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Pulmonary disease Flashcards

1
Q

How much does each lung weigh

A

200-250 grams each (r is heavier)

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2
Q

what does the lung consist of

A

Airways
BV
Connective tissue
Pleua

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3
Q

what makes up the airways of the lungs

A 
Trachea
Bronchi
bronchioles
Terminal Cronchioles
Respiratory unit (acini)
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4
Q

what is the blood supply to the lungs

A

Pulmonary

Bronchial

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5
Q

what is the main function of the lung

A

Gas exchange

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6
Q

what all is needed for respiration to occur

A

uppre respiratory tract
Daiphram and accessory muscle
Neural regulation

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7
Q

what lines the vocal cord

A

Stratified squamous epithelium

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8
Q

what lines the large airways

A 
Pseudostratified ciliated Columbar epithelium 
Mucus glands (mucosal submucosal)
neuroendocrine cells and carilage
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9
Q

types of alveoli cells

A

type I, flat pneumocytes

Type II, Cuboidal pneumocytes

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10
Q

what type of alveolar cells are more common

A

Flat type I alveoli(95%)

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11
Q

what type of Alveoli cells produce surfactant

A

Type II

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12
Q

what makes up the alveolar capillary wall

A

Basement membrane and strands of interstitial connective tissue

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13
Q

what makes up the large airwasy

A

Larynx
Trachea
Bronchi

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14
Q

what is the defense mechanism of the upper airway

A

Filtering

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15
Q

what is the defense mechanisms of the lower airway

A

Mucociliary apparatus

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16
Q

what is the defense mechanisms of the lymphoid tissue

A

Cellular and humoral imunity(IgA)

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17
Q

what cell is present in the alveoli to provide defence

A

Alveolar macrophages

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18
Q

what is coughing up blood

A

Hemoptysis

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19
Q

what is difficulty breathing, preception of needing to breathe deeper and faster

A

Dyspnea (shortness of breath)

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20
Q

what is the collapse of lung volume

A

Atelectasis

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21
Q

what is air in the pleural psace or cavity leading to the collapse of the lung

A

Pneumothorox

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22
Q

what is the suppuration in pleural cavity

A

Empyema

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23
Q

what is FLuid in the pleural space

A

Pleural effusion

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24
Q

what is transudate

A

Low protein fluid

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25
Q

what causes transudate to form

A

increased venous pressure (CHF)

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26
Q

what is exudate

A

High protein fluid

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27
Q

can exudate have inflammatory cells

A

yes and no

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28
Q

what causes exudate

A

Increased vascular permeability (damage)

- pneumonia

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29
Q

where does Pulmonary Edema fill

A

first in interstitial tissue, then distal air space

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30
Q

what causes pulmonary edema

A 
Increased intravsacular pressur
Hypoproteinemia (low protein)
Vascular damage (infections, autoimmune diseases)
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31
Q

what is the problem with pulmonary edema

A

Inhibits normal oxygen exhange

predisposes to infection

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32
Q

where do Pulmonary thromboemboli come from

A

Deep veins of the leg or pelvis

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33
Q

do all thromboemboli cause dmage

A

small cause minimal damage

Large causes hemorrhage or infarction

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34
Q

where do cery large pulmonary thromboemobli lodge themsleves

A

Bifurcation of pulmonary arteries (saddle embolus)

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35
Q

what does saddle embolus lead to

A

Sudden death

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36
Q

what are the predisposing factors for pulmonary thrombo-emboli

A

chronic illness
Prolonged bed rest (immobility)
hypercoagulable state (factor V leiden)
deep vein thromboses (DVT)

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37
Q

what is Obstructive Pulmonary disease

A

Group of disease that results in airflow limitation or obstruction

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38
Q

what are the 4 classic disorders of Obstructive pulmonary disease

A

Emphysema
Chronic Bronchitis
Bronchiectasis
Asthma

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39
Q

what is the other name for Emphysema/Chronic Bronchitis

A

COPD

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40
Q

what is permanent enlargement of the distal small air spaces due to destruction of the alveolar septal walls

A

Emphyseam

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41
Q

how does Emphyseam present clinically

A

Dyspnea
Cough
Prolonged exhalation (pink puffers)

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42
Q

what is the pathogenesis of Emphyseam

A

Imbalance between protease and anti-protease enzymes

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43
Q

what is the major cause of the imbalance between protease and anti-protease enzymes

A

Smoking

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44
Q

what are the genetic causes of Emphysema

A

TGF-beta 1 polymorphisms

alpha1 antitrypsin deficiency

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45
Q

what hapens to inflammatory cells in emphysema

A

Cytokines + Proteases degrade ECM

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46
Q

what happens to the epithelium in emphysema

A

Apoptosis

Necrosis

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47
Q

what happens to the Mesenchumal cells in Emphyseam

A

Apoptosis
Impaired proliferation
Decreased contraction
decreased matrix synth

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48
Q

what is Centriacinar emphyseam

A

Central portion of the acini involved

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49
Q

what lobes tend to be infected with centriacinar emphyseam

A

Upper lobes

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50
Q

what problem is usually associated with centriacinar emphysema

A

Smoking

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51
Q

what is Panacinar emphyseam

A

involves entire acinar unit from the respiratory bronchioles to terminal alveoli

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52
Q

what lobes tend to be infected with Panacinar emphyseam

A

lower lobes

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53
Q

what problem is usually associated with Panacinar emphysema

A

Alpha1-AT deficiency

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54
Q

what is the sign that you have Chronic Bronchitis

A

Cough and sputum production for 3 consecutive months in 2 consecutive years

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55
Q

symptoms of Chronic Bronchitis

A

Hypoxemia

Cyanosis (blue bloaters)

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56
Q

what is the pathogenesis of chronic Bronchitis

A 
Chronic Irritiation (smoking)
Infection
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57
Q

what is the pathology of chronic Bronchitis

A

increased mucus gland layer
Chronic inflammation
fibrosis and narrowing of airways

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58
Q

what are the predisposing factors for chronic bronchitis and emphysema

A

Cigarette smoking
Atmosphere pollutants
Infection
genetic factors

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59
Q

what effect does cigarettes have to induce emphysema and chronic Bronchitis

A 
Causes mucus gland hypertrophy
Increase smooth muscle tone
Inhibit cilia
Inhibit phagocytosis
induce squamous metaplasia
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60
Q

what genetic factors lead tochronic Bronchitis and emphyseam

A

Cf

Alpha-1-AT deficinecy

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61
Q

what is bronchiectasis

A

Chronic infection with permanent major airway dilatuion

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62
Q

what does bronchiectasis follow

A

Obstruction, infection or both

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63
Q

what are the clinical signs of bronchiectasis

A

sever cough
Bloody mucoid
Expectoration
Dyspnea

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64
Q

what complications occur from bronchiectasis

A

Abscess
Pneumonia
Bronchopleual fistual
Empyema

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65
Q

what are the predisposing factors for Bronchiectasis

A 
Obstructive tumors
Foreign bodies
Cystric fibrosis (mucus plus)
Other COPD
Suppurative or Necrotizin pneumonia
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66
Q

what pathology is associated with Bronchiectasis

A

Dilated distal bronchi and bronchioles

Chronic infection with inflammation and variable purulence

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67
Q

what iw Asthma

A

Increased irritability and prominence of smooth muscle in bronchi and bronchioles

68
Q

what does Asthma lead to

A

Marked, reversible episode of contraction and airway constriction

69
Q

what are the initiating factors for asthma

A 
Allergies
Infection
Exercise
drugs
Emotions
70
Q

how common is asthma

A

5% of adults
7-10% kids
- esp inner city kids

71
Q

Clinical signs of Asthma

A

Wheezing
long exhalation
hyperinflation of lungs

72
Q

what are the types of Astham

A

Atopic

Non-atopic

73
Q

what is Atopic Asthma

A

Allergic and extrinsic

74
Q

What is Non-atopic

A

intrinsic

75
Q

what sensitivty causes Atopic Asthma

A

Type I hypersensitivity (IgE mediated)

76
Q

what causes Atopic asthma

A

Environmental antigens

77
Q

what type of asthma has a family history

A

Positive family history is common

78
Q

what can initiate non-atopic asthma

A

Initiated by viruses

Air pollutants

79
Q

what type of asthma is triggered by emo stress, exervise, cold temps

A

atopic

non-atopic

80
Q

Pathology of asthma

A

Increased mucus glands
Smooth muscle hypertrophy
inflammation with eosinophils
type 2 helper T cells

81
Q

what is the Pathogensis of asthma

A

Antigen binds to surface IgE on Mast cells releaseing a large number of mediates
Including histamine and leukotrienes

82
Q

how to treat Asthma

A

attach subsides spontaneously
inhalation bronchodilators for immediate relief (albuterol)
Controler meds (corticosteroids)

83
Q

how lethal is Pneumonia

A

one of the leading causes of death

84
Q

what does Pneumonia do when relating to other disease

A

Complicates other chronic debilitating diseases

85
Q

what organisms can cause pneumonia

A

any organism (bacterial, viral, fungal, parasites)

86
Q

what are the predisposing factors for bacterial pneumonia

A 
Loss of cough reflex(alcohol)
Injury to cilia
Decreased phagocytosis 
pulmonary edema
Immunocompromised condition
87
Q

what are the clinical sings of bacterial pneumonia

A 
Cough 
Dyspnea
Fever
Chills
 Sputum production
88
Q

where does Bronchopneumonia form

A

PAtchy process around the small bronchi

89
Q

who tends to get Bronchopneumonia

A

Very old and young

90
Q

where does Lobar Pneumonia form

A

the entire lobe

91
Q

what bacteria causes Lobar pneumonia

A

Stroptococcus pneumiae in 90% of cases

92
Q

who tends to get lobar pneumonia

A

Healthy adults

93
Q

why doe Pulmonary edema increase the likelyhood of bacterial pneumonia

A

its a place where bacteria can thrive

94
Q

why is it important to know which bacteria causes which type of pneumonia

A

Drives the antibiotic choice

95
Q

what are the stages of inflammation of the lung

A

Congestion
Red Hepatization
gray hepatization
Resolution

96
Q

what is early stage pneumonia

A

Red Hepatization

97
Q

what causes red hepatization

A

Purulent exudate with many RBC’s

98
Q

what is Late stage pneumonia

A

grey hepatization

99
Q

what causes Grey hepatization

A

exudate with fibrin and macrophages

- RBC’s broken down and gone

100
Q

what is the eventual outcome of pneumonia

A

Complete resolution or a scar

101
Q

what are the complications of Pneumonia

A 
Abscess
Pleuritis
Pericardititis
Bacteremia
Empyema
102
Q

what is Empyema

A

neutrophils in and out of the alveoli creating an adhesion to the pleural wall

103
Q

how do you fix empyema

A

Must removed Adhesion

104
Q

what cells do bacterial invasions recruit

A

neutrophil

105
Q

what causes Atypical (interstital) pneumonia

A

Mycoplasma Pneumoniae

Viruses

106
Q

what are the clinical signs of atypical (interstitial pneumonia

A

Highly variable

  • mild fever
  • Headach
  • dry cough
  • Myalgia
  • life thretening
107
Q

what is the pathology of atypical (interstitial) pneumonia

A

Interstitial inflammation
mononuclear cells
Congestion and hyaline membranes (diffuse alveolar damage)

108
Q

WHAT IS THE problem with Diffuse alveolar damge from atypical (interstitial) pneumonia

A

layer of Hyanline cartilage that does not exchange O2 well

109
Q

speed of Acuute respiratory Distress syndrome

A

Rapidly developing and serieous

110
Q

what does Acute respiratory distress syndrome look like

A

Histo like interstitial pneumonia

111
Q

causes of acute respiratory distress syndrome

A 
Shock
infection
trauma
Drug OD
irritiants
112
Q

what get injured in Acute respiratory Distress syndrome

A

Endothelium and alveolar epithelium

113
Q

what does Acute Respiratory Distress syndrom do to the endothelium

A

Icnreases its permability (leaky)

114
Q

what does the leakyness of Acute Respiratory Distress Syndrome cause

A

no more room for air, and loses ability to oxygenate surrounding tissues

115
Q

what are the clinical signs of pulmonary absecess

A

Cough
Fever
Purulent sputum

116
Q

What are the predisoposing factors to pulmonary abscess

A 
Bronchiectasis
Aspiration
Septic emboli
Airway obstruction
dental sepsis
117
Q

what is the course taken by pulmonary abscess

A

Scar
Cavitate
Progressive enlargement to make a hole in tissue

118
Q

what causes Tuberculosis

A

Mycobacterium tuberculosis

119
Q

how much are infected with TB

A

1/3 of world population

120
Q

how common is death via tuberculosis

A

most common infectious cause of death (1.5 mill/year)

121
Q

how has the prevelance of TB changed in the US

A

mid 80s numbers rose and has now been declining since the 90s

122
Q

what tends to be the causes of TB in the US

A

HIV infection
Overcrowding
Poor living conditions
Immigrants

123
Q

what is the shape of Mycobacterium tubeculosis

A

Bacillus (rod)

124
Q

what does Mycobacterium tuberculosis like to breath

A

Aerobe

125
Q

how does Mycobacterium tuberculosis Move

A

Non-motile

126
Q

how fast does Mycobacterium tuberculosis Grow

A

slow

127
Q

how does Mycobacterium tuberculosis stain

A

Acid fast bacilus do to wazy coat that resistas acid destaiing

128
Q

what kind of inflammation does mycobacterium tuberculosis lead to

A

Caseating granulomatous inflammation (classic tissue reaction)

129
Q

how is Tuberculosis acquired

A

Inhalation

130
Q

what is the early site of TB infection

A

Ghon lesion

131
Q

what is the Ghon Complex

A

the lung lesion +hilar lymph nodes infected with TB

132
Q

what inefficient method does the body have to stop TB

A

tries to wall it off, but still in effective

133
Q

where does Cavitary TB occur

A

at the Apex

134
Q

what does Cavity TB eventually lead to

A

Significant scarring

135
Q

where may cavitary TB seed

A

Large Airways
Lymph nodes
Blood

136
Q

how might cavitary TB affect the pleura

A

Effusion

137
Q

how does Tubercuolosis Heal

A

becomes inactive or progresses (90-95% of cases resolve)

138
Q

what happens to TB cases that have resolved/inactivated

A

Reactivate many years later

139
Q

what does reactivation of TB lead to

A

Induces type IV hypersensitivity and tissue necrosis

140
Q

what is Miliary TB

A

multi organ invovlement of TB dissemination

141
Q

why might TB reactivate

A

Immunity wanes(immunosenscnece, Immunosuppressive Treatment)

142
Q

what causes Miliary TB

A

spread via lymph or blood

143
Q

what are the bits of TB that spread in miliary TB called

A

Millet Seeds

144
Q

where might Miliary TB spread

A 
Other lung
CNS
kidney
Adrenals
Bones and Bone marrow
Liver
spleen
145
Q

what can cause Granulomatous lung disease

A

TB (classic)
Fungal infections
Sarcoidosis

146
Q

what is the usual fungal infection that causes Granulomatous

A

histoplasmosis, esp in ohio

147
Q

what is the leading cause of cancer deaths

A

Lung cancer

148
Q

risk factors for lung cancer

A

Cigs
Asbestos
Radon
Nickel, chromates, pollutants, lung scar

149
Q

what are the clinical signs of lung cancer

A 
Cough 
weight loss
Chest pain
Hemoptysis
Dyspnea
150
Q

what can lung cancer tumors produce

A

Hormones

  • paraneoplastic syndrome
  • ADH, ACTH, PTH, and others
151
Q

what are the types of lung cnacer

A 
Squamous cell carcinoma(25-30%)
adenocarcinoma(30-35%)
Small cell(20-25%)
Large cell(10-15%)
Bronchioloalveolar carcinoma
others: mesothlioma, carcinoid
152
Q

what type of lung cancer must be treated with chemo

A

Small cell (must be caught early)

153
Q

how can lung cancer affect breathing on a large scale

A

Pushes into the airways

154
Q

what is the survial of all types of Lung cancer (5 years)

A

16%

155
Q

what is the survivial rate for lung cancer is localized when found

A

45%

156
Q

what is Pneumoconioses

A

Group of lung disorders caused by inhalation of dust/particles

157
Q

what are the factors controlling pneumoconioses

A

size
shape
Concentration

158
Q

what size of particals in pneumoconioses is most dangerous

A

1-5micronemters

159
Q

what do inhaled particles induce

A

Fibsosis (scarring)

160
Q

where do particles normally get caught in healthy

A

the nose hairs

161
Q

what usually is the source of particles in Pneumoconioses

A

Occupational and environmental causes

162
Q

what is the appearaence of Coal worker’s Pneumoconiosis

A

Nodular/diffuse fibrosis with coal macules

163
Q

what is the worldwide most prevalent form of occupational disease

A

Silicosis

164
Q

what drug can cause Pneumoconioses

A

bleomycin

165
Q

what is Progressive massive fibrosis

A

Ongoing fibrosis and lung destruction from coal worker’s pneumoconiosis

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