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Patho Exam 2 > Patho Pulmonary System > Flashcards

Patho Pulmonary System Flashcards

1
Q

Alveoli and Lungs

A

Alveoli: Primary gas exchange units

Lungs contain approximately 25 million alveoli at birth and 300 million by adulthood

Pulmonary circulation has a lower pressure (18 mmHg) than systemic circulation (90 mmHg).

Only one third of vessels filled with blood at any given time.

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2
Q

Gases of Respiration

A

Primary function of respiratory system

  • Remove CO2
  • Addition of O2

Insufficient exchange of gasses

  • Hypoxemia
  • Hypercapnia
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3
Q

Hypoxemia

A

Hypoxemia results from

  • An inadequate O2 in the air
  • Disease of the respiratory system
  • Dysfunction of the neurological system
  • Alterations in circulatory function
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4
Q

Mechanisms of Hypoxia

A

Mechanisms

  • Hypoventilation
  • Impaired diffusion of gases
  • Inadequate circulation of blood through the pulmonary capillaries
  • Mismatching of ventilation and perfusion
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5
Q

Mild Hypoxemia

A

-Metabolic acidosis
-Increase in heart rate
Peripheral vasoconstriction
-Diaphoresis
-Increase in blood pressure
-Slight impairment of mental performance

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6
Q

Chronic Hypoxemia

A
  • Manifestations of chronic hypoxia may be insidious in onset and attributed to other causes.
    • –Compensation masks condition.
  • Increased ventilation
  • Pulmonary vasoconstriction
  • Increased production of red blood cells
  • Cyanosis
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7
Q

Signs and Symptoms of Dysfunction

A 
Dyspnea
Hyperventilation
Abnormal breathing patterns
Coughing
Hypoxema
Hypercapnia 
Cyanosis
Changes in mentation
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8
Q

Areas Involved in Respiratory Tract Infections

A

Upper respiratory tract
–Nose, oropharynx, and larynx

Lower respiratory tract
–Lower airways and lungs

Upper and lower airways

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9
Q

Common Respiratory Infections

A 
Common cold
Influenza
Pneumonia
Tuberculosis
Fungal infections of the lung
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10
Q

Transmission of Common Cold

A

Viral infection of the upper respiratory tract
—Rhinoviruses, parainfluenza viruses, respiratory syncytial virus, corona viruses, and adenoviruses

Fingers are the greatest source of spread.

Cough, sneeze
—The nasal mucosa and conjunctival surface of the eyes are the most common portals of entry of the virus.

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11
Q

Types of Influenza Viruses

A

Type A and Type B

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12
Q

Type A Influenza Virus

A
  • Most common type
  • Can infect multiple species
  • Causes the most severe disease
  • Further divided into subtypes based on two surface antigens: hemagglutinin (H) and neuraminidase (N)
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13
Q

Type B Influenza Virus

A

Has not been categorized into subtypes

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14
Q

Antiviral Drugs

A

Amantadine

Rimantadine

Zanamivir

Oseltamivir

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15
Q

Trivalent inactivated influenza vaccine (TIIV)

A

Developed in the 1940s

Administered by injection

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16
Q

Live, attenuated influenza vaccine (LAIV)

A
  • Approved for use in 2003

- Administered intranasally

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17
Q

Pneumonia Definition

A

Respiratory disorders involving inflammation of the lung structures (alveoli and bronchioles)

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18
Q

Pneumonia Causes

A

Infectious agents: such as bacteria and viruses

Noninfectious agents: such as gastric secretions aspirated into the lungs

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19
Q

Factors Facilitating Development of Pneumonia

A

An exceedingly virulent organism

A large inoculum

Impaired host defenses

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20
Q

Classifications of Pneumonias

A

According to the source of infection

  • –Community-acquired
  • –Hospital-acquired

According to the immune status of the host
—Pneumonia in the immunocompromised person

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21
Q

Tuberculosis

A

World’s foremost cause of death from a single infectious agent

Causes 26% of avoidable deaths in developing countries

Lungs most commonly infected

1/3 of world’s population has TB
countries

Drug-resistant forms

Mycobacterium tuberculosis hominis

  • –Aerobic
  • –Protective waxy capsule
  • –Can stay alive in “suspended animation” for years
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22
Q

Forms of Tuberculosis

A

M. tuberculosis hominis (human tuberculosis)

Bovine tuberculosis

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23
Q

M. tuberculosis hominis (human tuberculosis

A

Airborne infection spread by minute droplet nuclei harbored in the respiratory secretions of persons with active tuberculosis

Living under crowded and confined conditions increases the risk for spread of the disease

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24
Q

Bovine tuberculosis

A

Acquired by drinking milk from infected cows; initially affects the gastrointestinal tract

Has been virtually eradicated in North America and other developed countries

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25
Q

Diagnostic Studies

A

Tuberculin skin test (TST)
—AKA: Mantoux test

—Assess for induration in 48 – 72 hours

—Positive if ≥15 mm induration in low-risk individuals

—Response ↓ in immunocompromised patients
Reactions ≥5 mm considered positive

—Interferon-γ gamma release assays (IGRAs)

—Chest x-ray

—Bacteriologic studies

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26
Q

Tuberculosis: Clinical manifestations

A

Latent tuberculosis infection: Asymptomatic

Fatigue, weight loss, lethargy, anorexia etc Diagnosis

Positive tuberculin skin test (TST) a purified protein derivative (PPD): Does not differentiate past, latent, or active disease

Sputum culture, immunoassays, indirect drug susceptibility testing

Chest radiographs

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27
Q

Tuberculosis: Treatment

A

Isoniazid, rifampin, pyrazinamide, and ethambutol

Drug-resistant bacilli: Combination of at least four drugs to which the microorganism is susceptible, administering for 18 months
—-Review drug effectiveness at 6 months

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28
Q

Lung Cancer

A

Causative factors: Smoking
Asbestos
Familial predisposition

Primary lung tumors (95%) versus bronchial, glandular, lymphoma

Secondary via metastasis

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29
Q

Categories of Bronchogenic Carcinomas

A

Squamous cell lung carcinoma (25% to 40%)

Adenocarcinoma (20% to 40%)

Small cell carcinoma (20% to 25%)

Large cell carcinoma (10% to 15%)

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30
Q

Squamous cell lung carcinoma (25% to 40%)

A

Closely related to smoking

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31
Q

Adenocarcinoma (20% to 40%)

A

Most common in North America

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32
Q

Small cell carcinoma (20% to 25%)

A

Small round to oval cells, highly malignant

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33
Q

Large cell carcinoma (10% to 15%)

A

Large polygonal cells, spread early in development

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34
Q

Categories of the Manifestations of Lung Cancer

A

Those due to involvement of the lung and adjacent structures

The effects of local spread and metastasis

The nonmetastatic paraneoplastic manifestations involving endocrine, neurologic, and connective tissue function

Nonspecific symptoms such as anorexia and weight loss

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35
Q

Respiratory Disorders in Children

A

Upper airway infections
-Viral croup
-Spasmodic croup
Epiglottis

Lower airway infection
-Acute bronchiolitis

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36
Q

Impending Respiratory Failure in Infants and Children

A

Rapid breathing

Exaggerated use of the accessory muscles

Retractions

Nasal flaring

Grunting during expiration

37
Q

Pleura

A

Parietal pleura lines the thoracic wall and superior aspect of the diaphragm.

Visceral pleura covers the lung.

Pleural cavity or the space between the two layers contains a thin layer of serous fluid.

38
Q

Characteristics and Symptoms of Pleural Pain

A

Abrupt in onset

Unilateral; localized to lower and lateral part of the chest

May be referred to the shoulder

Usually made worse by chest movements

Tidal volumes are kept small.

Breathing becomes more rapid.

Reflex splinting of the chest may occur.

39
Q

Disorders of the Pleura

A

Pleural effusion: abnormal collection of fluid in the pleural cavity
-Transudate or exudate, purulent (containing pus), chyle, or sanguineous (bloody)

Hemothorax

Pleuritis

Chylothorax

Atelectasis

Empyema

40
Q

Types of Pneumothoraxes

A

Spontaneous Pneumothorax

Traumatic Pneumothorax

Tension Pneumothorax

41
Q

Spontaneous Pneumothorax

A

Occurs when an air-filled blister on the lung surface ruptures

42
Q

Traumatic Pneumothorax

A

Caused by penetrating or nonpenetrating injuries

43
Q

Tension Pneumothorax

A

Occurs when the intrapleural pressure exceeds atmospheric pressure

44
Q

Causes of Disorders of Lung Inflation

A

Conditions that produce lung compression or lung collapse

  • -Compression of the lung by an accumulation of fluid in the intrapleural space
  • -Complete collapse of an entire lung as in pneumothorax
  • -Collapse of a segment of the lung as in atelectasis
45
Q

Pleural Effusion definition

A

An abnormal collection of fluid in the pleural cavity

46
Q

Pleural Effusion: Types of Fluid

A 
Transudate
Exudate
Purulent drainage (empyema)
Chyle
Blood
47
Q

Diagnosis of Pleural Effusion

A

Chest radiographs, chest ultrasound

Computed tomography (CT)

48
Q

Treatment of Pleural Effusion

A

Treatment: directed at the cause of the disorder

Thoracentesis

Injection of a sclerosing agent into the pleural cavity

Open surgical drainage

49
Q

Atelectasis Definition

A

The incomplete expansion of a lung or portion of a lung

50
Q

Causes of Atelectasis

A

Airway obstruction

Lung compression such as that occurs in pneumothorax or pleural effusion

Increased recoil of the lung due to loss of pulmonary surfactant

51
Q

Types of Atelectasis

A

Primary

Secondary

52
Q

Chest Trauma

A

Traumatic injuries to chest contribute to majority of all traumatic deaths

Range of injuries 
--Simple rib fractures → 
life-threatening organ rupture
--Blunt
--Penetrating
------Open wound through pleural space
53
Q

Chest Trauma

A

Hemothorax

  • -Blood in pleural space
  • -Treat with chest tube

Hemopneumothorax

Chylothorax

  • -Lymphatic fluid in pleural space
  • -Treat conservatively, with meds, surgery, or pleurodesis
54
Q

Asthma

A

A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production

Inflammation leads to cough, chest tightness, wheezing, and dyspnea.

The most common chronic disease of childhood

Can occur at any age

Allergy is the strongest predisposing factor.

55
Q

Contributing Factors to an Asthmatic Attack

A

Allergens

Respiratory tract infections

Exercise

Drugs and chemicals

Hormonal changes and emotional upsets

Airborne pollutants

Gastroesophageal reflux

56
Q

Factors Involved in the Pathophysiology of Asthma

A

Genetic

  • Atopy
  • Early versus late phase

Environmental

  • Viruses
  • Allergens
  • Occupational exposure
57
Q

Classifications of Asthma Severity

A

Mild intermittent

Mild persistent

Moderate persistent

Severe persistent

58
Q

Asthma Clinical Manifestations

A

-Asymptomatic between attacks

  • Chest constriction, expiratory wheezing, dyspnea, nonproductive coughing, prolonged expiration, tachycardia, tachypnea
  • Pulsus paradoxus
  • Status asthmaticus
  • -Bronchospasm not reversed by usual measures
  • -Life-threatening
-Ominous signs of impending death
Silent chest (no audible air movement) and a Paco2greater than 70 mmHg
59
Q

Chronic Obstructive Airway Disease

A

Inflammation and fibrosis of the bronchial wall

Hypertrophy of the submucosal glands

Hypersecretion of mucus

Loss of elastic lung fibers
–Impairs the expiratory flow rate, increases air trapping, and predisposes to airway collapse

Alveolar tissue
–Decreases the surface area for gas exchange

60
Q

Causes of Chronic Obstructive Airway Disease

A

Chronic bronchitis

Emphysema

Bronchiectasis

Cystic fibrosis

61
Q

Types of Chronic Obstructive Pulmonary Disease

A

Emphysema

Chronic Obstructive Bronchitis

62
Q

Emphysema

A

Enlargement of air spaces and destruction of lung tissue

Types: centriacinar and panacinar

63
Q

Chronic Obstructive Bronchitis

A

Obstruction of small airways

64
Q

Characteristics of Pulmonary Emphysema

A

Smoking history

Age of onset: 40 to 50 years

Often dramatic barrel chest

Weight loss

Decreased breath sounds

Normal blood gases until late in disease process

Cor pulmonale only in advanced cases

Slowly debilitating disease

65
Q

Characteristics of Chronic Bronchitis

A

Smoking history

Age of onset 30 to 40 years

Barrel chest may be present

Shortness of breath, a predominant early symptom

Rhonchi often present

Sputum frequent, an early manifestation

Often dramatic cyanosis

Hypercapnia and hypoxemia may be present.

Frequent cor pulmonale and polycythemia

Numerous life-threatening episodes due to acute exacerbations

66
Q

Pathophysiology of Chronic Bronchitis

A

Mucous accumulation

Mucous plug

Hyperinflation of aveoli

Inflammation of epithelium

Enlarged submucosal gland

67
Q

Bronchiectasis

A

Permanent dilation of the bronchi and bronchioles

Secondary to persisting infection or obstruction

Bronchiectasis demonstrates a damaged cell wall and increased mucuous

68
Q

Manifestations of Bronchiectasis

A

Atelectasis

Obstruction of the smaller airways

Diffuse bronchitis

Recurrent bronchopulmonary infection

Coughing; production of copious amounts of foul-smelling, purulent sputum; and hemoptysis

Weight loss and anemia are common

69
Q

Definition of Cystic Fibrosis

A

An autosomal recessive disorder involving fluid secretion in the exocrine glands and the epithelial lining of the respiratory, gastrointestinal, and reproductive tracts

70
Q

Cause of Cystic Fibrosis

A

Mutations in a single gene on the long arm of chromosome 7 that encodes for the cystic fibrosis transmembrane regulator (CFTR), which functions as a chloride (Cl−) channel in epithelial cell

71
Q

Manifestations of Cystic Fibrosis

A

Pancreatic exocrine deficiency

Pancreatitis

Elevation of sodium chloride in the sweat

Excessive loss of sodium in the sweat

Nasal polyps

Sinus infections

Cholelithiasis- the formation of gallstones

72
Q

Definition of Diffuse Interstitial Lung Diseases

A

A diverse group of lung disorders that produce similar inflammatory and fibrotic changes in the interstitium or interalveolar septa of the lung

73
Q

Types of Diffuse Interstitial Lung Diseases

A

Sarcoidosis

The occupational lung diseases

Hypersensitivity pneumonitis

Lung diseases caused by exposure to toxic drugs

74
Q

Occupational Lung Diseases

A

Pneumoconioses

Hypersensitivity diseases

Byssinosis

75
Q

Pneumoconioses

A

The inhalation of inorganic dusts and particulate matter

76
Q

Hypersensitivity diseases

A

The inhalation of organic dusts and related occupational antigens

77
Q

Byssinosis

A

cotton workers; has characteristics of the pneumoconioses and hypersensitivity lung disease

78
Q

Development of Pulmonary Embolism

A

A blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flow

79
Q

Types of Development of Pulmonary Embolism

A

Thrombus: arising from DVT

Fat: mobilized from the bone marrow after a fracture or from a traumatized fat depot

Amniotic fluid: enters the maternal circulation after rupture of the membranes at the time of delivery

80
Q

PE Risk Factors

A 
Deep vein thrombosis 
Immobility or reduced mobility
Surgery 
History of DVT
Malignancy
Obesity
Oral contraceptives/ hormones
Smoking
Heart failure
Pregnancy/delivery
Clotting disorders
Atrial fibrillation
Central venous catheters
Fractured long bones
81
Q

Cor Pulmonale

A

Right heart failure resulting from primary lung disease and long-standing primary or secondary pulmonary hypertension

Involves hypertrophy and the eventual failure of the right ventricle

Manifestations include the signs and symptoms of the primary lung disease and the signs of right-sided heart failure.

82
Q

Right Sided <3 Failure (Cor Pulmonale)

A 
Manifestations:
Fatigue
Ascites
Enlarged Liver and Spleen
May be secondary to chronic pulmonary problems
Distended Jugular Veins
Anorexia and complaints of GI distress 
Weight gain 
Dependent Edema
83
Q

Acute Respiratory Distress Syndrome

A

A number of conditions that produces pathologic lung changes that include diffuse epithelial cell injury with increased permeability of the alveolar–capillary membrane

84
Q

Causes of Acute Respiratory Distress Syndrome

A

Aspiration of gastric contents

Major trauma (with or without fat emboli)

Sepsis secondary to pulmonary or nonpulmonary infections

Acute pancreatitis

Hematologic disorders

Metabolic events

Reactions to drugs and toxins

85
Q

Causes of Respiratory Failure

A

Impaired ventilation

Impaired matching of ventilation and perfusion

Impaired diffusion

86
Q

Impaired ventilation

A

Upper airway obstruction

Weakness of paralysis of respiratory muscles

Chest wall injury

87
Q

Impaired diffusion

A

Pulmonary edema

Respiratory distress syndrome

88
Q

Treatment of Respiratory Failure

A

Respiratory supportive care directed toward maintenance of adequate gas exchange

Establishment of an airway

Use of bronchodilating drugs

Antibiotics for respiratory infections

Ensure adequate oxygenation

89
Q

Tracheostomy

A

Surgically created stoma (opening) used to

  • Establish a patent airway
  • Bypass an airway obstruction
  • Facilitate secretion removal
  • Permit long-term mechanical ventilation
  • Facilitate weaning from mechanical ventilation

Patho Exam 2 (2 decks)

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