Patho 2 Unit 1-2

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Patho 2 Unit 1-2
2012-04-17 00:50:11

Material for quiz 2; Atrial Septal to chest wall restriction
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  1. What is Atrial Septal Defect? What direction is the shunt?
    An opening between the right and left atria

    Causes a left to right shunt that can be reversable

    Well tolerated but leads to to PHTN
  2. What is the most common congenital heart defect?
    Ventricular Septal Defect
  3. What is VSD? What direction is the shunt?
    Ventricular septal defect; an opening between the left and right ventricle.

    Causes a left to right shunt with frequent reversal

    Leads to progressive PHTN and is mroe likely to need surgical correction
  4. Why is it serious when the shunt reverses with a VSD?
    Because deoxygenated blood is sent out the aorta which leads to hypoxia.
  5. What is Patent Ductus Arteriosis? What direction is the shunt?
    A connection between the pulmonary a. and the aorta

    A left to right shunt (aorta to pulmonary) which doesn't reverse

    Leads to PHTN and requires surgical correction

    Oxygenated blood mixes with deoxygenated blood
  6. (T or F) All defects can lead to congestive heart failure.
    All defects can lead to CHF
  7. What is CHF?
    Congestive heart failure; heart is unable to eject all the blood delivered to it
  8. What can cause l. heart failure?
    Systemic hypertension

    MV/AV disease

    Ischemic heart disease

  9. What can cause r. heart failure?
    L. heart failure

    Lung disease

    PV/TV disease

    L. to r. shunts

  10. What are 3 compensatory mechanisms for CHF?
    - Increased SNS activity (positive inotropic affect; epinephrine)

    - Increased HR

    - Hypertrophy of myocardium
  11. What happens if the compensation for CHF isn't enough?
    Increased EDV which causes the heart to dilate
  12. What is Frank-Starling's Law?
    When the ventricles dilate, m. fibers intially contract forcibly to increase CO

    If dilation continues contractions becomes weaker progressively decreasing CO
  13. How does compensated CHF relate to Frank - Starling's Law?
    Mild vent. dilation lead to forcible contraction and increased CO
  14. How does Decompensated CHF relate to Frank - Starling's Law?
    Greatly increased EDV (leading to ventricle dilation) leads to weaker contractions and decreased CO
  15. Where does blood back up during l. heart failure?
    From the l. vent to the l. atrium to the lungs
  16. What is PHTN?
    Pulmonary hypertension; increase in hydrostatic pressure of pulmonary vessels
  17. What is pulmonary edema?
    Leakage of fluid in the interstitial spaces of the pulmonary vessels (and eventually into the alveoli)
  18. What are common results of l. heart failure?

    Pulmonary edema

    R. heart failure
  19. What is the most common cause of r. heart failure?
    L. heart failure
  20. What are common results of r. heart failure?
    Venous congestion

    Soft tissue edema
  21. What are clinical signs of r. heart failure?
    Distended neck veins

    Splenomegaly leading to ascites (stomach edema)

    DVT and PE
  22. How does CHF affect the kidneys?
    Decompensated CHF leads to decreased renal perfusion

    Renin-angiotensin cycle activate, water is retained

    Heart unable to pump increased fluid volume leads to venous pooling
  23. What should the first treatment be to protect the kidneys from CHF?
  24. Describe the bronchial tree
    Trachea: C- shaped cartilage

    Bronchi: Transition from cartilage to smooth m.

    Bronchioles: no cartilage, all smooth m.

    Alveoli: exchange surface closely associated w/ capillaries
  25. What is the major function of the lungs?
    Excrete carbon dioxide while obtaining oxygen
  26. Where does diffusion between blood and air occur?
    The alveoli
  27. Describe intrathoracic pressure during inspiration
    The diaphragm moves down while the ribs move up and out

    Chest volume increases while pressure inside the chest decreases

    Air moves into the chest
  28. Describe intrathoracic pressure during expiration
    Diaphragm moves up and ribs move down and in

    Chest volume decreases, pressure inside the chest increases

    Air moves out of the chest
  29. What is dyspnea?
    Difficulty breathing (SOB)
  30. What is orthopnea?
    Difficulty breathing while laying down
  31. What is exertional dyspnea?
    Difficulty breathing while excercising
  32. What is hypoventilation?
    Inadequate alveolar ventilation in relation to metabolic demands
  33. What is hyperventilation?
    Alveolar ventilation exceeds metabolic demands
  34. Cough's can be either _____ or non - ______.
    Coughing can either be productive (wet) or non-productive (dry).
  35. What are the 2 types of productive coughing?
    Purulent sputum: infection

    Non-purulent: nonspecific irritation
  36. What are the 2 types of cough medicines?
    Expectorants (productive coughs)

    Suppressants (Non-prodcuctive; can lead to pneumonia if used with productive cough)
  37. What is cyanosis?
    Bluish skin discoloration caused by increased unoxygenated hemoglobin

    Tx with supplemental oxygen
  38. What is hemoptysis?
    Coughing up bloody/bloody secretions

    Coughed blood: high pH, bright red

    Thrown up blood: low pH, dark red
  39. WHat are 3 mechanisms of pulmonary edema?
    L. heart failure

    Inflammation of alveoli

    Blockage of lymphatic vessel
  40. What is pleural effusion? What are the 2 types?
    Fluid in pleural space

    Transudate (hydrothorax, serous effusion): fluid w/ little fluid; yellowish; low specific gravity

    Exudate: high protein; cloudy; high specific gravity
  41. What are the 3 types of exudates in pleural effusion?
    Empyema (pus)

    Hemothorax (serosanguinous; blood)

    Chlyothorax (Chyle; lymph fluid)
  42. What is atelectasis?
    Loss of lung volume due to inadequate expansion of airspaces

    Results in poorly oxygenated blood
  43. What are the common symptoms of resp. disease?




  44. What are the different types of atelectasis?



  45. What is resoption atelectasis?
    Occurs when an obstruction prevents air from reaching distal airways

    Air already present gradually becomes absorbed

    Tumor, foreign body,mucous plug
  46. What is compression atelectasis?
    Occurs w. accumulation of fluid, blood, or air in pleural cavity

    Pleural effusion (fluid), pneumothorax (air)
  47. What is pneumothorax?
    Presences of air/gas in pleural space
  48. What are the 3 types of pneumothorax?
    Tension: increased pressure

    Open: pressure equal with outside environment (e.g. stab wound)

    Iatrogenic: occurs with open chest surgery
  49. What is microatelectasis?
    Generalized loss of lung expansion

    Decreased surfactant

    Neonatal resp. distress syndrome
  50. What is contraction atelectasis?
    Occurs with fibrotic changes (wound healing) in the lung/pleura and make expansion difficult

    Not reversible!
  51. What is aspiration?
    Passage of fluid and/or solid particles into the lung.
  52. Where to particles typically lodge with aspiration?
    Lower lobe of r. lung if upright.
  53. What are some predispositions for aspiration?
    Impaired swallowing mechanism

    Impaired cough reflex

    Alt. level of consciousness
  54. What are the different types of aspiration?
    Foreign body

    Large food particles

    Acidic gastric fluid
  55. What is the complication associated with aspiration?
    Aspiration pneumonia
  56. What are 4 different chest wall restrictions?

    Skeletal disorders (kyphoscoliosis)

    Neuromuscular disease ( myasthenia gravis, muscular dystrophy, spinal cord trauma)

    Flail chest