Patho Exam 4 Pulmonary Flashcards
What is the pathogenesis of epiglottitis?
microbe localizes in the supraglottic area causing rapid and potentially fatal inflammation
Clinical manifestations of TB
hx of contact w/ infected person
low grade fever
cough w/ rust colored sputum
night sweats
weight loss
apical crackles
Pathology in what areas causes restrictive disorders?
lungs, pleura, ribs, neuromuscular, and obesity
Physiology of the late phase of asthma
WBC invade bronchioles causing edema and swelling of epithelium
What disease is bronchiectasis associated with?
cystic fibrosis
TB treatment
ABX for 9-12 months, rifampin
Occupational lung disease
-treatment
prevent further exposure, corticosteriods, inhaled bronchiodialotors, O2 therapy, positive pressure ventilation, postural drainage, and deep breathing exercises
What type of medication will the immediate phase of asthma respond to?
Beta agonist
What is the treatment for bronchiectasis?
antibiotics, bronchodilators, and chest PT.
Hypersensitivity Type III Pneumonitis
-clinical manifestations: acute
Symptoms start after 4-6 hours after exposure
chilled, sweating, fatigue, dyspnea at rest, dry cough, lung base crackles, late cyanosis
What is the normal population for epiglottitis?
Children 2-4 y/o
types of retractions
suprasternal, supraclavicular, intercostal, and epigastric
Guillain-Barre etiology and clinical manifestations
immune based
demyelination of peripheral nerves
recent history of viral or bacterial illness followed by ascending paralysis
Which spirometry results indicate a restrictive disorder?
decreased vital capacity, residual volume, functional residual capacity, tidal volume, and total lung capacity
What causes the reactivation of primary tuberculosis?
HIV, steroids, silicosis, and diabetes
Hypersensitivity Type III Pneumonitis
-pathogenesis and hallmark of disease
!Diffuse pulmonary fibrosis in upper lobes (hallmark)
genetic predisposition
antigen-antibody complexes elicit granulomatous inflammation leads to lung tissue injury
Opportunistic pneumonia fungi
pneumocystis jiroveci and aspergillus
Diagnosis of pneumonia
Chest xray- parenchymal infiltrates (white shadows)
sputum culture
CURB-65
WBC > 15000 bacteria
Signs and symptoms of bronchiolitis?
wheezing, crackles, decreased breath sounds, retractions, increased sputum, dyspnea, tachypnea, and low-grade fever.
Which COPD disease is a pink puffer?
emphysema
Pickwikian syndrome
increased abdominal size forces thoracic contents upward into chest cavity. Decreases lung expansion.
Clinical manifestations of epiglottitis
drooling, dysphagia, dysphonia, inspiratory stridor and retractions. Oropharynx is swollen and cherry red.
Diffuse interstitial lung disease
-diagnosis
Chest xray, pulmonary function tests, lung biopsy, CT scan.
Hypersensitivity Type III Pneumonitis
-clinical manifestations: intermediate and chronic
heart!
cor pulmonale, acute febrile episodes, progressive pulmonary fibrosis with cough, dyspnea, fatigue.
What are the chest xray findings for bronchitis?
congested lung fields, increased bronchial vascular markings, enlarged horizontal heart
Diffuse interstitial lung disease
-clinical manifestations
shortness of breath, nonproductive coughing, fatigue, and weight loss, which tend to develop slowly, over several months. Nail clubbing and bibasilar end-expiratory crackles. Late-stage cyanosis.
In which COPD disease are retractions present?
Emphysema and end stage bronchitis
What is the CES of asthma?
Constriction of bronchiole smooth muscle
Edema due to inflammatory processes
Secretions of thick mucus
treatment of pneumothorax
Less than 25% collapse treat symptoms
Greater than 25% chest tube and oxygen
Chemical pleurodesis
Thoracotomy
Which COPD disease has hyper-resonance upon percussion?
emphysema
Occupational lung disease
-etiology
results from inhalation of toxic gases or foreign particles
Three lung parenchyma disorders
diffuse interstitial lung disease, hypersensitivity pneumonitis, and occupational lung disease
Which type of COPD is evidence of right sided heart failure?
bronchitis
Amyotrophic Lateral Sclerosis
More common in men than women
Degenerative disease of the nervous system (upper and lower motor neurons)
progressive muscle weakness and wasting leading to respiratory muscle failure
Mycoplasmal pneumonia
-description
-symptoms
common in summer and fall in ages 5-20
fever, cough, headache, and malaise
tension pneumothorax
traumatic origin
penetrating or nonpenetrating injury
also caused by medical causes
medical emergency
In which COPD disease is edema present?
Emphysema
Which COPD disease presents with jugular vein distension?
bronchitis
What is the pathogenesis of bronchiolitis?
Proliferation and necrosis of the bronchiolar epithelium which causes obstruction and increased mucus production. Leads to lung collapse and hyperinflation.
What body build is associated with emphysema?
thin and wasted
Signs and symptoms of late-phase asthma
dyspnea, wheezing, cough, hyper resonance, tachypnea, retractions, and speech dyspnea
Muscular Dystrophies (Duchenne)
hereditary, 1/3500
progressive muscular weakness bottom up
respiratory muscles involved in later years and lead to hypoxia, hypercapnia, and frequent respiratory infections
What is status asthmaticus
severe, prolonged asthma attack which does not respond to usual treatment
Occupational lung disease
-pathogenesis
pollutants interfere and paralyze cilia
Macrophages secrete lysozyme while trying to remove particles but excessive lysozyme damages alveolar walls create a fibrous tissue
What four things cause acute asthma exacerbations?
cold air, allergens (IgE), irritants (smoke/pollen), medications (nsaids)
Hypersensitivity Type III Pneumonitis
-treatment
prevent exposure and oral corticosteroids
Which type of COPD has a barrel chest as a sign?
emphysema
Fibrotic Interstitial lung disease description
180+ disease entities charecterized by acute/subacute/chronic infiltration of alveolar walls caused by cells, fluid, and connective tissue. Can lead to fibrosis.
What is the pathogenesis of bronchiectasis?
Breakdown of the airways due to an excessive inflammatory response.Bronchi become enlarged and thus less able to clear secretions. Secretions increase the amount of bacteria in the lungs, resulting in airway blockage and further breakdown of the airways. Many infections.
Which COPD disease has hyper resonance upon percussion?
emphysema
What is heard when listening to the chest of a patient with bronchitis?
wheezes, crackles, and rhonchi
Occupational lung disease
-clinical manifestations
no signs and symptoms in the early stage for 10-20 years
progressive productive cough
SOB w/ exercise
late features are cor pulmonale, chronic hypoxemia, respiratory failure
What are obstructive disorders characterized by?
reduction in airflow, problem with exhalation, are will remain in lung after exhalation
anaerobic bacteria pneumonia
presents as a lung abscess and is usually caused by aspiration of normal oral bacteria
Types of pneumoconiosis (inhalation of inorganic dust particles)
Anthracosis (coal miner’s lung), silicosis, and asbestosis
Diffuse interstitial lung disease
-treatment
Smoking cessation, avoid environmental cause, anti-inflammatories, immunosuppresant agents, oxygen, lung transplant.
What are the chest xray findings for emphysema?
narrowed mediastinum, normal or small vertical heart, hyperinflation, low/flat diaphragm, presence of blebs or bullae
catamenial pneumothorax causes
Associated with menstruation and endometriosis
right hemothorax
pathogenesis of pneumothorax
results from build up of air under pressure in pleural space
Myasthenia Gravis
More common in females
weakness and fatigue of voluntary muscles, especially with exercise
abnormality at neuromuscular junction
What is bronchiolitis?
wide spread inflammation of the bronchioles. Found commonly in RSV
What are the three types of COPD?
chronic bronchitis, asthma, and emphysema
Which spirometry results indicate an obstructive disorder?
Decreased vital capacity, inspiratory reserve volume, and expiratory reserve volume
Increased residual volume, functional residual volume, and total lung capacity
What is the treatment for bronchiolitis?
Humidified O2 and bronchodilators
Hypersensitivity Type III Pneumonitis
-etiology
known as extrinsic allergic alveolitis
restrictive and occupational disease
predominant in nonsmokers (80%-95%)
TB diagnosis
sputum culture (definitive)
chest x ray (nodules with infiltrates in apex and posterior segments)
DNA/RNA tests
PFTs
What are two signs of status asthmaticus?
silent chest and acidosis
What are the clinical manifestations of chronic obstructive bronchitis?
excess body fluids, chronic cough, shortness of breath on exertion, increased spetum, and cyanosis in the late stage.
What is heard when listening to the chest of a patient with emphysema?
decreased breath sounds, decreased heart sounds, and prolonged expiration
Which COPD disease is a blue bloater?
Chronic obstructive brochitis
What is epiglottitis?
rapidly progressive cellulitis of the epiglottis
What are the clinical manifestations of bronchiectasis?
productive foul-smelling tri-layer sputum, digital clubbing, fever, and night sweats
what is the pathological manifestation of TB?
ghon complex which is a necrotic nodule that becomes fibrous and calcified
clinical manifestations of pneumonia
-general
*viral
+chlamydia
crackles/rales and bronchial breath sounds
chills
fever
cough and purulent sputum, except viral
*fever, dry cough, hoarseness, coryza, wheezing/crackles
+ cough, tachypnea, crackles, wheezing, no fever
Primary pneumothorax causes
spontaneous in thin men 20-40
cigarette smoking increases risk
rupture of small sub-pleural blebs in apices
Pulmonary function test results for diffuse interstitial lung disease
Decreased VC, TLC, and diffusing capacity
pathogenesis of pneumonia
Pulmonary inflammation is causes by microbes. Alveolar septa are invaded by inflammatory cells, and alveoli fill with exudative fluid, except in viral pneumonia.
Treatment of croup in the hospital and out
In: O2, nebulizer epi and intubation
Out: mist, oral hydration,and rest
What is croup and who does it affect?
Acute viral inflammation of the larynx. Affects kids 6 m/o to 3 y/o.
What body build type is associated with bronchitis?
stocky/overweight
Legionnaires disease
-etiology
-signs and symptoms
-treatment
-spread by A/C units and hot tubs
-fever, diarrhea, abdominal pain, liver and kidney failure, and pulmonary infiltrates
-macrolide abx
What disease often coincides with bronchiolitis?
otis media
Pathogenesis of croup
Inflammation of entire airway an edema in the subglottic region
In which COPD disease is central cyanosis present?
late stage of bronchitis
Diagnosis of pneumothorax
ABG for decreased PaO2
EKG
Chest x ray
What are restrictive disorders characterized by?
reduction in lung volume, problem with inhalation, air will not enter lung after inhalation
clinical manifestations of pneumothorax
sudden chest pain on the affected side
lack of breath sounds
hyper resonance
SOB
tachycardia
hypotension
tracheal shift
subcutaneous emphysema
Hypersensitivity Type III Pneumonitis
-diagnosis
-lab values
history, antibodies, scratch testing, PFT, chest xray
labs: increased WBC, decreased PaO2, increased sedimentation rate, increase C-reactive protein
Secondary pneumothorax causes
result of complications from preexisting pulmonary disease
ruptured cyst or bleb
Which COPD disease presents with pursed-lip breathing?
emphysema
What is the result of mediastinum shift due to collapsed lung
decreased venous return and cardiac output
Physiology of the immediate stage of asthma
release of histamine, bronchoconstriction, and bronchial edema
What are the clinical manifestations of emphysema?
use of accessory muscles to breath, pursed lip breathing, minimal or absent cough, tripoding, barrel chest, digital clubbing, and shortness of breath on exertion.
Occupational lung disease
-diagnosis
chest xray, PFT, ABG
miliary tuberculosis
TB bacteria spread throughout body through the blood.
Clinical manifestations of croup
barking cough with stridor
Diffuse interstitial lung disease
-pathogenesis
Pathogenesis: injury of alveolar epithelial or capillary endothelial cells leads to abnormal healing which tissue around the alveoli becomes scarred and thickened. Leads to large air filled sacs (cysts) and dilated bronchioles which creates a honey comb pattern in xrays. Inflammation, fibrosis, and destruction.
