Comprehensive Respiratory Disorders: Gas Exchange, Obstructions, Infections, and Cancers

What is hypoxemia?

Low oxygen in arterial blood, defined as PaO2 < 80 mmHg.

What are common causes of hypoxemia?

Problems with ventilation, respiration, or perfusion, such as asthma, pneumonia, pulmonary embolism, and narcotic overdose.

What physiological response does hypoxemia trigger?

It triggers pulmonary arteriole vasoconstriction, which can lead to pulmonary hypertension and heart failure (cor pulmonale).

What hormone is released due to hypoxemia and what is its effect?

Erythropoietin is released, increasing red blood cell production in the bone marrow.

What are early manifestations of hypoxemia?

Tachypnea, vasoconstriction, increased blood pressure, restlessness, anxiety, and tachycardia.

What severe symptoms occur with sustained hypoxemia (PaO2 < 60)?

Hemoglobin releases oxygen, leading to behavior changes, impaired judgment, delirium, and coma.

What metabolic shift occurs due to severe hypoxemia?

The body shifts to anaerobic metabolism, resulting in increased lactate levels.

What is cyanosis and how does it present in hypoxemia?

Cyanosis appears as a bluish discoloration, central in the lips and mouth or peripheral in the extremities.

What long-term effect can hypoxemia have on the body?

Clubbing of the fingers or toes may develop with long-term hypoxemia.

What are the two methods for diagnosing hypoxemia?

Non-invasive measurement of peripheral oxygen saturation (SpO2) and invasive arterial blood gas analysis (PaO2).

What is the primary treatment for hypoxemia?

Supplemental oxygen via nasal cannula, mask, or ventilator, along with treatment of the underlying cause.

What is hypercapnia?

Excess carbon dioxide (CO2) in the blood, measured by PaCO2.

What causes hypercapnia?

Problems with ventilation, respiration, and perfusion.

What is the primary drive for breathing in the body?

CO2 levels; an increase in CO2 (hypercapnia) stimulates the drive to breathe.

What happens to PaCO2 levels during hyperventilation?

PaCO2 decreases as CO2 is 'blown off', reducing the drive to breathe.

What are common manifestations of respiratory distress?

Shortness of breath (SOB), tachypnea, tachycardia, poor thinking, and disorientation.

What is pleural effusion?

A collection of fluid in the pleural cavity that compresses lung tissue.

What causes transudate pleural effusion?

Fluid moves from capillaries or lymph vessels into the pleural space due to high hydrostatic pressure, often caused by heart, renal, or liver failure.

What is exudate pleural effusion characterized by?

High specific gravity, high protein and LDH levels, and often contains inflammatory cells, typically caused by infections.

What is a parapneumonic effusion?

A type of pleural effusion that contains purulent fluid, often due to infections.

What are the clinical manifestations of pleural effusion?

Signs of hypoxia, decreased breath sounds on the affected side, sharp pleuritic chest pain, and dullness on percussion.

How is pleural effusion diagnosed?

Through chest x-ray, ultrasound, or CT scans.

What is the treatment for pleural effusion?

Thoracentesis, chest tube placement, and pleurodesis.

What is hemothorax?

A specific type of pleural effusion that contains blood in the pleural space, often caused by injury, surgery, or cancer.

What are the clinical manifestations of pneumothorax?

Chest pain, signs of hypoxia, hyperresonance over the affected area, and diminished or absent breath sounds.

What is a tension pneumothorax?

A life-threatening condition where air continues to enter the pleural space, increasing pressure and compressing lung tissue and blood vessels.

What is atelectasis?

The collapse of alveoli, resulting in part of a lung not being expanded, which can lead to pneumonia.

What are the two types of atelectasis?

Primary (due to lack of surfactant in newborns) and acquired (due to airway obstruction or lung compression).

What are common clinical manifestations of obstructive airway diseases?

Wheezing, prolonged expiration, chest tightness, coughing, dyspnea, and signs of hypoxia.

What triggers asthma attacks?

Allergens, exercise, stress, infections, NSAIDs, and GERD.

What is the role of IgE in asthma?

IgE promotes inflammation and airway swelling, leading to bronchoconstriction.

What are the common diagnostic methods for asthma?

Patient history and pulmonary function tests measuring forced expiratory volume and forced vital capacity.

What is the first-line treatment for asthma?

Avoidance of triggers, relaxation techniques, and the use of asthma inhalers.

What types of inhalers are used for asthma management?

Inhaled bronchodilators, including short-acting beta-2 adrenergic agonists and anticholinergics.

What is the significance of deep breathing and ambulation in postoperative patients?

These practices help prevent atelectasis by promoting lung expansion and preventing airway obstruction.

What are the types of fluid involved in pleural effusion?

Transudate, exudate, parapneumonic, and chylothorax.

What are the treatment options for pleural effusion?

Thoracentesis, chest tube placement, and pleurodesis.

What causes pneumothorax?

A collapsed lung due to air in the pleural space, often caused by trauma or ruptured alveoli.

What are the types of pneumothorax?

Primary spontaneous, secondary spontaneous, catamenial, traumatic, and tension pneumothorax.

How is pneumothorax diagnosed?

Using chest x-ray and CT scans.

What can cause atelectasis?

Compressive forces, obstruction preventing alveoli inflation, or loss of surfactant.

What are the clinical manifestations of atelectasis?

Signs of hypoxia.

What are the prevention and treatment strategies for atelectasis?

Encouraging deep breathing, coughing, early ambulation, turning frequently, maintaining hydration, and treating the underlying cause.

What are obstructive airway diseases?

Conditions where airflow is obstructed in the respiratory system.

What are the risk factors for asthma?

Allergies, family history, exposure to smoke and pollution, and frequent viral infections.

What happens in the airways during an asthma attack?

Airways become hyperreactive, leading to bronchoconstriction and airway swelling.

What are common triggers for asthma?

Allergens, exercise, stress, infections, NSAIDs, GERD, and sleep.

What are the clinical manifestations of asthma?

Wheezing, prolonged expiration, chest tightness, coughing, dyspnea, and signs of hypoxia.

How is asthma diagnosed?

Through patient history and pulmonary function tests.

What are the treatment options for asthma?

Trigger avoidance, relaxation techniques, and inhalers (short-acting and long-acting bronchodilators).

What is the purpose of inhaled anti-inflammatory medications like fluticasone and montelukast?

They are used for maintenance and prevention of asthma, not for acute treatment.

What is status asthmaticus?

An emergency condition where an asthma attack does not respond to usual treatment.

What is COPD?

Chronic obstructive pulmonary disease, a condition caused by chronic bronchitis, emphysema, bronchiectasis, or asthma.

What is the leading cause of COPD?

Smoking, accounting for 80% of cases.

What are common risk factors for developing COPD?

Smoking, secondhand smoke, being over 40 years old, chemical exposures, AAT deficiency, and living in polluted areas.

What characterizes chronic bronchitis?

Inflammation of bronchi/oles from smoking and irritants, leading to increased goblet cells and excessive mucus production.

How is chronic bronchitis diagnosed?

By a productive cough lasting at least 3 months in 2 consecutive years.

What causes emphysema?

Smoking and decreased levels of alpha-1 antitrypsin (AAT), leading to the destruction of alveoli and loss of lung elasticity.

What happens to alveoli in emphysema?

They become overdistended and destroyed, forming large air sacs (blebs) with reduced surface area for oxygen exchange.

What are the potential complications of asthma?

Status asthmaticus, COPD, hypoxic injury, death, and hospitalization.

What is the fourth leading cause of death in the US?

Chronic obstructive pulmonary disease (COPD).

What is the role of leukotriene antagonists in asthma treatment?

They help reduce inflammation and bronchoconstriction in asthma management.

What is the significance of AAT deficiency in lung health?

It allows elastase to destroy lung tissue, contributing to conditions like emphysema.

What are the symptoms of COPD?

Chronic cough, sputum production, and difficulty breathing.

What is the relationship between COPD and smoking?

80% of COPD cases are related to smoking, highlighting the importance of smoking cessation.

What is a common treatment strategy for asthma?

Using a combination of inhaled corticosteroids and leukotriene antagonists for long-term management.

What are common clinical manifestations of respiratory disorders?

Dyspnea, productive cough, activity intolerance, wheezing, rhonchi, cyanosis, tripod posture, low O2 saturation, CO2 retention, barrel chest, clubbing, right heart failure, edema, jugular vein distension, and pursed lip breathing.

What is the primary goal for oxygen therapy in respiratory patients?

To maintain oxygen saturation between 88-92%.

What is cystic fibrosis and what causes it?

An autosomal recessive disorder affecting exocrine glands, caused by a mutation in the cystic fibrosis transmembrane regulator gene, leading to thickened mucus and obstructions.

What are the clinical manifestations of cystic fibrosis?

Productive cough with thick mucus, difficulty clearing airways, frequent infections (especially with Pseudomonas aeruginosa), decreased pancreatic enzymes leading to malabsorption, and potential diabetes.

What diagnostic test is used for cystic fibrosis?

The sweat chloride test, which shows increased sodium and chloride content.

What are the treatment options for cystic fibrosis?

Antibiotics, chest percussion, bronchodilators, pancreatic enzyme replacement, and optimizing nutrition with a low-fat diet.

What characterizes Chronic Interstitial Lung Diseases (ILD)?

Inflammatory and fibrotic changes in the lung interstitium, leading to reduced lung volume and hypoxia.

What are common clinical manifestations of ILD?

Signs of hypoxia, dry cough, decreased lung breath volume, increased respiratory rate, and cyanosis.

What is the primary treatment for ILD?

Removing or avoiding the injurious agent, immunosuppressants, steroids, supplemental oxygen, and lung transplant.

What is pulmonary embolism (PE)?

A blockage in the pulmonary arterial circulation caused by a blood clot or other substance, commonly originating from venous thromboembolism.

What are the clinical manifestations of pulmonary embolism?

Sudden onset of chest pain, dyspnea, tachypnea, hemoptysis, hypoxia, and shock.

What diagnostic tests are used for pulmonary embolism?

D-dimer, helical CT angiogram, and ventilation-perfusion (VQ) scan.

What is primary pulmonary arterial hypertension?

A rare condition characterized by high blood pressure in pulmonary arteries due to intrinsic problems in the pulmonary vasculature.

What are the clinical manifestations of primary pulmonary arterial hypertension?

Fatigue, angina, syncope, and high pulmonary artery pressure with normal left heart function.

What is acute respiratory failure?

A condition characterized by severe hypoxemia and/or hypercapnia due to various respiratory problems.

What are the clinical manifestations of acute respiratory failure?

PaO2 <50 mmHg and/or PaCO2 >50 mmHg, signs of hypoxemia, and respiratory acidosis.

What is Adult Respiratory Distress Syndrome (ARDS)?

A severe form of acute lung injury characterized by widespread injury of alveoli and inflammation, not caused by heart problems.

What are the clinical manifestations of ARDS?

Rapid onset, tachypnea, tachycardia, hypoxemia even with oxygen, cyanosis, and crackles in the lungs.

What is the treatment for ARDS?

Mechanical ventilation with PEEP, bronchodilators, prone positioning, and treatment of the underlying cause.

What is the most common respiratory tract infection?

The common cold

What is the primary cause of the common cold?

Over 200 viruses, with rhinovirus being the most common.

When do rhinovirus infections peak?

Early fall and late spring.

What are the major portals of entry for cold viruses?

Nasal mucosa and eye conjunctiva.

What is the typical duration of cold symptoms?

7 days, with an incubation period of 12 hours to 3 days.

What are common clinical manifestations of a cold?

Dry stuffy nasopharynx, clear nasal secretions, post-nasal drip, sore throat, headache, and malaise.

What is the recommended treatment for the common cold?

Symptomatic treatment, rest, and over-the-counter medications; antibiotics are not effective.

What is influenza commonly referred to as?

The flu.

What types of viruses cause influenza?

Types A, B, and C.

How does influenza spread?

Primarily through inhalation of droplet nuclei.

What is the incubation period for influenza?

Average of 2 days.

What are the early symptoms of influenza?

Fever, chills, malaise, body aches, headache, runny nose, cough, and sore throat.

What is a serious complication of influenza in older adults?

Influenza pneumonia, which can lead to hypoxemia and death.

What is pneumonia?

Inflammation of lung tissue in the lower respiratory tract, specifically the alveoli and bronchioles.

What are the two main types of pneumonia based on acquisition?

Community-acquired pneumonia (CAP) and hospital-associated pneumonia (HAP).