Path 2, Exam 1 Flashcards
What can cause pulmonary hypoplasia? (2)
- Space-occupying lesions in uterus
2. Congenital diaphragmatic hernia
What is a TE fistula?
abnormal connection between esophagus and trachea
What is the most common TE fistula?
TYPE C
What is atelectasis?
Incomplete expansion of lung due to collapse, compression or obstruction
Is atelectasis a disease?
NO
What causes atelectasis? (3)
- Bronchial Obstruction-tumor
- Compression- pneumothorax/pleural effusion
- Contraction-fibrotic lung
A lesion on RUL is what until proven otherwise?
TB
What is NRDS?
Neonatal Respiratory Distress Syndrome, lack of surfactant
What are other names for NRDS? (2)
Hyaline membrane disease (neonate)
Surfactant deficiency disorder (adult)
What is pulmonary edema?
accumulation of fluid in the lungs—>impaired gas exchange, possible respiratory failure
What causes pulmonary edema? (2)
- Failure of the heart to remove fluid from lung circulation (cardiogenic)
- Direct injury to the lung
Pathophysiology of PE? (3)
- Capacity of the lymphatics to absorb and drain interstitial fluid is exceeded
- Architecture of the alveolar epithelial cells breaks down
- Fluid entering the alveolar spaces reduces or halts gas exchange
What is the pathophysiology of ARDS? (6)
- Neutrophils produce pro-inflammatory products
- Immune is compromised and unable to balance the pro-inflammatory products.
- Increased permeability of capillary
- Flooding transudate fluid into alveolus.
- Loss of gas exchange fxn
- Decrease surfactant production
What is the pathophysiology of COPD?
Inflammation throughout airways, activated inflammatory cytokines????
What is chronic bronchitis?
Persistent cough with sputum production for at least 3 months in 2 consecutive years without identifiable cause
What is unusual about the chronic bronchitis diagnosis
No clinical findings
What does atopic mean?
Atopic is allergic (IgE mediated) whereas non-atopic is infxn
What is Samter’s Triad (3)
- Asthma
- Rhinitis and nasal polyps
- Hives
Things aspirin causes
What is exercise induced asthma?
People who experience asthma in exercise, but not other circumstances. Could be due to sensitivity to changes in temperature and humidity of air entering lungs—air is not warmed and humidified with rapid breathing rate
How can exercise induced asthma be prevented?
warm up and cool down
What is airway remodeling? (2)
- Hypertrophy and hyperplasia of muscle layer
2. Deposition of sub epithelial collagen
Is bronchiectasis a disease?
NO, condition in which large bronchi are damaged and dilated
What is the most lethal genetic disease to Caucasians?
Cystic Fibrosis
What is Cystic Fibrosis?
Disorder of ion transport of epithelial cells–
resulting from genetic mutations in the CTFR (cystic fibrosis transmembrane conductance regulator gene)
What are characteristics of Cystic Fibrosis?
- Atelectasis
- Obstruction v restriction
- COPD
- Restrictive Pulmonary Diseases
- Reduced compliance
- Diffuse- increase
fluid secretion in exocrine glands–defective ion transport
Particle sizes for pneumonconiosis–most dangerous
1-5 micrometers
What is silicosis?
Most common chronic occupational disease due to inhalation of TETRAHEDRAL (shape increases chemical activity) silica crystals that damage epithelial cells and macrophages causing inflammatory response—fibroblasts proliferate
What would you see on CXR for silicosis?
Eggshell calcification of hilar lymph notes 1-2 cm in diameter with walls 2 mm thick (typically upper lung)
What is Asbestosis?
A diffuse parachymal disease; asbestos fibres are engulfed by macrophages and cause infllatory reaction in airways
What 2 cancers are associated with asbestosis?
Bronchiogenic carcinoma and mesothlioma
What is Sarcoidosis?
systemic granulomatous disease of unknown cause that may involve many different tissues and organs—presents with bilateral hilar LA, no known cause-disease of exclusion
Why is pulmonary HTN a vicious cycle?
Alveoli become wider and arterioles become narrower, increases pulmonary blood pressure and enlargement of right ventricle which causes right sided heart failure
Narrowing causes HTN and HTN causes narrowing
Pneumonia v Pneumonitis?
Pneumonia is bacterial infxn and pneumonitis is caused by inhalation of particulates
Risk factors for pneumonia? (5)
- Any condition leading to diminished gag reflex
- Mucociliary elevator dysfunction/damage causing to decreased clearance of defective agents
- Accumulation of secretions
- Decrease in phagocytic or bactericidal action of alveolar macrophages
- Pulmonary congestion and edema
What organism is responsible for most cases of community acquired pneumonia worldwide?
Streptococcus pneumoniae
Gram staining for streptococcus pneumoniae?
Gram +
What are ssx of pneumonia
- cough
- fatigue
- myalgia
- incerased sputum production
- Pleuritic chest pain
How are signs and sx different depending on lobar, viral or bronchopneumonia?
lobar
viral
broncho
Difference between congestion and consolidation?
Congestion: leaky dilated capillaries- protein rich exudate into interstitium/intra-alveolar fluid with few neutrophils, exudative rxn—not solidification
Consolidation: Exudative rxn and subsequent solidification
4 stages of lobar pneumonia
- congestion
- Red hepatization
- grey hepatization
- Resolution
Characteristics of red hepatization (3)
- Red cell exudate, neutrophils, and fibrin in alveolar spaces
- Red, firm, airless
- consistency: liver tissue
Gray Hepatization characteristics (4)
- Red cell disintegration, shift to increased fibrinization
- Persistent neutrophils, fibrin and supperative exudate
- Alveoli still consolidated
- appears grayer and browner and drier
In which populations is Haemophilus Pneumonia most prevalent? (2)
- Children under 2 with otitis media, URI, meningitis, cellulitis or osteomylitis
- Adults with COPD
How does Haemophilus Pneumonia gram stain?
Gram -
Antibiotic for haemophilus pneumoniae
Bactrim
2nd most Common cause of pneumonia in people with COPD?
Moraxells Catarrhalis
Gram staining of Moraxells Catarrhalis?
negative
Which population most often get Klebsiella Pneumoniae? (2)
- Debilitated/malnourished
2. Alcoholics
Klebsiella gram staining properties?
negative
Cystic Fibrosis patients with pneumonia presumably have which bacteria?
Pseudomonas Aeruginosa
Gram staining properties of Pseudomonas Aeruginosa?
negative
How is legionella transmitted?
inhalation of aerosolized organisms or aspiration of contaminated water
What is unusual about Legionella?
?
What are the atypical pneumonias
viral (influenza)
mycoplasmal (mycoplasma pneumoniae (obligate intracellular)
not bacterial
What is walking pneumonia?
cell wall deficient bacteria cause walking pneumonia legionella coxiella burnetti mycoplasma pneumoniae chlamydia pneumoniae
Are cultures helpful for atypical/walking pneumonia
NO
What findings in tympanic membrane of a person with pneumonia might indicate the causative organism
Bullous myringitus
blisters on tympanic membrane
What is unusual about the original location of viral versus bacterial pneumonia?
Viral- interstitial
bacterial- alveolar
What is the most common viral overall
Influenza A/varicella zoster
Most common viral in children
RSV/ respiratory synctal virus
What is an oxygen tent
enclosure/high oxygen. helps them breath better
What is virus responsible for SARS
Corona virus
How is SARS identified
by PCR, giant cells present
What most common causes of nosocomial pneumonia?
hospital acquired, bugs resistentant to antibiotics
MRSA or psuedomonias
What are the characteristics of aspiration pneumonia?
Aspiration of gastric contents
prolonged bed rest
posterior lobes
leads to abscesses
Common organisms of aspiration pneumonia
aerobic–Strep, Staph, H FLu. Pseudomonas—normal oral flora
anaerobic bacteroides and fusobacteriam
What is the difference between pleural effusion and empyema?
Pleural effusion- fluid in between visceral and parietal lung layers
empyema- pus not fluid—will be cloudy on CXR
What is bronchoplueral fistula?
pus filled empyema/fistula/sinus tract from bronchus to pleural space
What 4 organisms associated with chronic pneumonia?
tb, histoplasmosis, blastomycosis, coccidiomycosis
