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Respiratory System Case Study
Trudy, a home health respiratory therapist, especially enjoys her
older patients, and her Tuesday morning patient is one of her
favorites. Jonas Hershel, a 79-year-old former respiratory
therapist himself, has been hospitalized over the weekend for
extreme difficulty with breathing from emphysema. Jonas'
physical examination has noted crackles, clubbing, and DOE.
Blood gases reveal hypoxemia and hypercapnia. Jonas'
emphysema has now progressed to COPD.
After being stabilized, Jonas has been released to his home with
home health care visits. Trudy has treated Jonas in the hospital
and is now his home health care professional. Tracking Jonas'
breathing capacity using spirometry is part of her duties.
However, today Jonas is too tired to sit up; therefore Trudy
performs the spirometry while Jonas is reclining.
1. Give another name for crackles and define it.
2. What does spirometry measure?
3. Define emphysema. What is destroyed in emphysema?
4. What do the terms hypoxemia and hypercapnia stand for?
5. What do the abbreviations DOE and COPD stand for? Define
and explain.
Beacon Roofing Supply Inc.'s Proposed $300 Million
Senior Secured Notes Rated 'BB', Unsecured Notes
Lowered to 'B-'
September 25, 2019
FARMERS BRANCH (S&P Global Ratings) Sept. 25, 2019--
S&P Global Ratings assigned its 'BB'
issue-level rating and '1' recovery rating to Beacon Roofing
Supply Inc.'s proposed $300 million
senior secured notes issuance. The proposed senior secured
notes will rank equally with the
company's $970 million term loan, which is unchanged and
carries a 'BB' issue-level rating, with a
'1' recovery rating. Beacon plans to use the proceeds from the
notes offering to pre-fund the
company's redemption of its $300 million senior unsecured
notes due 2023 on Oct. 1, 2019.
However, the increased amount of senior secured debt will
result in diminished recovery available
to unsecured lenders. As a result, we have lowered the issue-
level rating on Beacon's $1.3 billion
senior unsecured notes due 2025 to 'B-' from 'B' and revised the
recovery rating to '6' from '5'.
The '1' recovery rating on the Beacon's secured debt indicates
our expectation for very high
(90%-100%; rounded estimate: 90%) recovery in a default
scenario. Our '6' recovery rating on the
unsecured notes reflects our expectation of negligible recovery
(0%-10%; rounded estimate: 0%)
in the event of a default.
For more information on Beacon Roofing Supply Inc., see our
research update published on Aug.
30, 2019.
Key analytical factors
- Our assessment of recovery prospects contemplates a
reorganization value for the company of
about $2.07 billion, reflecting emergence EBITDA of about
$345 million and a 6x multiple. Our
emergence EBITDA assumption contemplates a rebound in
profitability following the sharp
cyclical downturn that we believe is required for the company
to default with the present
capital structure. As a result, our EBITDA assumption does not
purport to represent a
default-level EBITDA, which we think could be substantially
lower. The 6x multiple is within the
5x-6x range that we generally use for building products
companies.
- Our simulated default scenario contemplates a default in 2023,
stemming from a downturn in
the company's end markets (U.S. residential and nonresidential
roofing and reroofing),
heightened competition, and significant price increases imposed
by suppliers that cannot be
passed on to customers. These adverse developments hamper
margins and cash flow,
pressuring Beacon's ability to meet its financial obligations and
prompting the need for a
bankruptcy filing or restructuring.
Beacon Roofing Supply Inc.'s Proposed $300 Million
Senior Secured Notes Rated 'BB', Unsecured Notes
Lowered to 'B-'
September 25, 2019
PRIMARY CREDIT ANALYST
Pablo A Garces
Farmers Branch
+ 1 (214) 765 5884
pablo.garces
@spglobal.com
SECONDARY CONTACT
Thomas J Nadramia
New York
+ 1 (212) 438 3944
thomas.nadramia
@spglobal.com
www.spglobal.com/ratingsdirect September 25, 2019 1
THIS WAS PREPARED EXCLUSIVELY FOR USER RONALD
SALINAS.
NOT FOR REDISTRIBUTION UNLESS OTHERWISE
PERMITTED.
mailto: [email protected]
mailto: [email protected]
mailto: [email protected]
mailto: [email protected]
- For purposes of our default scenario, we assumed aggregate
borrowings of about $725 million
under the asset-based loan (ABL) facility, representing usage of
about 60% of the $1.2 billion
U.S. commitment amount.
- We assume the collateral package for Beacon's secured debt
will encompass all of the
available reorganization value. Only a small portion of the
reorganization value is
unencumbered under our analysis, representing the equity value
of foreign subsidiaries not
pledged to secure the term loan.
Simulated default assumptions
- Year of default: 2023
- EBITDA at emergence: $345 million
- Implied enterprise value (EV) multiple: 6x
- Gross EV: $2.07 billion
Simplified waterfall
- Obligor (U.S. operations)/nonobligor (Canadian operations)
valuation split: roughly 95%/5%
($1.97 billion/$105 million)
- Valuation split (net 5% administrative costs): $1.87
billion/$100 million
- Priority claims and adjustments (60% usage of the $1.2 billion
U.S. ABL facility): $725 million
- Priority nonobligors claims: $60 million
- Collateral from nonobligor (65% stock pledge of remaining
$35 million net EV at nonobligors
after subtracting secured nonobligors claims): $25 million
- Total collateral value for secured claims ($1.14 billion U.S.
value remaining after coverage of
ABL facility plus $25 million remaining collateral from
nonobligor): $1.17 billion
- Secured claims (Total term loan claim*: $950 million,
proposed senior secured notes: $305
million): $1.25 billion
- --Recovery expectation for term loan: 90%-100% (rounded
estimate: 90%)
- Unpledged value available to unsecured claims: $15 million
- Estimated unsecured claims: $1.31 billion
- --Recovery expectation for senior notes: 0%-10% (rounded
estimate: 0%)
*Senior secured claim amount reflects $925 million of term loan
principal, less payment of
scheduled amortization of 1% per year through 2022, plus an
assumption for accrued but unpaid
interest outstanding at default.
Related Criteria
- General Criteria: Group Rating Methodology, July 1, 2019
- Criteria | Corporates | General: Corporate Methodology:
Ratios And Adjustments, April 1, 2019
- Criteria | Corporates | General: Recovery Rating Criteria For
Speculative-Grade Corporate
Issuers, Dec. 7, 2016
www.spglobal.com/ratingsdirect September 25, 2019 2
THIS WAS PREPARED EXCLUSIVELY FOR USER RONALD
SALINAS.
NOT FOR REDISTRIBUTION UNLESS OTHERWISE
PERMITTED.
Beacon Roofing Supply Inc.'s Proposed $300 Million Senior
Secured Notes Rated 'BB', Unsecured Notes Lowered to 'B-'
- Criteria | Corporates | General: Methodology And
Assumptions: Liquidity Descriptors For Global
Corporate Issuers, Dec. 16, 2014
- Criteria | Corporates | Industrials: Key Credit Factors For The
Building Materials Industry, Dec.
19, 2013
- General Criteria: Country Risk Assessment Methodology And
Assumptions, Nov. 19, 2013
- Criteria | Corporates | General: Corporate Methodology, Nov.
19, 2013
- General Criteria: Methodology: Industry Risk, Nov. 19, 2013
- General Criteria: Methodology: Management And Governance
Credit Factors For Corporate
Entities, Nov. 13, 2012
- General Criteria: Use Of CreditWatch And Outlooks, Sept. 14,
2009
Certain terms used in this report, particularly certain adjectives
used to express our view on rating relevant factors,
have specific meanings ascribed to them in our criteria, and
should therefore be read in conjunction with such
criteria. Please see Ratings Criteria at
www.standardandpoors.com for further information. Complete
ratings
information is available to subscribers of RatingsDirect at
www.capitaliq.com. All ratings affected by this rating
action can be found on S&P Global Ratings' public website at
www.standardandpoors.com. Use the Ratings search
box located in the left column.
www.spglobal.com/ratingsdirect September 25, 2019 3
THIS WAS PREPARED EXCLUSIVELY FOR USER RONALD
SALINAS.
NOT FOR REDISTRIBUTION UNLESS OTHERWISE
PERMITTED.
Beacon Roofing Supply Inc.'s Proposed $300 Million Senior
Secured Notes Rated 'BB', Unsecured Notes Lowered to 'B-'
www.spglobal.com/ratingsdirect September 25, 2019 4
THIS WAS PREPARED EXCLUSIVELY FOR USER RONALD
SALINAS.
NOT FOR REDISTRIBUTION UNLESS OTHERWISE
PERMITTED.
Beacon Roofing Supply Inc.'s Proposed $300 Million Senior
Secured Notes Rated 'BB', Unsecured Notes Lowered to 'B-'
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Research:Key analytical factorsRelated Criteria
Chapter 12
The Respiratory System
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Learning ObjectivesName the organs of the respiratory system
and describe their location and function.Identify various
pathological conditions that affect the system.Recognize
medical terms that pertain to respiration.
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Learning Objectives (cont’d.)Describe important clinical
procedures related to the respiratory system and recognize
relevant abbreviations.Apply your new knowledge to
understanding medical terms in their proper contexts, such as
medical reports and records.
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Chapter 12
Lesson 12.1
Copyright © 2005 by Elsevier Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Introduction
External respiration: exchange of air in lung capillariesoxygen
inhaled into the air sacs of the lungsimmediately passes into
capillariescarbon dioxide passes from capillaries into air sacs,
to be exhaled
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*What percent of oxygen does inhaled air contain? (about 21
%)What percent of oxygen does exhaled air contain? (about 16
%)What is the medical term for air sacs?
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Introduction (cont’d.)
Internal respiration: exchange of gases in the cells occurs
simultaneously between cells and capillariesoxygen passes out
of the bloodstream into the tissuescarbon dioxide passes out of
tissues back into the bloodstream to travel to the lungs
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Respiratory AnatomyMediastinum: middle of chest where
trachea divides into two branchesBronchi: each leads to a
separate lungLungs: not mirror images, have lobesHilum: blood
vessels, nerves, lymphatic tissue, and bronchial tubes enter and
exit
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*What is the singular form of bronchi? (bronchus)Which lung is
larger? (right)How many lobes does each lung have? (right:
three, left: two)
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Anatomy of Respiration
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Engage the class to identify the organs of the respiratory
system. Trace the path of a breath of air.
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Inc. All rights reserved.
Anatomy of Respiration
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Engage the class to identify the organs of the respiratory
system. Trace the path of a breath of air.
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Respiratory Structures
Conduct airNoseNasal cavities and paranasal
sinusesPharynxLarynxTrachea
Exchange gasesBronchiolesAlveoliLung capillaries
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Respiratory Flow Chart
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Trace the flow and then conduct the class activity in the lesson
plan by dividing the class into two groups and assigning each a
gas. (see LP 12.1)
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Respiratory Flow Chart
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Trace the flow and then conduct the class activity in the lesson
plan by dividing the class into two groups and assigning each a
gas. (see LP 12.1)
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
VOCABULARYadenoidsalveolus (alveoli)apex of the
lungbase of the lungbrochiolesbronchus (bronchi)carbon dioxide
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Reference pages 260-262 for definitions of vocabulary terms
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
VOCABULARYciliadiaphragmepiglottisexpirationglottishilumi
nspirationlarynx
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Inc. All rights reserved.
*
Reference pages 260-262 for definitions of vocabulary terms
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
VOCABULARYlobemediastinumnaresoxygenpalatine
tonsilparanasal sinusparietal pleura
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Inc. All rights reserved.
*
Reference pages 260-262 for definitions of vocabulary terms
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
VOCABULARYpharynxpleurapleural cavitypulmonary
parenchymarespirationtracheavisceral pleura
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Inc. All rights reserved.
*
Reference pages 260-262 for definitions of vocabulary terms
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
QUICK QUIZ:
1. What is the tip or uppermost portion of the lung?
base
lobe
apex
nares
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Inc. All rights reserved.
*
CORRECT Answer is C, apex
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
COMBINING FORMS
AND TERMINOLOGY
adenoid/o adenoidsalveol/o alveolus, air sacbronch/o
bronchial tubebronchi/o bronchusbronchiol/o
bronchiole, small bronchuscapn/o carbon dioxide
Combining Form Meaning
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
COMBINING FORMS
AND TERMINOLOGY
coni/o dustcyan/o blueepiglott/o
epiglottislaryng/o larynx, voice boxlob/o
lobe of the lungmediastin/o mediastinum
Combining Form Meaning
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
COMBINING FORMS
AND TERMINOLOGY
nas/o noseorth/o straight, uprightox/o
oxygenpector/o chestpharyng/o pharynx, throatphon/o
voice
Combining Form Meaning
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
COMBINING FORMS
AND TERMINOLOGY
phren/o diaphragmpleur/o pleurapneum/o
air, lungpneumon/o lungpulmon/o lungrhin/o
nose
Combining Form Meaning
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
COMBINING FORMS
AND TERMINOLOGY
sinus/o sinus cavityspir/o breathingtel/o
completethorac/o chesttonsill/o
tonsilstrache/o trachea, windpipe
Combining Form Meaning
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
COMBINING FORMS, SUFFIXES, AND TERMINOLOGY
SUFFIXES
-ema condition
-osmia smell
-pnea breathing
-ptysis spitting
-sphyxia pulse
-thorax pleural cavity, chest
Suffix Meaning
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Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Chapter 12
Lesson 12.2
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Inc. All rights reserved.
*
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Diagnostic Termsauscultationpercussionpleural rubrale
(crackle)rhonchussputumstridorwheeze
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Many of these terms are ways to help identify respiratory
abnormalities that can be heard.Discuss the fact that
auscultation, though not high tech, is still a very effective way
to uncover disease.
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Pathologic Terms
Upper Respiratory
Disorderscroupdiphtheriaepistaxispertussis
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Distinguish between disorders arising from infectious agents,
trauma, neoplasms, or genetic disorders. Which are most often
caused by smoking?Epistaxis is also known as rhinorrhagia, but
epistaxis is the more commonly used term for nosebleed.
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Pathologic Terms
Bronchial Tube
Disordersasthmabronchiectasischronic bronchitiscystic fibrosis
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Distinguish between disorders arising from infectious agents,
trauma, neoplasms, or genetic disorders. Which are most often
caused by smoking?Epistaxis is also known as rhinorrhagia, but
epistaxis is the more commonly used term for nosebleed.
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Pathologic Terms (cont’d.)
Lung Disordersatelectasisemphysemalung
cancerpneumoconiosispneumoniapulmonary abscesspulmonary
edemapulmonary embolism (PE)pulmonary
fibrosissarcoidosistuberculosis (TB)
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Distinguish between disorders arising from infectious agents,
trauma, neoplasms, or genetic disorders.What are the types of
pneumoconiosis?
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Pathologic Terms, Lung Disorders (cont’d.)
Atelectasis
Two forms
Proximal obstruction of distal airways
Accumulations of fluid, blood, or air in pleural cavity
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Inc. All rights reserved.
*Distinguish between atelectasis and pneumothorax.
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Pathologic Terms Pleural Disordersmesotheliomapleural
effusionpleurisy (pleuritis)pneumothorax
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Inc. All rights reserved.
*Distinguish between disorders arising from infectious agents,
trauma, neoplasms, or genetic disorders.Use slides to discuss
definitions, context, spelling, and derivations.
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Pathologic Terms,
Pleural Disorders
Pneumothorax: Air gathers in the pleural cavity
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Inc. All rights reserved.
*Explain collapsed lung.What conditions may cause a lung to
collapse?What are some examples of trauma- and disease-
induced collapsed lung?
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
STUDY SECTIONanthracosisasbestosisbacillichronic
obstructive pulmonary disease (COPD)cor
pulmonaleexudatehydrothoraxpalliativeparoxysmalpulmonary
infarctionpurulentsilicosis
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Distinguish between disorders arising from infectious agents,
trauma, neoplasms or genetic disorders.
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Inc. All rights reserved.
Chapter 12
Lesson 12.3
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Inc. All rights reserved.
*
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Inc. All rights reserved.
Clinical ProceduresX-rayschest x-ray (CXR)computed
tomography (CT) scan of the chestpulmonary angiography
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Briefly discuss the technology of each type of x-ray.For what
kinds of information (hard tissues, soft tissue, etc.) and which
conditions is each type best-suited?
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Clinical Procedures (cont’d.)
X-rays: radiographic imaging
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Inc. All rights reserved.
*Use this slide to discuss point of view, right and left, dorsal
and ventral, and landmarks.
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Inc. All rights reserved.
Clinical Procedures (cont’d.)
Magnetic resonance imaging (MRI): Magnetic waves create
images
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Inc. All rights reserved.
*
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Inc. All rights reserved.
Clinical Procedures (cont’d.)Radioactive TestsPositron emission
tomography (PET) scan of the lung: Ventilation-perfusion
(V/Q) scan: inhalation of radioactive gas for imaging, followed
by injection of different radioactive material for imaging
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Inc. All rights reserved.
*
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Inc. All rights reserved.
Clinical Procedures (cont’d.)
Bronchioscopy: Fiberoptic or rigid endoscope inserted into the
bronchial tubes for diagnosis, biopsy, or collection of
specimens
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Why would a physician recommend this invasive diagnostic
procedure? What are the pros and cons? What can the physician
expect to learn?
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Inc. All rights reserved.
Clinical Procedures (cont’d.)
Endotracheal intubation: placement of tube from mouth to
trachea to establish airway
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Watch an episode of ER and count how many times they do
this procedure in the ER. Why do many people coming into the
emergency room need this procedure?Why is this done for
surgical patients?
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
Clinical Procedures (cont’d.)laryngoscopylung
biopsymediastinoscopypulmonary function tests
(PFTs)thoracotomythorascopytracheostomytuberculin testtube
thoracostomy
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Why do many of these procedures start with “thor”?What is the
difference between laryngoscopy, mediastinoscopy, and
thorascopy?
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Inc. All rights reserved.
Clinical Procedures (cont’d.)
Thoracentesis: surgical puncture to
remove fluid from pleural space
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Inc. All rights reserved.
*
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Inc. All rights reserved.
Clinical Procedures (cont’d.)
Tracheostomy: Surgical creation of opening into the trachea
through
the neck
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
Inc. All rights reserved.
*Under what conditions would a physician perform this invasive
procedure? Explain advantages and disadvantages.
Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
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adenoid/o ____________
alveol/o ____________
bronch/o ____________
bronchi/o ____________
bronchiol/o ____________
capn/o ____________
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adenoid/o adenoidsalveol/o alveolus; air sac; small
sacbronch/o bronchial tubebronchi/o bronchial
tubebronchiol/o bronchiolecapn/o carbon dioxide
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Inc. All rights reserved.
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cyan/o ___________
epiglott/o ___________
laryng/o ___________
lob/o ___________
mediastin/o ___________
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epiglottislaryng/o larynx (voice box)lob/o
lobemediastin/o mediastinum
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orth/o __________
ox/o __________
pector/o __________
pharyng/o __________
phon/o __________
Suffix Meaning
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oxygenpector/o chestpharyng/o throat
(pharynx)phon/o voice; sound
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pneum/o ___________
pneumon/o ___________
pulmon/o ___________
rhin/o ___________
Suffix Meaning
REVIEW SHEET
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phren/o diaphragm; mindpleur/o pleurapneum/o
lung; air; gaspneumon/o lung; air; gaspulmon/o
lungrhin/o nose
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sinus/o ___________
spir/o ___________
tel/o ___________
thorac/o ___________
tonsill/o ___________
trache/o ___________
Suffix Meaning
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Inc. All rights reserved.
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Inc. All rights reserved.
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sinus/o sinusspir/o to breathetel/o
completethorac/o chesttonsill/o tonsiltrache/o
trachea (windpipe)
Suffix Meaning
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Inc. All rights reserved.
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-osmia ___________
-pnea ___________
-ptysis ___________
-sphyxia ___________
-thorax ___________
Suffix Meaning
REVIEW SHEET
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Inc. All rights reserved.
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-ema condition-osmia smell-pnea
breathing-ptysis spitting-sphyxia pulse-
thorax chest; pleural cavity
Suffix Meaning
REVIEW SHEET
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Beacon Roofing Supply Notes Rating Impact

  • 1. Respiratory System Case Study Trudy, a home health respiratory therapist, especially enjoys her older patients, and her Tuesday morning patient is one of her favorites. Jonas Hershel, a 79-year-old former respiratory therapist himself, has been hospitalized over the weekend for extreme difficulty with breathing from emphysema. Jonas' physical examination has noted crackles, clubbing, and DOE. Blood gases reveal hypoxemia and hypercapnia. Jonas' emphysema has now progressed to COPD. After being stabilized, Jonas has been released to his home with home health care visits. Trudy has treated Jonas in the hospital and is now his home health care professional. Tracking Jonas' breathing capacity using spirometry is part of her duties. However, today Jonas is too tired to sit up; therefore Trudy performs the spirometry while Jonas is reclining. 1. Give another name for crackles and define it. 2. What does spirometry measure? 3. Define emphysema. What is destroyed in emphysema? 4. What do the terms hypoxemia and hypercapnia stand for? 5. What do the abbreviations DOE and COPD stand for? Define and explain. Beacon Roofing Supply Inc.'s Proposed $300 Million Senior Secured Notes Rated 'BB', Unsecured Notes Lowered to 'B-' September 25, 2019
  • 2. FARMERS BRANCH (S&P Global Ratings) Sept. 25, 2019-- S&P Global Ratings assigned its 'BB' issue-level rating and '1' recovery rating to Beacon Roofing Supply Inc.'s proposed $300 million senior secured notes issuance. The proposed senior secured notes will rank equally with the company's $970 million term loan, which is unchanged and carries a 'BB' issue-level rating, with a '1' recovery rating. Beacon plans to use the proceeds from the notes offering to pre-fund the company's redemption of its $300 million senior unsecured notes due 2023 on Oct. 1, 2019. However, the increased amount of senior secured debt will result in diminished recovery available to unsecured lenders. As a result, we have lowered the issue- level rating on Beacon's $1.3 billion senior unsecured notes due 2025 to 'B-' from 'B' and revised the recovery rating to '6' from '5'. The '1' recovery rating on the Beacon's secured debt indicates our expectation for very high (90%-100%; rounded estimate: 90%) recovery in a default scenario. Our '6' recovery rating on the unsecured notes reflects our expectation of negligible recovery (0%-10%; rounded estimate: 0%) in the event of a default. For more information on Beacon Roofing Supply Inc., see our research update published on Aug. 30, 2019. Key analytical factors - Our assessment of recovery prospects contemplates a reorganization value for the company of
  • 3. about $2.07 billion, reflecting emergence EBITDA of about $345 million and a 6x multiple. Our emergence EBITDA assumption contemplates a rebound in profitability following the sharp cyclical downturn that we believe is required for the company to default with the present capital structure. As a result, our EBITDA assumption does not purport to represent a default-level EBITDA, which we think could be substantially lower. The 6x multiple is within the 5x-6x range that we generally use for building products companies. - Our simulated default scenario contemplates a default in 2023, stemming from a downturn in the company's end markets (U.S. residential and nonresidential roofing and reroofing), heightened competition, and significant price increases imposed by suppliers that cannot be passed on to customers. These adverse developments hamper margins and cash flow, pressuring Beacon's ability to meet its financial obligations and prompting the need for a bankruptcy filing or restructuring. Beacon Roofing Supply Inc.'s Proposed $300 Million Senior Secured Notes Rated 'BB', Unsecured Notes Lowered to 'B-' September 25, 2019 PRIMARY CREDIT ANALYST Pablo A Garces Farmers Branch
  • 4. + 1 (214) 765 5884 pablo.garces @spglobal.com SECONDARY CONTACT Thomas J Nadramia New York + 1 (212) 438 3944 thomas.nadramia @spglobal.com www.spglobal.com/ratingsdirect September 25, 2019 1 THIS WAS PREPARED EXCLUSIVELY FOR USER RONALD SALINAS. NOT FOR REDISTRIBUTION UNLESS OTHERWISE PERMITTED. mailto: [email protected] mailto: [email protected] mailto: [email protected] mailto: [email protected] - For purposes of our default scenario, we assumed aggregate borrowings of about $725 million under the asset-based loan (ABL) facility, representing usage of about 60% of the $1.2 billion U.S. commitment amount. - We assume the collateral package for Beacon's secured debt will encompass all of the
  • 5. available reorganization value. Only a small portion of the reorganization value is unencumbered under our analysis, representing the equity value of foreign subsidiaries not pledged to secure the term loan. Simulated default assumptions - Year of default: 2023 - EBITDA at emergence: $345 million - Implied enterprise value (EV) multiple: 6x - Gross EV: $2.07 billion Simplified waterfall - Obligor (U.S. operations)/nonobligor (Canadian operations) valuation split: roughly 95%/5% ($1.97 billion/$105 million) - Valuation split (net 5% administrative costs): $1.87 billion/$100 million - Priority claims and adjustments (60% usage of the $1.2 billion U.S. ABL facility): $725 million - Priority nonobligors claims: $60 million - Collateral from nonobligor (65% stock pledge of remaining $35 million net EV at nonobligors after subtracting secured nonobligors claims): $25 million - Total collateral value for secured claims ($1.14 billion U.S. value remaining after coverage of
  • 6. ABL facility plus $25 million remaining collateral from nonobligor): $1.17 billion - Secured claims (Total term loan claim*: $950 million, proposed senior secured notes: $305 million): $1.25 billion - --Recovery expectation for term loan: 90%-100% (rounded estimate: 90%) - Unpledged value available to unsecured claims: $15 million - Estimated unsecured claims: $1.31 billion - --Recovery expectation for senior notes: 0%-10% (rounded estimate: 0%) *Senior secured claim amount reflects $925 million of term loan principal, less payment of scheduled amortization of 1% per year through 2022, plus an assumption for accrued but unpaid interest outstanding at default. Related Criteria - General Criteria: Group Rating Methodology, July 1, 2019 - Criteria | Corporates | General: Corporate Methodology: Ratios And Adjustments, April 1, 2019 - Criteria | Corporates | General: Recovery Rating Criteria For Speculative-Grade Corporate Issuers, Dec. 7, 2016 www.spglobal.com/ratingsdirect September 25, 2019 2 THIS WAS PREPARED EXCLUSIVELY FOR USER RONALD
  • 7. SALINAS. NOT FOR REDISTRIBUTION UNLESS OTHERWISE PERMITTED. Beacon Roofing Supply Inc.'s Proposed $300 Million Senior Secured Notes Rated 'BB', Unsecured Notes Lowered to 'B-' - Criteria | Corporates | General: Methodology And Assumptions: Liquidity Descriptors For Global Corporate Issuers, Dec. 16, 2014 - Criteria | Corporates | Industrials: Key Credit Factors For The Building Materials Industry, Dec. 19, 2013 - General Criteria: Country Risk Assessment Methodology And Assumptions, Nov. 19, 2013 - Criteria | Corporates | General: Corporate Methodology, Nov. 19, 2013 - General Criteria: Methodology: Industry Risk, Nov. 19, 2013 - General Criteria: Methodology: Management And Governance Credit Factors For Corporate Entities, Nov. 13, 2012 - General Criteria: Use Of CreditWatch And Outlooks, Sept. 14, 2009 Certain terms used in this report, particularly certain adjectives used to express our view on rating relevant factors, have specific meanings ascribed to them in our criteria, and should therefore be read in conjunction with such
  • 8. criteria. Please see Ratings Criteria at www.standardandpoors.com for further information. Complete ratings information is available to subscribers of RatingsDirect at www.capitaliq.com. All ratings affected by this rating action can be found on S&P Global Ratings' public website at www.standardandpoors.com. Use the Ratings search box located in the left column. www.spglobal.com/ratingsdirect September 25, 2019 3 THIS WAS PREPARED EXCLUSIVELY FOR USER RONALD SALINAS. NOT FOR REDISTRIBUTION UNLESS OTHERWISE PERMITTED. Beacon Roofing Supply Inc.'s Proposed $300 Million Senior Secured Notes Rated 'BB', Unsecured Notes Lowered to 'B-' www.spglobal.com/ratingsdirect September 25, 2019 4 THIS WAS PREPARED EXCLUSIVELY FOR USER RONALD SALINAS. NOT FOR REDISTRIBUTION UNLESS OTHERWISE PERMITTED. Beacon Roofing Supply Inc.'s Proposed $300 Million Senior Secured Notes Rated 'BB', Unsecured Notes Lowered to 'B-' STANDARD & POOR’S, S&P and RATINGSDIRECT are registered trademarks of Standard & Poor’s Financial Services LLC. S&P may receive compensation for its ratings and certain analyses, normally from issuers or underwriters of securities or from obligors.
  • 9. S&P reserves the right to disseminate its opinions and analyses. S&P's public ratings and analyses are made available on its Web sites, www.standardandpoors.com (free of charge), and www.ratingsdirect.com (subscription), and may be distributed through other means, including via S&P publications and third-party redistributors. Additional information about our ratings fees is available at www.standardandpoors.com/usratingsfees. S&P keeps certain activities of its business units separate from each other in order to preserve the independence and objectivity of their respective activities. As a result, certain business units of S&P may have information that is not available to other S&P business units. S&P has established policies and procedures to maintain the confidentiality of certain non-public information received in connection with each analytical process. To the extent that regulatory authorities allow a rating agency to acknowledge in one jurisdiction a rating issued in another jurisdiction for certain regulatory purposes, S&P reserves the right to assign, withdraw or suspend such acknowledgment at any time and in its sole discretion. S&P Parties disclaim any duty whatsoever arising out of the assignment, withdrawal or suspension of an acknowledgment as well as any liability for any damage alleged to have been suffered on account thereof. Credit-related and other analyses, including ratings, and statements in the Content are statements of opinion as of the date they are
  • 10. expressed and not statements of fact. S&P’s opinions, analyses and rating acknowledgment decisions (described below) are not recommendations to purchase, hold, or sell any securities or to make any investment decisions, and do not address the suitability of any security. S&P assumes no obligation to update the Content following publication in any form or format. The Content should not be relied on and is not a substitute for the skill, judgment and experience of the user, its management, employees, advisors and/or clients when making investment and other business decisions. S&P does not act as a fiduciary or an investment advisor except where registered as such. While S&P has obtained information from sources it believes to be reliable, S&P does not perform an audit and undertakes no duty of due diligence or independent verification of any information it receives. Rating-related publications may be published for a variety of reasons that are not necessarily dependent on action by rating committees, including, but not limited to, the publication of a periodic update on a credit rating and related analyses. No content (including ratings, credit-related analyses and data, valuations, model, software or other application or output therefrom) or any part thereof (Content) may be modified, reverse engineered, reproduced or distributed in any form by any means, or stored in a database or retrieval system, without the prior written permission of Standard & Poor’s Financial Services LLC or its affiliates (collectively, S&P). The Content shall not be used for any unlawful or unauthorized purposes. S&P and any third-party providers, as well as their
  • 11. directors, officers, shareholders, employees or agents (collectively S&P Parties) do not guarantee the accuracy, completeness, timeliness or availability of the Content. S&P Parties are not responsible for any errors or omissions (negligent or otherwise), regardless of the cause, for the results obtained from the use of the Content, or for the security or maintenance of any data input by the user. The Content is provided on an “as is” basis. S&P PARTIES DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING, BUT NOT LIMITED TO, ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE, FREEDOM FROM BUGS, SOFTWARE ERRORS OR DEFECTS, THAT THE CONTENT’S FUNCTIONING WILL BE UNINTERRUPTED OR THAT THE CONTENT WILL OPERATE WITH ANY SOFTWARE OR HARDWARE CONFIGURATION. In no event shall S&P Parties be liable to any party for any direct, indirect, incidental, exemplary, compensatory, punitive, special or consequential damages, costs, expenses, legal fees, or losses (including, without limitation, lost income or lost profits and opportunity costs or losses caused by negligence) in connection with any use of the Content even if advised of the possibility of such damages. Copyright © 2020 by Standard & Poor’s Financial Services LLC. All rights reserved. Research:Key analytical factorsRelated Criteria
  • 12. Chapter 12 The Respiratory System Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Learning ObjectivesName the organs of the respiratory system and describe their location and function.Identify various pathological conditions that affect the system.Recognize medical terms that pertain to respiration. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Learning Objectives (cont’d.)Describe important clinical procedures related to the respiratory system and recognize relevant abbreviations.Apply your new knowledge to
  • 13. understanding medical terms in their proper contexts, such as medical reports and records. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Chapter 12 Lesson 12.1 Copyright © 2005 by Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Introduction External respiration: exchange of air in lung capillariesoxygen inhaled into the air sacs of the lungsimmediately passes into capillariescarbon dioxide passes from capillaries into air sacs, to be exhaled Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *What percent of oxygen does inhaled air contain? (about 21 %)What percent of oxygen does exhaled air contain? (about 16
  • 14. %)What is the medical term for air sacs? Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Introduction (cont’d.) Internal respiration: exchange of gases in the cells occurs simultaneously between cells and capillariesoxygen passes out of the bloodstream into the tissuescarbon dioxide passes out of tissues back into the bloodstream to travel to the lungs Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Respiratory AnatomyMediastinum: middle of chest where trachea divides into two branchesBronchi: each leads to a separate lungLungs: not mirror images, have lobesHilum: blood vessels, nerves, lymphatic tissue, and bronchial tubes enter and exit Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *What is the singular form of bronchi? (bronchus)Which lung is larger? (right)How many lobes does each lung have? (right: three, left: two)
  • 15. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Anatomy of Respiration Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Engage the class to identify the organs of the respiratory system. Trace the path of a breath of air. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Anatomy of Respiration Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Engage the class to identify the organs of the respiratory system. Trace the path of a breath of air. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Respiratory Structures Conduct airNoseNasal cavities and paranasal sinusesPharynxLarynxTrachea Exchange gasesBronchiolesAlveoliLung capillaries Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  • 16. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Respiratory Flow Chart Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Trace the flow and then conduct the class activity in the lesson plan by dividing the class into two groups and assigning each a gas. (see LP 12.1) Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Respiratory Flow Chart Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Trace the flow and then conduct the class activity in the lesson plan by dividing the class into two groups and assigning each a gas. (see LP 12.1) Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. VOCABULARYadenoidsalveolus (alveoli)apex of the lungbase of the lungbrochiolesbronchus (bronchi)carbon dioxide Copyright © 2008, 2005 by Saunders, an imprint of Elsevier
  • 17. Inc. All rights reserved. * Reference pages 260-262 for definitions of vocabulary terms Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. VOCABULARYciliadiaphragmepiglottisexpirationglottishilumi nspirationlarynx Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Reference pages 260-262 for definitions of vocabulary terms Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. VOCABULARYlobemediastinumnaresoxygenpalatine tonsilparanasal sinusparietal pleura Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Reference pages 260-262 for definitions of vocabulary terms
  • 18. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. VOCABULARYpharynxpleurapleural cavitypulmonary parenchymarespirationtracheavisceral pleura Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Reference pages 260-262 for definitions of vocabulary terms Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. QUICK QUIZ: 1. What is the tip or uppermost portion of the lung? base lobe apex nares Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * CORRECT Answer is C, apex Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS
  • 19. AND TERMINOLOGY adenoid/o adenoidsalveol/o alveolus, air sacbronch/o bronchial tubebronchi/o bronchusbronchiol/o bronchiole, small bronchuscapn/o carbon dioxide Combining Form Meaning Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS AND TERMINOLOGY coni/o dustcyan/o blueepiglott/o epiglottislaryng/o larynx, voice boxlob/o lobe of the lungmediastin/o mediastinum Combining Form Meaning Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  • 20. COMBINING FORMS AND TERMINOLOGY nas/o noseorth/o straight, uprightox/o oxygenpector/o chestpharyng/o pharynx, throatphon/o voice Combining Form Meaning Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS AND TERMINOLOGY phren/o diaphragmpleur/o pleurapneum/o air, lungpneumon/o lungpulmon/o lungrhin/o nose Combining Form Meaning Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *
  • 21. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS AND TERMINOLOGY sinus/o sinus cavityspir/o breathingtel/o completethorac/o chesttonsill/o tonsilstrache/o trachea, windpipe Combining Form Meaning Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS, SUFFIXES, AND TERMINOLOGY SUFFIXES -ema condition -osmia smell -pnea breathing -ptysis spitting -sphyxia pulse -thorax pleural cavity, chest Suffix Meaning Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *
  • 22. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Chapter 12 Lesson 12.2 Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Diagnostic Termsauscultationpercussionpleural rubrale (crackle)rhonchussputumstridorwheeze Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Many of these terms are ways to help identify respiratory abnormalities that can be heard.Discuss the fact that auscultation, though not high tech, is still a very effective way to uncover disease. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pathologic Terms
  • 23. Upper Respiratory Disorderscroupdiphtheriaepistaxispertussis Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Distinguish between disorders arising from infectious agents, trauma, neoplasms, or genetic disorders. Which are most often caused by smoking?Epistaxis is also known as rhinorrhagia, but epistaxis is the more commonly used term for nosebleed. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pathologic Terms Bronchial Tube Disordersasthmabronchiectasischronic bronchitiscystic fibrosis Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Distinguish between disorders arising from infectious agents, trauma, neoplasms, or genetic disorders. Which are most often caused by smoking?Epistaxis is also known as rhinorrhagia, but epistaxis is the more commonly used term for nosebleed. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pathologic Terms (cont’d.) Lung Disordersatelectasisemphysemalung cancerpneumoconiosispneumoniapulmonary abscesspulmonary edemapulmonary embolism (PE)pulmonary fibrosissarcoidosistuberculosis (TB)
  • 24. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Distinguish between disorders arising from infectious agents, trauma, neoplasms, or genetic disorders.What are the types of pneumoconiosis? Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pathologic Terms, Lung Disorders (cont’d.) Atelectasis Two forms Proximal obstruction of distal airways Accumulations of fluid, blood, or air in pleural cavity Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Distinguish between atelectasis and pneumothorax. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pathologic Terms Pleural Disordersmesotheliomapleural effusionpleurisy (pleuritis)pneumothorax Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Distinguish between disorders arising from infectious agents, trauma, neoplasms, or genetic disorders.Use slides to discuss
  • 25. definitions, context, spelling, and derivations. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Pathologic Terms, Pleural Disorders Pneumothorax: Air gathers in the pleural cavity Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Explain collapsed lung.What conditions may cause a lung to collapse?What are some examples of trauma- and disease- induced collapsed lung? Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. STUDY SECTIONanthracosisasbestosisbacillichronic obstructive pulmonary disease (COPD)cor pulmonaleexudatehydrothoraxpalliativeparoxysmalpulmonary infarctionpurulentsilicosis Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Distinguish between disorders arising from infectious agents, trauma, neoplasms or genetic disorders.
  • 26. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Chapter 12 Lesson 12.3 Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Clinical ProceduresX-rayschest x-ray (CXR)computed tomography (CT) scan of the chestpulmonary angiography Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Briefly discuss the technology of each type of x-ray.For what kinds of information (hard tissues, soft tissue, etc.) and which conditions is each type best-suited? Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Clinical Procedures (cont’d.) X-rays: radiographic imaging Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  • 27. *Use this slide to discuss point of view, right and left, dorsal and ventral, and landmarks. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Clinical Procedures (cont’d.) Magnetic resonance imaging (MRI): Magnetic waves create images Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Clinical Procedures (cont’d.)Radioactive TestsPositron emission tomography (PET) scan of the lung: Ventilation-perfusion (V/Q) scan: inhalation of radioactive gas for imaging, followed by injection of different radioactive material for imaging Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  • 28. Clinical Procedures (cont’d.) Bronchioscopy: Fiberoptic or rigid endoscope inserted into the bronchial tubes for diagnosis, biopsy, or collection of specimens Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Why would a physician recommend this invasive diagnostic procedure? What are the pros and cons? What can the physician expect to learn? Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Clinical Procedures (cont’d.) Endotracheal intubation: placement of tube from mouth to trachea to establish airway Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Watch an episode of ER and count how many times they do this procedure in the ER. Why do many people coming into the emergency room need this procedure?Why is this done for surgical patients? Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Clinical Procedures (cont’d.)laryngoscopylung biopsymediastinoscopypulmonary function tests (PFTs)thoracotomythorascopytracheostomytuberculin testtube thoracostomy
  • 29. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Why do many of these procedures start with “thor”?What is the difference between laryngoscopy, mediastinoscopy, and thorascopy? Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Clinical Procedures (cont’d.) Thoracentesis: surgical puncture to remove fluid from pleural space Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. Clinical Procedures (cont’d.) Tracheostomy: Surgical creation of opening into the trachea through the neck Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *Under what conditions would a physician perform this invasive procedure? Explain advantages and disadvantages.
  • 30. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. REVIEW SHEET COMBINING FORMS adenoid/o ____________ alveol/o ____________ bronch/o ____________ bronchi/o ____________ bronchiol/o ____________ capn/o ____________ CF Meaning Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. REVIEW SHEET COMBINING FORMS adenoid/o adenoidsalveol/o alveolus; air sac; small sacbronch/o bronchial tubebronchi/o bronchial tubebronchiol/o bronchiolecapn/o carbon dioxide Suffix Meaning Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  • 31. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS coni/o ___________ cyan/o ___________ epiglott/o ___________ laryng/o ___________ lob/o ___________ mediastin/o ___________ Suffix Meaning REVIEW SHEET Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS coni/o dustcyan/o blueepiglott/o epiglottislaryng/o larynx (voice box)lob/o lobemediastin/o mediastinum
  • 32. Suffix Meaning REVIEW SHEET Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS nas/o __________ orth/o __________ ox/o __________ pector/o __________ pharyng/o __________ phon/o __________ Suffix Meaning REVIEW SHEET Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS
  • 33. nas/o noseorth/o straightox/o oxygenpector/o chestpharyng/o throat (pharynx)phon/o voice; sound Suffix Meaning REVIEW SHEET Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS phren/o ___________ pleur/o ___________ pneum/o ___________ pneumon/o ___________ pulmon/o ___________ rhin/o ___________ Suffix Meaning REVIEW SHEET Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *
  • 34. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS phren/o diaphragm; mindpleur/o pleurapneum/o lung; air; gaspneumon/o lung; air; gaspulmon/o lungrhin/o nose Suffix Meaning REVIEW SHEET Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS sinus/o ___________ spir/o ___________ tel/o ___________ thorac/o ___________ tonsill/o ___________ trache/o ___________ Suffix Meaning REVIEW SHEET Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  • 35. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. COMBINING FORMS sinus/o sinusspir/o to breathetel/o completethorac/o chesttonsill/o tonsiltrache/o trachea (windpipe) Suffix Meaning REVIEW SHEET Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. SUFFIXES -ema ___________ -osmia ___________ -pnea ___________ -ptysis ___________ -sphyxia ___________ -thorax ___________ Suffix Meaning REVIEW SHEET
  • 36. Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. * Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. SUFFIXES -ema condition-osmia smell-pnea breathing-ptysis spitting-sphyxia pulse- thorax chest; pleural cavity Suffix Meaning REVIEW SHEET Copyright © 2008, 2005 by Saunders, an imprint of Elsevier Inc. All rights reserved. *