ALU 201: Intermediate Medical Life Insurance Writing PDF

Chapter 7: The Respiratory System THE RESPIRATORY SYSTEM Introduction expelled into the exhaled breath. The lungs are entirely within the chest cavity. They are covered by the pleura, which is a thin tubes, collectively called the bronchial tree. The upper nasal airway hydrates and warms the air ) i...

Chapter 7: The Respiratory System THE RESPIRATORY SYSTEM Introduction expelled into the exhaled breath. The lungs are entirely within the chest cavity. They are covered by the pleura, which is a thin tubes, collectively called the bronchial tree. The upper nasal airway hydrates and warms the air ) is taken up by the capillary red blood cells and carbon dioxide 2 ) is exchanged into the alveolus and removed by exhalation. 2 the pulmonary circulation is a branching system in which the arteries taking blood to the lungs veins as carrying deoxygenated blood and arteries as carrying oxygenated blood. In the lung it is the opposite – deoxygenated blood arrives into the lung via pulmonary arteries, and oxygenated blood leaves the alveolar bed veins Page 217 ALU 201: Intermediate Medical Life Insurance Writing The pressure in the pulmonary arterial system is much lower than that in the circulation to the circulation, with respiration being secondarily compromised. 2 2 Physiology (exhalation), the chest wall muscles relax, the diaphragm passively moves upward, and air is Air is delivered to the alveoli, and the pulmonary circulation carries blood to the alveolar 2 2 2 2 is more than a waste or carbonic acid can be adjusted rapidly by the body to maintain the critical 2 continue, tetany (i.e., muscle contractions) and convulsions. load by creating sodium bicarbonate, a weak alkali. 2 to hemoglobin and dissolved in blood and that can damage the eyes, central nervous system, Page 218 Chapter 7: The Respiratory System dissolved in blood. /FVC ratio. The results are usually recorded along with /FVC 1. airway (in which the reduction in FEV is larger than the reduction in FVC resulting in an FEV 2. chest wall or lung restriction (in which the FVC and FEV are both proportionally reduced with the FEV /FVC >80%) 3. FVC is a volume measurement and can be decreased with severe airway obstruction in diseases restricts chest wall motion. These conditions would cause spirometry to show reduced FVC but normal FEV1/FVC ratio, indicating restriction. In such cases, the reduced lung volumes would need Page 219 ALU 201: Intermediate Medical Life Insurance Writing x 40 should also suggest spirometry results but probably should be, since it is the only measurement in spirometry that Clinical History In lung disease, as in many medical conditions, clinical history is the most valuable segment progressing. Progressive worsening is a poor prognostic sign. Medications taken, especially daily Page 220 Chapter 7: The Respiratory System disease but always indicate an abnormality. Wheezes are whistling sounds heard when the airways also be described in the very obese or those muscular individuals with thick chest walls. abnormalities are consistent with the proposed insured’s known condition. Page 221 ALU 201: Intermediate Medical Life Insurance Writing is a relative contraindication to doing CT angiography whenever the serum creatinine is at the interstitial lung disease. metabolically active nodules or masses taking up these radioactive molecules. Such uptake is Page 222 Chapter 7: The Respiratory System down the throat and into the airways. During this procedure, the lung can be lavaged with saline have been developed that allow the CT lung imaging to “guide” the bronchoscope to the lesion, malignancy. systems. In most individuals, symptoms are persistent (asthma being an exception) and some anticipated. Selected Lung Diseases individual to severe destructive emphysema and liver disease. Emphysema is more common in Page 223 ALU 201: Intermediate Medical Life Insurance Writing damage. apnea, negative pressure in the pharynx during inspiration causes the posterior pharyngeal wall to 1. 2. 3. 2 4. ) >10/hr being a concern. 5. 6. to airway obstruction). 1. 2. 3. 4. 5. 6. 7. 8. male gender older age snoring obesity nasal obstruction tonsillar or uvular hypertrophy jaw abnormalities alcohol abuse Page 224 Chapter 7: The Respiratory System 9. hypothyroidism 10. 11. acromegaly 12. 13. central apneas there are, the greater the concern is. Central apneas can also be seen with continuous 1. 2. 3. 4. oximetry 5. 6. 7. 1. 2. Page 225 ALU 201: Intermediate Medical Life Insurance Writing obstructive apneas or hypopneas causing a sleep arousal to improve breathing. 1. 2. episodic hypoxia. 2 pressure, right ventricular overload, depression, and cognitive impairment. apnea is diagnosed and adequately treated, and even then requires combined changes in dietary air is applied by mask and acts as a pneumatic splint to keep the upper airway open. Compliance individuals with mild sleep apnea who usually do not perceive that they have a problem in the party medical insurers requiring that small computer chips implanted in the CPAP machine be downloaded and reviewed by a physician at least once yearly. Studies have shown that wearing sleep apnea. maxillary surgery is showing some success. A tracheostomy is usually done as a last resort but is a most common arrhythmias are bradycardia, prolonged asystole, and second degree AV block. In Page 226 Chapter 7: The Respiratory System 2 desaturation and/or excessive daytime somnolence with accidents. Persons with persisting oxygen while wearing CPAP. drugs on the market to address this puzzling problem. A major evolving, and as yet unanswered, question is whether much simpler and less expensive Asthma Asthma is a clinical syndrome characterized by completely reversible airway obstruction at some point in the clinical history (i.e., when the individual is completely well and asymptomatic). there is no known cause. Asthma with onset in childhood tends to diminish in severity with increasing age, but some had childhood asthma will show increased bronchial reactivity in many. children raised in “sterile” enviroments such as homes and high rises, than in children raised on Page 227 ALU 201: Intermediate Medical Life Insurance Writing immune systems to develope a tolerance that the city children do not have. This is called the “hygiene hypothesis.” 1. 2. hospitalizations 3. treatment 4. longer as commonly advocated to be done on a regular daily basis. 1. are not on appropriate inhaled corticosteroid daily therapy 2. take oral corticosteroids daily 3. 4. 5. have ever required intubation with mechanical ventilation. Status asthmaticus is a severe attack that does not respond to the usual measures. It usually Page 228 Chapter 7: The Respiratory System visits would be an underwriting concern. Atelectasis is no problem. plate-like atelectasis (discoid atelectasis) Blebs, Bullae and Cysts Page 229 ALU 201: Intermediate Medical Life Insurance Writing disease. lung disease. Bronchiectasis in an otherwise healthy person can have a good prognosis. The major hazards are recurrent and no excess morbidity or mortality. 100 degrees and the kyphosis exceeds 20 degrees, respiratory compromise can occur. In very Page 230 Chapter 7: The Respiratory System / percent predicted, with FEV percent predicted > 80% being mild, FEV moderate, FEV very severe. and sputum production. Acute isolated bronchitis can be seen in otherwise healthy individuals with consequences. Chronic bronchitis is a serious disease that can lead to progressive disability and is called centrilobular emphysema. Page 231 ALU 201: Intermediate Medical Life Insurance Writing been minimal change in exercise tolerance, the prognosis would be better. A more accurate way to request the results. A current FEV and inspiratory capacity (IC) are the best prognosticators and advanced stages. Cystic Fibrosis disease. Page 232 Chapter 7: The Respiratory System anatomical space in between and surrounding all alveoli. There are some 200 known occupational Another emerging disease problem is idiopathic interstitial lung diseases, with “idiopathic” Pleural Disease The most common symptom with pleural disease is chest pain, which can be aggravated by malignant. Page 233 ALU 201: Intermediate Medical Life Insurance Writing Empyema lung disease. seen in asbestos workers, is a primary pleural cancer. Any malignant pleural disease carries a and mortality prediction. Pneumoconioses asbestos, silica dust, and coal dust. Asbestosis Silicosis coal miners and those digging tunnels through rock are at serious risk. It is also seen in sandblasters and those who work with grinding wheels. Page 234 Chapter 7: The Respiratory System Coal workers’ pneumoconiosis (black lung) Pneumonia Pneumothorax to moderate pneumothoraces to resolve on their own. Procedures that cause the lung to adhere to the chest wall are occasionally necessary in these serious underlying lung disease. Pulmonary Emboli Page 235 ALU 201: Intermediate Medical Life Insurance Writing 1. local trauma to the vessel wall 2. hypercoagulability 3. stasis. Many who have a pulmonary embolism have an inherited susceptibility that is activated when and antiphospholipid syndrome) are much more serious. Most emboli originate in the leg veins where deep vein thrombosis (DVT) and thrombophlebitis eliminated, the peripheral veins are normal on exam, there is no edema, and recovery is complete, (Coumadin® ® disorders. Page 236 ® ), dabigatran (Pradaxa® Chapter 7: The Respiratory System and glycogen storage diseases. no other lung abnormality. in these nodules is less than 1%. At younger ages cancer is a rare cause, but the incidence rises hamartomas and bronchial adenomas. insured is a young nonsmoker and there are radiologic characteristics that make malignancy very Page 237 ALU 201: Intermediate Medical Life Insurance Writing Positron emission tomography (PET) imaging uses a radioactive isotope attached to a glucose (sugar) molecule to look at the metabolic activity Additional caveats relating to PET imaging include documentation that the nodule being imaged is 1 cm or larger and that the person being tested does not have existing hyperglycemia (reports histology report must be reviewed, and Pulmonary Fibrosis process can cease spontaneously. 1. 2. occupational exposure, most commonly in asbestos and coal workers with pneumoconiosis 3. heart disease with chronic pulmonary congestion 4. sclerosis 5. sarcoidosis 6. cancer. Page 238 Chapter 7: The Respiratory System pneumonia. Sarcoidosis involved, but the intrathoracic structures, especially the lungs and mediastinal and hilar lymph in children and the elderly. severe damage to the lungs. Some can have damage to the heart, eyes, or nervous system. Page 239 ALU 201: Intermediate Medical Life Insurance Writing not lung reticulonodular interstitial changes and prominent mediastinal/hilar lymph node enlargement. Stage 1 is the most common presentation, generally is without symptoms, resolves spontaneously over time, and has an excellent prognosis with no extra mortality. The usual initial concern with hilar lymph nodes melt away, and these changes are much more likely to be permanent. Stage 3 lung zone distribution. nervous system involvement is associated with very high mortality. without corticosteroids, it will not recur. Page 240 Chapter 7: The Respiratory System , will be normal in many cases, lung involvement. Serial measurements showing stability or improvement in vital capacity are more valuable than a single measurement. Even when the process in the lungs has been stabilized, some permanent lung damage can remain. and the number smoking in conjunction with exposure to chromate, nickel, coal, or uranium. those who continue to smoke, and there always appears to be some mortality advantage to quitting Page 241 ALU 201: Intermediate Medical Life Insurance Writing Tuberculosis in the world. those who are not immunocompromised, who have minimal disease, and whose TB organisms are sensitive to the usual drugs, the extra risk is small. treat TB. or mild disease. In an otherwise healthy person with no symptoms, there should be no extra risk Page 242