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Pathology 3 > Lecture 5 - Respiratory Pathologies pt 1 > Flashcards

Lecture 5 - Respiratory Pathologies pt 1 Flashcards

1
Q

What are 6 SSx of pneumonia?

A
  1. sudden, sharp pleuritic chest pain
  2. Productive cough
  3. dyspnea; tachypnea; cyanosis
  4. sputum (green and pus)
  5. chills, fever, HA’s
  6. fatigue
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2
Q

What are 5 treatment options for pneumonia?

A
  1. meds (antibiotics, antifungal, expectorants)
  2. bed rest
  3. fluids
  4. analgesics
  5. pulmonary physical therapy
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3
Q

How long does it take most mild cases of pneumonia to resolve?

A

within 1-2 weeks

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4
Q

What 2 types of pneumonia might have symptoms linger longer?

A
  1. viral

2. mycoplasmic

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5
Q

What are 3 complications included with pneumonia?

A
  1. pleural effusion (fluid around lungs)
  2. empyema (pus in pleural cavity)
  3. lung abscess
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6
Q

Who is the pneumonia vaccine recommended for?

A
  1. people 65+
  2. people with chronic disorders of lung, liver or kidney
  3. diabetics
  4. immunocompromised
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7
Q

The pneumonia vaccine has been successful in reducing what type of pneumonia?

A

penicillin - resistant streptococcus pneumonia

infants 81%; elderly 49%

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8
Q

What demographic is pneumocystis carnii pneumonia seen in?

A

Special form of pneumonia in people with AIDs (often fatal)

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9
Q

What is pneumocystis carnii pneumonia caused by?

A

pneumocystis carinii (a fungus)

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10
Q

What are 4 SSx of pneumocystis carnii pneumonia?

A
  1. fever
  2. hypoxia
  3. dyspnea/ NON-PRODUCTIVE cough
  4. fatigue/ weight loss
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11
Q

How is pneumocystis carnii pneumonia diagnosed and treated?

A

dx: chest x-ray or fiber-optic bronchoscopy
tx: antifungal meds and symptomatic tx

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12
Q

What are 3 types of pneumonia, based on the location of the infection?

A
  1. bronchopneumonia
  2. lobar pneumonia
  3. interstitial pneumonia
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13
Q

What is pulmonary tuberculosis?

A

A CHRONIC, BACTERIAL systemic infection that affects the lung and may disseminate (spread) to lymph nodes and other organs

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14
Q

What is pulmonary TB caused by?

A

mycobacterium TB

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15
Q

What are 3 things that characterize PULMONARY TB?

A
  1. granulomas = Tuberculomas (FIRM lumps)
  2. caseous necrosis (cheese)
  3. TB cavern = formation of cavities
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16
Q

What chance is there, over a lifetime, for latent TB to develop into the infectious form?

A

10% chance

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17
Q

What are 2 things that characterize PRIMARY TB?

A
  1. usually asymptomatic - seen as an initial infection, usually in children
  2. granulomas = TUBERCULOMA accompanied by HILAR LYMPH NODE infection
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18
Q

Where is PRIMARY TB located?

A

Usually in the middle or lower lung area.

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19
Q

What happens with granulomas in nearly all cases of PRIMARY TB?

A

the granulomas resolve and there is no further spread of infection.

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20
Q

What does PRIMARY TB predispose and infected person to?

A

Chronic pulmonary or extra-pulmonary TB at a later time.

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21
Q

What does SECONDARY TB develop due to?

A

Endogenous OR exogenous re-infection

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22
Q

What is the most common form of clinical TB?

A

Secondary TB

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23
Q

Where in the lungs is SECONDARY TB commonly located?

A

Upper lobe of one lung

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24
Q

What are 4 characteristics of SECONDARY TB?

A
  1. Granuloma - Tuberculomas (FIRM LUMPS)
  2. Caseous necrosis (cheese)
  3. TB cavern (cavern formation)
  4. Gains access to BLOOD STREAM
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25
Q

What is the primary cause of SECONDARY TB when immune function is low?

A

ENDOgenous infection

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26
Q

What are 6 demographics that are at a higher risk for TB?

A
  1. HIV infection
  2. 65+ (50%)
  3. economically disadvantaged
  4. malnourished, immunocompromised
  5. Hispanic, Native American, Asian/Pacific Islander
  6. Children, younger then 5 years old
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27
Q

What are 4 clinical manifestations of TB?

A
  1. PRODUCTIVE COUGH for 3+ weeks, may include HEMOPTYSIS
  2. Weight loss, anorexia
  3. Fatigue
  4. Fever/ night sweats
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28
Q

When may symptoms present for TB?

A

May be delayed one year after infection - most Sx do not appear in early stages when TB is most curable

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29
Q

What are 4 complications presented by TB infection?

A
  1. broncho-pleural and esophago-pleural fistula
  2. PLEURISY with effusion (escape of a fluid from its natural bv and into a body cavity)
  3. pneumonia/ laryngitis
  4. lung atelectasis (collapse)
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30
Q

What are 6 areas that TB can involve outside the lungs (extrapulmonary involvement)?

A
  1. abdominal
  2. pericardial
  3. genitourinary system
  4. lymph nodes
  5. CNS (brain and meninges)
  6. Skeleton = paget’s disease
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31
Q

What is a fistula?

A

an abnormal or surgically made passage between a hollow or tubular organ and the boys surface OR between two hollow or tubular organs

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32
Q

What are 4 ways TB can be medically managed?

A
  1. prevention of transmission (masks?)
  2. improved living conditions and nutrition
  3. adequate ventilation
  4. vaccination
    (involuntary isolation or supervised tx are NOT currently acceptable)
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33
Q

What is the name of the TB vaccine?

A

BCG = bacillus calmette - guerin vaccine

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34
Q

If TB is left untreated, what is the mortality rate?

A

50-80% fatal in 2.5 years

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35
Q

What are 2 conditions that can permit the start of TB treatment?

A
  1. one positive tuberculin skin test - even without x-rays
  2. sputum confirmation
    (primary anti-TB drugs are combined and given in one signle dose per day)
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36
Q

Define fungal diseases of the lung:

A

Community - aquired pulmonary infection from inhalation of dried fungi and their spores

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37
Q

Define spores:

A

one-celled, reproductive unit, capable of giving rise to a new individual without sexual fusion.

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38
Q

What is a primary characteristic of fungal lung disease?

A

miliary nodes (small 1-4 mm) : pulmonary nodules scattered throughout the lungs, which can induce granuloma formation and CALCIFICATION.

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39
Q

What infection can resemble TB presentation?

A

Fungal lung diseases (maybe asymptomatic or have a solitary pulmonary lesion)

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40
Q

What are 2 specific fungi that can cause lung disease?

A
  1. histoplasmosis (histoplasma capsulatum)

2. coccidiomycosis (endemic in southwest deserts)

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41
Q

What are 3 HOSPITAL-ACQUIRED fungal infections?

A
  1. candida
  2. aspergillius
  3. pneumocystis carinii
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42
Q

What 3 demographics are commonly affected by hospital-acquired fungal infections?

A
  1. terminally-ill
  2. cancer pt’s
  3. People with AIDS
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43
Q

What is a lung abscess?

A

a localized accumulation of pus WITHIN the lung - usually a cx of pneumonia

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44
Q

What are 4 ways that bacteria can reach the lungs?

A
  1. aspiration from oropharynx with foreign material or vomit
  2. septic emboli from ENDOCARDITIS of the TRICUSPID valve into pulmonary trunk
  3. I.V. drug use
  4. Infected neoplasm of the lung
45
Q

What are 5 clinical manifestations almost always seen with a lung abscess?

A
  1. PRODUCTIVE COUGH, with foul smelling sputum and hemoptysis
  2. persistent fever/ chills
  3. Dyspnea
  4. Pleuritic chest pain
  5. Cyanosis and clubbing of finger nails
46
Q

How can a lung abscess be treated?

A

The use of specific antibiotic treatment - but can also be helped by drainage of the abscess via percussion or bronchoscopy

47
Q

What is the mortality rate of lung abscesses?

A

5 - 10 % (prognosis is good if antibiotics work!)

48
Q

Define pneumonitis:

A

a generic term used for inflammation of the lungs due to CAUSES OTHER THAN INFECTIONS

49
Q

What are 5 types of pneumonitis?

A
  1. hypersensitivity
  2. lupus
  3. aspiration
  4. obstructive (cancer obstruction)
  5. interstitial (AIDS related)
50
Q

What is acute bronchitis?

A

Inflammation of the bronchial tree structures for SHORT DURATION (1-3 weeks) and it is self-limiting.

51
Q

What are the 3 main anatomical divisions of the respiratory system and what is included in them?

A
  1. upper airways: nasal cavity and paranasal sinuses, pharynx and tonsils, and larynx
  2. lower airways: trachea and bronchial tree
  3. terminal bronchioles: respiratory bronchioles, alveolar ducts and alveoli
52
Q

What are the two functional divisions of the respiratory system and what do they contain?

A
  1. ventilation function (conducting airways): upper and lower airways
  2. respiratory function (gas exchange): acini (alveoli)
53
Q

What are 4 conditions for normal respiration?

A
  1. airways must be open
  2. lungs must be able to expand rhythmically during each respiratory movement
  3. alveolar respiratory membrane must be intact
  4. proper coordination of the control centres of respiration in CNS, diaphragm and respiratory thoracic mm.
54
Q

Besides respiration, what are 3 other functions of the respiratory system?

A
  1. voice production by the larynx
  2. Protection from infections (MALT)
  3. Maintaining acid-base balance
55
Q

What does MALT stand for?

A

Mucosa - Associated Lymphoid Tissue

56
Q

What 4 areas are MALT located?

A
  1. Tonsils
  2. Lymphoid Follicles in wall of bronchi
  3. macrophages in the alveoli
  4. pulmonary capillaries = circulatory pool for leukocytes
57
Q

What is a sequel?

A

pathological condition resulting from a disease

58
Q

What is a major sequel of pulmonary disease/injury?

A

hypoxemia: deficient oxygenation of the arterial blood

59
Q

What are 4 mechanisms that result in hypoxemia?

A
  1. ventilation/perfusion mismatch (ex. asthma)
  2. decreased oxygen content (high altitude)
  3. hypoventilation (OD)
  4. alveolarcapillary diffusion abnormality/ pulmonary shunting (emphysema)
60
Q

What are 7 SSx of pulmonary disease?

A
  1. cough
  2. abnormal sputum
  3. hemoptysis
  4. dyspnea/ altered breathing patterns
  5. chest pain
  6. cyanosis
  7. digital clubbing
61
Q

What is the definition of a cough?

A

Sudden, explosive, expiratory maneuver that expels air from lungs and tends to clear material from airways

62
Q

What makes a cough essential?

A

it is a protective response - secretion is important to bring out accumulated debris from respiratory tract

63
Q

What are 5 causes of a cough?

A
  1. tumor
  2. allergies/ congestion
  3. infection - cough w. purulent sputum
  4. airway irritation
  5. GERD
64
Q

What is hemoptysis and what are a few possible causes of it?

A

cough and spitting blood d/t infection, abscess, tumor

65
Q

What does dyspnea usually indicate?

A

hypoxemia, but also emotional stress (anxiosis)

66
Q

What is hypoxemia usually caused by?

A

diffuse and extensive, rather than focal pulmonary disease, except PE

67
Q

What is orthopnea and what causes it?

A

dyspnea when laying flat, caused by redistribution of body water (CHF), which increases fluid in the lungs

68
Q

When laying supine and prone, the abdominal contents press on the diaphragm, resulting in what?

A

increased work of breathing and limited vital capacity.

69
Q

Where are pulmonary pain usually located?

A

substernal, in the lung fields (anterior and posterior)

70
Q

Where are 3 areas that pulmonary/chest pain can radiate?

A
  1. neck/ upper traps
  2. costal margins/thoracic area of the back
  3. scapula/shoulder
71
Q

MSK causes of chest wall pain must be differentiated from pain originated in what 4 other areas?

A
  1. heart
  2. lung
  3. brest
  4. epigastric region
72
Q

What are 4 characteristics of pleural pain?

A
  1. sharp
  2. localized
  3. aggravated with breathing
  4. alleviated when lying on affected side
73
Q

What two things does the presentation of cyanosis depend on?

A
  1. oxygen saturation of arterial blood

2. total amount of circulating hemoglobin

74
Q

What is central cyanosis often associated with?

A

Cardiac RIGHT TO LEFT SHUNTS and pulmonary disease

75
Q

Where on the body would central cyanosis be seen?

A
  1. oral mucosa
  2. conjunctiva
  3. lips
76
Q

What is peripheral cyanosis often due to?

A

cold temp, anxiety, heart failure or shock

77
Q

Where would peripheral cyanosis be seen on the body?

A
  1. extremities
  2. nail beds
  3. nose
78
Q

What % of digital clubbing is due to pulmonary disease?

A

75-85%

79
Q

What are 3 other pathologies digital clubbing may occasionally be present in?

A
  1. heart disease
  2. PVD
  3. liver and gi disorders
80
Q

define apnea:

A

cessation of breathing

81
Q

define bradypnea:

A

decreased FREQUENCY of breathing

82
Q

define hyperpnea:

A

increased DEPTH of breathing

83
Q

describe apneustic:

A

gasping inspiration followed by short expiration

84
Q

describe hyperventilation

A

abnormally prolonged and deep breathing

85
Q

describe hypoventilation:

A

reduction in amount of air entering pulmonary alveoli = increase in arterial CO2 levels

86
Q

What % of URI are caused by rhinovirus?

A

50%

87
Q

What are 4 characteristics of URI?

A
  1. nose, sinus, throat or larynx involvement
  2. extend to trachea and bronchi
  3. in kids, can extend to inner ear
  4. can have pneumonia complication
88
Q

What 3 symptoms are seen more in a common cold than a flu?

A
  1. runny, stuffy nose
  2. sore throat
  3. sneezing
89
Q

define pneumonia:

A

an inflammation affecting the parenchyma of the lungs

90
Q

What are 3 causes of pneumonia?

A
  1. infection
  2. inhalation of toxic or caustic chemicals
  3. aspiration (food, fluid or vomit)
91
Q

define mycoplasmal:

A

organism with both bacterial and viral characteristics

92
Q

Define lobar pneumonia:

A

the inflammation may involve one or both lungs at the lobe level

93
Q

Define bronchopneumonia:

A

affects more distally at the bronchioles and alveoli

94
Q

What is the incidence of bacterial pneumonia?

A

30% - typically present in airways

95
Q

What is the incidence of viral pneumonia?

A

50% - usually not life-threatening, except in the immunocompromised

96
Q

What is the incidence of mycoplasmal pneumonia?

A

20%

97
Q

define aspiration pneumonia:

A

pneumonia caused by foreign matter such as food in the lungs - right upper lobe is most often affected!

98
Q

What are 5 risk factors for developing aspiration pneumonia?

A
  1. seizure
  2. depressed CNS, cough reflex
  3. recurrent GERD
  4. anatomical abnormalities
  5. debilitating illness
99
Q

what are 3 of the most common types of fungus causing fungal pneumonia?

A
  1. hystoplasmosis
  2. coccidiomycosis
  3. blastomycosis
100
Q

What area does viral pneumonia usually affect?

A

alveolar septa - NOT intra alveolar spaces (interstitial pneumonia) - bilateral or panlobular

101
Q

What is the cause of bacterial pneumonia?

A

50% of all bacterial pneumonia caused by Str. Pneumonia (aka alveolar pneumonia=bronchopneumonia - preceded by viral URI)

102
Q

What are 2 characteristics of bacterial pneumonia?

A
  1. limited to 1 or 2 lobes

2. alveoli fill with pus

103
Q

What are 2 causes of acute bronchitis?

A
  1. chemical irritation (smoke, fume, gas)

2. viral infection (chick pox, flu, measles)

104
Q

What are 4 early symptoms of URI/acute bronchitis?

A
  1. fever
  2. dry, irritating cough/sore throat
  3. laryngitis
  4. chest pain from coughing/wheezing
105
Q

What is a characteristic of VIRAL acute bronchitis?

A

dry cough in paroxysms (attacks) aggravated by cold, dry or dusty air

106
Q

What demographic is BACTERIAL acute bronchitis common in?

A

people with COPD (presents with retro-sternal pain aggravated with coughing)

107
Q

What are 5 other DDx to note when it comes to acute bronchitis?

A
  1. chronic bronchitis
  2. pneumonia
  3. whopping cough
  4. sinus conditions
  5. GERD
108
Q

What are two things not recommended for treating acute bronchitis?

A
  1. bronchodilators
  2. antibiotics
    (viral or chemical irritation)

Pathology 3 (6 decks)

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