Pulm 1 Shea Flashcards
What are the 4 diseases which compromise COPD?
- Chronic Bronchitis
- Emphysema
- Bronchial Asthma
- Bronchiectasis
(may coexist w/ one another)
A clinical term used for lung diseases characterized by chronic airway obstruction w/ increased resistance to air flow.
COPD
(chronic obstructive pulmonary disease)
What is the #1 bronchogenic carcinoma?
Squamous Cell Carcinoma
A chronic cough and production of sputum for a set time. What are the time parameters and which disease is this?
- Chronic Bronchitis
- Minimum of 3 months/year for at least 2 consecutive years
What causes 90% of cases of chronic bronchitis?
- Smoking, it correlates w/ # of cigarettes (pack year)
- Clinical sxs improve w/ cessation
What other 4 things play a role in the development or not of Chronic Bronchitis?
- Good genetics may prevent people of smoke from getting COPD
- Air polution
- Exposure to toxic fumes
- Pneumonias
Pathology of which disease?
- Fibrous thickening of the walls of the bronchi and bronchiole
- Their lumens are completely filled w/ thickened mucous
- Hypertrophy of bronchial mucous glands
- Increased # of goblet cells
- Mucosa is infiltrated w/ which 3 things??
- Chronic Bronchitis
- Mucosa contains:
- lymphocytes
- macrophages
- plamsa cells
Pathology of which disease?
- Surface epithelium w/ time may show focal ulcerations or metaplasia of columnar epithelium into –> stratified squamous epithelium
Chronic Bronchitis
Which disease?
- Increased mucous production causing prolonged coughing, expectoration of thick tenacious or purulent sputum and dyspnea
- Hypoxia may be so pronounced during coughing that it causes cyanosis.
Chronic Bronchitis
(Blue Bloaters)
- What is Cor Pulmonale?
- Which disease predisposes a patient to developing this?
- Right heart failure
- Chronic Bronchitis can lead to CHF/right heart failure/Cor Pulmonale
Which disease can lead to pulmonary hypertension?
Chronic Bronchitis
Is the pulmonary vasculature involved in chronic bronchitis?
Yes, the pulm vasculature is affected by the peribronchial fibrosis which results in pulm HTN and Cor Pulmonale.
Enlargement of airspaces distal to the _____ bronchioles w/ destruction of alveolar walls.
- Emphysema
- Terminal bronchioles
Which disease is rare in “non-smokers” except in patients w/ a ____ deficiency of _____?
- Emphysema
- Genetic deficiency
- Alpha 1 Antitrypsin
Pathology of which disease?
- Irritants in smoke provoke an influx of inflammatory cells into alveoli
Emphysema
W/ Emphysema, what causes the alveolar walls to be destroyed, leading to enlargement of the alveolar spaces?
- Leukocytes release proteolytic enzymes which causes destruction of the alveolar walls
W/ Emphysema, what accounts for the loss of elastin fibers in the alveolar walls?
Increased activity of leukocyte-derived elastases in the lungs
Pathology of which disease?
- Grossly, lungs are enlarged and remain filled w/ air and DO NOT collapse
- Lungs are whiter than normal, billowy, and touch in the chest midline
Emphysema
Subpleural air-filled spaces formed by rupture alveoli which can rupture into the pleural cavity causing a _____.
( a small collection of air between the lung and the outer surface of the lung (visceral pleura) usually found in the upper lobe of the lung. )
- Bleb
- causing a pneumothorax
Parenchymal air filled spaces greater than 1 cm in diameter
(Lung parenchyma is the portion of the lung involved in gas transfer - the alveoli, alveolar ducts and respiratory bronchioles. )
Bullae
Which disease?
- No bronchial obstruction
- Compensatory tachypnea, why?
- Over-expanded chest
- “Barrel-Shaped” chest
- What position are they in and why?
Emphysema
- Tachypneic bc/ of reduced respiratory surface
- Hunched forward to engage auxiliary respiratory muscles
Are emphysema patients hyperventilating or hypoventilating?
Hyperventilating, they oxygenate the blood adequately, so they are not blue and have no brain anoxia.
“Pink Puffers”
What are the 6 chest x-ray findings of a pt w/ emphysema?
- Clear lung fields
- Over inflated lungs
- Barrel Shaped chest
- Increased interstitial markings
- Flattened diaphragm
- Long AP diameter
- Some dyspnea
- Terrible cough
- Mucopurulent sputum
- Cyanosis
- Pulm HTN
- Peripheral edema
- Densities on radiograph
Bronchitis
- Bad dyspnea
- Mild cough
- +/- sputum
- Mucoid sputum if any
- No cyanosis
- No pulm HTN
- No peripheral edema
- Overinflation of radiograph
Emphysema
Which of the COPD diseases have (Hypertrophy and Hyperplasia)?
- Chronic Bronchitis
- Bronchial Asthma
- Which 2 of the 4 COPD diseases have the most mucous production? (overabundance of mucus in the lumen)
- And which of the 2 has more mucus than the other?
- Chronic Bronchitis (way more mucus)
- Bronchial Asthma
Which of the COPD diseases have lungs described as pink and billowy which touch midline?
- Emphysema
- Bronchial Asthma
Increased responsiveness of the bronchial tree to variety of stimuli
Bronchial Asthma
3 sxs of bronchial asthma
- wheezing during expiration
- cough
- dyspnea
Age and sex most affected by Bronchial Asthma
- 50% of cases develop in childhood
- Males 2X more
Mucus containing whorls of shed epithelial cells
Curschmann Spirals
(Bronchial Asthma)
A patient w/ which disease needs to worry about getting an acute PNA?
Bronchiectasis
A permanent dilatation of the bronchi, which is the most common complication of chronic bronchitis
Bronchiectasis
Which disease?
- Abnormally dilated bronchi
- Bronchioles filled w/ mucopurulent material which stagnates (cannot be cleared by coughing)
- Infected occurs due to stagnation, spreads to adjacent alveoli, recurrent PNAs are common
- Hematogenic spread of infection to other organs
- Adhesions between lobes may occur
Bronchiectasis
- While auscultating lung fields of a 45 yr old patient w/ bronchiectasis, the patient has an exam finding significant for their diagnosis.
- What is this exam finding which is due to the mucous sitting stagnant in the bronchiole tubes?
Halitosis (bad breath)
Inflammation of lung that occurs in 2 major forms
Pneumonia
- Alveolar PNA
- Intersitial PNA
Inflammation of the lung marked by intra-alveolar inflammation
Alveolar PNA
What are the 2 types of Alveolar PNA?
- Bronchopneumonia (patchy)
- Lobar pneumonia (diffuse - confluence)
Inflammation of the lung which primarily involved the alveolar septae
Interstitial pneumonia
Which PNA is bacterial?
Alveolar PNA
Which PNA is viral?
Interstitial PNA
Which type of PNA has PMN leukocytes inside the alveolus?
Alveolar (bacterial) PNA
Which type of PNA has a layer of fibrin along the alveolus?
Intersitial (viral) PNA
2nd largest protein in the body?
Fibrinogen
Which type of PNA has no neutrophils or bacteria?
Intersitial (viral) PNA
Which PNA can be classified as either focal or diffuse?
Alveolar PNA (bacterial)
Which PNA may be limited to the alveoli or may involve the alveoli and the bronchi?
Alveolar PNA
