resulting from impaired gas exchange.

question

The primary function of the respiratory system is to remove appropriate amounts of ____ from the blood entering the pulmonary circulation and to add adequate amounts of _____ to the blood leaving the pulmonary circulation.

answer

carbon dioxide (CO2), oxygen (O2)

question

___ involves the movement of fresh atmospheric air to the alveoli for delivery provision of oxygen and removal of carbon dioxide.

answer

Ventilation

question

As a general rule, ____ of the blood primarily depends on factors that promote diffusion of oxygen from the alveoli into the pulmonary capillaries; whereas, ____ primarily depends on the minute ventilation and elimination of carbon dioxide from the alveoli.

answer

oxygenation, removal of carbon dioxide (CO2)

question

___ refers to a reduction in blood oxygen levels.

answer

Hypoxemia

question

Hypoxemia produces its effects through tissue ____ and the compensatory mechanisms that the body uses to adapt to the lowered oxygen level.

answer

hypoxia

question

The body compensates for chronic hypoxemia by increased _____, pulmonary ______, and increased production of _____ cells.

answer

ventilation, vasoconstriction, red blood

question

_____ can occur in a number of disorders that cause hypoventilation or mismatching of ventilation and perfusion resulting in increased arterial carbon dioxide.

answer

Hypercapnia

question

Elevated levels of partial pressure carbon dioxide produce a decrease in _____ and respiratory _____.

answer

pH, acidosis

question

____ refers to an abnormal collection of fluid in the pleural cavity.

answer

Pleural effusion

question

____ is a specific type of pleural effusion in which there is blood in the pleural cavity.

answer

Hemothorax

question

Primary atelectasis of the newborn implies that the lung has never been _____.

answer

inflated

question

Obstructive airway disorders are caused by disorders that limit _____ airflow.

answer

expiratory

question

Bronchial ____ is a chronic disorder of the airways that causes episodes of airway obstruction, bronchial hyperresponsiveness, and airway inflammation that are usually reversible.

answer

asthma

question

Recent research has focused on the role of ____ in the pathogenesis of bronchial asthma.

answer

T lymphocyte

question

_____ pulmonary disease (COPD) is characterized by chronic and recurrent obstruction of airflow in the pulmonary airways.

answer

Chronic obstructive

question

In COPD, _____ and _____ of the bronchial wall, along with excess mucus secretion, obstruct airflow and cause mismatching of ventilation and perfusion.

answer

inflammation, fibrosis

question

____ is thought to result from the breakdown of elastin and other alveolar wall components by enzymes, called _____ that digest proteins.

answer

Emphysema, proteases

question

A hereditary deficiency in _____ accounts for approximately 1% of all cases of COPD and is more common in young persons with emphysema.

answer

Alpha-1-antitrypsin

question

The earliest feature of chronic bronchitis is ____ in the large airways, associated with hypertrophy of the submucosal glands in the trachea and bronchi.

answer

hypersecretion of mucus

question

Persons with predominant emphysema are classically referred to as _____, a reference to the lack of cyanosis, the use of accessory muscles, and pursed-lip breathing.

answer

pink puffers

question

Persons with a clinical syndrome of chronic bronchitis are classically labeled _____, a reference to cyanosis and fluid retention associated with right-sided heart failure.

answer

blue bloaters

question

____ is a permanent dilation of the bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue resulting from a vicious cycle of infection and inflammation.

answer

Bronchiectasis

question

____ is an autosomal recessive disorder involving fluid secretion in the exocrine glands in the epithelial lining of the respiratory, gastrointestinal, and respiratory tracts.

answer

Cystic fibrosis

question

The diffuse _____ diseases are a diverse group of lung disorders that produce similar inflammatory and fibrotic changes in the interalveolar septa of the lung.

answer

interstitial

question

The interstitial lung disorders exert their effects on the _____ and _____ connective tissue found between the delicate interstitium of the alveolar walls.

answer

collagen, elastic

question

Pulmonary _____ develops when a blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flow, almost all of which are thrombi that arise from deep vein thrombosis.

answer

embolism

question

Chest pain, dyspnea, and increased respiratory rate are the most frequent signs and symptoms of _____.

answer

pulmonary embolism

question

_____ is a disorder characterized by an elevation of pressure within the pulmonary circulation, namely the pulmonary arterial system.

answer

Pulmonary hypertension

question

Continued exposure of the pulmonary vessels to _____ is a common cause of pulmonary hypertension.

answer

hypoxemia

question

____ can be viewed as a failure in the gas exchange due either to pump or lung failure, or both.

answer

Respiratory failure

question

Define ventilation

answer

Movement of gas into or out of lungs.

question

Define PF ratio

answer

Difference between arterial partial pressure oxygen and the fraction of inspired oxygen.

question

Define cyanosis

answer

Results from an excessive concentration of reduce hemoglobin

question

Define respiratory quotient

answer

Ratio of carbon dioxide production to oxygen consumption

question

Define empyema

answer

Infection in the pleural cavity.

question

Define hypercapnia

answer

Increase in the carbon dioxide content of arterial blood.

question

Define venous oxygen saturation

answer

Reflects the body's extraction and utilization of oxygen at the tissue levels

question

Define pneumothorax

answer

Air in pleural space

question

Define hypoxemia

answer

Decreased oxygenation

question

Define plueritis

answer

Infection of the pleura

question

Define cor pulmonale

answer

Right hear failure resulting from primary lung disease

question

Define pneumoconioses

answer

Caused by inhalation of inorganic dusts and particulate matter.

question

Define CFTR

answer

Cystic fibrosis transmembrane regulator

question

Define ARDS

answer

Acute respiratory distress syndrome

question

Define Atelectasis

answer

Incomplete expansion of a lung or portion of a lung.

question

Define mismatching of ventilation and perfusion

answer

Areas of the lung are ventilated but not perfused, or when areas are perfused but not ventilated

question

Define bronchiectasis

answer

Lung tissue destruction resulting from a vicious cycle of infection and inflammation

question

Define emphysema

answer

Enlargement of air spaces and destruction of lung tissue

question

Define sarcoidosis

answer

Granulomas found in the lung and lymphatic system

question

Define chronic bronchitis

answer

With increased mucus production, obstruction of small airways, and a chronic productive cough.

question

Put the events of IGE-mediated asthma reaction in order. a. Infiltration of inflammatory cells. b. Mast cell activation. c. Bronchospasm d. Increased airway responsiveness e. Exposure to allergen f. Airway inflammation

answer

1. Exposure to allergen 2. Mast cell activation 3. Bronchospasm 4. Infiltration of inflammatory cells 5. Airway inflammation 6. Increased airway responsiveness.

question

What are the mechanisms of hypoxemia?

answer

The mechanisms that result in hypoxemia are hyperventilation, impaired diffusion of gases, inadequate circulation of blood through the pulmonary capillaries, and mismatching of ventilation and perfusion.

question

What are the clinical features of atelectasis?

answer

The clinical manifestations of atelectasis include tachypnea, tachycardia, dyspnea, cyanosis, signs of hypoxemia, diminished chest expansion, absence of breath sounds, and intercostal retractions. Both chest expansion and breath sounds are decreased on the affected area. There may be intercostal retraction over the involved area during inspiration.

question

Explain what is meant by the acute-response and the late-phase reactions of asthma.

answer

The symptoms of the acute response are caused by the release of chemical mediators from the presensitized mast cells. Mediator release results in the infiltration of inflammatory cells, opening of the mucosal intercellular junctions, and increased access of antigen of submucosal mast cells. There is bronchospasm caused by direct stimulation of parasympathetic receptors, mucosal edema caused by increased vascular permeability, and increased mucus secretions. The late-phase response involves inflammation and increased airway responsiveness that prolong the asthma attack. An initial trigger in the late-phase response causes the release of inflammatory mediators from mast cells, macrophages, and epithelial cells. These substances include the migration and activation of other inflammatory cells, which then produce epithelial injury and edema, changes in mucociliary function and reduced clearance of respiratory tract secretions, and increased airway responsiveness.

question

What factors are causative to the development of bronchiectasis?

answer

The two processes that are critical to the pathogenesis of bronchiectasis are airway obstruction and chronic persistent infection, causing damage to the bronchial walls, leading to weakening and dilation.

question

Describe the pathogenic mechanism of cystic fibrosis.

answer

Cystic fibrosis is caused by mutations in a single gene on the long arm of chromosome that encodes for the cystic fibrosis transmembrane regulatory (CFTR), which functions as a chloride channel in epithelial cell membranes. Mutations in the CFTR gene render the epithelial membrane relatively impermeable to the chloride ion. The impaired transport of chloride ion ultimately leads to a series of secondary events, including increased absorption of sodium ion and water from the airways into the blood. This lowers the water content of the mucociliary blanket coating the respiratory epithelium, causing it to become more viscid. The resulting dehydration of the mucous layer leads to defective mucociliary function and accumulation of viscid secretions that obstruct the airways and predispose to recurrent pulmonary infections. The obstruction develops from the thick mucous and recurrent infections damage lung tissue leading to the development of bronchiectasis.

question

What are the effects of a pulmonary embolism on lung tissue?

answer

Obstruction of pulmonary blood flow causes reflex bronchoconstriction in the affected area of the lung, wasted ventilation and impaired gas exchange, and loss of alveolar surfactant. Pulmonary hypertension and right heart failure may develop when there is massive vasoconstriction because of a large embolus.

question

Describe the disease-producing changes of acute respiratory distress syndrome.

answer

Pathologic lung changes include diffuse epithelial cell injury with increased permeability of the alveolar-capillary membrane, which permits fluid, plasma proteins, and blood cells to move out of the vascular compartment of the interstitium and alveoli of the lung. Diffuse alveolar cell damage leads to accumulation of fluid, surfactant inactivation, and formation of a hyaline membrane. the work of breathing becomes greatly increased as the lung stiffens and becomes more difficult to inflate. There is increased intrapulmonary shunting of blood, impaired gas exchange, and hypoxemia despite high supplemental oxygen therapy. Gas exchange is further compromised by alveolar collapse resulting from abnormalities in surfactant production. When injury to the alveolar epithelium is severe, disorganized epithelial repair may lead to fibrosis.

question

The parents of a 14-year-old girl arrive in the emergency department after being notified by the school nurse that their daughter had a "spell" at school and was taken to the emergency department by ambulance. When they arrive their daughter is sitting up on the stretcher, has oxygen on at 1 L/min, and is answering questions asked by the nurse. The doctor talks to the family and tells them he suspects their daughter has asthma. What diagnostic tests would the nurse expect to be ordered to confirm the diagnosis of asthma?

answer

Diagnostic test the nurse would expect to be ordered to confirm the diagnosis of asthma include spirometry, inhalation challenge tests, and laboratory findings.

question

The parents of a 14-year-old girl arrive in the emergency department after being notified by the school nurse that their daughter had a "spell" at school and was taken to the emergency department by ambulance. When they arrive their daughter is sitting up on the stretcher, has oxygen on at 1 L/min, and is answering questions asked by the nurse. The parents mention to the nurse that their daughter values her independence. They want to know how her treatment plan will impact her independence. How would the nurse correctly respond?

answer

A plan of care will be developed with the input of both you and your daughter to encourage independence as it relates to the control of her symptoms, along with measures directed at helping her develop and keep a positive self-concept.

question

There can be many reasons for a patient to present with hypoxemia. For a client's partial pressure of oxygen to fall, a respiratory disease is usually involved. Often, patients have involvement from more than one mechanism. What is the outcome of the mechanism of decreased oxygen in air?

answer

Hypoxemia

question

There can be many reasons for a patient to present with hypoxemia. For a client's partial pressure of oxygen to fall, a respiratory disease is usually involved. Often, patients have involvement from more than one mechanism. What is the outcome of the mechanism of inadequate circulation through pulmonary capillaries?

answer

Decreased partial pressure of oxygen

question

There can be many reasons for a patient to present with hypoxemia. For a client's partial pressure of oxygen to fall, a respiratory disease is usually involved. Often, patients have involvement from more than one mechanism. What is the outcome of the mechanism of hypoventilation?

answer

Decreased partial pressure of oxygen

question

There can be many reasons for a patient to present with hypoxemia. For a client's partial pressure of oxygen to fall, a respiratory disease is usually involved. Often, patients have involvement from more than one mechanism. What is the outcome of the mechanism of disease in respiratory system?

answer

Hypoxemia

question

There can be many reasons for a patient to present with hypoxemia. For a client's partial pressure of oxygen to fall, a respiratory disease is usually involved. Often, patients have involvement from more than one mechanism. What is the outcome of the mechanism of mismatched ventilation and perfusion?

answer

Decreased partial pressure of oxygen

question

There can be many reasons for a patient to present with hypoxemia. For a client's partial pressure of oxygen to fall, a respiratory disease is usually involved. Often, patients have involvement from more than one mechanism. What is the outcome of the mechanism of dysfunction of neurologic system?

answer

Hypoxemia

question

When carbon dioxide levels in the blood rise, a state of hypercapnia occurs in the body. What factors contribute to hypercapnia?

answer

Alteration in carbon dioxide production, abnormalities in respiratory function, disturbance in gas exchange function, and changes in neural control of respiration. Hypercapnia refers to an increase in carbon dioxide levels. In the clinical setting, four factors contribute to hypercapnia: alterations in carbon dioxide production, disturbance in the gas exchange function of the lungs, abnormalities in respiratory function of the chest wall and respiratory muscles, and changes in neural control of respiration. A decrease in carbon dioxide production does not cause hypercapnia.

question

The complications of a hemothorax can impact the total body. Left untreated, what can a moderate or large hemothorax cause?

answer

Fibrothorax. One of the complications of untreated moderate of large hemothorax is fibrothorax - the fusion of the pleural surfaces by fibrin, hyalin, and connective tissue - and in some cases, calcification of the fibrous tissue, which restricts lung expansion. Calcification of the lung tissue does not occur because of a hemothorax, neither does pleuritis or an atelectasis.

question

Talc lung can occur from injected or inhaled talc powder that has been mixed with heroin, methamphetamine, or codeine as a filler. What are people with talc lung very susceptible to?

answer

Fibrothorax. Persons with talc lung are also highly susceptible to the occurrence of pneumothorax. Talc lung ma result from inhalation of talc particles, but is more commonly an occurrence of injected or inhaled talc powder that is used as a filler with heroin, methamphetamine, or codeine. A hemothorax is not a complication of talc lung, neither are chylothorax or fibrothorax.

question

Pleuritis, an inflammatory process of the pleura, is a common in infectious processes that spread to the pleura. Which are the drugs of choice for treating pleural pain?

answer

Indomethacin. Treatment of pleuritis consists of treating the underlying disease and inflammation. Analgesics and nonsteroidal anti-inflammatory drugs (e.g. indomethacin) may be used for pleural pain. Although these agents reduce inflammation, they may not entirely relieve the discomfort associated with deep breathing and coughing.

question

Atelectasis is the term used to designate an incomplete expansion of a portion of the lung. Depending on the size of the collapsed area and the type of atelectasis occurring, you may see a shift in the mediastinum and trachea. Which way does the mediastinum and trachea shift in compression atelectasis?

answer

Away from the affected lung. If the collapsed area is large, the mediastinum and trachea shift to the affected side. In compression atelectasis, the mediastinum shifts away from the affected lung.

question

Infants and small children have asthma and need to be medicated, just as adults do. There are special systems manufactured for the delivery of inhaled medications of children. At which age is it recommended that children may begin using an metered-dose inhaler (MDI) with a spacer?

answer

3 to 5 years. For children younger than 2 years of age, nebulizer therapy usually is preferred. Children between 3 and 5 years of age may begin using an MDI with a spacer and holding chamber.

question

Chronic obstructive pulmonary disease (COPD) is a combination of disease processes. What disease processes have been identified as being part of COPD?

answer

Chronic obstructive bronchitis and emphysema. The term chronic obstructive pulmonary disease encompasses two types of obstructive airway disease: emphysema, with enlargement of air spaces and destruction of lung tissue; and chronic obstructive bronchitis, with increased mucus production, obstruction of small airways, and a chronic productive cough. Persons with COPD often have overlapping features of both disorders. Asthma and chronic bronchitis have not been identified as components of COPD.

question

Bronchiectasis is considered a secondary COPD and, with the advent of antibiotics, it is not a common disease entity. In the past, bronchiectasis often followed specific diseases. Which disease did it not follow?

answer

Chickenpox. In the past, bronchiectasis often followed a necrotizing bacterial pneumonia that frequently complicated measles, pertussis, or influenza. Chickenpox has never been linked to bronchiectasis.

question

Cystic fibrosis (CF) is an autosomal recessive disorder involving the secretion of fluids in specific exocrine glands. The genetic defect in CF inclines a person of chronic respiratory infections from a small group of organisms. Which organisms create chronic infection in a child with cystic fibrosis?

answer

Pseudomonas aeruginosa and S. aureus. In addition to airway obstruction, the basic genetic defect that occurs with cystic fibrosis predisposes to chronic infection with a surprising small number of organisms the most common being Pseudomonas aeruginosa, Burkholderia cepacia, Staphylococcus aureus, and Haemophilus influenzae.

question

What etiologic determinants are important in the development of the pneumoconioses?

answer

Chemical nature of the dust particle, size of dust particle, ability of particle to incite lung destruction. Important etiologic determinants in the development of the pneumoconioses are the size of the dust particle, its chemical nature and ability to incite lung destruction, and the concentration of dust and length of exposure to it. The density and biologic nature of the dust particles are not linked to their ability to cause pneumoconioses.

question

There are cytotoxic drugs used in the treatment of cancer that cause pulmonary damage because of their direct toxicity and because they stimulate an influx of inflammatory cells into the alveoli. Which cardiac drug is known for its toxic effect in the lungs?

answer

Amiodarone. Drugs can cause a variety of both acute and chronic alterations in lung function. For example, some of the cytotoxic drugs (e.g. bleomycin, busulfan, methotrexate, and cyclophosphamide) used in treatment of cancer cause pulmonary damage as a result of direct toxicity of the drug and by stimulating the influx of inflammatory cells into the alveoli. Amiodarone, a drug used to treat resistant cardiac arrhythmias, is preferentially sequestered in the lung and causes significant pneumonitis in 5% to 15% of persons receiving it.

question

A pulmonary embolism occurs when there is an obstruction in the pulmonary artery blood flow. Classic signs and symptoms of a pulmonary embolism include dyspnea, chest pain, and increased respiratory rate. What is a classic sign of pulmonary infarction?

answer

Pleuritic pain.Chest pain, dyspnea, and increased respiratory rate are the most frequent signs and symptoms of pulmonary embolism. Pulmonary infarction often causes pleuritic pain that changes with respiration; it is more severe on inspiration and less severe on expiration. Mediastinal and tracheal shifts are not signs of a pulmonary infarction, and neither is pericardial pain.

question

Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response?

answer

Pulmonary vessels constrict. Continued exposure to the pulmonary vessels to hypoxemia is a common cause of pulmonary hypertension. Unlike blood vessels in the systemic circulation, most of which dilate in response to hypoxemia and hypercapnia, the pulmonary vessels constrict.

question

The management of cor pulmonale is directed at the underlying lung disease and heart failure. Why is low-flow oxygen therapy a part of the management of cor pulmonale?

answer

Reduces pulmonary hypertension and polycythemia associated with chronic lung disease. Management of cor pulmonale focuses on the treatment of the lung disease and heart failure. Low-flow oxygen therapy may be used to reduce the pulmonary hypertension and polycythemia associated with severe hypoxemia caused by chronic lung disease. Low-flow oxygen used in treating cor pulmonale does not stimulate the body to breathe; it does not act in an inhibitory way on the respiratory center in the brain; nor does it reduce the formation of pulmonary emboli.

question

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) are distinguishable between the two by the extent of hypoxemia involved. What is the clinical presentation of ARDS?

answer

Rapid onset, increase in respiratory rate, and hypoxemia refractory to treatment. Clinically, ALI/ARDS is marked by a rapid onset, usually within 12 to 18 hours of the initiating event, of respiratory distress, an increase in respiratory rate, and signs of respiratory failure. Chest radiography shows diffuse bilateral infiltrates of the lung tissue in the absence of cardiac dysfunction. Marked hypoxemia occurs that is refractory to treatment with supplemental oxygen therapy, which results in a decrease in the PF ratio. Many persons with ARDS have a systemic response that results in multiple organ failure, particularly the renal, gastrointestinal, cardiovascular, and central nervous systems.

question

Acute respiratory failure is commonly signaled by varying degrees of hypoxemia and hypercapnia. Respiratory acidosis develops manifested by what?

answer

Increased cerebral spinal fluid pressure. Many of the adverse consequences of hypercapnia are the result of respiratory acidosis. Direct effects of acidosis include depression of cardiac contractility, decreased respiratory muscle contractility, and arterial vasodilation. Raised levels of partial pressure of oxygen greatly increase cerebral blood flow, which may result in headache, increased cerebral spinal fluid pressure, and sometimes papilledema.

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