Pulmonary Part 2 (Exam 3) Flashcards
Restrictive Lung Disease
thickened alveolar interstitial which leads to fibrosis
less oxygen in the lung and less gas exchange
fibrosis of the lung leads to decreased ____________ and reduces the ability for ________________
lung compliance
alveoli to recoil
in restrictive lung disease, collagen and elastic connective tissue ___________ and become _______
harden
unusable
Pulmonary fibrosis risk factors
occupational (farming/agriculture)
environmental (metal/wood dust)
dusts (organic/inorganic)
tobacco
comorbidities
chronic viral respiratory infections
genetic
what are the main types of medications that are risk factors for pulmonary fibrosis?
amiodarone
anti-cancer agents
macrobid
some DPLDs are ___________ in nature
idiopathic
typical wound process
fibroblasts and mesenchymal cells get to site of injury and repair the epithelium
cells undergo apoptosis
mesenchymal cells recruit
connective tissues and extracellular matrix proteins to make new connective tissue
connective cell molecules in the lungs
mesenchymal cells
collagen
elastin
leukocytes
major pathophysiology of restrictive lung disease
failed wound repair leads to scarring and fibrosis
In IPF, cells do not undergo ________ and just ___________ causing _____________ in the alveolar walls
apoptosis
accumulate
scarring
in a diseased lung what happens when mesenchymal cells reach the injury?
they accumulate and further contribute to tissue destruction
in restrictive lung diseases, lung volume capacity is ________ in setting of _________________
reduced
resistance to expansion
what happens to elastic resistance in restrictive lung diseases?
work of breathing?
increased
increased –> faster breathing to maintain ventilation requirements
diagnosis of pulmonary fibrosis can be by
CT imaging or surgical biopsy
does airflow resistance change in pulmonary fibrosis?
No!
only elasticity
what happens to the FEV1/FVC ratio in a restrictive pulmonary disorder?
it is preserved or increased
Clinical presentation of idiopathic pulmonary fibrosis
SOB gradually gets worse
dry cough
compensatory tachypnea
pulmonary HTN
crackles on inspiration
reduced lung volume
honeycombing
digital cyanosis and clubbing
honeycombing
seen in pulmonary fibrosis
fibrosis around airspaces
mutations in the CFTR lead to _____?
why?
production of thick and sticky secretions
there is a buildup of chord and bicarbonate ions in the cell
does CF just effect the respiratory system?
NO!
it also effects epithelial cells in the GI and reproductive tracts
pathophysiology of cystic fibrosis
small airways cause bronchiectasis –> airways widen and thicken
dehydration –> thick secretions
thick secretions –> permanent scarring and cysts in lungs
in CF, once cells in lungs are damaged, they further recruit
more inflammatory cells and become necrotic
continuous inflammation in CF causes
permanent damage and invites persistent infection and additional damage
why are natural defenses diminished in CF?
pH of the airway becomes acidic due to reduced bicarbonate secretion
why are bacterial infections persistent in CF?
thick/sticky mucus is retained in the lower airways, preventing inhaled bacteria from being cleared
signs and symptoms of CF
cough
wheezing
nasal congestion
headache and inflammation
clubbing (advanced)
how to treat CF?
airway clearance therapy
airway clearance therapy steps
- bronchodilators - open airway
- inhaled mucolytics - break up and thin mucus
- inhaled antibiotics - clear mucus secretions
types of inhaled mucolytics
dornase alpha
hypotonic saline
hypotonic saline
pulls water out of epithelial cells and into mucus secretions
pulmonary edema
excessive fluid in the alveolar space or interstitium
hallmark symptom of pulmonary edema
dyspnea (SOB)
normal movement of fluid in the lungs
fluid flows out of the blood vessels into the interstitial space because pressure in the capillaries is higher than the interstitial space
how to alveoli protect themselves from interstitial fluid?
barrier formed by the epithelium
epithelial cells transport sodium out of alveolar space
gradient allows alveoli to function properly
pulmonary lymphatic system
what does the pulmonary lymphatic system do?
removes excessive fluid in the interstitial space
due to negative pressure, fluid accumulates _______ from the airspaces and gets ___________ back into the blood vessels
away
reabsorbed
Pulmonary edema types
increased permeability pulmonary edema (non-cariogenic)
increased hydrostatic pulmonary edema (cariogenic)
impairment of lymphatic drainage pulmonary edema
pulmonary embolism
embolus is dislodged somewhere in circulation and it moves to pulmonary circulation, gets stuck, blockage of the vessel and obstructing perfusion
what can cause pulmonary embolism?
air during surgery
amniotic fluid
fat from long bone fracture
foreign body
septic emboli
DVT
tumor
risk factors for venous thromboembolism
venous stasis
increased coagulopathy
vascular injury
dead spaces
ventilated well with fresh oxygen but not all perfused so carbon dioxide can’t be removed
in pulmonary embolism, pulmonary vascular resistance and pulmonary arterial pressure both ___________ which can cause ___________ into the right ventricle and can severely ___________ cardiac output
shoot up
circulatory backup
limit
clinical presentation of pulmonary embolism
chest pain
dyspnea
hemoptysis
sinus tachycardia
inspiratory crackles due to atelectasis
can there be evidence of DVT in the lower extremity when someone has a pulmonary embolism?
yes, but not all the time
warm, red, tender and swollen calf
tuberculosis
macrophages eat bacteria –> bacteria replicates in macrophage –> granuloma forms –> if one bursts they can multiply
region of the lungs TB typically infects
posterior apical region (deep lung infection)
cycle of TB infection continues until the mycobacteria
disseminates in the intravascular space
pulmonary symptom of TB
cough
what can be visualized on chest imaging when someone has TB?
patchy and nodular infiltrates
how does the body fight the TB infection?
form granulomas around the microorganism and T lymphocytes induce apoptosis
can TB evade detection and lysis of apoptosis?
yes and they can become dormant
how can someone contract pneumonia?
inhalation of infectious particles
aspiration of oropharyngeal contents
hematogenous spread from other side of infection
risk factors of pneumonia
immunocompromised
primary lung infection
alcohol consumption and narcotic use
comorbidities
how can alcohol consumption and narcotic use lead to pneumonia?
they depress mucociliary transport
clinical presentation of pneumonia
pulmonary infiltrates on chest imaging
fever
cough
increased sputum production
SOB
how does lung cancer develop?
normal bronchial epithelial cells acquire multiple genetic mutations over time
mutations of lung cancer include
activating proto oncogenes
inhibiting tumor suppressor genes
production of self stimulating growth factors
biomarkers identified as drivers of tumor growth and survival can serve as
targets for drug therapy
most common mutated genes in lung cancer
EGFR
KRAS
BRAF
HER2 (not as much as the other 3)
risk factors of lung cancer
smoking
respiratory exposure to asbestos, arsenic and benzene
genetics
history of COPD
types of lung cancer
which is more prevalent?
Small cell lung cancer (SCLC)
non small cell lung cancer (NSCLC) - more prevalent
different types of infiltrates seen on chest imaging and which lung disease they correlate to
pulmonary infiltrates - pneumonia
nodular/patchy infiltrates - TB
honeycombing - pulmonary fibrosis
