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Patho 1 > 3 - Pulmonary Patho > Flashcards

3 - Pulmonary Patho Flashcards

1
Q

What is dyspnea?

A

Subjective experience of breathing discomfort

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2
Q

Normal tidal volume

A

400-800 ml

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3
Q

Kussmaul respirations are characterized by: (3)

A

increased RR

Very large tidal volume

No expiratory pause

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4
Q

Cheyne-Stokes Respiration

A

Alternating deep and shallow breathing patterns with 15-60 seconds apnea in between

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5
Q

What causes Cheyne Stokes?

A

Any condition that slows the blood flow to the brainstem or impairs conduction above the brainstem

It basically indicates a delayed reaction to chemoreceptors

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6
Q

Minute volume =

A

Tidal volume x RR

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7
Q

What causes peripheral cyanosis?

Centra cyanosis?

A

Poor blood delivery to the periphery, but normal PaO2

Decreased PaO2

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8
Q

What amount of unsaturated hemoglobin causes cyanosis?

A

5g of Hgb

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9
Q

How can you reverse clubbing?

A

You can’t, even if you restore normal oxygen levels

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10
Q

What probably causes clubbing?

A

Megakaryocytes and platelt clumps escape filtration in the pulmonary bed

They enter the systemic circulation

They lodge in the tissues and release platelet-derived growth factor at the nail bed

Can also happen 2/2 inflammatory cytokins and growth factors released during cancer

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11
Q

What do V and Q represent?

A

V = amount of air getting into the alveoli

Q = among of blood perfusing the capillary

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12
Q

What is a normal V/Q?

Why?

A

0.8-0.9

perfusion is usually somewhat greater than ventilation in the lung bases

AND

bronchial venous blood (non-participating) is shunted into peripheral circulation

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13
Q

What is alveolar dead space?

A

Alveoli are ventilated but not perfused

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14
Q

What does it mean if a V/Q is high?

A

Ventilation outstrips perfusion

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15
Q

What is the most common cause of a high V/Q?

A

PE

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16
Q

What is the definition of Acute Respiratory Failure?

A

PaO2 < 50

AND/OR

PaCO2 > 50 with pH <7.25

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17
Q

What are the four most common causes of postop resp failure?

A

atelectasis

pneumonia

pulmonary edema

pe

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18
Q

Who is most at risk for primary/spontaneous pneumothorax?

A

Young men, usually smokers

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19
Q

What is the cause of primary pneumothorax?

A

Blebs in the visceral pleura rupture and create a conduit for air to get into the pleural space

No clear cause, but almost everyone who has it has emphysema-like changes to their lung, whether they smoke or not

Autosomal dominant inheritance

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20
Q

What kind of Pneumothorax or COPD pts prone to?

Why?

A

Secondary/traumatic

they have large vesicles in their lungs that can rupture

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21
Q

What are other words for transudative?

Exudative?

A

watery

proteinaceous

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22
Q

What is the usual cause of transudative pleural effusion?

A

Cardiogenic

Hypoproteinemia from kidney or liver disease

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23
Q

What is the usual cause of exudative pleural effusion?

A

infection, inflammation, malignancy

Caused by anything that releases biochemical mediators and increased capillary permeability

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24
Q

What is the usual cause of empyema?

A

Detritus of infection d/t blocked lymph vessels

pneumonia, lung abscess, infected wounds

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25
Q

What is the usual cause of a chylothorax?

A

chyle dumped into plueral space by lymph instead of passing from the GI tract to the thoracic duct

Traumatic injury, injfection, disorder than disrupts lymph transport

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26
Q

What are parapneumonic effusions?

A

Occur in association with pneumonia

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27
Q

Physical examination of a patient with pleural effusion reveals:

A

Decreased breath sounds

dullness to percussion

pleural friction rub

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28
Q

In severe cases of empyema, what can be done?

A

Instillation of fibrinolytics and/or deoxyribonucelase

Deoxyribonuclease stimulates pleural fluid formation, which decreases the viscosity of the pus and makes it easier to drain

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29
Q

Restrictive Lung disorder are caused by _______

A

decreased compliance

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30
Q

A pulmonary function test in restrictive lung disease will show:

A

decreased FVC

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31
Q

Aspiration is restrictive or obstructive?

A

Restrictive

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32
Q

What are the three types of atelectasis?

A

Compression (tumor, fluid, air, abdominal distention)

Absorption (gradual absoprtion of air from obstructed or hypoventilated alveoli)

Surfactant Impairment

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33
Q

Is atelectasis restrictive or obstructive?

A

restrictive

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34
Q

The pore of Kohn only open during:

A

deep breathing

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35
Q

What does TCDB/IS improve atelectasis?

A
  1. promotes ciliary clearance
  2. redistributes surfactant
  3. Opens the pores of Kohn to allow collateral ventilation
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36
Q

What is bronchiectasis?

A

persistent abnormal dilation of the bronchi

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37
Q

What is cylindrical bronchiectasis? When is it typically seen?

A

symmetrically dilated bronchioles

seen after pneumonia and is reversible

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38
Q

What are some hallmark s/s of bronchiectasis?

A

chronic, productive cough that lasts from months to years

Hemoptysis

Cups and cups of foul-smelling purulent sputum

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39
Q

What is bronchiolitis?

A

Diffuse inflammation of the small airways or bronchioles

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40
Q

Bronchiolitis is most common in _________

A

children

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41
Q

What are some hallmark symptoms of bronchiolitis?

A

nonproductive,d ry cough

hyperinflated chest

rapid RR and accessory muscle use

low grade fever

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42
Q

What is BOOP?

A

Bronchiolitis Obliterans Organizing Pneumonia

Complication of Bronchiolitis obliterans

alveoli and bronchioles become filled with plugs of connective tissue

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43
Q

What is Bronchiolitis Obliterans Syndrome?

A

inflammatory, fibrotic deposits of connective tissue in lung

Occurs as a complication of lung transplant

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44
Q

What are the top three causes of pulmonary fibrosis?

A
  1. Remodeling from an active disease
  2. Autoimmune (SLE, sarcoidosis, RA)
  3. Inhalation of harmful substances (Coal dust and asbestos especially)
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45
Q

What is the survival rate for idiopathic pulmonary fibrosis?

A

2-5 years after diagnosis

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46
Q

What is the primary presenting symptom of idiopathic pulmonary fibrosis?

A

dyspnea on exertion

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47
Q

What is oxygen toxicity?

A

Prolonged exposure to high FiO2 at normal atmospheric pressure causes severe inflammation d/t free radicals

Leads to cellular necrosis or apoptosis, damage to alveolocapillary membrane, disruption of surfactant

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48
Q

What is pneumoconiosis?

A

lung changes d/t inhalation of dust particles

usually asbestos, silica, coal dust

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49
Q

What are the three phases of ARDS?

A

Exudative (within 72 hours)

Proliferative (1-3 weeks)

Fibrotic (2-3 weeks)

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50
Q

What happens during the exudative phase of ARDS?

A

Inflammatory cytokins are released

They active macrophages, which release more cytokines

Neutrophils release ROS and Arachidonic acid metabolites

metabolites turn into prostaglandins, thromboxanes, and leukotrines

Vessel walls get annihilated

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51
Q

What happens during the proliferative phase of ARDS?

A

fibroblasts, myofibroblasts, type II pneumocytes begin the recovery

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52
Q

What happens during the fibrotic phase of ARDS?

A

remodeling and fibrosis,

oblierates the alveoli, respiratory bronchioles and insterstitium

Decreased FRC and V/Q mismatch

Severe right to left shunt and respiratory failure

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53
Q

In obstructive pulmonary disease, airway obstruction is worsened during ________

A

expiration

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54
Q

What are the unifying signs and symptoms of obstructive pulmonary disease?

A

symptom: dyspnea
sign: wheezing

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55
Q

What spirometry metric is primarily effected by obstructive lung disease?

A

FEV1

The amount of air that is expelled during the first second of expiration

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56
Q

What are the most common obstructive lung disease?

A

asthma and COPD

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57
Q

Asthmas causes:

A

hyperresponsiveness of mucosa

constriction of the airway

variable airflow obstruction that is reversible

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58
Q

Asthma prevalence is ________ and death rates are highest for:

A

increasing

adult females, blacks, adults over 65

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59
Q

What is the early asthmatic response?

A

reaches a maximum within the first thirty minutes and resolves within 1-3 hours

bronchospasm, tenacious mucus, narrowing of airways and obstruction to airflow

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60
Q

What is the late asthmatic response?

A

develops 4-8 hours after early response

increased hyperresponsiveness

61
Q

What is the normal PaCO2 progression during asthma?

A

Usually low at first due to hyperventilation

Eventually will elevate as airways close off

Respiratory acidosis is a sign of impending respiratory failure

62
Q

When is an asthma attack considered status asthmaticus?

A

When it fails to respond to normal measures

63
Q

What are the two phenotypes of COPD?

A

Chronic bronchitis

Emphysema

64
Q

In chronic bronchitis, inhalation of irritants causes:

A

bronchial inflammation and edema

increase size and number of goblet cells

hypertrophied smooth muscle/fibrosis

narrowed airways

More mucus, and no cilia to move it out

65
Q

Emphysema is characterized by:

A

destruction of alveoli through breakdown of elastin

There’s an imbalance between proteases and antiproteases, which leads to oxidative stress and apoptosis

66
Q

What causes primary emphysema?

A

alpha 1 antitrypsin

Alpha 1 normally inhibits the action of proteolytic enzymes, so when it’s absent, there’s an imbalance between proteases and antiprotease

Thats when emphysema happens

67
Q

What is universally true of COPD, whether chronic bronchitis or emphysema?

A

They will have prolonged expiration

68
Q

More than 90% of bronchitis infections are caused by _______

A

viruses

69
Q

How can you tell the difference between bronchitis and pneumonia?

A

chest x ray

bronchitis will not have infiltrates

70
Q

Patients with bacterial bronchitis usually have these three symptoms:

A

productive cough

fever

pain behind the sternum that is aggravated by coughing

71
Q

Bacterial bronchitis is rare and usually only happens to people who:

A

have had a viral bronchitis

have COPD

72
Q

What pathogens are found in HCAP but rarely in CAP?

A

Psuedomonas aeruginosa

Klebsiella pneumoniae

Enterobacter

73
Q

What is normally the cause of legionella, viral, and mycobacterial outbreaks?

A

inhalation of organisms that are released by coughs/sneezes

OR

aerosolized water, like in contaminated RT equipment

74
Q

What is the #1 guardian of the lower respiratory tract?

A

The alveolar macrophage

75
Q

What is the most common cause of bacterial pneumonia?

A

pneumococcal (streptococcus pneumoniae)

76
Q

What happens when S. Pneumoniae is treated with antibiotics?

A

Rapidly lysed

Releases intracellular bacterial proteins that are toxic (namely pneumolysin)

77
Q

Why do some patients with pneumonia get worse after initiating antibiotic treatment?

A

the massive release of pneumolysin causes massive inflammation and edema, which creates a pungent medium for more bacterial growth and spread

78
Q

How severe is viral pneumonia?

A

Usually seasonal, mild, and self-limiting

most dangerous when followed by an opportunistic bacterial pathogen

79
Q

What disease can reactivate a dormant TB infection

A

Biggest and most concerning is HIV

cancer, diabetes, immunosuppressants, poor nutritional status, renal failure

80
Q

What kind of necrosis is involved in TB?

A

caseous necrosis

cheeselike material that lays inside tubercles

81
Q

An abscess is a type of _______necrosis

A

liquefactive

82
Q

Abscess formation follows ______

A

consolidation of the lung

83
Q

What types of pneumonia are most likely to form abscesses?

A

klebsiella and Staphylococcus

84
Q

When a patient with a known abscess develops a cough with copiuos amounts of foul smelling sputum and/or blood, what might that indicate?

A

Abscess communication with a bronchus

85
Q

What is the most common cause of PE?

A

EMbolization of a DVT

86
Q

What genetic mutations result in hypercoaguability?

A

Protein C and S deficiency

Factor V Leiden

87
Q

How is Troponin level useful in PE management?

A

can indicate how serious things are

Elevated troponin indicates RV dysfunction and the possibility of serious adverse events

88
Q

The #1 cause of laryngeal cancer is:

A

smoking, especially with alcohol consumption

89
Q

Primary lung cancers are also called ________ and arise from the _________

A

bronchogenic cancer

epithelium of the respiratory tract

90
Q

What are the two major categories of bronchogenic lung cancer?

A

Nonsmall Cell Lung Cancer

Neuroendocrine tumors

91
Q

What are the three types of Nonsmall Cell Lung Cancer?

A

Squamous cell (30%)

Adenocarcinoma (35-40%)

Large Cell (10%)

92
Q

What are the two types of neuroendocrine lung tumors?

A

Small Cell lung carcinomas (15% of cases, but 25% of deaths)

Bronchial Carcinoid Tumors (1%)

93
Q

Which lung cancers are associated with smoking?

Which are not?

A

Small cell and Squamous cell

Adenocarcinoma and bronchial carcinoid

94
Q

How aggressive is mesothelioma?

A

Extremely fast to metastasize, but their metastases are usually slow growing

Usually live 10-15 years after diagnosis

95
Q

What is the TNM classification system?

A

Used for staging

T: Extent of the tumor

N: Nodal involvement

M: Extent of metastasis

96
Q

What is functional residual capacity?

A

resting lung volume

balance between elastic recoil of the lungs and elastic recoil of the chest

97
Q

Infants up to _______ are obligate nose breathers

A

2-3 months

98
Q

Surfactant is produced by _______ cells

A

Type II alveolar

99
Q

Surfactant is produced by ______ weeks and secreted into the lungs by ______ weeks

A

20-24

30

100
Q

What’s the old name for respiratory distress syndrome in neonates?

A

Hyaline membrane disease

101
Q

Is chest wall compliance higher or lower in infants?

A

Higher

hasn’t totally ossified

M 1203

102
Q

How do infants maintain FRC with increased chest wall compliance?

A

To keep airways from closing, have muscular “braking” of expiration

Caused either by active glottic narrowing or increased action of external intercostals

103
Q

How long do placentally transferred IgG levels last in neonates?

A

A few months (half life 21 days)

104
Q

Which immune antibody types are transferred in breast milk?

A

IgA

IgG

IgM

105
Q

Infants have an exaggerated apneic response to ________

A

laryngeal stimulation

106
Q

Most common causes of acute onset Upper Airway Obstruction in peds

A

infection

foreign body

angioedema

OSA

trauma

107
Q

Most common causes of chronic Upper Airway Obstruction in peds

A

congenital malformations

subglottic stenosis

catilaginous weakness

vocal cord paralysis

108
Q

Agitation in infants should be regarded as _______

A

a sign of hypoxemai or obstruction

109
Q

You should never attempt examination of the pharynx in a kid if:

A

any suspicion of epiglottitis or retropharyngeal abscess

Any stimulation could precipitate acute obstruction

110
Q

In peds a loud gasping snore indicates

A

enlarged tonsils/adenoids

111
Q

In peds stridor during inspiration suggests

A

airway compromise in the eiglottis, arytenoids, vocal cords, glottis

112
Q

In peds expiratory stridor or wheeze results from

A

narrowing or collapse of the lower trachea or bronchi

113
Q

in peds airway noise during inspiration and expiration indicates

A

a fixed obstruction of the vocal cords or subglottic space

114
Q

If a peds cough is croupy or low pitched, you should suspect

A

tracheal pathology

115
Q

What is the most common cause of croup?

A

viral (laryngotracheitis)

and recurrent (spasmodic croup)

116
Q

Croup illnesses are characterized by _____ and ______

A

infection

UAO

117
Q

Kids are most likely to get croup at what age?

A

2 years average

(6mo to 5 years)

118
Q

What causes croup?

A

subglottic edema or obstruction

119
Q

In moderate to severe croup, ____ and____ should be given for treatment

A

steroids

neb of racemic epi (to help until steroids kick in)

120
Q

What pathogen historically caused acute epiglottitis?

A

Hib

Haemophilus infuenzae type B

Now we vaccinate against it

121
Q

Acute epiglottitis is associated with what signs and symptoms?

A

Hot potato voice

insp stridor

severe respiratory distress

tripod positioning

drooling and dysphagia

122
Q

Most common cause of peritonsilar abscess

A

GABHS tonsillitis

123
Q

Treatment for peritonsillar abscess

A

must be drained! if it spontaneously ruptures it can kill the child

124
Q

What is the most common, potentially life threatening upper airway infection in children?

A

Bacterial tracheitis (psuedomembranous croup)

125
Q

What is the treatment for bacterial tracheitis?

A

intubation

IV antibiotics

126
Q

Angioedema is usually caused by:

A

mast cell mediated allergies (peanuts, milk, eggs)

127
Q

What is laryngomalacia?

A

abnormally soft laryngeal cartilage

most common cause of chronic stridor in infants

128
Q

What happens in laryngomalacia?

A

epiglottis or arytenoids fold inward with inspiration, partially covering the glottis

129
Q

What is tracheomalacia?

A

tracheobronchial cartilages are flaccid and tend to collapse

130
Q

What are the most common causes of stridor in children?

A

Tracheomalacia

Vocal Cord Paralysis

131
Q

What is subglottic stenosis?

A

subglottic airway diameter of < 4 mm at the cricoid in full term infant, < 3 in premie

132
Q

What is choanal atresia?

A

unilateral or bilateral lack of patency in the nasal cavity

lifethreatening in newborns

133
Q

What is laryngeal atresia?

A

failure of larynx to recanalize during embryogenesis

134
Q

What are some symptoms of OSA in children (besides snoring)?

A

FTT

labored breathing

restlessness

sweating during sleep

nocturnal enuresis

135
Q

Untreated pediatric OSA can cause:

A

cardiovascular disease

insulin resistance

136
Q

What is bronchopulmonary dysplasia?

A

chronic lung disease of prematurity

137
Q

Aside from RDS, what increases the risk of bronchopulmonary dysplasia?

A

antenatal chorioamnionitis

preeclampsia

inflammation and postnatal sepsis

PDA

hyperoxia

genetics

138
Q

What is the canalicular stage of fetal lung development?

When does it occur?

A

type II epithelial cells appear

capillaries grow into alveolar regions

16-28 weeks

139
Q

What is the saccular stage of fetal lung development?

When does it occur?

A

septation and formation of alveoli and respiratory units

26-28 weeks

140
Q

Which pathogen most commonly causes bronchiolitis?

A

RSV

Nasal swabs positive for RSV in 70% of cases

141
Q

Having childhood bronchiolitis is a risk factor for ______

A

developing asthma

142
Q

______ pneumonia is 2-3x more common in children than adults

A

viral

143
Q

What is bronchiolitis obliterans?

A

fibrotic obstruction of the respiratory bronchioles and alveolar ducts d/t inflammation

very rare in kids

144
Q

Asthma diagnosis depends on testing using spirometry, which can only be done after age:

A

5-6 years

145
Q

The most common manifestations of cystic fibrosis involve which two systems

A

resp and GI

146
Q

The incidence of SIDS is low during ______

A

the first month of life

increases sharply in the second month

peaks at 2-4 months

unlikely after 6 months

147
Q

which blade should be used to intubate peds?

A

Miller easier than Mac

148
Q
A

Patho 1 (17 decks)

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