Pulm pathology prt 2 Flashcards
Pleuritic pain is caused by an irritated ___ nerve
Phrenic
(C3-4-5) referred to shoulder
Patients with ___ are at increased risk for lung abscess due to the aspiration of oral flora during periods of unconsciousness.
alcohol use disorder
The main pathogens of aspiration induced lung abscess are ____ of the oral flora
strict and facultative anaerobic
(Bacteroides, Prevotella, Fusobacterium, Peptostreptococcus).
Manifestations include subacute fever, cough, and foul-smelling sputum.
aspiration induced lung abscess
Lobar pneumonia is marked by the cytokine-mediated accumulation of neutrophils and _____ material in the alveoli. Over several days, the material becomes fibrinous.
neutrophils are replaced by macrophages, and macrophages digest the fibrinous exudate,
thereby restoring normal lung histology.
proteinaceous
bilateral "Velcro"-sounding crackles Reticular nodular (bright, branching, lines) opacities
Pulmonary fibrosis
Lung parenchyma inflammation
Aspiration of gastric acid with direct tissue injury
chemical pneumonitis
Periods of altered consciousness (alcoholism, seizures, dementia)
Impaired swallowing (nasogastric tube, dysphagia)
Periodontal disease, particularly gingivitis
Increased risk for
Lung abscess from microaspiration
fever, cough productive of copious sputum (often foul-smelling), and chest x-ray evidence of cavitation with air-fluid level.
Lung abscess
(microaspiration, untreated pneumonia)
NEUTROPHILS MEDIATE Liquifying necrosis
has a propensity to affect older adults with chronic lung disease who smoke.
It causes high fever, diarrhea, headache, and confusion.
It is a non-staining gram-negative rod diagnosed by PCR
Legionella pneumophila
triad of respiratory distress, neurologic dysfunction, and petechial rash that characterizes the condition
Fat Embolism
Recent trauma
syndrome commonly presents with chronic fatigue, dyspnea, and difficulty concentrating.
Obesity hypoventilation
*OHS results from physical restriction of lung expansion by excessive thoracic tissue mass. Low TV
Loss of intrapleural negative pressure (pneumothorax) causes the chest wall to spring outward & inspiratory compliance is
decreased
*Hemithorax increases in volume
Age-related changes to the respiratory system include decreased chest wall compliance and ____ alveolar elastic recoil with resulting alveolar enlargement and air trapping.
decreased
Malignancies like adenocarcinoma can cause Pleural effusion due to increased vascular permeability or ___
*Lymphatic obstruction
Thoracentesis yields fluid with a large number of red blood cells and numerous atypical cells staining positive for mucin
Pleural fluid normally enters the pleural space via intercostal microvessels of the parietal pleura, and exits the pleural space via
parietal pleura lymphatics.
*Visceral pleural fluid comes from bronchial microvessels
Autosomal dominant mutations impairing TGF-β signaling
Disrupted angiogenesis & loss of vascular integrity causing VASCULAR malformation
Hereditary Hemorrhagic Telangiectasia
telangiectasia
Recurrent nose bleeds
Visceral organ Vascular Malformation:
gastrointestinal tract (bleeding), lung (hemoptysis), brain (hemorrhagic stroke), liver
Complications High-output heart failure Pulmonary hypertension Paradoxic embolism Iron deficiency anemia
Hereditary Hemorrhagic Telangiectasia
In the lungs, the binding of O2 to hemoglobin drives the release of ____(2) from hemoglobin (Haldane effect).
H+ and CO2
In the _____ tissues, high concentrations of CO2 and H+ facilitate O2 unloading from hemoglobin (Bohr effect).
peripheral
Ciliated epithelium persists up to and ends at the respiratory
bronchioles
(Proximal bronchioles → Terminal → Respiratory bronchioles) PTR
Terminal bronchiles have ciliated epithelium, serous glands, and
club cells
After terminal bronchioles are RESPIRATORY bronchioles which have only ciliated cells, club cells and
Macrophages
*next comes alveoli which also have MQs
Patients who are upright tend to aspirate into the ___ segments of the lower lobes.
basilar
Supine patients typically aspirate into the ___ segments of the upper lobes and ____ segments of the lower lobes.
posterior
superior
Ventilation is lowest in the ___ and highest in the ___ because gravity acts to stretch the lungs downward so that the alveoli at the apex are expanded more than those at the base
apex
base
Perfusion is also lowest in the ___ and highest in the ___, as the increased hydrostatic pressure in the lower lung regions facilitates increased blood flow.
apex
base
increased extraction of oxygen by skeletal muscle results in _____ mixed venous oxygen content
decreased
IL-4 causes
IgE production
IL-5 causes
Eosinophil recruitment
bronchoconstriction is mediated by the ___ nervous system when the vagus nerve is stimulated (via an inhaled irritant)
parasympathetic
Supplemental oxygen administration in patients with chronic obstructive pulmonary disease can lead to increased CO2 retention (oxygen-induced hypercapnia), resulting in confusion and depressed consciousness. The major cause is reversal of hypoxic pulmonary vasoconstriction, which increases physiologic dead space as blood is shunted away from well-ventilated alveoli.
Arterial partial pressure of carbon dioxide (PaCO2) is the major stimulator of respiration in healthy individuals; even a slight increase in PaCO2 stimulates central chemoreceptors and triggers increased ventilation. In patients with chronic obstructive pulmonary disease, the response to PaCO2 is blunted and hypoxemia can contribute to respiratory drive. Peripheral chemoreceptors are primarily responsible for sensing arterial partial pressure of oxygen (PaO2) and can be suppressed with oxygen administration causing hypoventilation
Patients with severe emphysema typically have chronic ____ leading to chronic respiratory acidosis with metabolic compensation and hypoxemia
CO2 retention
is the predominant substance contained within eosinophilic granules, and it acts as a potent toxin against helminths (parasitic worms).
Major basic protein
Aspirin/NSAIDs Nonselective beta blockers Upper respiratory infection Exercise & cold, dry air Gastroesophageal reflux disease can cause
Asthma exacerbation
eosinophilia
is a major problem in lung transplant recipients; it affects small airways, causing bronchiolitis obliterans. It is characterized by lymphocytic inflammation, fibrosis, and, ultimately, destruction of the bronchioles.
Chronic rejection
Thickened bronchial walls, lymphocytic infiltration, mucous gland enlargement, and patchy squamous metaplasia of the bronchial mucosa are features of
chronic bronchitis
Exposure to high temperature or exercise can lead to hyponatremia and hypochloremia due to excessive sodium chloride loss through sweat; therefore, salt supplementation is recommended.
Cystic Fibrosis
Vitamin A maintains orderly differentiation of specialized epithelia, including the mucus-secreting columnar epithelia of the ocular conjunctiva, respiratory and urinary tracts, and pancreatic and other exocrine ducts. Avitaminosis A can cause squamous metaplasia of such epithelia to a keratinizing epithelium.
Cystic Fibrosis causing Pancreatic Problems
This neonate has respiratory distress with asymmetric breath sounds and a scaphoid abdomen, findings concerning for congenital
diaphragmatic hernia (CDH) *causes pulm HYPOplasia
In cystic fibrosis, impairment of the cystic fibrosis transmembrane conductance regulator (CFTR) protein reduces chloride secretion and ___ sodium absorption by the respiratory epithelia, resulting in dehydrated mucus.
increases
*When saline is applied to the nasal mucosa, the increased sodium absorption in patients with CF causes a more negative nasal transepithelial potential difference
This mutation causes impaired post-translational processing (eg, improper folding and glycosylation) of the receptor protein, which is detected by the endoplasmic reticulum. As a result, the abnormal protein is targeted for proteasomal degradation, preventing it from reaching the cell surface. Certain drugs (lumacaftor) can partially correct this folding defect, leading to expression of functional receptor protein on cell surface
CFTR
Cystic Fibrosis
