Pathophysiology Chapter 8

an inflammation of the mucous membrane of the nose caused by allergic reaction to airborne substances. Approximately 17 million, or 7%, of American adults are diagnosed with this in any 12-month period. Risk factors include family history, having other allergies, and exposure to allergens. Signs and symptoms may include runny nose, congestion, watery eyes, and sneezing. Signs and symptoms are caused by hypersensitivity to an allergen. Diagnosis depends on physical examination, medical history, and allergy testing. Treatment may include avoiding the allergen, if possible, and nasal steroids. Some people undergo treatment to desensitize them to allergens (allergy shots).

Allergic Rhinitis (Upper Respiratory Diseases)

The________are thin-walled sacs surrounded by blood capillaries and are the site of gas exchange.

Alveoli

Blood test that is performed to determine the concentration of oxygen, carbon dioxide, and bicarbonate, as well as the pH of the blood.

Arterial blood gas (ABGS)

a condition in which the bronchial tubes in the lungs react to certain stimuli by becoming inflamed. More than 25 million Americans suffer from this, including over 8% of adults and over 9% of children. Risk factors include a family history and exposure to certain irritants known as triggers. The etiology is idiopathic. People with this have very sensitive airways that react and narrow in response to many different substances, activities, and conditions that, in these persons, cause signs and symptoms to start or worsen. The following are common triggers: indoor and outdoor allergens, tobacco smoke, chemical irritants, cold air, extreme emotional arousal, certain medications (aspirin and other nonsteroidal anti-inflammatories and beta blockers), and physical exercise. There are two basic types of medications used in treatment: steroids and other anti-inflammatory medications and bronchodilators. Anti-inflammatory medications, particularly inhaled steroids, are the most important treatment for most people with this. It cannot be prevented. However, it can be managed by identifying and avoiding triggers, taking medication as prescribed, and obtaining continued monitoring by a physician.

Asthma

a collapse of lung tissue affecting part or all of one lung. The alveoli in that part of the lung no longer fill with air. As a result, they can't take part in gas exchange. Risk factors include anesthesia, prolonged bed rest with few changes in position, shallow breathing, and underlying lung disease. Signs and symptoms include dyspnea, chest pain, cyanosis, and coughing. It may be caused by a blockage of the bronchus or bronchioles or by pressure on the lung. A mucus plug is the most common cause. Diagnosis is based on medical history, physical examination, and chest x-ray. Treatment may include aerosolized respiratory treatments to open the airway; positioning the body on the unaffected side to allow the affected lung to reexpand; removing obstructions by bronchoscopy; breathing exercises, clap, or percussion on the chest to loosen mucus; tilting the body (postural drainage) so that the head is lower than the chest to drain mucus; and treating a tumor or underlying condition, if present. Prevention includes encouraging movement and deep breathing in anyone who is bedridden for long periods, keeping small objects out of the reach of young children, and maintaining deep breathing after anesthesia.

Atelectasis

Tubular passageways from the trachea to the lungs.

Bronchi

Weakened and dilated bronchial tubing.

Bronchiectasis

is a chronic inflammation of the bronchi. There are two types: acute and chronic. Acute comes on quickly and lasts 2-3 weeks. Chronic is defined as having a cough with sputum production that lasts at least 3 months for 2 consecutive years. Over 10 million people in the United States are diagnosed with chronic ______ each year. Risk factors for chronic _____ include tobacco use, exposure to secondhand tobacco smoke, exposure to irritants on the job, and decreased immunity Signs and symptoms of chronic ______ include mucus-producing cough, wheezing, fatigue, slight fever, chills, and chest discomfort. Auscultation may reveal decreased breath sounds, wheezing, and crackles. Cigarette smoking is the most common cause of chronic ________. People exposed to industrial dusts and fumes in the workplace, such as coal miners, grain handlers, and metal molders, are also at high risk of developing the disease. Diagnosis is based on medical history, physical examination, chest x-ray, pulmonary function testing (spirometry), and sputum analysis. There is no cure. The goal of therapy is to relieve symptoms, prevent complications, and slow the progression of the disease. Quitting smoking is also essential. Treatment may include bronchodilator medications, inhaled steroids, antibiotics, oxygen therapy, pulmonary rehabilitation, and surgery (lung reduction surgery to remove damaged lung tissue, lung transplant). Prevention includes never smoking or quitting smoking, wearing a mask over your mouth and nose when using lung irritants (paint, paint remover, or varnish), frequent handwashing to reduce exposure to viruses and bacteria, and getting the seasonal flu vaccine.

Chronic bronchitis

Disease characterized by airflow limitation that is preventable and treatable but not fully reversible. Risk factors for COPD include exposure to tobacco smoke, occupational exposure to dust and chemicals, and genetics Signs and symptoms include dyspnea, frequent coughing, wheezing, tachypnea, and tightness in the chest. The main cause of COPD is tobacco use. Breathing in secondhand smoke, air pollution, or chemical fumes or dust from the environment or workplace can also contribute to COPD.

Chronic obstructive pulmonary disease (COPD).

Hairlike projections such as those found in the mucous membrane that lines the respiratory tract.

Cilia

Numerous hairlike projections called _________project from the surface of the pharynx and trachea.

Cilia

a blue color in skin and nails; indicator of low oxygen

Cyanosis

Disease that affects all the exocrine glands of the body, the glands of external secretion usually affecting children. It is an inherited disease affecting the exocrine glands of the lungs and pancreas, causing these glands to secrete excessive thick mucus. It affects about 30,000 children and adults in the United States and about 70,000 children and adults worldwide. Risk factors for include a family history of and being of Northern European or Central European descent. People with this have a higher than normal level of salt in their sweat; therefore, they have very salty-tasting skin. The thick, sticky mucus secreted in the lungs causes dyspnea, wheezing, and a persistent cough with thick sputum. The abnormally thick mucosal surface increases susceptibiliy to recurrent lung infections. Bronchiectasis, or weakened and dilated bronchial tubing, is a common complication or aftermath. There is no cure but treatment can ease signs and symptoms and reduce complications.

Cystic fibrosis

Excessive and thick mucus is secreted in the inherited disease called_____.

Cystotic Fibrosis

hoarseness

Dysphonia

difficulty breathing

Dyspnea

is a long-term, progressive obstructive lung disease in which the alveoli that promote oxygen exchange between the air and the bloodstream are destroyed. This causes increased shortness of breath and a loss of elasticity in the alveolar walls that have not been destroyed. It affects about 5 million people in the United States. The risk factors include smoking, exposure to secondhand smoke, occupational exposure to dust and chemicals, and genetics (alpha-1-antitrypsin deficiency). Signs and symptoms vary from mild to severe and include dyspnea and coughing. Auscultation may reveal decreased breath sounds, crackles, and wheezing. The percussion note is hyperresonant. Other signs and symptoms may include cyanosis, edema of the feet and ankles, fatigue, headache (especially in the morning), and wheezing.

Emphysema

Dyspnea is the coughing up of blood. T or F

False

Laryngitis may be treated by removal of the tonsils. T or F

False

The bronchi branch into smaller and smaller tubules called alveoli. T or F

False

The bronchioles are the site of gas exchange. T or F

False

The common cold is easily treated with antibiotics. T or F

False

The incidence of tuberculosis is declining because of potent antibiotics. T or F

False

There is a cure for the common cold. T or F

False

coughing blood

Hemoptysis

Normal arterial blood gases should be high in______and low in

High in Oxygen and Low in Carbon Dioxide

an inflammation of the larynx or voice box. The prevalence of this is not known. Risk factors include having a respiratory infection, exposure to irritating substances (cigarette smoke, alcohol, stomach acid, workplace chemicals), and overuse of the voice. Dysphonia is the main sign of this. Other signs and symptoms may include difficulty swallowing, throat pain, and fever. The most common cause of this is a viral infection; other causes include overuse of the voice or bacterial infections. Diagnosis is based on signs and symptoms and physical examination and may include laryngoscopy to visually examine the vocal cords. Treatment is focused on treating the underlying cause and may include resting the voice, controlling heartburn, and reducing exposure to alcohol or cigarette smoke. Corticosteroids may be used to reduce inflammation of the vocal cords. Prevention includes frequent handwashing, avoiding people with respiratory infections, practicing proper respiratory hygiene, not smoking, and limiting exposure to secondhand smoke.

Laryngitis (Upper Respiratory Diseases)

An organ of the respiratory system located at the entrance of the trachea that contains the vocal cords; sometimes called the voice box.

Larynx

an acute, highly contagious respiratory infection. According to the Centers for Disease Control and Prevention, 5-10% of the U.S. population is infected with the this each year, 200,000 are hospitalized, and 36,000 die from complications. The World Health Organization estimates 3-5 million people worldwide are infected with the this each year, resulting in 250,000-500,000 deaths. Those at high risk for developing ____-related complications include children under age 5, adults over age 65, pregnant women, and people with immune deficiency, HIV/AIDS, cancer, diabetes mellitus, and chronic respiratory diseases such as asthma, bronchitis, cystic fibrosis, emphysema, or other chronic disease. The signs and symptoms come on suddenly and may include fever, cough, muscle or body aches, headache, fatigue, and chest discomfort. Complications can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions. The virus is transmitted by respiratory droplets (cough, sneeze) or by touching an inanimate object contaminated with the virus and then touching your eyes or nose. It is caused by infection with the influenza virus. It is more common in the winter months, and outbreaks of the illness occur nearly every year throughout the world. The extent and severity of outbreaks vary considerably from year to year and from location to location. Serious local outbreaks generally occur about every 1-3 years, and global outbreaks (pandemics) occur about every 10-15 years. Diagnosis is usually based on signs and symptoms; there are diagnostic tests available that can detect the virus. It usually resolves within 2 weeks without medical intervention. Antiviral medications may be used to shorten the severity and duration and reduce the risk of complications. Other treatment is symptomatic and may include a cough suppressant and acetaminophen to relieve headaches and muscle or body aches and reduce fever. To help prevent this, avoid close contact with people who have the it. Wash your hands frequently and avoid touching your eyes, nose, and mouth. Practice proper respiratory hygiene. The best way to prevent this is to receive a vaccine each year. The signs and symptoms of allergy, influenza, and cold overlap but remain distinctive

Lower Respiratory Diseases Influenza

an infection in one or both lungs affecting primarily the alveoli. The alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake. Approximately 3 million cases of pneumonia are diagnosed and 60,000 people die of this each year in the United States. The risk factors include age (younger than 5 years or over 65 years), immune deficiency, having certain chronic diseases (asthma, heart disease, chronic obstructive pulmonary disease), smoking, and being on a mechanical ventilator. When someone develops this in the community (not in a hospital), it is called community-acquired ______. if it developed during or following a stay in a health care facility (e.g., hospitals, long-term care facilities, and dialysis centers) is called health-care-associated ________, which includes hospital-acquired _________ and ventilator-associated ___________. Signs and symptoms include cough (the person may cough up mucus or blood), fever, chills, dyspnea, and chest pain. Auscultation may reveal reduced breath sounds and crackles. The percussion note is dull. It is usually caused by a bacterial or viral infection. Diagnosis is based on medical history, physical examination, a chest x-ray, and sputum culture. Treatment varies with the etiological agent. Bacterial __________ is treated with antibiotics. Viral ___________treatment is symptomatic and may include rest, oxygen therapy, increased fluid intake, pain relievers, and a high-calorie diet. Prevention includes vaccination (seasonal flu shot, pneumococcal), frequent handwashing, practicing proper respiratory hygiene, and not smoking.

Lower Respiratory Diseases Pneumonia

is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. People are symptomatic and can spread the bacteria to others. Signs and symptoms of this disease include a bad cough that lasts 3 weeks or longer, pain in the chest, coughing up blood or sputum, weakness or fatigue, weight loss, no appetite, chills, fever, and night sweats. Auscultation may reveal diminished breath sounds and crackles. It is caused by the bacterium Mycobacterium ____________. The bacteria are spread through microscopic droplets released into the air when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs, or sings. People nearby may breathe in these bacteria and become infected. Inhaled bacteria infect the lungs and induce a chronic inflammatory response that leads to necrosis or tissue death. Diagnosis is based on medical history, physical examination, a test infection (skin test or blood test), chest x-ray, and sputum smear. In the Mantoux skin test for infection, antigens from the bacteria are injected beneath the skin. If the person was previously exposed, the skin swells with slight elevation at the injection site. The test is read within 48-72 hours by a trained health care worker, who looks for a reaction (induration) on the arm. The blood test measures the patient's immune system reaction. Treated with antibiotics. The exact drugs and length of treatment depend on the patient's age, overall health, possible drug resistance, the form of infection (latent or active), and the infection's location in the body. The United States does not vaccinate for it because the incidence is low and screening is more reliable. Vaccines are used in other countries where the prevalence and risk is much higher. In addition to vaccination, prevention includes isolation of contagious patients, and practicing proper respiratory hygiene.

Lower Respiratory Diseases Tuberculosis (TB)

The_____test is used to screen for tuberculosis.

Mantoux Tuberculin Skin Test

an inflammation of the pharynx, is characterized by pain in the throat. Approximately 30 million cases of this are diagnosed annually in the United States. Risk factors include living or working in close quarters, being immunocompromised, having diabetes mellitus, and smoking or exposure to cigarette smoke. The main symptom is a sore throat. Other signs and symptoms may include fever, headache, swollen lymph nodes in the neck, and joint pain or muscle aches. The most common cause of this is a viral infection; bacterial infections can also cause this. Diagnosis is based on physical examination and may include a rapid strep test or throat culture. Treatment depends on the etiological agent. Treatment for viral form is symptomatic and may include gargling with salt water, anti-inflammatory medications, and pain relievers. Antibiotics are appropriate for treating the bacterial form. Prevention includes practicing proper respiratory hygiene, frequent handwashing, and avoiding close contact with anyone with a respiratory infection.

Pharyngitis (Upper Respiratory Diseases)

Throat

Pharynx

Space between the two layers of the pleura containing a small amount of fluid that lubricates the surfaces, preventing friction as the lungs expand and contract.

Pleural cavity

an inflammation of the pleural membranes that line the chest wall and encase each lung. The incidence of this is not known. Risk factors include lung infection, chest trauma, and pulmonary embolism or be idiopathic. . The main symptom are sharp chest pains that worsen with breathing in or coughing caused by the inflamed pleura layers rubbing together. It may also cause dyspnea and tachypnea. Diagnosis is based on signs and symptoms, physical examination, blood tests for pathogens, and imaging tests. In some cases pleural fluid and tissue will be removed for testing. The treatment depends on the cause and may include antibiotics if it is caused by a bacterial infection as well as over-the-counter or prescription nonsteroidal anti-inflammatory medication for pain relief. Prevention includes seeking medical attention early for lung infections and getting the pneumonia vaccine if recommended.

Pleurisy

a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse. Risk factors include being male, smoking, being tall and underweight, having certain lung diseases, and a history of the disease. Signs and symptoms include a sudden, sharp pain on the same side as the affected lung and dyspnea. It can be caused by injury to the chest, damage to the lungs caused by an underlying lung disease (emphysema, TB, CF, pneumonia, lung cancer), or rupture of air-filled blisters (blebs) found in the lungs of some people who are tall and underweight. The blebs can spontaneously rupture or can rupture due to a change in air pressure (e.g., scuba diving, flying, mountain climbing). It can also be idiopathic. It is diagnosed by physical examination, arterial blood gas analysis, and imaging tests. Prevention includes smoking cessation and seeking medical attention for respiratory problems.

Pneumothorax

_________is a blockage in one or more arteries of the lungs.

Pulmonary Embolism

Tests that are used to measure air flow within the lungs and evaluate lung function.

Pulmonary function tests

is a procedure used to measure the oxygen level (or oxygen saturation) in the blood.

Pulse oximetry

Mucous membrane that lines the entire respiratory tract.

Respiratory epithelium

an inflammation of the mucous membrane lining of the sinuses. The sinuses are air-filled cavities behind the facial bones. Approximately 30 million Americans are diagnosed with this each year. Risk factors include having an upper respiratory infection, allergies, obstruction of the nose (deviated septum, polyps), and a weakened immune system. A common cold often leads to this because the mucous membranes that line the nasal cavity extend into and also line the sinuses. Signs and symptoms may include facial pain and pressure, nasal stuffiness, nasal discharge, loss of smell, and cough or congestion. Is usually caused by a viral infection, often the common cold virus. Diagnosis may include medical history, physical examination, nasal endoscopy to visually inspect the sinuses, imaging tests, nasal and sinus cultures, and allergy testing. Treatment is symptomatic and may include using a saline nasal spray to rinse the nasal passages, nasal corticosteroids to reduce inflammation, decongestants, and pain relievers. Preventing this includes avoiding upper respiratory infections, managing allergies, avoiding smoke and pollutants, and using a humidifier.

Sinusitis (Upper Respiratory Diseases)

In the vast majority of people, _________is the cause of emphysema.

Smoking

Diagnostic procedure that measures and records changes in gas volume in the lungs, determining ventilation capacity and flow rate.

Spirometry

_________is the first and most commonly done lung function test.

Spirometry

rapid breathing

Tachypnea

an acute contagious disease of the upper respiratory tract that is marked by inflammation of the mucous membranes of the nose, throat, eyes, and eustachian tubes with a watery, then purulent, discharge. The average incidence of this is five to seven per year in preschool children and two to three colds per year in adulthood. The risk factors include age (infants and preschoolers), exposure to infected people, being immunocompromised, and time of year (fall and winter). Signs and symptoms may include sore throat, runny nose, sneezing, and cough. Are caused by more than 200 different viruses, the rhinoviruses being the most common cause followed by the coronavirus. The virus is transmitted by respiratory droplets (cough, sneeze) or by touching an inanimate object contaminated with the virus and then touching your eyes or nose. Diagnosis is based on physical examination and signs and symptoms. There is no cure for this, but symptomatic treatment including pain relievers, decongestants, antihistamines, and cough suppressants may be helpful.

The Common Cold (Upper Respiratory Diseases)

The main cause of lung cancer is ________.

Tobacco

Bacteria or viruses contaminate the tonsils, the result is an infectious inflammation of the tonsils, or ______. The prevalence of this is not known. Risk factors include young age and frequent exposure to people with bacterial or viral infections. Signs and symptoms may include a severe sore throat; red, swollen tonsils; difficulty or painful swallowing; white or yellow patches on the tonsils; and fever. Bacterial and viral infections are the cause. Diagnosis is based on visual examination of the tonsils; a rapid strep test or throat culture may also be done. Treatment depends on the cause. If it is a result of a bacterial infection antibiotics are an appropriate treatment. Treatment for viral form is symptomatic and may include pain relievers, rest, and fluids. If infections are severe and recurrent, the tonsils may be surgically removed. It can be prevented by avoiding close contact with people with a respiratory infection, practicing proper respiratory hygiene, and frequent handwashing.

Tonsillitis (Upper Respiratory Diseases)

Tubular structure that connects the larynx to the primary bronchi of the lungs. Sometimes called the windpipe.

Trachea

The bronchial challenge test is used to detect and quantify airway hypersensitivity. T or F

True

The flu can be prevented by vaccine. T or F

True

The lungs are a common site for metastatic cancer. T or F

True

The common cold and influenza are caused by_______.

Viruses

The trachea descends and branches into two primary __________. a. bronchi b. bronchioles c. pleura d. alveoli

a. bronchi

What is the leading cause of cancer death among men and women? __________. a. lung b. colon c. pancreatic d. stomach

a. lung

The most common cause of pharyngitis is a __________. a. virus b. bacterium c. fungi d. prion

a. virus

The bronchioles terminate in the lungs as small air sacs called _____________.

alveoli

A condition in which the bronchial tubes in the lungs react to different stimuli by becoming inflamed is__________. a. laryngitis b. asthma c. sinusitis d. emphysema

b. asthma

In this respiratory disease, the alveolar walls break down, adjacent alveoli fuse, and the lungs lose their elasticity and surface area required for normal gaseous exchange. a. chronic bronchitis b. emphysema c. pneumonia d. cystic fibrosis

b. emphysema

The etiological agent of influenza is a __________. a. bacterium b. virus c. fungi d. helminth

b. virus

The bronchi branch into smaller and smaller tubules called _____________.

bronchioles

A long-term, progressive obstructive lung disease in which the alveoli that promote oxygen exchange between the air and the bloodstream are destroyed is called __________. a. pneumonia b. chronic bronchitis c. emphysema d. tuberculosis

c. emphysema

The lungs are encased by a double membrane consisting of two layers called __________. a. alveoli b. bronchi c. pleura d. atelectasis

c. pleura

What is an infection in one or both lungs affecting primarily the alveoli? __________. a. chronic bronchitis b. emphysema c. tuberculosis d. pneumonia

d. pneumonia

What is a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse? __________. a. atelectasis b. pneumonia c. emphysema d. pneumothorax

d. pneumothorax

The lungs are encased by a double membrane consisting of two layers called ___________

pleura