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
2
Q
2 functions of respiration
A
- ventilation (move air in and out of lungs)
2. gas exchange (exchange O2 and CO2 b/t alveoli and pulmonary capillaries)
3
Q
respiratory circulation coordination
A
- IVC and SVC return venous blood to RA
- RV pumps blood to pulmonary artier, caries to lungs for O2 (CO2 is removed by gas exchange)
- pulmonary veins return oxygenated blood to the LA
- LV pumps oxygenated blood to body via aorta
- arteries and arterioles deliver oxygenated blood to capillaries
- gas exchanged between tissue and capillaries (o2 goes to tissue, picks up CO2)
4
Q
upper airway consists of
A
nose/mouth
pharynx/larynx
glottis/epiglottis
5
Q
right lung
A
3 lobes
RUL (well aerated)
RML (straight bronchi)
RLL
6
Q
left lung
A
2 lobes and 1 segnet
LUL (well treated)
LLL
singular segment (straight bronchi)
7
Q
lower airway consists of
A
trachea
lunchs
bronchi
8
Q
trachea
A
splits into right and left mainstream
9
Q
bronchi
A
becomes bronchioles –> terminal bronchioles –> acini
stimulated to produce mucous by the parasympathetic nervous system
10
Q
which receptors regulate bronchi
A
Beta 2
11
Q
respiratory unit is the
A
acinus
12
Q
acinus consists of
A
respiratory bronchioles
alveolar ducts/alveolar sacs/alveoli
alceolar septa
13
Q
alveolar septa
A
pulmonary capillaries and supporting connective tissue
14
Q
alveoli are lined by what cell types
A
- flat epithelial squamous cells (supportive)
2. colmumnar (adenomatous) cells – product surfactant
15
Q
surfactant
A
lipid secreted by glandular cells in alveoli
improves inflation of alveoli and reduces tendency of them to collapse
16
Q
inspiration results from
A
negative intra thoracic pressure
17
Q
negative intra-thoracic pressure is generated by
A
- intercostal muscles lifting ribs horizontally
- diaphragm flattening
pulls the air into the lungs
18
Q
expiration results from
A
postive intra thoracic pressure
19
Q
positive intra-thoracic pressure is generated by
A
- ribs moving vertically
- diaphragm rising
pushes air out
20
Q
normal respiration depends on
A
- brain function
- innervation of intercostals and diaphragm
- integrity and mobility of rib cage
21
Q
gas gradients of lung alveoli
A
pCO2= 35 mmHG
pO2- 105 mmHG
22
Q
gas gradient of pulmonary arteries
A
pCO2= 47 mm HG pO2= 40 mmHG
23
Q
gas diffusion
A
close proximity between alveoli and pulmonary capillaries cause diffusion of the oxygen into blood DOWN CONCENTRATION GRADIENT
24
Q
diffusion of O2 into blood depends on
A
- number of alveoli/alveolar membrane
- Alveolar septa/interstitial tissue
- capillaries/pulmonary blood supply
- O2 delivery/effective ventilation
25
pleura
two surfaces which slide over each other smoothly
small amount of fluid between them
visceral and parietal
negative presusre keeps lung inflated
26
parietal pleura
membrane covering inner cavity surface of thorax
27
visceral pleura
membrane covering surface of lungs
28
pleural effusion
collection of fluid between two laters
29
pathological mechanisms of pleural effusion
1. increased production
2. inflammation of lungs and pleura
3. decreased absorption
30
increased fluid production
pleural effusion
increased hydrostatic pressure forces fluid to leave capillaries and it stays trapped in pleural space
31
inflammation of lungs and pleura
pleural effusion
causes an increase of fluid
due to lung infection or cancer
32
decreased absorption
pleural effusion
low facular oncotic pressures allow fluid to seep out of vessels
33
how do you narrow the diagnosis for pleural effusion
must know why it is there so we perform a thoracocentesis
differentiate into transudates and exudates based on LIght's criteria
34
thoracentisis
```
looks at
protein
LDH
gram stain
cluture
hlucose
cytology
```
35
exudates
pleural effusion caused by local factors
fluid is inflammatory and proteinaceous
36
causes of exudate pleural effusion
```
malignancy
connective tissue dx (SLE, RA)
pneumonia/parapneumonic empyema
TB
PE
```
37
transudates pleural effusion
pleural effusion caused by systemic factors
fluid has minimal protein and is non inflammatory
38
causes of transudate pleural effusion
congestive heart failure
CKD
nephrotic syndrom
myxedma
39
Pneumothorax
occurs when free air enters potential space between visceral and parietal pleura
can be primary or secondary
40
primary pneumothoraces
occur without clinically apparent lung dx
more common in men, 20-40, tall, thin, smoked OR from penetrative trauma
41
secondary pneumothoraces
occur in patients with underlying lung disease
ex. COPD
42
types of pneumothorax
spontaneous
traumatic
can be tension or non tension
43
spontaneous pneumothorax
more often in men, tall, skinny
smokers (marijuana)
rupture of sub pleural bleb
44
traumatic pneumothorax
result of penetrating chest trauma, blast injury, iatrogenic (mechanical ventilator, central line)
45
tension pneumothroax
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
atelectasis
collapsed ALVEOLI
air can't get into alveoli
decreased lung volume
elevated diaphragm on one side
47
causes of atelectasis
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
treatment for atelectasis
incentive spirometer device
| cornet device
49
pneumonia
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
legionnaires disease
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
pneumocystis pneumonia
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
Tb transmission and pathogen
inhaled air borne droplets land in alveoli
pathogen: mycobacterium Tb
53
latent Tb
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
reactivation Tb
a person with latent Tb develops a breakdown in cellular immunity caused it to escape it's granuloma
55
primary Tb
immunocompromised person inhaled Tb and they can't confine it to a granuloma
they are contagious
56
disseminated TB
primary Tb in a severely immunocompromised patient
disease spreads to other organs such as liver, kidney, bone (Potts), spleen, GI, gyn tract, meningitis
57
radiographic image of latent Tb
granuloma will be seen on CXR
*granulomas can be caused by other dxs
58
radiographic image of reactivated Tb
apical cavitation
progressions into lymph node inflammation
59
radiographic image of disseminated Tb
military Tb
finding when Tb is disseminated thought the entire body
60
diagnosis of active Tb disease via
sputum, gram stain (looking for acid fast bacteria) culture, and PCR
61
diagnosis of Tb exposure
via PPD and CXR
induration
intradermal on forearm, read in 48-72 hrs
62
induration levels in indicators (Tb PPD)
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
bronchitis
bronchial inflammation
may have bronchospasm
two types: acute and chronic
64
acute bronchitis
can be found in trachea, sinus, secondary to upper respiratory infection
65
chronic bronchitis
permanent changes in respiratory cells and pulmonary vasculature
caused by smoking or other irritant
mucous plugging impedes air getting down into alveoli
66
bronchiectasis
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
2 types of COPD
emphysema
| chronic bronchitis
68
emphysema pathophysiology
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
chronic bronchitis pathophysiology
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
pathophysiology of asthma
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
pulmonary fibrosis caused by
environmental organic and inorganic toxins that damage lung connective tissues
therefore it causes progressive impairment of gras diffusion and exchange
72
etiologies of pulmonary fibrosis
occupational (silicosis, asbestosis)
collagen vascular disease
idiopathic
73
pulmonary hypertension caused by
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
etiologies pulmonary HTN
```
def side heart failure
COPD
recurrent PE
collagen capsular disorders
HIV
```
75
etiologies of acute respiratory distress syndrome
1. systemic shock (reduce blood flow causing leaky pulmonary capillaries)
3. diret insult to pulmonary capillaries and alveoli
76
ARDS pathphysiology
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
