question

Cilia

answer

● Hair like projections that extend from cell surfaces of lung epithelial cells. They propel mucous and trapped particles out of lower airway to be coughed out or swallowed

question

Surfactant

answer

a lipoprotein produced by alveoli cells that has a detergent-like quality.produces surface tension on the alveoli, which enhances pulmonary compliance and prevents the alveoli from collapsing

question

Diaphragm

answer

Dome shaped muscle that separates the thoracic and abdominal cavities. Diaphragm receives impulses that cause it to contract, lower and flatten which draws air into the lungs.

question

Mediastinum

answer

the part of the thoracic cavity between the lungs that contains the heart and aorta and esophagus and trachea and thymus (but not lungs and pleura)

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Pleura

answer

Lung lining

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Hemothorax

answer

hemorrhage into pleural space

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Pneumothorax

answer

presence of air/gas in pleural space caused by rupture in visceral pleura or parietal pleura and chest wall.

question

Empyema

answer

presence of pus in pleural space

question

Atalactasis

answer

collapse of alveoli, surfactant inactivation

question

Orthopnea

answer

dyspnea when a person is lying down

question

COPD

answer

A combination of Emphysema and Chronic Bronchitis. COPD is irriversible, chronic hypercapnic shift. Leads to cor pulmonale & right sided HF.

question

Emphysema

answer

Destruction of the alveolar walls leads to large, permanently inflated alveoli.Enzyme necessary for lung remodeling is deficient.Loss of elastic recoil and hyperinflation of the alveoli, leading to air trapping Manifestations: dyspnea upon exertion, diminished breath sounds, wheezing, chest tightness, tachypnea, hypoxia, hypercapnia, activity intolerance, anorexia, and malaise

question

Chronic bronchitis

answer

Characterized by inflammation of the bronchi, a productive cough, and excessive mucus production Manifestations:hypoventilation, hypoxemia, cyanosis, hypercapnia, polycythemia, clubbing of fingers, dyspnea at rest, wheezing, edema, weight gain, malaise, chest pain, and fever

question

Asthma

answer

Intermittent reversible airway obstruction. Acute airway inflammation, Bronchoconstriction, Bronchospasms, bronciole edema, mucous production Manifestations: wheezing, dyspnea, cough, anxiety, tachypnea, shortness of breath, chest tightness

question

Manifestations of Pulmonary Embolism

answer

increase HR, increase RR, SOB, anxiety; pleural pain, hemoptysis, fever, increase WBC

question

What causes Pulmonary Embolism

answer

Blood clot, 90% often from DVT Fats - femur fracture Air May infarct segment of lung, may cause sudden death Multiple small emboli (showers) - chronic or recurrent 2nd to cancer or clotting disorder

question

How does O2 and CO2 exchange in the lungs? What process of movement is this called?

answer

In the capillary bed of the alveoli by passive diffusion

question

Hypercapnia

answer

increase CO2 levels

question

Hypocapnia

answer

decrease CO2 levels

question

Hypoxia

answer

decreased O2 levels in tissue and cells

question

Hypoxemia

answer

decreased O2 levels in the blood

question

ARDS

answer

(Acute Respiratory Distress Syndrome) Hyperventilation, Respiratory alkalosis, Dyspnea and hypoxemia, Metabolic acidosis, Hypoventilation, Respiratory acidosis, Further hypoxemia, Hypotension, decreased cardiac output, death ○ PaO2 less than 50 mm Hg ○ PaCO2 greater than 50 mm Hg ○ pH less than 7.25

question

What causes ARDS?

answer

Occurs in response to other condition:Sepsis,fluid overload,shock, burns, DIC,aspiration,neurologic injuries Massive pulmonary inflammation Damage to the alveolocapillary membrane pulmonary edema, decreased lung compliance, impaired alveolar ventilation Surfactant inactivation - Atelectasis

question

What are manifestations of ARDS?

answer

labored/shallow respirations, rales, productive cough w/ frothy sputum, hypoxia, caynosis, tachycardia

question

Cor pulmonale

answer

Pulmonary heart disease causesRight ventricular enlargement Secondary to pulmonary hypertension Pulmonary hypertension creates chronic pressure overload in the right ventricle leading to right sided HF

question

What are the clinical manifestations of cor pulmonale

answer

Exertion dyspnea Fatigue and weakness Jugular vein distention, hepatosplenomegaly, peripheral edema Abnormal ECG showing right ventricular hypertrophy

question

Community acquired pneumonia

answer

Streptococcus pneumoniae— most common Mycoplasma pneumoniae—common in adolescents Influenza virus—most common viral in adults

question

Hospital acquired pneumonia

answer

Pseudomonas aeruginosa Staphylococcus aureus

question

Pneumonia associated w/ HIV/AIDS

answer

Pneumocystis jiroveci (formerly carinii)

question

Clinical manifestations of lung cancer

answer

persistent cough(chronic over 2-3 weeks) or a change in usual cough, dyspnea, hemoptysis, frequent respiratory infections, chest pain, hoarseness, weight loss, anemia, fatigue, and other symptoms specific to site of metastasis

question

Pathophysiology of TB

answer

1. Primary infection:bacillus enters body, some travel to lymph nodes, activates type IV hypersensitivity, lymphocytes/macrophages for a granuloma, tubercle, caseous necrotic tissue, in healthy people become calcified (Ghon Complexes) but can remain dormant 2. Secondary/ Active infection: TB spreads in lungs/other organs

question

Manifestations of TB

answer

productive cough, hemoptysis, night sweats, unexplained weight loss, fever/chills, anorexia

question

What allows TB to lie dormant?

answer

Scar tissue around tubercle - tubercles form and become scar tissue (caseous necrosis) after 10 days, becomes dormant but not dead for life. Reactivated by malnutrition, type 1 diabetes, immunocompromise.

question

Manifestations of chronic hypoxia

answer

clubbing, polycythemia, cor pulmonale, prolonged hypercapnia

question

Review ABG values

answer

PaCO2= 35-45 HCO3= 22-26 PH= 7.35-7.45 PaO2=80-100

question

Describe cardiovascular circulation

answer

Superior/Inferior Vena Cava, RA, Tricuspid, RV, Pulmonary Valve, Pulmonary Artery, Lungs, Pulmonary Vein, LA, Mitral, LV, Aortic Valve, Aorta, Body

question

Vessels of the Coronary Arteries

answer

Right Coronary Artery, Right Marginal, Anterior Intraventricular Artery, Posterior Intraventricular Artery, Left Coronary Artery, Left Circumflex Great Cardiac Vein, Middle Cardiac Vein, Small Cardiac vein

question

Where is the opening of the Coronary Arteries?

answer

Coronary ostea

question

Where do Coronary veins drain into?

answer

Coronary sinus in the RA

question

Describe the conduction of a healthy heart

answer

SA Node, Atrial Contraction, AV Node, Bundle of His, L/R bundles, Perkenji fibers, Ventricular contraction

question

What is the primary pacemaker?

answer

Sinal Atrial (SA) Node 60-100 bpm

question

What are the back up pacemaker?

answer

Atrial Ventricular (AV) Node 40-60 bpm Bundle branches/Perkenji Fibers <40 bpm

question

Describe pericarditis

answer

● Pericarditis- inflammation of the pericardium. ○ Fluid accumulates called pericardial effusion, swollen tissue creates friction. ● Constrictive pericarditis- loss of elasticity, results from chronic inflammation

question

Clinical manifestation of pericarditis

answer

pericardial friction rub, sharp sudden , severe chest pain that increases with deep inspiration and decreases when sitting up and leaning forward, dyspnea, tachycardia, edema, flulike symptoms

question

Describe cardiac temponade

answer

cardiac compression from excessive fluid accumulation. Life threatening

question

Clinical manifestations of cardiac temponade

answer

arterial pressures fall, rising venous pressures, narrowing pulse pressure, and muffled heart sounds. Comp- heart failure, shock, and death

question

What causes Dilated Cardiomyopathy?

answer

Caused by ischemic heart disease and hypertension, infections, toxins, connective tissue disease, nutritional deficiencies, idiopathic results from extensively damaged myocardium fibers

question

What causes hypertrophic Cardiomyopathy?

answer

Diastolic dysfunction, hypertrophic ventricle becomes stiff leading to decreased ventricular filling. leading to decreased CO

question

Manifestations of Dilated Cardiomyopathy

answer

Dyspnea, non productive cough, orthopnea, paroxysmal nocturnal dyspnea, dysrhythmias, angina, dizziness, activity intolerance, jugular vein distention, murmurs, peripheral edema, poor cap refill, Hepatomegaly

question

Manifestations of Hypertrophic Cardiomyopathy

answer

Syncope, left ventricular failure, infarction (similar to dilated)

question

Patho and Manifestations of Aortic Stenosis and problems it causes

answer

Aortic Stenosis:→hypertrophy of left ventricle→blood backs into left atrium→AFIB→blood back up into pulmonary circulation→pulmonary edema, leads to left sided heart failure Manifestations: murmur, angina, syncope, pulmonary edema, dyspnea on exertion

question

Patho and Manifestations of Mitral Stenosis and problems it causes

answer

Mitral Stenosis:→hypertrophy of left atrium→blood backs up into pulmonary circulation→pulmonary edema, leads to left sided heart failure Manifestations:similar to aortic, dysrhythmias, decreased cardiac output, pulmonary hypertension, orthopnea, increased respiratory infections.

question

What is Rheumatic heart disease?

answer

Valvular damage: inflammation, erosion, and deposition of clumps of vegetation.Myocarditis and pericarditis can also occur.

question

What causes Rheumatic heart disease?

answer

Type II reaction. Group A beta hemolytic strep. Not the strep itself but body's response to the strep that causes the problem. 10% of patients with untreated rheumatic fever will develop RHD.

question

Infective endocarditis and 3 steps of progression

answer

○ Infection by Streptococcus viridans and Staphylococcus aureus infections ○ Vegetation forms on internal structures and creates small thrombi ○ Microemboli occur as they are dislodged, resulting in microhemmorages

question

Risk factors for Infective endocarditis

answer

valvular heart disease, prosthetic valves, long term indwelling catheters, IV drug use, dental procedures, recent cardiac surgery

question

What are the clinical manifestations of infective endocarditis

answer

flu like symptoms, splinter hemorrhage under nails, Osler's nodes, petechiae, Hematuria

question

Describe heart failure

answer

congestive heart failure, blood cannot pump adequate amount of blood to meet the body's needs

question

Manifestations of Left Sided HF

answer

pulmonary congestion (rales), orthopnea

question

Manifestations of Right Sided HF

answer

weight gain, edema, distended jugular veins, cor pulmonale (systemic effects)

question

Preload

answer

how much blood is coming into heart and the stretch against ventricles because of that blood Frank Starling Law= greater volume, greater pressure, better contractility until a point and then it starts to lose contractility over time

question

Afterload

answer

force the heart is working against, resistance

question

Stroke Volume

answer

effected by preload, afterload and contractility

question

Cardiac output

answer

Amount of blood pumped every minute Stroke Volume X HR=CO 4-8 L per minute

question

Cardiogenic shock

answer

Failure of heart pump, something happened at heart level- left ventricle cannot maintain adequate cardiac output. Compensatory mechanisms of heart failure are triggered;however these mechanisms increase cardiac workload and O2 consumption, resulting in decreased contractility. Tissue and organ perfusion decreases, leading to multi-system organ failure

question

Nuerogenic shock

answer

decrease in sympathetic tone in vascular smooth muscle leads to massive vasodilation

question

Septic shock

answer

caused by bacterial infection (septicemia)

question

Anaphylactic shock

answer

Hypersensitive reaction to an allergen

question

Hypovolemic shock

answer

Venous return reduces because of external blood volume losses. Preload drops decreasing ventricular filling and stroke volume. As cardiac output falls, tissue and organ perfusion decreases.

question

Common steps for all forms of shock

answer

1.activation of compensatory mechanisms such as the SNS and RAA 2. compensatory mechanisms fail to maintain CO, cells use anaerobic respiration, lactic acid builds up, metabolic acidosis, sluggish blood flow, increased coagulation 3. irreversible shock leading to irrerversible organ damage and cardiac failure

question

What does the P wave represent on an EKG

answer

Atrial Depolarization

question

What does the QRS complex represent on an EKG

answer

Ventricle Depolarization

question

What does the T wave on represent on an EKG

answer

Ventricle Repolarization

question

Automaticity

answer

cell's ability to generate electrical impulse (generate own impulse)

question

Refractoriness

answer

rest before another impulse

question

Excitability

answer

The ability to respond to stimuli by the production of electrical impulses

question

Conductivity

answer

ability to transmit an impulse from cell to cell

question

What occurs during Diastole

answer

relaxation of ventricles- ventricles fill

question

What occurs during Systole

answer

contraction of ventricles- blood is pushed out of ventricles

question

Describe the steps in the development of atherosclerosis.

answer

Chronic inflammatory disease characterized by thickening and hardening of the arterial wall. Triggered by a vessel wall injury. Lesions develop on vessel wall and calcify over time. Leads to vessel obstruction, platelet aggregation, and vasoconstriction

question

List the risk factors for the development of primary hypertension

answer

Age, Race, Overweight/Obese, Sedentary, Tobacco use, high Sodium diet, low Potassium diet, high Vitamin D, Alcohol, Stress, Chronic conditions (dyslepedemia, diabetes, renal disease, sleep apnea)

question

List complications that may occur from hypertension.

answer

atherosclerosis, aneurysms, HF, Stroke, Hypertensive crisis, Renal damage, Vision loss, Metabolic syndrome, Problems w/ memory and understanding

question

What is orthostatic hypotension? What are the causes?

answer

Decrease in both systolic and diastolic blood pressure upon standing Sluggish blood pressure compensation in response to (baroreceptor) gravitational changes on the circulation Causes: Medications, Dehydration, Physical exhaustion Venous pooling (pregnancy, extensive varicosities)

question

What is an embolus? Thrombus?

answer

● Thrombus- stationary blood clot ● Embolus- traveling body. Floats through blood. May be a thrombus, air, fat, tissue, bacteria, amniotic fluid, tumor cells, and foreign substances. Can become lodged in places like the lungs, brain, and heart

question

Describe the different types of aneurysm.

answer

○ saccular aneurysm- bulge on the side ○ fusiform- occurs the entire circumference Atherosclerosis is the most common cause, hypertension is a contributing factor

question

What is a true aneurysm?

answer

affects all 3 vessel layers.

question

Describe Raynaud phenomenon and disease, think about the causes, processes and symptoms

answer

result of vasospasms of arteries, most often of the hands, that occur because of sympathetic stimulation. Raynaud's phenomenon describes when these vasospasms occur with an autoimmune disease (systemic lupus erythema and scleroderma). As vessel occlusion increases, the ischemia to the affected tissue becomes worse.

question

What are clinical manifestations of chronic venous insufficiency?

answer

DVT- Virchow's Triad o Venous stasis o Venous endothelial damage o Hypercoagulable state Vericose Veins:dilated, tortuous, engorged veins (vericose veins) Manifestations: Irregular, purplish, bulging veins,Pedal edema, Fatigue,cAching in the legs, Shiny, pigmented, hairless skin on the legs and feet-Skin ulcer formation

question

What is stable angina? What causes it? How is it different from unstable angina.

answer

ischemia that is initiated by increased demand (activity) and relieved with the reduction of that demand (rest) Caused by reduction of O2 to the cardiac muscles that produces chest pain Unstable angina is unpredictable, pre-infarction stage

question

What lab values are monitored to confirm the diagnosis of myocardial infarction (MI)?

answer

● Cardiac troponins (troponin I and troponin T) are most specific for MI (these are enzymes released when heart muscle damaged) ○ creatine kinase (released w/any type of muscle damage ○ lactic dehydrogenase

question

What is hematopoiesis and where does it occur?

answer

the production of blood cells, takes place in the spleen and liver of a fetus and in the bone marrow after birth.

question

What is a stem cell?

answer

Stem cells (primitive cells) differentiate the precursors for the different blood cells. All blood cells come from one pluripotent stem cell. Can branch into Myologenic/Lymphactic

question

What are erythropoietin and thrombopoietin, where do they come from and what do they do?

answer

erythropoietin- hormone produced by the kidneys that stimulates production of RBCs in bone marrow thrombopoietin- hormone produced by the kidneys that stimulates the production of platelets in bone marrow

question

Describe the functions of the spleen and lymph nodes

answer

Spleen: Filters and cleans blood, mounts immune response against blood-borne pathogens, serves as blood reservoir Lymph nodes - Part of the immune and hematologic systems ● Facilitates maturation of lymphocytes ● Transports lymphatic fluid back to the circulation ● Cleanses the lymphatic fluid of microorganisms and foreign particles

question

What is a normal platelet count?

answer

● Normal Value: 150,000-400,000/mm3 ● <50,000/mm3: hemorrhage from minor trauma (anything uner 100,000 should not be on asprin or any other kind of blood thinner) ● <15,000/mm3: spontaneous bleeding ● <10,000/mm3: severe bleeding

question

What is the role of platelets in hemostasis?

answer

Forms platelet plug Thrombin + Fibrinogen= fibrin

question

What other processes and substances participate in hemostasis?

answer

1. Vessel spasm 2. Formation of platelet plug 3. Blood coagulation 4. Clot retraction 5. Clot dissolution

question

What is polycythemia vera? What are the clinical manifestations?

answer

Abnormally high erythrocytes,Considered a neoplastic disease Increased blood volume and viscosity, leading to tissue ischemia and necrosis Manifestations:cyanotic or plethoric skin, high blood pressure, tachycardia, dyspnea, headaches, visual abnormalities

question

Know the normal WBC count.

answer

● White blood cells -normal level is 5,000 to 10000 mm3

question

List the WBCs, identify which are granulocytes and agranulocytes, describe their function

answer

● Granulocytes ○ Neutrophils - small phagocyte ○ Eosinophil- ○ Basophil-histamine ● Agranulocytes ○ Monocytes/Macrophages - phagocytize bacteria ○ Lymphocyte -involved in immune protection

question

What is the cause of infectious mononucleosis? Which cells are infected?

answer

● Cause: Epstein Barr Virus ● Infects B cells by killing the cell or being incorporated into genome

question

Describe multiple myeloma

answer

(plasma cell) B cell cancer, malignant plasma cells, chromosomal break, plasma cells infiltrate bone and organs. ii. Anemia, thrombocytopenia, leukopenia, decreased bone density, bone pain,

question

Describe Leukemia

answer

Cancer of the leukocytes Leukemia cells abnormally proliferate, crowding normal blood cells

question

Differentiate between the different types of leukemia

answer

a. Acute lymphocytic (ALL) b. Acute myelogenous (AML) c. Chronic lymphocytic (CLL) d. Chronic myelogenous (CML

question

contractility

answer

mechanical response, how well the heart contracts

question

What causes cool/clammy skin in shock pts

answer

Vasoconstriction/shunting of blood to vital organs

question

ITP (Idiopathic Thrombocytopenia Purpura)

answer

○ causes: idiopathic, autoimmune diseases, immunizations with a live vaccine, immunodeficiency disorders, and viral infections ■ Hypocoagulation resulting from an autoimmune destruction of platelets ○ clinical manifestations:bleeding or indications of bleeding (e.g. bruising, petechia, etc)

question

DIC (

answer

○ causes: Life-threatening complications of many conditions, Results from an inappropriate immune response ■ Widespread coagulation followed by massive bleeding because of the depletion of clotting factors ○ clinical manifestations: tissue ischemia and bleeding

question

TTP (Thrombotic Thrombocytopenia Purpura)

answer

○ causes: idiopathic causes, heredity, bone marrow transplants, cancer, medications, pregnancy, and HIV ■ Deficiency of enzyme necessary for cleaving von Willebrand's factor, leading to hypercoagulation ■ Hypercoagulation depletes platelet levels ○ clinical manifestations:purpura, changes in consciousness, confusion, fatigue, fever, headache, tachycardia, pallor, dyspnea on exertion, speech changes, weakness, and jaundice

question

Pernicious Anemia (Macrocytic Normochromic)

answer

● Cause: B12 deficiency caused by lack of instrinsic factor ● Manifestations:•bleeding gums, diarrhea, impaired smell, loss of deep tendon reflexes, anorexia, personality or memory changes, positive Babinski's sign, stomatitis, paresthesia, and unsteady gait

question

Iron Deficiency Anemia (Mycrocytic Hypochromic)

answer

● Cause: inadequate intake, inadequate absorption, increased bleeding ● Manifestations: cyanosis to sclera, brittle nails, decreased appetite, headache, irritability, stomatitis, pica, and delayed healing

question

Aplastic Anemia (Normocytic Normochromic)

answer

● Cause: insidious, autoimmune, medications, medical treatments, viruses, and genetic ● Manifestations:-Anemia (e.g., weakness, pallor, dyspnea)-Leukocytopenia (e.g., recurrent infections)-Thrombocytopenia (e.g., bleeding)

question

cricoid cartilage

answer

...

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