NSG-530 Quiz 2 Questions and Verified Detailed Answers; for Guaranteed Success -Wilkes University

alveoli epithelial cells

Type I alveolar cells (alveolar structure)

Type II alveolar cells (surfactant production)

1.Which of the following is TRUE regarding the pulmonary system?

A.Each lobe is divided into bronchi.

B.The left lobe is divided into three lobes.

C.The mediastinum contains the lungs and heart.

D.The larynx connects the upper and lower airways.

Correct Answer: D

The larynx connects the upper and lower airways. The mediastinum is located between the lungs and contains the heart, great vessels, andesophagus. The right lung has three lobes, and the left lung has two. Each lobe is divided into segments and lobules

Neurochemical control: Respiratory center

•Dorsal and ventral respiratory groups

•Pneumotaxic and apneustic centers

Neurochemical control: Lung receptors

•Irritant receptors

•Stretch receptors

Neurochemical control: Chemoreceptors:

Central chemoreceptors

Peripheral chemoreceptors

Muscles of Breathing: Major muscles of inspiration

Diaphragm

External intercostals

Muscles of Breathing: Accessory muscles of inspiration

ØSternocleidomastoid muscle

ØScalene muscles

Mechanics of Breathing: Gas Transport

Four steps

ØVentilation of the lungs

ØDiffusion of oxygen from the alveoli into the capillary blood

ØPerfusion of systemic capillaries with oxygenated blood

ØDiffusion of oxygen from systemic capillaries into the cells

Diffusion of CO2 occurs in reverse order

1.A patient has bulbous enlargement of the distal segments of the fingers. Which disease is associated with this condition?

A.Cystic fibrosis

B.Acute pneumonia

C.Sickle cell disease

D.Acute myocardial infarction

A

This condition describes clubbing, in which there is enlargement of the distal segment of the finger. It is associated with conditions of decreased oxygenation such as bronchiectasis, cystic fibrosis, pulmonary fibrosis, lung abscess, and congenital heart disease.

Open pneumothorax

An open wound to the chest that allows air to enter the pleural space and cause lung collapse

tension pneumothorax

a pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels.

Spontaneous (primary) pneumothorax

Occurs in the absence of a traumatic injury to the chest or a known lung disease

secondary pneumothorax

Underlying lung disease leads to weakened small airways which collapse with respirations.

Pleural effusion

fluid in pleural space

ØTransudative (watery)

ØExudative (WBCs and plasma proteins)

ØHemothorax (blood)

ØEmpyema (pus)

Chylothorax (chyle)

Acute respiratory distress syndrome (ARDS)

ØAcute lung inflammation and diffuse alveolocapillary injury that results from injury or severe inflammation

•Bilateral infiltrates on chest radiograph

•Low ratio of PaO2 to FiO2

ØThree phases:

•Exudative (within 72 hours)

•Proliferative (4 to 21 days)

•Fibrotic (14 to 21 days)

2.Which of the following is TRUE regarding acute respiratory distress syndrome (ARDS)?

A.It is caused by injury to the bronchioles.

B.It can cause severe pulmonary edema.

C.It is most commonly caused by exposure to inhaled irritants.

D.Macrophages are not involved in response.

Correct Answer: B

Acute respiratory distress syndrome (ARDS) is characterized by damage that is done to the alveolar capillary membrane and causes severe pulmonary edema. The most common cause of ARDS is either sepsis or multiple trauma. Macrophages, neutrophils, complement, and endotoxins are all important mediators.

Asthma

ØChronic inflammation of the airways

ØCauses bronchial hyperresponsiveness, constriction of airways, and reversible airflow obstruction

ØPulsus paradoxus, status asthmaticus

ØSymptoms include expiratory wheezing, dyspnea, and tachypnea

ØPeak flow meters, corticosteroids, beta agonist inhalers, and anti-inflammatories used to treat

Obstructive Lung Diseases: Emphysema

ØAbnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis

ØInherited deficit of α1-antitrypsin

ØLoss of elastic recoil

ØAir trapping

3.Which of the following is TRUE regarding the pathophysiology of asthma?

A.IgA is the major factor.

B.There is decreased vascular permeability.

C.Inflammation results in hyperresponsiveness.

D.The inflammatory process is caused by the loss of bronchial smooth muscle spasm.

Correct Answer: C

Asthma is caused by increased bronchial smooth muscle spasm and increased vascular permeability. IgE is the major factor. There is increased capillary permeability. Inflammatory mediators cause vasodilation, increased capillary permeability, mucosal edema, bronchial smooth muscle contraction (bronchospasm), and mucus secretion from mucosal goblet cells with narrowing of the airways and obstruction to airflow.

Acute bronchitis

ØAcute infection or inflammation of the airways or bronchi

ØCommonly follows a viral illness

ØAcute bronchitis causes symptoms similar tothose of pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates

Pneumonia

ØLower respiratory tract infection

ØCaused by bacteria, viruses, fungi, protozoa, or parasites

ØTypes:

•Community acquired (CAP)

Streptococcus pneumoniae

Influenza

•Healthcare acquired (HCAP)

•Ventilator-associated (VAP)

Lung cancer

ØNearly 80% caused by cigarette smoking

•Smokers with COPD have even greater risk

ØEnvironmental, occupational, and genetic risk factors are also associated

ØTypes:

•Non-small cell cancer:

Squamous cell carcinoma

Adenocarcinoma

Large cell carcinoma

•Small cell lung carcinoma—from neuroendocrine tissue

4.A patient has right ventricular enlargement secondary to pulmonary hypertension. Which of the following would be the most likely diagnosis?

A.Cor pulmonale

B.Acute bronchitis

C.Pulmonary embolism

D.Pulmonary thromboembolism

Correct Answer: A

Cor pulmonale consists of right ventricular enlargement and failure. Acute bronchitis is an acute infection or inflammation of the airways. Pulmonary embolism is occlusion of a portion of the pulmonary vascular bed by an embolus. Pulmonary thromboembolism is obstruction of a pulmonary vessel by a thrombus.

1.A child is born prematurely and requires respiratory support. The child experiences neonatal lung injury and several weeks later develops hypoxemia and hypercapnia. Which of the following is the most likely diagnosis?

A.Pneumonia

B.Bronchiolitis

C.Aspiration pneumonitis

D.Bronchopulmonary dysplasia

Bronchopulmonary dysplasia is also known as chronic lung disease of infancy and is the term used for persisting lung disease following neonatal lung injury. Bronchiolitis is a seasonal viral-induced lower respiratory tract infection that occurs in infants and toddlers. Pneumonia is inflammation and infection in the terminal airways and alveoli caused by viruses and bacteria. Aspiration pneumonia is caused by a foreign substance entering the lung and causing inflammation.

IgE antibodies

response to environmental antigens, allergies

Seasonal allergic rhinitis - watery itchy eyes, runny nose, congestion

active immunity

immunization or exposure to antigen

Vaccine types:

inactive antigen, killed organism, requires booster

attenuated antigen, reducing the virulence (causes disease) of a pathogen, but still keeping it viable or "alive"

Humoral Immunity

body produces a special kind of antibodies, called immunoglobulin E (IgE), to the antigen

Immediate hypersensitivity, example, hay fever or allergic rhinitis, bee sting

cell-mediated immunity

type of immunity produced by T cells that attack infected or abnormal body cells

-immune response not involving antibodies

-involves the activation of phagocytes, antigen-specific cytotoxic T-lymphocytes, & release of various cytokines responding to an antigen

-Delayed hypersensitivity example, allergic contact dermatitis, may take hours or days before obvious

poison ivy from touching contaminated person or thing

Deficiencies in Immunity Primary caused by genetic defect

DiGeorge Syndrome - velocardiofacial syndrome, 22q11. 2 deletion syndrome

Color blindness most frequently in males on X chromosome!

Deficiencies in Immunity Secondary or acquired immune deficiency

Caused by another condition

Cancer, AIDS, infection, Diabetes, LupusErythematosis

Autoimmune Diseases

Elevated antinuclear antibody may indicate autoimmune disease

systemic lupus erythematosus (SLE)

autoimmune disease in which immune system attacks connective tissue throughout body such as in joints and skin.

Ankylosing Spondylitis (AS)

a form of rheumatoid arthritis that primarily causes inflammation of the joints between the vertebrae

Multiple Sclerosis (MS)

disease of the central nervous system characterized by the demyelination (deterioration of the myelin sheath) of nerve fibers, with episodes of neurologic dysfunction (exacerbation) followed by recovery (remission)

myasthenia gravis

autoimmune neuromuscular disorder characterized by weakness of voluntary muscles

rheumatoid arthritis (RA)

chronic joint condition with inflammation and pain; caused by an autoimmune reaction against joint tissue, particularly the synovial membrane

Sarcoidosis

autoimmune disease with fibrous lesions forming in lymph nodes, liver, skin, lungs, spleen, eyes, and small bones of hands and feet

celiac disease

malabsorption syndrome caused by an immune reaction to gluten

Polymyalgia rheumatica

inflammatory disorder of the muscles and joints characterized by pain and stiffness in the neck, shoulders, upper arms, and hips and thighs

Pathogens directly cause tissue damage by producing

Exotoxins produced with tetanus

uEndotoxins produced with gram negative bacteria

Cancer Staging (spreading)

Generally microscopic 4

1-Confined, small

2-No spread

3-Regional lymph nodes

4-Spread to distant sites

TNM specialized

-Tumor - size varies according to location, 0-3

-Nodes - involved, 0 -2

-Metastases - extent of distant, 0-2

Tumor Markers

-identify individuals at high risk for cancer

-False positive

-Used to diagnose certain cancers

Cause of cancer

1.Persistent inflammation - Helicobacter pylori

2. Viral related

-HPV-16 & 18 rising incidence genital (male and female) & oropharyngeal

-Cervical, vaginal and vulva cancer

-Head and neck cancer

-HCV and HCB, liver cancer

-EBV (Epstein Barr virus ) nasopharynx, Hodgkin's & non Hodgkin's

Clinical Manifestations of Cancer

-Pain - obstruction, pressure, tissue destruction

-Fatigue - malnutrition, anemia

-Cachexia - severe malnutrition

-Anemia - blood forming cells affected, malnutrition

-Leukopenia - direct tumor invasion to the bone marrow

Vascular Disease: Veins

1. Venous insufficiency - valves don't work examples and signs

-varicose - bulging, tortuous, venous stasis ulcers, skin hyperpigmentation & edema

-thrombus & vena cava syndrome (emergent)

-Lower leg pain with swelling and redness - think thrombus!

Vascular Disease: Arteries

Primary HBP, essential or idiopathic HBP, secondary HBP and complicated HBP

Vascular Disease: Diseases of the arteries and veins

-Orthostatic (postural) hypotension - light headed or fainting

-Aneurysm - abdominal most common

-Thrombus and embolism

Vascular Disease: Peripheral Artery Disease

Burgers or Raynaud's syndrome

Vascular Disease: Arteriosclerosis

thickening, loss of compliance

most common cause of myocardial ischemia (MI)

coronary artery disease

1. atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle

2. Myocardial ischemia most common cause atherosclerosis

uMyocardial infarction (MI)

-Cellular injury, cellular death, structural and functional changes and repair

-Atherosclerotic changes with vessel obstruction

-Symptoms: sudden severe chest pain, radiates, nausea, vomiting, diaphoresis & dyspnea

3. Diagnosing history, physical exam, ECG, serial cardiac troponin elevations

-Cardiac troponin I (cTnI) most specific indicator of MI

-cTnI detected 2-4 hrs after onset of symptoms

Disorders of Endocardium (thin, smooth membrane lines inside chambers forms surface of the valves)

1. Valvular Dysfunction - regurgitation

A. Aortic regurgitation/insufficiency aortic valve's/leaflets do not close completely

-heard best - patient sits up & forward stethoscope on left (Erb's point, at the 3rd intercostal space ) at end expiration

-Symptoms, widened pulse pressure, prominent carotid pulsations and bounding or throbbing peripheral pulses (Corrigan pulse)

B. Mitral valve prolapse - one or both of cusps do not close completely

-heard best - at the apex & sounds like mid-systolic click, followed by a late systolic murmur

-most common valve disease & most frequently in woman

2. Rheumatic Heart Disease

-Acute infection with group A B-hemolytic streptococcus infection

-Vegetations on mitral valve

-Can start with untreated strept throat

Left ventricular failure called Congestive Failure

-Reduced ejection fraction called systolic failure - heart looses pumping ability

-Heart failure with preserved ejection fraction called diastolic failure - heart walls stiffen, unable to relax

-Increased systemic vascular resistance - blood vessels tighten or constrict resulting in diminished compliance

-Cardiorenal implications - dysfunction in either may exacerbate the function of the other

Heart Failure: Brain natriuretic peptide (BNP) secreted from myocardial cells in ventricles

-BNP measured when in failure

-Helps to regulate sodium and water absorption by kidneys

-Inhibit renin and aldosterone

-Increases urine production causing decreased blood volume and blood pressure

-Atrial natriuretic peptide (ANP) is secreted from the atrium & also is monitored

Hypertension

1. Elevation of systemic arterial blood pressure- resulting in

-Increase in cardiac output/volume

-Increase in total peripheral resistance or both

2. Primary unknown cause or theory of vasoconstriction

-Overactivity of the sympathetic nervous system or increased cardiac conduction

-Overactivity of the renin angiotensin aldosterone system (RAAS)

-Management of high blood pressure (HBP) with uBeta, alpha adrenergic agonists and or calcium channel agonists - potential first line of treatment

3. Secondary HBP resulting from disease

-Kidney disease, diabetes, atherosclerosis

-Aortic stiffness occurs with aging causes HBP

4. End organ damage silent but lethal

-Malignant hypertension

-Extremely high blood pressure, develops rapidly

-Untreated HBP can cause the following:

-----stroke, retinopathy, coronary heart disease, including proteinuria & renal failure

renin-angiotensin-aldosterone system (RAAS)

a coordinated system of hormones that regulate the body's blood pressure and water balance.

https://www.youtube.com/watch?v=M0vpn6YVwiI

systolic pressure

1. left ventricle ejects blood into the aorta & aortic pressure rises and reaches maximal aortic pressure

2. Aorta compliance (stretch or stiffness) effects systolic pressure

-Aneurism stretched aorta causes falling BP

-Rigidity, stiffness causes increased BP

Diastolic pressure

-The lowest pressure in the aorta, occurs just before the ventricle ejects blood into the aorta

pulse pressure

-Difference between systolic & diastolic pressures

-Typically ranges between 40 and 50 mmHg

Congenital heart disease (CHD

1. Left right shunt such as atrial (ASD) or ventricle septal defects (VSD)

-Patent ductus arteriosus (PDA) artery connect aorta & pulmonary artery allowing left to right shunt

-Atrial and ventricle septal defects opening in septal wall

-VSD most common cardiac congenital defect

2. Tetralogy of Fallot most common cyanotic, hypoxic heart defect

3. Obstructive defects

-Coarcation of the aorta - weak or absent femoral pulses

-Aortic stenosis - narrowing or stricture of the outlet of the left ventricle

-Pulmonic stenosis- narrowing or stricture of pulmonary valve

3. CHD and genetic factors occur in trisomy (13,18,21),Turner, Down and cri du chat syndrome

-Down Syndrome and Trisomy 21 may have - AVSD: atrioventricular septal defect; VSD: ventricular septal defect.

ARDS (acute respiratory distress syndrome)

1. ARDS - swelling of lungs causing tiny blood vessels to leak fluid & alveoli collapse or fill with fluid, preventing the lungs from working

2. Alvelolocapillary membrane injury cause inflammatory response

3. Signs and symptoms:

•Severe SOB

•labored breathing

•tachypnea

•low BP

•confusion & exhaustion

•Causes direct injuries: pneumonia, aspiration, chest injury. Indirect injuries include: sepsis, severe injury causing low BP, pancreatitis.

Cystic Fibrosis

1. complicated multisystem disorder: lungs, digestive enzymes, missing vas deferens (95% males)

2. Autosomal-recessive disease

3. Diagnostic lab includes the Sweat test - excess sodium chloride

4. Transmembrane conductance regulator (CFTR) protein is either not made or incorrectly made

--Chloride channel transports across membrane of cells producing: mucus, sweat, saliva, tears, and digestive enzymes.

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Emphysema

1. Emphysema risk factors

-Smoking causes emphysema

--the most preventable cause

-Air pollution, airway reactivity, heredity,

-Male sex, and age (typically 40-60 but may be any age)

2. Genetic factor causing emphysema

-Alpha 1 antitrypsin deficiency (protein that protects the lungs & is produced by liver )

-Genetic disorder that may result in lung disease or liver disease at any age but may occur as early as 20 years of age but typically between 20-50 years of age