Pulmonary disease Flashcards
1
Q
How much does each lung weigh
A
200-250 grams each (r is heavier)
2
Q
what does the lung consist of
A
Airways
BV
Connective tissue
Pleua
3
Q
what makes up the airways of the lungs
A
Trachea Bronchi bronchioles Terminal Cronchioles Respiratory unit (acini)
4
Q
what is the blood supply to the lungs
A
Pulmonary
Bronchial
5
Q
what is the main function of the lung
A
Gas exchange
6
Q
what all is needed for respiration to occur
A
uppre respiratory tract
Daiphram and accessory muscle
Neural regulation
7
Q
what lines the vocal cord
A
Stratified squamous epithelium
8
Q
what lines the large airways
A
Pseudostratified ciliated Columbar epithelium Mucus glands (mucosal submucosal) neuroendocrine cells and carilage
9
Q
types of alveoli cells
A
type I, flat pneumocytes
Type II, Cuboidal pneumocytes
10
Q
what type of alveolar cells are more common
A
Flat type I alveoli(95%)
11
Q
what type of Alveoli cells produce surfactant
A
Type II
12
Q
what makes up the alveolar capillary wall
A
Basement membrane and strands of interstitial connective tissue
13
Q
what makes up the large airwasy
A
Larynx
Trachea
Bronchi
14
Q
what is the defense mechanism of the upper airway
A
Filtering
15
Q
what is the defense mechanisms of the lower airway
A
Mucociliary apparatus
16
Q
what is the defense mechanisms of the lymphoid tissue
A
Cellular and humoral imunity(IgA)
17
Q
what cell is present in the alveoli to provide defence
A
Alveolar macrophages
18
Q
what is coughing up blood
A
Hemoptysis
19
Q
what is difficulty breathing, preception of needing to breathe deeper and faster
A
Dyspnea (shortness of breath)
20
Q
what is the collapse of lung volume
A
Atelectasis
21
Q
what is air in the pleural psace or cavity leading to the collapse of the lung
A
Pneumothorox
22
Q
what is the suppuration in pleural cavity
A
Empyema
23
Q
what is FLuid in the pleural space
A
Pleural effusion
24
Q
what is transudate
A
Low protein fluid
25
what causes transudate to form
increased venous pressure (CHF)
26
what is exudate
High protein fluid
27
can exudate have inflammatory cells
yes and no
28
what causes exudate
Increased vascular permeability (damage)
| - pneumonia
29
where does Pulmonary Edema fill
first in interstitial tissue, then distal air space
30
what causes pulmonary edema
```
Increased intravsacular pressur
Hypoproteinemia (low protein)
Vascular damage (infections, autoimmune diseases)
```
31
what is the problem with pulmonary edema
Inhibits normal oxygen exhange
| predisposes to infection
32
where do Pulmonary thromboemboli come from
Deep veins of the leg or pelvis
33
do all thromboemboli cause dmage
small cause minimal damage
| Large causes hemorrhage or infarction
34
where do cery large pulmonary thromboemobli lodge themsleves
Bifurcation of pulmonary arteries (saddle embolus)
35
what does saddle embolus lead to
Sudden death
36
what are the predisposing factors for pulmonary thrombo-emboli
chronic illness
Prolonged bed rest (immobility)
hypercoagulable state (factor V leiden)
deep vein thromboses (DVT)
37
what is Obstructive Pulmonary disease
Group of disease that results in airflow limitation or obstruction
38
what are the 4 classic disorders of Obstructive pulmonary disease
Emphysema
Chronic Bronchitis
Bronchiectasis
Asthma
39
what is the other name for Emphysema/Chronic Bronchitis
COPD
40
what is permanent enlargement of the distal small air spaces due to destruction of the alveolar septal walls
Emphyseam
41
how does Emphyseam present clinically
Dyspnea
Cough
Prolonged exhalation (pink puffers)
42
what is the pathogenesis of Emphyseam
Imbalance between protease and anti-protease enzymes
43
what is the major cause of the imbalance between protease and anti-protease enzymes
Smoking
44
what are the genetic causes of Emphysema
TGF-beta 1 polymorphisms
| alpha1 antitrypsin deficiency
45
what hapens to inflammatory cells in emphysema
Cytokines + Proteases degrade ECM
46
what happens to the epithelium in emphysema
Apoptosis
| Necrosis
47
what happens to the Mesenchumal cells in Emphyseam
Apoptosis
Impaired proliferation
Decreased contraction
decreased matrix synth
48
what is Centriacinar emphyseam
Central portion of the acini involved
49
what lobes tend to be infected with centriacinar emphyseam
Upper lobes
50
what problem is usually associated with centriacinar emphysema
Smoking
51
what is Panacinar emphyseam
involves entire acinar unit from the respiratory bronchioles to terminal alveoli
52
what lobes tend to be infected with Panacinar emphyseam
lower lobes
53
what problem is usually associated with Panacinar emphysema
Alpha1-AT deficiency
54
what is the sign that you have Chronic Bronchitis
Cough and sputum production for 3 consecutive months in 2 consecutive years
55
symptoms of Chronic Bronchitis
Hypoxemia
| Cyanosis (blue bloaters)
56
what is the pathogenesis of chronic Bronchitis
```
Chronic Irritiation (smoking)
Infection
```
57
what is the pathology of chronic Bronchitis
increased mucus gland layer
Chronic inflammation
fibrosis and narrowing of airways
58
what are the predisposing factors for chronic bronchitis and emphysema
Cigarette smoking
Atmosphere pollutants
Infection
genetic factors
59
what effect does cigarettes have to induce emphysema and chronic Bronchitis
```
Causes mucus gland hypertrophy
Increase smooth muscle tone
Inhibit cilia
Inhibit phagocytosis
induce squamous metaplasia
```
60
what genetic factors lead tochronic Bronchitis and emphyseam
Cf
| Alpha-1-AT deficinecy
61
what is bronchiectasis
Chronic infection with permanent major airway dilatuion
62
what does bronchiectasis follow
Obstruction, infection or both
63
what are the clinical signs of bronchiectasis
sever cough
Bloody mucoid
Expectoration
Dyspnea
64
what complications occur from bronchiectasis
Abscess
Pneumonia
Bronchopleual fistual
Empyema
65
what are the predisposing factors for Bronchiectasis
```
Obstructive tumors
Foreign bodies
Cystric fibrosis (mucus plus)
Other COPD
Suppurative or Necrotizin pneumonia
```
66
what pathology is associated with Bronchiectasis
Dilated distal bronchi and bronchioles
| Chronic infection with inflammation and variable purulence
67
what iw Asthma
Increased irritability and prominence of smooth muscle in bronchi and bronchioles
68
what does Asthma lead to
Marked, reversible episode of contraction and airway constriction
69
what are the initiating factors for asthma
```
Allergies
Infection
Exercise
drugs
Emotions
```
70
how common is asthma
5% of adults
7-10% kids
- esp inner city kids
71
Clinical signs of Asthma
Wheezing
long exhalation
hyperinflation of lungs
72
what are the types of Astham
Atopic
| Non-atopic
73
what is Atopic Asthma
Allergic and extrinsic
74
What is Non-atopic
intrinsic
75
what sensitivty causes Atopic Asthma
Type I hypersensitivity (IgE mediated)
76
what causes Atopic asthma
Environmental antigens
77
what type of asthma has a family history
Positive family history is common
78
what can initiate non-atopic asthma
Initiated by viruses
| Air pollutants
79
what type of asthma is triggered by emo stress, exervise, cold temps
atopic
| non-atopic
80
Pathology of asthma
Increased mucus glands
Smooth muscle hypertrophy
inflammation with eosinophils
type 2 helper T cells
81
what is the Pathogensis of asthma
Antigen binds to surface IgE on Mast cells releaseing a large number of mediates
Including histamine and leukotrienes
82
how to treat Asthma
attach subsides spontaneously
inhalation bronchodilators for immediate relief (albuterol)
Controler meds (corticosteroids)
83
how lethal is Pneumonia
one of the leading causes of death
84
what does Pneumonia do when relating to other disease
Complicates other chronic debilitating diseases
85
what organisms can cause pneumonia
any organism (bacterial, viral, fungal, parasites)
86
what are the predisposing factors for bacterial pneumonia
```
Loss of cough reflex(alcohol)
Injury to cilia
Decreased phagocytosis
pulmonary edema
Immunocompromised condition
```
87
what are the clinical sings of bacterial pneumonia
```
Cough
Dyspnea
Fever
Chills
Sputum production
```
88
where does Bronchopneumonia form
PAtchy process around the small bronchi
89
who tends to get Bronchopneumonia
Very old and young
90
where does Lobar Pneumonia form
the entire lobe
91
what bacteria causes Lobar pneumonia
Stroptococcus pneumiae in 90% of cases
92
who tends to get lobar pneumonia
Healthy adults
93
why doe Pulmonary edema increase the likelyhood of bacterial pneumonia
its a place where bacteria can thrive
94
why is it important to know which bacteria causes which type of pneumonia
Drives the antibiotic choice
95
what are the stages of inflammation of the lung
Congestion
Red Hepatization
gray hepatization
Resolution
96
what is early stage pneumonia
Red Hepatization
97
what causes red hepatization
Purulent exudate with many RBC's
98
what is Late stage pneumonia
grey hepatization
99
what causes Grey hepatization
exudate with fibrin and macrophages
| - RBC's broken down and gone
100
what is the eventual outcome of pneumonia
Complete resolution or a scar
101
what are the complications of Pneumonia
```
Abscess
Pleuritis
Pericardititis
Bacteremia
Empyema
```
102
what is Empyema
neutrophils in and out of the alveoli creating an adhesion to the pleural wall
103
how do you fix empyema
Must removed Adhesion
104
what cells do bacterial invasions recruit
neutrophil
105
what causes Atypical (interstital) pneumonia
Mycoplasma Pneumoniae
| Viruses
106
what are the clinical signs of atypical (interstitial pneumonia
Highly variable
- mild fever
- Headach
- dry cough
- Myalgia
- life thretening
107
what is the pathology of atypical (interstitial) pneumonia
Interstitial inflammation
mononuclear cells
Congestion and hyaline membranes (diffuse alveolar damage)
108
WHAT IS THE problem with Diffuse alveolar damge from atypical (interstitial) pneumonia
layer of Hyanline cartilage that does not exchange O2 well
109
speed of Acuute respiratory Distress syndrome
Rapidly developing and serieous
110
what does Acute respiratory distress syndrome look like
Histo like interstitial pneumonia
111
causes of acute respiratory distress syndrome
```
Shock
infection
trauma
Drug OD
irritiants
```
112
what get injured in Acute respiratory Distress syndrome
Endothelium and alveolar epithelium
113
what does Acute Respiratory Distress syndrom do to the endothelium
Icnreases its permability (leaky)
114
what does the leakyness of Acute Respiratory Distress Syndrome cause
no more room for air, and loses ability to oxygenate surrounding tissues
115
what are the clinical signs of pulmonary absecess
Cough
Fever
Purulent sputum
116
What are the predisoposing factors to pulmonary abscess
```
Bronchiectasis
Aspiration
Septic emboli
Airway obstruction
dental sepsis
```
117
what is the course taken by pulmonary abscess
Scar
Cavitate
Progressive enlargement to make a hole in tissue
118
what causes Tuberculosis
Mycobacterium tuberculosis
119
how much are infected with TB
1/3 of world population
120
how common is death via tuberculosis
most common infectious cause of death (1.5 mill/year)
121
how has the prevelance of TB changed in the US
mid 80s numbers rose and has now been declining since the 90s
122
what tends to be the causes of TB in the US
HIV infection
Overcrowding
Poor living conditions
Immigrants
123
what is the shape of Mycobacterium tubeculosis
Bacillus (rod)
124
what does Mycobacterium tuberculosis like to breath
Aerobe
125
how does Mycobacterium tuberculosis Move
Non-motile
126
how fast does Mycobacterium tuberculosis Grow
slow
127
how does Mycobacterium tuberculosis stain
Acid fast bacilus do to wazy coat that resistas acid destaiing
128
what kind of inflammation does mycobacterium tuberculosis lead to
Caseating granulomatous inflammation (classic tissue reaction)
129
how is Tuberculosis acquired
Inhalation
130
what is the early site of TB infection
Ghon lesion
131
what is the Ghon Complex
the lung lesion +hilar lymph nodes infected with TB
132
what inefficient method does the body have to stop TB
tries to wall it off, but still in effective
133
where does Cavitary TB occur
at the Apex
134
what does Cavity TB eventually lead to
Significant scarring
135
where may cavitary TB seed
Large Airways
Lymph nodes
Blood
136
how might cavitary TB affect the pleura
Effusion
137
how does Tubercuolosis Heal
becomes inactive or progresses (90-95% of cases resolve)
138
what happens to TB cases that have resolved/inactivated
Reactivate many years later
139
what does reactivation of TB lead to
Induces type IV hypersensitivity and tissue necrosis
140
what is Miliary TB
multi organ invovlement of TB dissemination
141
why might TB reactivate
Immunity wanes(immunosenscnece, Immunosuppressive Treatment)
142
what causes Miliary TB
spread via lymph or blood
143
what are the bits of TB that spread in miliary TB called
Millet Seeds
144
where might Miliary TB spread
```
Other lung
CNS
kidney
Adrenals
Bones and Bone marrow
Liver
spleen
```
145
what can cause Granulomatous lung disease
TB (classic)
Fungal infections
Sarcoidosis
146
what is the usual fungal infection that causes Granulomatous
histoplasmosis, esp in ohio
147
what is the leading cause of cancer deaths
Lung cancer
148
risk factors for lung cancer
Cigs
Asbestos
Radon
Nickel, chromates, pollutants, lung scar
149
what are the clinical signs of lung cancer
```
Cough
weight loss
Chest pain
Hemoptysis
Dyspnea
```
150
what can lung cancer tumors produce
Hormones
- paraneoplastic syndrome
- ADH, ACTH, PTH, and others
151
what are the types of lung cnacer
```
Squamous cell carcinoma(25-30%)
adenocarcinoma(30-35%)
Small cell(20-25%)
Large cell(10-15%)
Bronchioloalveolar carcinoma
others: mesothlioma, carcinoid
```
152
what type of lung cancer must be treated with chemo
Small cell (must be caught early)
153
how can lung cancer affect breathing on a large scale
Pushes into the airways
154
what is the survial of all types of Lung cancer (5 years)
16%
155
what is the survivial rate for lung cancer is localized when found
45%
156
what is Pneumoconioses
Group of lung disorders caused by inhalation of dust/particles
157
what are the factors controlling pneumoconioses
size
shape
Concentration
158
what size of particals in pneumoconioses is most dangerous
1-5micronemters
159
what do inhaled particles induce
Fibsosis (scarring)
160
where do particles normally get caught in healthy
the nose hairs
161
what usually is the source of particles in Pneumoconioses
Occupational and environmental causes
162
what is the appearaence of Coal worker's Pneumoconiosis
Nodular/diffuse fibrosis with coal macules
163
what is the worldwide most prevalent form of occupational disease
Silicosis
164
what drug can cause Pneumoconioses
bleomycin
165
what is Progressive massive fibrosis
Ongoing fibrosis and lung destruction from coal worker's pneumoconiosis
