Term
| ....pH = 7.56, CO2 = 28, HCO3 = 25 |
|
Definition
|
|
Term
| ....pH = 6.96, CO2 = 71, HCO3 = 16 |
|
Definition
|
|
Term
| ....pH = 7.16, CO2 = 82, HCO3 = 29 |
|
Definition
| PARTLY COMPENSATED RESPIRATORY ACIDOSIS |
|
|
Term
| ...pH = 7.50, CO2 = 9, HCO3 = 7 |
|
Definition
| PARTLY COMPENSATED RESPIRATORY ALKALOSIS |
|
|
Term
| ....pH = 7.75, CO2 = 29, HCO3 = 40 |
|
Definition
|
|
Term
| ....pH = 7.33, CO2 = 66, HCO3 = 35 |
|
Definition
| PARTLY COMPENSATED RESPIRATORY ACIDOSIS |
|
|
Term
| ....pH = 6.68, CO2 = 85, HCO3 = 10 |
|
Definition
|
|
Term
| ...pH = 7.35, CO2 = 42, HCO3 = 23 |
|
Definition
|
|
Term
| ...pH = 7.21, CO2 = 60, HCO3 = 24 |
|
Definition
|
|
Term
| ....pH = 7.48, CO2 = 19, HCO3 = 14 |
|
Definition
| PARTLY COMPENSATED RESPIRATORY ALKALOSIS |
|
|
Term
|
Definition
Diffuse inflammation of the small airways (bronchioles)
-destruction may happen distal to lesion due to atelectasis, emphysema |
|
|
Term
| What population is most often associated with bronchiolitis? What is the most common cause within this population? |
|
Definition
| Most common in children, most often caused by a virus (RSV)*** |
|
|
Term
|
Definition
increased respiratory rate
accessory muscle use
fever
cough
hyperinflation of chest (barrel chest) |
|
|
Term
| How is bronchiolitis diagnosed? |
|
Definition
spirometry
bronchoscopy with biopsy
-CXR may show hyperinflated lungs and flattened diaphragm, infiltrates, atelectasis |
|
|
Term
| What are 3 common treatments for bronchiolitis? |
|
Definition
Antibiotics
Steroids
CPT (chest physiotherapy)
-humidified air
-coughing
-deep breathing
-postural drainage
-percussion |
|
|
Term
| What mediates the hypersensitivity reaction associated with bronchiolitis? |
|
Definition
| cell-mediated by granulocytes |
|
|
Term
|
Definition
A CHRONIC inflammatory disorder of the bronchial mucosa that causes bronchial hyperresponsiveness
--airway constriction
--airway obstruction (reversible)** |
|
|
Term
| What type of hypersensitivity is asthma associated with? |
|
Definition
| Type 1 hypersensitivity, mediated by IgE. |
|
|
Term
| What is early asthmatic response? What are the effects of IL4 and IL5? |
|
Definition
Antigen exposure to bronchial mucosa
IL4: stimulates IgE=>mast cell degranulation
-vasodilation
-mucosal edema
-bronchosmasm ****
IL5:Eosinophils cause fibroblast proliferation, epithelial injury, and scarring*** |
|
|
Term
| What is the time frame and etiology for late asthmatic response? |
|
Definition
chemotaxis in 4-8 hours.
Eosinophils cause fibroblast proliferation and airway scarring***
Air trapping leads to increased intrapleural pressure, poor perfusion, increased lung volume and hypoxemia without CO2 retention (respiratory alkalosis) |
|
|
Term
| what is the major concern with late asthmatic response? |
|
Definition
damaged ciliary cells prevent clearance of cellular debris and form mucus plugs
-leads to airway remodeling if not treated!!*** |
|
|
Term
| What are the three common CLINICAL manifestations of asthma? |
|
Definition
between attack: PFT normal, no clinical S/S
Partial remission: negative for clinical symptoms, but PFT ABnormal
Attack: wheezing, dyspnea, nonporductive cough, prolonged expiration, tachycardia, tachypnea, pulsus paradoxus (drop in SBP with inspiration) |
|
|
Term
| what is Status Asthmaticus? |
|
Definition
Severe Bronchospasm!
an acute exacerbation of asthma that doesn't respond to treatment (bronchodilators, steroids)
-severe asthma attacks follow one another without pause |
|
|
Term
| How do we diagnose status asthmaticus? |
|
Definition
check for triggers or underlying infection
Acute:ABGs, expiratory flow rate***; give O2, Beta agonist bronchodilators, oral corticosteroids
Chronic:Immunotherapy, IgE monoclonal antibodies (i.e.omalizumab) |
|
|
Term
| What differentiates pediatric asthma? |
|
Definition
More often in boys than girls
airway obstruction can be more severe due to smaller airways.
Risk factors: allergen exposure, pollution, dust mites, tobacco exposure,viral respiratory infections, vitamin D deficiency |
|
|
Term
| What is the goal for asthma treatment? |
|
Definition
control by reduction of impairment and risk
-reassess therapy to evaluate need to "step up" or "step down" therapy-need 3 months of therapy to change |
|
|
Term
|
Definition
Bronchiolitis Obliterans with Organizing Pneumonia. -think granulation.
Non-infectious pneumonia causing inflammation of the bronchioles -late stage fibrotic disease
-granulation scarring, fibrin, mucous plugs |
|
|
Term
What is the most common pediatric virus causing pneumonia and bronchiolitis?
How is it treated?
When is the peak season? |
|
Definition
RSV (respiratory cyncytial virus)
major cause of lower respiratory tract infections-causes decreased surfactant
-prophylactic medications are available for infants with heart/lung diseases
-C-PAP and O2 therapy are treatments
-happens in winter months most often |
|
|
Term
| How are viruses transmitted? |
|
Definition
-Aerosol
-Direct contact
-Droplet transmission |
|
|
Term
What damage occurs with viral infections?
What is the inflammatory response, and where is it? |
|
Definition
infection results in destruction of ciliated epithelium of the distal airway, with sloughing of cellular material
mononucleaar-predominant inflammatory response occurs:
-first in the interstitium
-later in the alveoli
Diagnosis requires laboratory confirmation (immunofluorescence tests) |
|
|
Term
What is pulmonary edema, and what is the most common cause?
Describe the etiology. |
|
Definition
Excess water IN the lung
left-sided heart disease is the most common cause for edema- it causes increased pulmonary capillary hydrostatic pressure
-fluid in the interstitium of the lung drains to the lympatic system, but if rate of flow out of the capillaries is too high, edema develops |
|
|
Term
| What is the relationship between pulmonary edema and surfactant? |
|
Definition
| the surfactant loses its ability to repel water due to increased fluid in the alveoli |
|
|
Term
| What are some causes of pulmonary edema related to injury? |
|
Definition
capillary injury results in increased capillary permeability
this happens from ARDS, toxic gases, pneumonia |
|
|
Term
| What is POPE? What are the S/S, and treatment? |
|
Definition
Post-Obstructive Pulmonary Edema
Acute airway obstruction causing edema
S/S: dyspnea, othopnea, hypoxemia, increased work of breathing, rales (inspiratory crackles), dullness to percussion
Treatment: PEEP, O2, mechanical ventilation |
|
|
Term
|
Definition
the 'essential cells of an organ'
for the lung, it is ALVEOLI, as well as respiratory broncioles, alveolar ducts, terminal bronchioles |
|
|
Term
| What is the function of Pores of Kohn? |
|
Definition
allow air to pass through between adjacent alveoli
provides collateral ventilation and even distribution of air to the alveoli.
-play important role in prevention of collapse of lung.
allow the passage of other materials such as fluid and bacteria, which is an important mechanism of spread of infection in Lobar pneumonia and spread of fibrin in grey hepatisation |
|
|
Term
| What is the process of forming a cavity? |
|
Definition
Consolidation- inflammation causes alveoli to FILL with fluid, pus, and microorganisms
Abscess-circumscribed area of suppuration and destruction of lung parenchyma
Cavitation- process of ABSCESS EMPTYING and the formation of a cavity |
|
|
Term
| what is the difference between consolidation and cavitation? |
|
Definition
consolidation is the filling of alveoli
cavitation is abscess emptying |
|
|
Term
| what is the most common cause of consolidation? |
|
Definition
|
|
Term
| What is the treatment for cavitation? |
|
Definition
Diagnosed with CXR
-treat with antibiotics, CPT (including postural drainage and percussion), and bronchoscopy |
|
|
Term
| what are the four causes of Pleural Effusion? |
|
Definition
Fluid in pleural space:
1. increased intravascular hydrostatic pressure (i.e. CHF)
2. increased vascular permeability due to inflammation (i.e.infection, injury)
3. Decreased capillary oncotic pressure (i.e. liver or kidney disease)
4. decreased lymphatic drainage |
|
|
Term
| What qualifies small effusion, large effusion, and normal fluid levels in pleural space? |
|
Definition
small is < 150ml
large is > 150ml
normal is <15ml |
|
|
Term
| what is a transudative effusion? |
|
Definition
watery, diffusion out of capillaries
-chf, decreased protein in the blood d/t kidney/liver dysfunction |
|
|
Term
| what is exudative effusion? |
|
Definition
thicker fluid with increased WBCs, increased plasma protein.
-often caused by staph aureus, klebsiella, and e-coli |
|
|
Term
|
Definition
pus due to infection, abscess, wound
-manifests with tachycardia, cough, fever |
|
|
Term
|
Definition
hemorrhage into the pleural space
-trauma, surgery, malignancy |
|
|
Term
|
Definition
chyle from lymphatics
-trauma, injury, infection [or an oops in surgery] |
|
|
Term
|
Definition
infection of lower respiratory tract caused by viruses, bacteria, fungi, protozoa, or parasites
-6th leading cause of death in U.S.
-responsible for more disease than ANY OTHER INFECTION |
|
|
Term
| what is the most common cause of pneumonia in adults? |
|
Definition
Streptococcus
-verified with urinary antigen test |
|
|
Term
| what is the most common route for pneumnoia? |
|
Definition
| Aspiration of oropharyngeal secretions is the most common route for lower respiratory tract infections |
|
|
Term
| What are the risk factors for pneumonia? |
|
Definition
| age, compromised host, lung disease, ETOH, altered LOC, impaired swallowing, smoking, E-T intubation, malnutrition, hospitalization, immobilization, heart disease, liver disease, living at nursing home |
|
|
Term
| 1/3 of all admissions for pneumonia are associated with what risk factor? |
|
Definition
| HCAP: nursing home, dialysis, wound care, etc. |
|
|
Term
| What is the 2nd most common nosocomial infection but has the greatest rate of mortality? |
|
Definition
HAP: hospital acquired pneumonia
-associated with intubated patients (9-27% will get pneumonia) |
|
|
Term
What is the leading cause of morbidity and mortality in infants?
What are the risk factors? |
|
Definition
CAP: community acquired pneumonia
-risk factors: age<2, overcrowded living conditions, winter, recent antibiotics treatment, daycare center attendance, passive smoke exposure |
|
|
Term
| What is the clinical manifestation difference between bacterial and viral pneumonia? |
|
Definition
Bacterial pneumonia has:
higher fever
higher absolute neutrophil count
higher %bands (left shift) |
|
|
Term
| What is the most common bacteria to cause bacterial pneumonia? |
|
Definition
Pneumoccocal pneumonia
-streptococcus or staphylococcus |
|
|
Term
| what sign is most common and distinguishing with pneumococcal pneumonia? |
|
Definition
|
|
Term
| What is a common route for bacterial pneumonia? |
|
Definition
| aspiration of host's own nasopharyngeal bacteria |
|
|
Term
| what are virulence factors? |
|
Definition
| capsules to enhance survival and proliferation of bacterial pneumonia |
|
|
Term
| how can preceding viral infections result in bacterial pneumonia? |
|
Definition
| viral infections can cause epithelial damage and reduced mucociliary clearance, allowing for increased survivability of bacteria |
|
|
Term
Does bacterial pneumonia vary in severity?
Does bacterial pneumonia present acutely? |
|
Definition
|
|
Term
| What if bacterial pneumonia cannot be controlled? |
|
Definition
Then neutrophils are recruited and an intense cytokine-mediated inflammation occurs.
this results in edema, exudate=>
-sepsis, shock; V/Q mismatch and hypoxemia
Macrophage-most important guardian of the lower respiratory tract. |
|
|
Term
what is the relationship between empyema and pneumonia?
What are common S/S? |
|
Definition
strong association between empyema and pneumococcal infection/antibiotic resistant infections.
-often preceded by viral illness
-fever, chills and rigors, SOB, cough, crackles
---BAD: malaise, nausea/emesis, abd pain, chest pain |
|
|
Term
| What is the most common cause of lobar pneumonia? |
|
Definition
| most commonly caused by bacteria |
|
|
Term
|
Definition
When the lobe of the lung is effused with matter and appears more like the liver.
-red hepatization is filling with blood and the lobe is no longer pervious to air
-gray hepatization is when the RBCs have been broken down and all that is left is fibrinosuppurative exudate |
|
|
Term
| Name some types of bacterial pneumonia |
|
Definition
Staphyloccoccus aureus
Streptococcus
Haemophilus Influenzae
Mycoplasma pneumoniae |
|
|
Term
| Name some types of viral pneumonia |
|
Definition
Influenza virus A, B
Respiratory syncytial virus (RSV)
Human parainfluenza viruses (in children; 2nd only to RSV for children) |
|
|
Term
| What are the common causes for HCAP/HAP/VAP? |
|
Definition
pseudomonas aeruginosa
staphylococcus aureus (+MRSA)
klebsiella pneumoniae
enterobacter |
|
|
Term
| Common pneumonias associated with compromised host? |
|
Definition
pneumocystis jiroveci
mycobacterium tuberculosis
atypical mycobacteria
respiratory viruses
protozoa
parasites |
|
|
Term
| What is the most common route of lower respiratory infections? |
|
Definition
|
|
Term
| What is the first line of protection from pneumonia? |
|
Definition
| cough, mucociliary clearance |
|
|
Term
| What is most important cell in the alveoli to prevent infection? |
|
Definition
the alveolar macrophage- recognizes pathogens, presents antigens to activate t-cells and b-cells
=>induces cellular and humoral immunity
=>releases TNF alpha, IL-1, and CHEMOKINES
===>leads to widespread inflammation |
|
|
Term
| What is the role of neutrophils in the inflammatory response associated with pneumonia? |
|
Definition
-Kill microbes by forming phagolysosomes filled with enzymes, antimicrobial proteins, and free radicals
-release NET (neutrophil extracellular trap) that captures bacteria not yet phagocytized |
|
|
Term
| How does release of inflammatory mediators result in hypoxemia? |
|
Definition
inflammatory mediators damage bronchial mucous membranes and alveocapillary membranes, causing acini and terminal bronchiles to fill with fluid, DEBRIS, & EXUDATE
-leads to V/Q mismatch
--this leads to hypoxemia |
|
|
Term
|
Definition
many-lobed SACS containing alveoli
-where bronchiles in lungs terminate |
|
|
Term
| What is the cause of sarcoidosis? What is it? |
|
Definition
An inflammatory disease that affects multiple organs, mostly the lungs and lymph
-caused by granulomas
-can be chronic and crippling OR spontaneous and resolving |
|
|
Term
| How is sarcoidosis diagnosed? |
|
Definition
CXR: infiltrates, lymphadenopathy
CT: lungs, lymph
PFTs
Bronchoscopy
Treatment: steroids |
|
|
Term
|
Definition
Bronchopulmonary dysplasia
LUNG IMMATURITY AND INFLAMMATION
-the major cause of lung disease in infants
-associated with perinatal SUPPLEMENTAL OXYGEN, POSITIVE PRESSURE VENTILATION
-may not display respiratory distress and still get BPD |
|
|
Term
| What are manifestations of BPD? |
|
Definition
arrested lung development
poor formation of the alveolar structure
fewer or largee alveoli (decreased surface area for gas exchange)
decreased surfactant
abnormal pulmonary capillary development
mild fibrosis with persistent inflammation
pulmonary HTN |
|
|
Term
|
Definition
V/Q mismatch
increased work of breathing
hypercapnea (increased CO2 in blood)
mucous plugs
bronchospasm and wheezing
pulmonary HTN |
|
|
Term
| What is the treatment for BPD? |
|
Definition
surfactant
O2 (89%-94%)
CPAP
steroids
caffeine
Vit A
diuretics
bronchodilators |
|
|
Term
| What needs to happen for diagnosis of croup?What are the two types of croup? |
|
Definition
Infection and obstruction of upper airway
types:
1) laryngeotracheobronchitis
2) spasmotic croup |
|
|
Term
| what is the common cause for croup? |
|
Definition
| Viruses, particularly Parainfluenza |
|
|
Term
| What is spasmodic croup? What causes it? |
|
Definition
similar hoarseness, barking cough, stridor
-sudden, at night, without viral prodrome
-UNKNOWN ETIOLOGY |
|
|
Term
| What causes croup (laryngeotracheobronchitis)? |
|
Definition
subglottic edema from infection
-increased resistance, increased work of breathing leads to decreased intrathoracic pressure- may exacerbate movement of upper airway |
|
|
Term
|
Definition
common:barking cough,
-viral symptoms:rhinorrhea, sore throat, low-grade fever, hoarse voice, inspiratory stridor
Sicker child:stridor, retractions, agitation |
|
|
Term
| what is treatment for croup? |
|
Definition
glucocorticoids-oral, nebulized
racemic epi- moderate to severe croup
oxygen |
|
|
Term
What is Hypoxia?
What is Hypoxemia? |
|
Definition
Hypoxia- deficiency of oxygenation of tissues
hypoxemia- low oxygen concentration in the blood |
|
|
Term
| What are normal ABG values? |
|
Definition
pH: 7.35-7.45
CO2: 35-45
HCO3: 18-22 |
|
|
Term
What is cystic fibrosis?
what is the cause, and on what chromosome? |
|
Definition
Autosomal Recessive inherited disorder, associated with defective EPITHELIAL CHLORIDE ION transport
-chromosome 7, affects primarily caucasians |
|
|
Term
| What organs are affected by cystic fibrosis? |
|
Definition
It is a multi-organ disease
most problems arise from lungs and pancreas.
-Need replacement enzymes and the supplementation of fat soluble vitamins A,D,E, and K |
|
|
Term
| How is cystic fibrosis manifested? |
|
Definition
Abnormal Cl- production dries mucus membranes
increased production of mucus and # of mucus producing cells (goblet cells) and increased size of mucus-producing cells causes mucus plugging
Chronic inflammation leads to infection of small airways and progressive bronchiectasis
-resulting enlarged bronchial arteries cause hemoptysis |
|
|
Term
| 75% of cystic fibrosis children are colonized with what bacteria? |
|
Definition
|
|
Term
| what are S/S of cystic fibrosis? |
|
Definition
persistent cough/wheeze
sputum production
recurrent severe pneumonia
hemoptysis due to enlarged bronchial arteries |
|
|
Term
| How is cystic fibrosis diagnosed? what are the treatments? |
|
Definition
Test: immunoreactive trypsinogen (IRT blood test)
Treatment: DNase, aerosol antibiotics, bronchodilators, saline, supplements, CPT |
|
|
Term
|
Definition
Infection caused by Mycobacterium Tuberculosis- an acid-fast bacteria
-Leading cause of death from a curable infection in the world
-highly contagious airborne droplets
-managed by inflammatory and immune systems (for healthy individuals) |
|
|
Term
|
Definition
TB develops with NO clinical evidence of the disease
-TB may remain dormant for life- it stops metabolism, replication |
|
|
Term
| How long does it take to kill 1 cell of TB? |
|
Definition
|
|
Term
| Can TB survive within macrophages? |
|
Definition
|
|
Term
|
Definition
Fatigue, weight loss, lethargy, anorexia, fever, night sweats
[these also are s/s of any chronic infection] |
|
|
Term
|
Definition
Quantiferon gold**
PPD (purified protein derivative)-may be positive if received vaccine (BCG=bacille Calmette-Guerin)
Sputum culture
Immunoassay
CXR: positive PPD means yearly x-rays for life; upper loves may show nodules, calcifications, cavities, hilar enlargement |
|
|
Term
| what is the treatment of TB? |
|
Definition
18 months of 4 drugs that the bacteria is susceptible to (isoniazid, rifampin, pyrazinamide, ethambutol)
-waxy coat of TB renders may abx useless |
|
|
Term
| What are causes for decreased perfustion to the lung? (midterm) |
|
Definition
aspiration
pneumothorax
pleural effusion
asthma
atelectasis
bronchiectasis
COPD
emphysema |
|
|
Term
| What is atelectasis? (midterm) |
|
Definition
collapse of lung tissue
1) compression -external pressure (tumor, pneumothorax)
2) absorption -gradual absorption of air from obstructed or hypoventilated alveoli
3) surfactant impairment |
|
|
Term
| What is the difference between shunting and dead space? |
|
Definition
Shunting is when alveoli collapse or when they are filled with fluid [low V/Q]
Dead space is when poor perfusion prevents the oxygenation of blood [high V/Q] |
|
|
Term
| What is the most common pathogen for kids that causes bronchiolitis? |
|
Definition
|
|
Term
|
Definition
Decrease in SBP during inspiration; decrease of >10mmgHg
-associated with status asthmaticus and acute asthma attack |
|
|
Term
| What is the cause of croup? |
|
Definition
|
|
Term
| What is the most common cause of pulmonary edema? |
|
Definition
|
|
Term
| What are the clinical manifestations of BPD? |
|
Definition
Bronchopulmonary Dysplasia (associated with pre-term infants)
hypoxemia
hypercapnia
elevated work of breathing
bronchospasm
mucus plugging
pulmonary HTN |
|
|
Term
| What is the fundamental abnormality in cystic fibrosis? |
|
Definition
| chloride transport dysfunction |
|
|
Term
| What is the difference between PNA and pneumococcal PNA? |
|
Definition
| pneumococcal PNA is generally held to one lobe |
|
|
Term
| What are the four phases of pneumonia? |
|
Definition
1. consolidation
2. red hepatization
3. gray hepatization
4. resolution |
|
|
Term
| What is the best current test for TB now? |
|
Definition
|
|
Term
| What is a PE, where are they from, and what are the 3-4 causes? |
|
Definition
Pulmonary embolism: occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or air bubble.
-deep veins in the thigh
-Virchow's triad: venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels; AND ESTROGEN |
|
|
Term
| what is the purpose of surfactant? |
|
Definition
| decrease alveolar surface tension |
|
|
Term
| What is the most common potentially life-threatening upper airway infection in children? |
|
Definition
Bacterial tracheitis (staph is common)
-edema and secretions obstruct the airway
-either sudden or with viral prodrome |
|
|
Term
| What is the finding we should know regarding pneumococcal pneumonia in our assessment? |
|
Definition
| Rales-crackles on inspiration |
|
|
