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Clin Med III > Pulmonary Pathology Part 3 > Flashcards

Pulmonary Pathology Part 3 Flashcards

1
Q

What occurs in a restrictive lung disease

A

Lungs cannot fully expand and there are decreased lung volumes and total lung capacities

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2
Q

What happens to residual volume in restrictive lung disease

A

Decrease or normal

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3
Q

What are signs and symptoms of restrictive lung disease initially

A

Chronic hyperventilation and exertional dyspnea

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4
Q

What are signs and symptoms of restrictive lung disease later on

A

Decreased alveolar ventilation, CO2 retention, hypoxemia, rapid shallow breathing, ineffective cough, dyspnea at rest

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5
Q

How do you treat restrictive lung disease

A

It is based on cause but promote oxygenation, maintain airway, maximize function, corticosteroids, and surgery

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6
Q

True or False:

Most restrictive lung diseases are not reversible

A

True

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7
Q

True or False:
With progressive restrictive lung diseases there is pulmonary artery hypertension that leads to cor pulmonale which causes severely decreased oxygenation and ventilatory failure

A

True

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8
Q

What is cor pulmonale

A

Right sided heart failure

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9
Q

What are the restrictive lung diseases (10)

A
  1. Pulmonary fibrosis
  2. Pneumoconiosis
  3. Hypersensitivity pneumonconiosis
  4. Noxious fumes
  5. Atelectasis
  6. Pulmonary edema
  7. ARDS
  8. Sarcoidosis
  9. Lung cancer
  10. Cystic fibrosis
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10
Q

What are the other names for pulmonary fibrosis

A

Interstitial lung/pulmonary disease

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11
Q

What is pulmonary fibrosis

A

Fibrotic changes at the level of the alveoli that occurs following chronic inflammation of lung tissue that leads to scarring (fibrosis)

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12
Q

What portion of pulmonary fibrosis cases are ideopathic and due to reactive airway diseases

A

Idiopathic: 2/3

Reactive airway diseases: 1/3

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13
Q

What happens with pulmonary fibrosis

A

Increased fibroblast activity distorts and shrinks lobe at the alveoli resulting in decreased lung compliance causing lungs to become stiff

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14
Q

What are signs and symptoms of pulmonary fibrosis (2)

A
  1. SOB

2. Dry cough initially

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15
Q

What are a persons TLC, RV, and FEV with pulmonary fibrosis

A

TLC decreased
RV decreased or normal
FEV decreased

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16
Q

How do you treat pulmonary fibrosis (3)

A
  1. Corticosteroids
  2. Education
  3. Monitoring especially during exercise
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17
Q

What are the goals with treating pulmonary fibrosis (2)

A
  1. Maintain current level of pulmonary function

2. Prevent further disease progression

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18
Q

What are the environmental and occupational pulmonary disorders (3)

A
  1. Pneumonconiosis
  2. Hypersensitivity pneumonitis
  3. Noxious gases,fumes, and smoke inhalation
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19
Q

What do environmental and occupational pulmonary disorders have involvement of

A

Pulmonary parenchyma

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20
Q

What is another name for pneumonconiosis

A

Dusty lungs or black lung disease

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21
Q

What causes pneumonconiosis

A

Inhalation of large amounts of industrial substances (iron ore, coal, asbestos, and agricultural dust)

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22
Q

What are risk factors for pneumonconiosis (5)

A
  1. Type of exposure
  2. Duration and intensity
  3. Underlying pulmonary conditions
  4. Smoking history
  5. Particle size and water solubility of the inhalant
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23
Q

What happens with pneumoconiosis

A

Particles that are not filtered out are inhaled or swallowed entering the lungs causing the cells to become pierced resulting in inflammation thickening and scarring around the particle

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24
Q

How long does it take symptoms of pneumoconiosis to occur

A

10-20 years

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25
Q

Signs and symptoms of pneumoconiosis (4)

A
  1. Differ based on exposure type
  2. Progressive dyspnea
  3. Chest pain
  4. Productive cough
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26
Q

True or False:

It is important to do a lung biopsy to rule out cancer when diagnosing pneumoconiosis because it can develop into cancer

A

True

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27
Q

How do you treat pneumonconiosis (3)

A
  1. Prevention
  2. Relieve symptoms with corticosteroids
  3. Treatment of neoplasms
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28
Q

What is another name for hypersensitivity pneumonitis

A

Extrinsic allergic alveolitis

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29
Q

What causes hypersensitivity pneumonitis

A

Exposure to organic dusts such as mold, fungus, plant fibers cork dust, and coffee beans

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30
Q

What does hypersensitivity pneumonitis affect

A

Alveoli and distal airways

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31
Q

What happens in hypersensitivity pneumonitis

A

Granulomas or mild fibrosis of the alveolar walls occur due to organic dust

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32
Q

Signs and symptoms of hypersensitivity pneumonitis (4)

A
  1. Quick onset dyspnea
  2. Fever
  3. Chills
  4. Nonproductive cough
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33
Q

When does hypersensitivity pneumonitis often resolve

A

24-48 hours

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34
Q

How do you treat hypersensitivity pneumonitis

A

Remove exposure and modify handling process

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35
Q

What is it called when O2 is replaced by other substances

A

Asphyxiation

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36
Q

What does exposure to noxious gases, fumes, and smoke inhalation cause (4)

A
  1. Tissue anoxia
  2. Tissue asphyxia
  3. Airway edema
  4. Airway obstructions
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37
Q

What are the lung parenchymal disorders (5)

A
  1. Atelctasis
  2. Pulmonary edema
  3. ARDS
  4. Sarcoidosis
  5. Lung cancer
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38
Q

What is atelectasis

A

Collapse of a normally expanded lung at any level and can be all/part of the lung

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39
Q

What are the causes of atelectasis (4)

A
  1. Bronchus obstructed (primary cause is a mucus plug)
  2. Interference with lung expansion (post surgical)
  3. Insufficient surfactant
  4. Direct compression
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40
Q

What happens with atelectasis

A

Airway collapses or is obstructed and alveolar gas is absorbed into the blood and alveoli cannot stay open

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41
Q

What are the sign and symptoms of sudden atelectasis (6)

A
  1. Dyspnea
  2. Tachypnea
  3. Cyanosis
  4. Increased temp
  5. Elevated BP
  6. Shock
42
Q

What are the signs and symptoms of chronic atelectasis (3)

A
  1. Gradual onset
  2. Dyspnea
  3. Weakness
43
Q

How do you treat atelectasis

A

Remove the cause with suction, deep breathing or chest PT

44
Q

What is another name for pulmonary edema

A

Pulmonary cngestion

45
Q

What is pulmonary edema

A

Excessive fluid in lungs

46
Q

Where does the fluid accumulate in pulmonary edema

A

Interstitial tissue and/or alveoli

47
Q

True or False:

Pulmonary edema risk increases with age in those with heart failure

A

True

48
Q

What can cause pulmonary edema (6)

A
  1. Left ventricle failure
  2. Mitral valve disorder
  3. Kidney/liver sidorders
  4. Sepsis
  5. Transfusion reactions
  6. High altittude
49
Q

How does left ventricle failure result in pulmonary edema

A

Left ventricle muscle wall hypertrophies resulting in not being able to put as much blood in the ventricles so there is a backup of blood and it backs up into the lungs

50
Q

How does pulmonary edema occur

A

Fluid from the pulmonary vessels leaks into alveolar spaces decreasing the space for gas exchange

51
Q

What leads to the excess fluid in pulmonary edema (4)

A
  1. Fluid overload
  2. Decreased serum albumin
  3. Lymphatic obstruction
  4. Tissue injury leading to fibrosis
52
Q

What are the 4 stages of signs and symptoms of pulmonary edema

A
  1. Asymptomatic or restless, anxious, cold symptoms, diaphoresis (sweating)
  2. Worsened edema, increased RR, audible wheeing
  3. Cough that produces frothy blood tinged sputum
  4. Decreased responsiveness and consciousness
53
Q

How do you treat pulmonary edema (9)

A
  1. Prevention
  2. Improve gas exchange
  3. Reduce fluid overload
  4. Strengthen and slow heart beat (beta blockers)
  5. Fluid restriction
  6. Diuretics
  7. Diet
  8. Relieve anxiety
  9. O2 therapy
54
Q

Is pulmonary edema reversible

A

Yes

55
Q

What is acute respiratory distress syndrome (ARDS)

A

Acute respiratory failure

56
Q

What are other names for ARDS

A

Respiratory distress syndrome, hyaline membrane disease, defuse alveolar damage

57
Q

What could be causes of ARDS (7)

A
  1. Trauma
  2. Sepsis
  3. Coronary artery bypass
  4. Burns
  5. Embolism
  6. Near drowning
  7. Shock
58
Q

What happens in ARDS

A

Diffuse alveolar damage due to inflammatory response leads to inactivating surfactant and fluids, proteins, and blood cells leaking, which all results in collapsed alveoli and decreased lung compliance

59
Q

True or False:

People with ARDS can have multiple organ failure

A

True

60
Q

When do the symptoms of ARDS arise

A

12-48 hours after initial event

61
Q

What are the signs and symptoms of ARDS (5)

A
  1. Shallow rapid breaths
  2. Dyspnea
  3. Hyperventilation
  4. Cyanosis
  5. System failure
62
Q

How do you treat ARDS

A

Treat underlying problems, prevent any further complications, provide supportive respiratory therapy and sedation

63
Q

What is the mean survival of patients with ARDS

A

2 weeks

64
Q

When do ARDS survivors get normal lung function back

A

1 year after onset

65
Q

What percent of people with ARDS die

A

50-70%

66
Q

What is sarcoidosis

A

Asystemic disease with diffuse granulomas and inflammation of lungs

67
Q

True or False:

Sarcoidosis may regress or may progress to fibrosis

A

True

68
Q

What are the signs and symptoms of sarcoidosis (3)

A
  1. Lungs and thoracic lymph nodes are affected
  2. Affects eyes, skin, liver, spleen, heart, small bones of hands/feet
  3. Increased risk of osteoporosis
69
Q

What are the signs and symptoms of pulmonary involvement of sarcoidosis (7)

A
  1. Dyspnea
  2. Dry cough
  3. Fever
  4. Malaise
  5. Weight loss
  6. Skin lesions
  7. Fibrosis
70
Q

True or False:

A patient with sarcoidosis may be asymptomatic

A

True

71
Q

How long does it take for pulmonary symptoms to develop with sarcoidosis

A

Over weeks to months

72
Q

How do you treat sarcoidosis (4)

A
  1. Inhaled steroids
  2. Corticosteroids
  3. Manage/prevent osteoporosis
  4. Lung transplant
73
Q

When does complete resolution of symptoms usually occur with sarcoidosis

A

1-2 years

74
Q

What is another name for lung cancer

A

Bronchogenic carcinoma

75
Q

What are the 2 types of lung cancer

A
  1. Small cell lung cancer (20%)

2. Non-small cell lung cancer (80%)

76
Q

True or False:

Lung cancer is the leading cause of cancer death in the US

A

True

77
Q

What are the signs and symptoms of lung cancer (7)

A
  1. Dyspnea
  2. Systemic sympotms
  3. Metastatic symptoms
  4. Productive cough with hemoptysis
  5. Wheezing
  6. Chest pain
  7. Hoarseness
78
Q

How many stages of lung cancer

A

4

79
Q

What is the first stage of lung cancer

A

Within lung no metastases

80
Q

What is the second stage of lung cancer

A

Hilar/peribronchial lymph node involvement

81
Q

What is the third stage of lung cancer

A

Mediastinal or cervical lymph node mets, extension to the chest wall, mediatinum, diaphragm, and carina

82
Q

What is the fourth stage of lung cancer

A

Distant metastases

83
Q

How do you treat lung cancer

A

Prevention and chemotherapy with or without radiation

84
Q

How is lung cancer spread (3)

A
  1. Direct extension view the chest wall or diaphragm
  2. Lymphatic invasions (most frequent)
  3. Blood born metastases
85
Q

What are the areas that blood born metastases travel to (4)

A
  1. Adrenal gland
  2. Brain
  3. Bone
  4. Liver
86
Q

What is small cell lung cancer

A

Lung cells compressed into a mass

87
Q

Where is small cell lung cancer most often found

A

Bronchial submucosa centrally

88
Q

What does the tumor of the small cell lung cancer do

A

Releases hormones that stimulate further growth causing obstruction, pneumonia, and lymphatic involvement

89
Q

What are the signs and symptoms of small cell lung cancer (8)

A
  1. Cough with hemoptysis
  2. Dyspnea
  3. Stridor
  4. Wheezing
  5. Chest pain
  6. May cause broncopulmonary infections
  7. Referred pain
  8. Ectopic hormone production
90
Q

How do you treat small cell lung cancer (3)

A
  1. Chemotherapy
  2. Radiation therapy
  3. Surgical resection
91
Q

What are the 3 types of non small cell lung cancer

A
  1. Squamous cell
  2. Adenocarcinoma
  3. Large cell
92
Q

Where is squamous cell lung cancer

A

Centralized in major bronchi

93
Q

True or False:

Squamous cell lung cancer has rapid growth that is localized with cavitation

A

True

94
Q

Where is adenocarcinoma lung cancer typically found

A

Peripheral in upper lobes

95
Q

True or False:

Gland like structures form with adenocarcinoma lung cancer

A

True

96
Q

True or False:

Large cell lung cancer has poor differentiation

A

True

97
Q

True or False:

Non-small cell lung cancer is typically asymptomatic initially

A

True

98
Q

What are the symptoms of non-small cell lung cancer (10)

A
  1. Localized sharp severe pleural pain with inspiration
  2. Limited lung expansion
  3. Cough
  4. Dyspnea
  5. Clubbing
  6. Skin changes
  7. Joint swelling
  8. Osteoarthropathy
  9. Decreased/absent breath sounds
  10. Pleural rub
99
Q

How do you treat non-small cell lung cancer

A

Induction chemotherapy/chemoradiation and surgical resection

100
Q

What is the treatment of non-small cell lung cancer for stage 1 and 4

A

Stage 1: Surgery no chemotherapy

Stage 4: Chemotherapy and palliative care

Clin Med III (9 decks)

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