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KCSU17 Patho/Pharm Submodule 2 > Pulmonary Disease Objectives > Flashcards

Pulmonary Disease Objectives Flashcards

1
Q

respiratory system general

A

provide oxygen for aerobic respiration

remove byproduct of cellular respiration (CO2)

therefore controls acid base balance

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2
Q

2 functions of respiration

A
  1. ventilation (move air in and out of lungs)

2. gas exchange (exchange O2 and CO2 b/t alveoli and pulmonary capillaries)

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3
Q

respiratory circulation coordination

A
  1. IVC and SVC return venous blood to RA
  2. RV pumps blood to pulmonary artier, caries to lungs for O2 (CO2 is removed by gas exchange)
  3. pulmonary veins return oxygenated blood to the LA
  4. LV pumps oxygenated blood to body via aorta
  5. arteries and arterioles deliver oxygenated blood to capillaries
  6. gas exchanged between tissue and capillaries (o2 goes to tissue, picks up CO2)
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4
Q

upper airway consists of

A

nose/mouth
pharynx/larynx
glottis/epiglottis

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5
Q

right lung

A

3 lobes

RUL (well aerated)
RML (straight bronchi)
RLL

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6
Q

left lung

A

2 lobes and 1 segnet

LUL (well treated)
LLL

singular segment (straight bronchi)

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7
Q

lower airway consists of

A

trachea
lunchs
bronchi

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8
Q

trachea

A

splits into right and left mainstream

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9
Q

bronchi

A

becomes bronchioles –> terminal bronchioles –> acini

stimulated to produce mucous by the parasympathetic nervous system

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10
Q

which receptors regulate bronchi

A

Beta 2

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11
Q

respiratory unit is the

A

acinus

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12
Q

acinus consists of

A

respiratory bronchioles

alveolar ducts/alveolar sacs/alveoli

alceolar septa

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13
Q

alveolar septa

A

pulmonary capillaries and supporting connective tissue

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14
Q

alveoli are lined by what cell types

A
  1. flat epithelial squamous cells (supportive)

2. colmumnar (adenomatous) cells – product surfactant

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15
Q

surfactant

A

lipid secreted by glandular cells in alveoli

improves inflation of alveoli and reduces tendency of them to collapse

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16
Q

inspiration results from

A

negative intra thoracic pressure

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17
Q

negative intra-thoracic pressure is generated by

A
  1. intercostal muscles lifting ribs horizontally
  2. diaphragm flattening

pulls the air into the lungs

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18
Q

expiration results from

A

postive intra thoracic pressure

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19
Q

positive intra-thoracic pressure is generated by

A
  1. ribs moving vertically
  2. diaphragm rising

pushes air out

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20
Q

normal respiration depends on

A
  1. brain function
  2. innervation of intercostals and diaphragm
  3. integrity and mobility of rib cage
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21
Q

gas gradients of lung alveoli

A

pCO2= 35 mmHG

pO2- 105 mmHG

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22
Q

gas gradient of pulmonary arteries

A 
pCO2= 47 mm HG
pO2= 40 mmHG
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23
Q

gas diffusion

A

close proximity between alveoli and pulmonary capillaries cause diffusion of the oxygen into blood DOWN CONCENTRATION GRADIENT

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24
Q

diffusion of O2 into blood depends on

A
  1. number of alveoli/alveolar membrane
  2. Alveolar septa/interstitial tissue
  3. capillaries/pulmonary blood supply
  4. O2 delivery/effective ventilation
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25
Q

pleura

A

two surfaces which slide over each other smoothly

small amount of fluid between them

visceral and parietal

negative presusre keeps lung inflated

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26
Q

parietal pleura

A

membrane covering inner cavity surface of thorax

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27
Q

visceral pleura

A

membrane covering surface of lungs

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28
Q

pleural effusion

A

collection of fluid between two laters

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29
Q

pathological mechanisms of pleural effusion

A
  1. increased production
  2. inflammation of lungs and pleura
  3. decreased absorption
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30
Q

increased fluid production

pleural effusion

A

increased hydrostatic pressure forces fluid to leave capillaries and it stays trapped in pleural space

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31
Q

inflammation of lungs and pleura

pleural effusion

A

causes an increase of fluid

due to lung infection or cancer

32
Q

decreased absorption

pleural effusion

A

low facular oncotic pressures allow fluid to seep out of vessels

33
Q

how do you narrow the diagnosis for pleural effusion

A

must know why it is there so we perform a thoracocentesis

differentiate into transudates and exudates based on LIght’s criteria

34
Q

thoracentisis

A 
looks at 
protein 
LDH
gram stain 
cluture 
hlucose 
cytology
35
Q

exudates

A

pleural effusion caused by local factors

fluid is inflammatory and proteinaceous

36
Q

causes of exudate pleural effusion

A 
malignancy
connective tissue dx (SLE, RA) 
pneumonia/parapneumonic empyema 
TB
PE
37
Q

transudates pleural effusion

A

pleural effusion caused by systemic factors

fluid has minimal protein and is non inflammatory

38
Q

causes of transudate pleural effusion

A

congestive heart failure
CKD
nephrotic syndrom
myxedma

39
Q

Pneumothorax

A

occurs when free air enters potential space between visceral and parietal pleura

can be primary or secondary

40
Q

primary pneumothoraces

A

occur without clinically apparent lung dx

more common in men, 20-40, tall, thin, smoked OR from penetrative trauma

41
Q

secondary pneumothoraces

A

occur in patients with underlying lung disease

ex. COPD

42
Q

types of pneumothorax

A

spontaneous
traumatic

can be tension or non tension

43
Q

spontaneous pneumothorax

A

more often in men, tall, skinny

smokers (marijuana)

rupture of sub pleural bleb

44
Q

traumatic pneumothorax

A

result of penetrating chest trauma, blast injury, iatrogenic (mechanical ventilator, central line)

45
Q

tension pneumothroax

A

can be either spontaneous or traumatic pneumothorax

pleural tear and trapped air continues to expand and increase the intrathoracic pressure, causing decreased venous return to heart

46
Q

atelectasis

A

collapsed ALVEOLI

air can’t get into alveoli
decreased lung volume

elevated diaphragm on one side

47
Q

causes of atelectasis

A
  1. incomplete expansion/poor ventilation (not breathing, pain, post op sedation, burns, gall bladder)
  2. obstructive atelectasis (air doesn’t get out) (mucous plug, malignancy, asthma)
  3. compressive atelectasis (pnemuthorax, pleural effusion )
48
Q

treatment for atelectasis

A

incentive spirometer device

cornet device

49
Q

pneumonia

A

tissue inflammation caused by

  1. inflammatory response of local WBC
  2. bacterial toxin causing leaky capillaries
  3. accumulation of fluid and cells in alveoli and pleura space

fluid infiltrates the lung

50
Q

legionnaires disease

A

pneumonia caused by legionella

comes from contaminated water systems (inhalation of water droplets via ACs, shower heads, humidifiers)

causes diarrhea, hyponatremia, altered mental status

51
Q

pneumocystis pneumonia

A

condition that marks the transition of HIV to AIDS

initial s/s are subtle, but must consider HIV and immunodeficiency

hypoxia, SOB in patients with HIV/AIDS

dx from bronchoscopy

52
Q

Tb transmission and pathogen

A

inhaled air borne droplets land in alveoli

pathogen: mycobacterium Tb

53
Q

latent Tb

A

healthy person contracts the dx

the capsules resist phagocytic breath down

sealed off in granuloma where they wait and don’t cause disease

person is not contagious, and can mount immune response against infection

54
Q

reactivation Tb

A

a person with latent Tb develops a breakdown in cellular immunity caused it to escape it’s granuloma

55
Q

primary Tb

A

immunocompromised person inhaled Tb and they can’t confine it to a granuloma

they are contagious

56
Q

disseminated TB

A

primary Tb in a severely immunocompromised patient

disease spreads to other organs such as liver, kidney, bone (Potts), spleen, GI, gyn tract, meningitis

57
Q

radiographic image of latent Tb

A

granuloma will be seen on CXR

*granulomas can be caused by other dxs

58
Q

radiographic image of reactivated Tb

A

apical cavitation

progressions into lymph node inflammation

59
Q

radiographic image of disseminated Tb

A

military Tb

finding when Tb is disseminated thought the entire body

60
Q

diagnosis of active Tb disease via

A

sputum, gram stain (looking for acid fast bacteria) culture, and PCR

61
Q

diagnosis of Tb exposure

A

via PPD and CXR

induration

intradermal on forearm, read in 48-72 hrs

62
Q

induration levels in indicators (Tb PPD)

A

0 mm= negative

5 mm= positive if HIV, immunocompromised, immunosuppressive drugs, recent Tb contact

10 mm = positive if <4, high risk occupation, IVDA, high risk disease

15 mm = positive without risk factors

63
Q

bronchitis

A

bronchial inflammation

may have bronchospasm

two types: acute and chronic

64
Q

acute bronchitis

A

can be found in trachea, sinus, secondary to upper respiratory infection

65
Q

chronic bronchitis

A

permanent changes in respiratory cells and pulmonary vasculature

caused by smoking or other irritant

mucous plugging impedes air getting down into alveoli

66
Q

bronchiectasis

A

recurrent infection and inflammation destroys the bronchial wall

results in dilated bronchial segments

these segments retain mucus and repeated lung infections occur

daily cough with mucus, intermittently purulent

67
Q

2 types of COPD

A

emphysema

chronic bronchitis

68
Q

emphysema pathophysiology

A

pink puffers

minimal hypoxia and significant CO2 retention (bc decreased air exchange)

causes destruction and dilation of alveolar walls

coalescence of terminal bronchioles

loss of elastic recoils and air trapping

work of breathing increases its, use accessory muscles and lose weight from work of breathing

69
Q

chronic bronchitis pathophysiology

A

blue bloaters

significant hypoxia
retained CO2 and edema

inflamed bronchi with production of large volumes of mucous, causing V/Q mismatch

right heart overworks, causing peripheral edea

large volumes of mucous predispose them to repeated respiratory infection

70
Q

pathophysiology of asthma

A
  1. reversible bronchospasm
  2. increased mucus and bronchial obstruction by mucous plugs
  3. bronchial and bronchiolar edema

hyperresponsive arias triggered by allergy, cold, exercise, infection

71
Q

pulmonary fibrosis caused by

A

environmental organic and inorganic toxins that damage lung connective tissues

therefore it causes progressive impairment of gras diffusion and exchange

72
Q

etiologies of pulmonary fibrosis

A

occupational (silicosis, asbestosis)
collagen vascular disease
idiopathic

73
Q

pulmonary hypertension caused by

A

condition that deoxygenates or causes increased pulmonary artery pressure this leads to hypertrophy of pulmonary arteries

this increased then causes RV to hypertrophy to force blood thru pulmonary arteries

thicker wall causes it to work harder

74
Q

etiologies pulmonary HTN

A 
def side heart failure 
COPD
recurrent PE
collagen capsular disorders 
HIV
75
Q

etiologies of acute respiratory distress syndrome

A
  1. systemic shock (reduce blood flow causing leaky pulmonary capillaries)
  2. diret insult to pulmonary capillaries and alveoli
76
Q

ARDS pathphysiology

A

dump of cytokines due to shock or insult causes endothelial leak

pulmonary capillaries are permeable

boggy alveoli and gas exchanges is impaired

surfactant is wiped away

alveolar collapse occurs which impairs gas exchange

KCSU17 Patho/Pharm Submodule 2 (14 decks)

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