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MHD VI: Pulm > 11.19: Pulm I > Flashcards

11.19: Pulm I Flashcards

1
Q

Which lung has three lobes?

A

Right

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2
Q

Which lung has the lingula?

A

Left

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3
Q

What does the trachea branch into?

A

Left and right bronchus

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4
Q

Which lung will items tend to get lodged in?

A
  • Right

- Right bronchus is in direct continuity with trachea where as the left bronchus branches off more

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5
Q

What lines the trachea?

A

Pseudo stratified Ciliated columnar epithelial cells

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6
Q

Is there cartilage in trachea?

A

Only on anterior side

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7
Q

What is difference between bronchus and bronchiole?

A
  • Bronchus has plates of cartilage and mucosal glands

- Bronchiole has neither

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8
Q

What does terminal bronchiole become?

A

Respiratory bronchiole > Alveolar duct > Alveolar sac made of alveoli

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9
Q

2 cell types in alveoli?

A

Type I cells: squamous pneumocytes conducting gas exchange
- Thin: good for exchange, 95% of surface
Type II cells: granular pneumocytes secreting surfactant

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10
Q

Where are blood vessels found?

A
  • In the alveolar septum
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11
Q

Which pneumocytes are not able to regenerate?

A
  • Type I

- Type II can regenerate if damaged and can become Type I cells in case of tissue damage

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12
Q

What changes in alveolar can lead to hypoxia?

A
  1. Reduction in alveolar surface area
  2. Increased distance to capillary
    3.
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13
Q

What is the mucociliary escalator?

A
  • Rhythmic beating of cilia pushing mucus from goblet cells up and out of airway
  • Cilia and goblet cells are present to the end of respiratory bronchioles
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14
Q

Where does the mucociliary escalator end?

A
  • Below the respiratory bronchioles
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15
Q

What is oligohydramnios?

A
  • Impairment of amniotic fluid in development usually form agenesis of kidney leading to failure of lung to develop properly
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16
Q

What happens in agenesis of diaphragm?

A

GI will bump into respiratory space giving lungs less room to develop

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17
Q

What is a bronchogenic cyst?

A
  • Foregut buds that become disconnected from bronchial tree and enlarge to form cysts
  • Can compress on structures causing SOB, cough
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18
Q

What is CCAM?

A

“Congenital cystic adenomatoid malformation”

  • Cysts lined with bronchial epithelium w/in lungs
  • Can obstruct breathing or cause infection
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19
Q

What is pulmonary sequestration?

A
  • Discrete mass of lung tissue w/o connection to airway
  • Has vascular supply but not connected to airways
  • Likely to get infected as mucus wont train as in normal escalator
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20
Q

What does atelectasis mean?

A

Collapse of lung

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21
Q

3 main types of adult atelectasis?

A
  1. Contraction: fibrosis
  2. Compression: effusion
  3. Resorption / obstruction
22
Q

What will obstruction of lung cause?

A
  • Air that was in alveoli absorbed into circulation and area of lung collapses as no air to keep it inflated
  • Mediastinum pulled towards compressed lung
23
Q

What happens in compression ?

A
  • Mediastinum shifts away from compressed lung

- Air, blood, pleural secondary to CHF

24
Q

Can contraction be fixed?

A
  • No, tissue is fibrotic
25
What is pneumothorax?
- Air in chest wall leading to respiratory distress via compression or collapse - TB, asthma, or emphysema often cause - Pushes mediastinum away from affected lung
26
Where do aspirated items lodge?
- Right lower lobe
27
Causes of edema?
1. Increased hydrostatic pressure 2. Reduced osmotic pressure 3. Lymphatic obstruction 4. Na retention 5. Inflammation
28
What is edema?
- Increased fluid in interstitial spaces
29
What is most common cause of pulmonary edema?
1. Left sided heart failure | 2. Volume overload
30
What does edema do to lung structure?
- Makes them much heavier and distended
31
What is acute lung injury?
- Acute onset of dyspnea - Hypoxemia - Development of bilateral pulmonary infiltrate with absence of cardiac failure - Can progress to ARDS
32
What is ARDS?
"Adult respiratory distress syndrome" - Rapid onset of deadly respiratory insufficiency - Cyanosis - Can lead to organ failure - Arterial hypoxia that does not respond to oxygen therapy
33
Causes of ARDS?
``` "ARDS" A - Aspiration, acute pancreatitis, air/amniotic embolism R - Radiation D - Drug overdose, DIC, Drowning S - Shock, sepsis, smoke inhalation ```
34
Symptoms of ARDS?
- Tachypnea | - Dyspnea
35
What is DAD?
"Diffuse alveolar damage" | - This is what ARDS results in
36
How is ARDS different than acute, cardiogenic pulmonary edema?
Acute: increased hydrostatic pressure is the problem ARDS: neutrophils move to alveoli causing epithelial injury causing proteins to leak into alveolar space
37
What is hyaline membrane?
- Thickening of septa between alveoli see in ARDS from proteins being released - Hyalinization blocks oxygenation - Diuretics cannot fix this as it can in pulmonary edema
38
Characteristics of DAD?
- Pneumocyte and endothelial cell necrosis - Edema that does not respond to diuretic - Hyaline membrane formation blocking exchange - Type II pneumocyte proliferation
39
Fundamental abnormality in NRDS?
"Neonatal respiratory distress syndrome" | - Lack of surfactant resulting in failure of lungs to inflate at birth
40
Causes of Neonatal RDS?
1. Aspiration 2. Cord compression 3. Excessive sedation of mother 4. Hyaline membrane disease
41
Predisposing factors for NRDS?
1. Prematurity 2. C section 3. Maternal diabetes
42
Function of surfactant?
- Stabilizes lung be reduces surface tension - Barrier for inhaled particles - Made by type II Pneumocytes
43
Why is surfactant an issue in premature babies?
- Surfactant is not secreted in sufficient amounts until 34 weeks old - Alveoli cannot stay inflated and will collapse
44
Pathogenesis in NRDS?
- Lack of surfactant leads to alveolar collapse - Blood travels to area that can't be ventilated - Hypoxia and CO2 retention lead to acidosis leading to to vasoconstriction - Acidosis and hypoxia lead to cellular damage in lungs
45
What can induce surfactant synthesis?
Glucocorticoids
46
What can decrease surfactant production?
Insulin from diabetic mother
47
How to control NRDS?
- Delay labor as long as possible - Administer exogenous surfactant - Amniotic fluid analysis looking for lecithin:sphingomyelin ratio >2
48
Complications of oxygen therapy in RRDS?
1. Retinopathy | 2. Bronchopulmonary dysplasia
49
What causes ARDS?
- Imbalance between pro and antiinflammatory mediators
50
What is same findings as in DAD with no identifiable cause indicative of?
- Acute interstitial pneumonia
51
What is HMD?
"Hyaline membrane disease" | - Pathologic term for NRDS
52
What does normal capillary wedge pressure rule out?
Pulmonary edema

MHD VI: Pulm (20 decks)

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