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Pathophys > Pulmonary Pathophys > Flashcards

Pulmonary Pathophys Flashcards

1
Q

Which side of the lungs is a FB more likely to get stuck in?

A

Right

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2
Q

Where are Goblet cells and submucosal glands located in the respiratory tree?

A

Walls of trachea and bronchi. Not bronchioles.

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3
Q

What do neuroendocrine cells secrete in the respiratory tree?

A

Serotonin, Calcitonin

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4
Q

What are type 1 alveolar pneumocytes?

A

cover 95% of alveolar surface

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5
Q

What are type 2 alveolar pneumocytes?

A

they are rounded cells that secrete surfactin and cover 5% of alveolar surface. They give rise to type 1 cells.

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6
Q

What are Pores of Kohn?

A

connect alveoli to alveoli

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7
Q

Does hypoplasia lung defect usually affect 1 or both lungs?

A

both

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8
Q

What is agenesis?

A

congenital defect where 1 or 2 lobes are missing.

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9
Q

What is tracheal atresia?

A

condition of abnormally closed or absent trachea.

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10
Q

At which point is a tracheal/ bronchial stenosis a clinical manifestation?

A

When it is less than 50% of its size

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11
Q

What can happen with esophageal atresia and distal fistula?

A

Food/drink intake will induce vomiting

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12
Q

What can happen with no esoophageal atresia but “H” fistula”?

A

Fluid can pass from esophagus into trachea.

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13
Q

What is eupnic respirations

A

“normal” breathing. 8-16bpm, 400-800 tidal volume.

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14
Q

What are Kussmaul Respiration?

A

inc vent rate and tidal volume

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15
Q

Characteristics of restricted breathing?

A

small TV, rapid rate, rapid expiration

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16
Q

What are Cheyne Stokes Respiration?

A

Alternating periods of deep and shallow breathing.

Brainstem breathing pattern.

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17
Q

What could cause Kussmaul Respirations?

A

metabolic problem. DKA

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18
Q

What can hyperventilation cause?

A

hypocapnia= 1)tingling in fingers/lips 2)dec resp drive= fainting

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19
Q

What causes cyanosis?

A

saturated hemoglobin of 5gm or more

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20
Q

What are signs of central cyanosis?

A

blue buccal mucosa and lips

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21
Q

What are signs of peripheral cyanosis?

A

blue nail beds

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22
Q

What is clubbing associated with?

A

chronic hypoxia= inc vascular growth

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23
Q

What is important to consider about location of irritant receptors in the airway?

A

few receptors in distal bronchi and alveoli so it is possible for secretions to accumulate distally w/o cough.

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24
Q

what is the effectiveness of cough dependent on?

A

Inspiratory volume

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25
Q

what is chronic cough defined as?

A

persistent cough for > 3 weeks

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26
Q

What is typical with hemoptysis?

A

blood from airway
bright red
alkaline
mixed with frothy sputum

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27
Q

What is typical with hematemesis?

A

blood from GI tract
Dark
Acidic
Food particles may be present

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28
Q

What is type 1 resp failure?

A

hypoxia w/o hypercapnia

Pa02 less than or equal 50mmHg

29
Q

What is type 2 resp failure?

A

hypoxia with hypercapnia

Pa02 less than or equal 50mmHg and PaC02 greater than or equal 50 with pH less than or equal 7.25

30
Q

What is neonatal atelectasis?

A

incomplete expansion of the lungs

31
Q

What is Acquired atelectasis?

A

collapse of previously inflated lung

32
Q

Where does the mediastinum shift in Resorption atelectasis?

A

toward the affected side due to dec pressure

33
Q

Where does the mediastinum shift in compression atelectasis?

A

away from the affected side.

34
Q

What is bronchiectasis?

A

permanent dilation of bronchi and cronchioles

35
Q

What causes bronchiectasis?

A

Caused by destruction of muscle & elastic tissue, resulting from or associated with chronic necrotizing infections.

36
Q

What conditions can be associated with Bronchiectasis?

A

Congenital conditions: CF
Post-infectious conditions: TB, bact, virus
Bronchial obstruction: tumors, FB, mucus
Other conditions: RA, systemic Lupus, IBD

37
Q

What is characteristic of lungs with Bronchiectasis?

A 
Infection: 
Inflammation
Necrosis
Fibrosis
Dilation of airways
38
Q

What is Bronchiolitis?

A

Inflammatory obstruction of the small airways or bronchioles

39
Q

What is Bronchiolitis obliterans?

A

fibrotic process occluding airways and causes permanent scarring of the lungs
Common after lung transplantation.

40
Q

What are characteristics of Bronchiolitis?

A

Most commonly in children: Due to RSV

In adults: accompanies chronic bronchitis

Usually diffuse

41
Q

What causes pulm edema with inc hydrostatic pressure and normal oncotic pressure?

A

Left Heart failure, Mitral stenosis

42
Q

What causes Pulm edema with normal hydrostatic pressure and dec oncotic pressure?

A

nephrotic syndrome, liver Dz

43
Q

What causes pulm edema with normal hydrostatic pressure and normal oncotic pressure?

A

Microvascular Injury…

  • Infections
  • Aspiration
  • Drugs
  • Radiation
44
Q

What drug can cause pulm edema due to microvascular inj?

A

penicillin (after 10 days)

45
Q

Which part of the lungs is most affected by pulm edema?

A

lower lobes

46
Q

What are “heart failure cells?”

A

hemosiderin laden macrophages from pulm edema

47
Q

What occurs in the lungs with pulm edema?

A

Hemosiderin laden macrophages abundant
Fibrosis
Thickening of alveolar walls results in lungs becoming firm and brown “brown induration”

48
Q

What is the 2012 criteria for ARDS?

A

Respiratory symptoms must have started within one week of a known clinical insult
Bilateral opacities on chest radiograph or CT scan
Respiratory failure must not be fully explained by cardiac failure or fluid overload (consider echocardiograph to rule out)
Hypoxemia must be present on minimal ventilator settings

49
Q

What is mild ARDS?

A

PaO2/FiO2 >200mmHg but ≤300mmHg

50
Q

What is moderate ARDS?

A

PaO2/FiO2 >100mmHg but ≤ 200mmHg

51
Q

What is severe ARDS?

A

PaO2/FiO2≤100mmHg

52
Q

What are the majority of ARDS cases caused by?

A

Sepsis
Diffuse pulmonary infections
Gastric Aspiration
Mechanical Trauma

53
Q

What type of bacteria usually cause ARDS form sepsis?

A

gram negative which activates the complement system

54
Q

What is the pathogenesis of ARDS?

A

Imbalance between pro-inflammatory mediators and inflammatory mediators leading to accumulation of neutrophils releasing oxidants, PAF, LKs which damage albeolar epithelium.

55
Q

What does IL-8 do?

A

chemotaxic factor for neutrophils

56
Q

What does IL-1 and TNF do?

A

activation of endothelial cells and neutrophils

57
Q

Which transcription factor shifts the balance to a pro-inflammatory state?

A

Kappa Beta

58
Q

What is involved after macrophage activation?

A

cytokine production, IL-1 & TNF effect on endothelial cells

59
Q

What is involved after Neutrophil activation?

A

free radicals, PAF, LKTs, proteases

60
Q

What are the 3 main phases of ARDS?

A

1) Exudative: diffuse alveolar damage
2) Fibroproliferative: fibrosis and laying down of hyaline cartilage
3) Recover/chronic

61
Q

Which cells are affected first in exudative phase of ARDS?

A

Type 1 alveolar pneumocytes

62
Q

What are the consequences of damage to alveolar pneumocytes?

A

Swelling
Bleb formation
Necrosis

63
Q

What cells other than pneumocytes are damaged in the exudative phase of ARDS and what is the implication of this?

A

Capillary endothelial cells are damaged causing microthrombi. This is indicated by presence of vWF.

64
Q

What is the implication of diffuse alveolar damage during exudative phase of ARDS?

A

inc vascular permeablility

65
Q

What is the implication of basement membrane thickening during exudative phase of ARDS?

A

dec diffusion of O2= vent-perfusion mismatch

66
Q

What occurs in the fibroproliferative phase of ARDS?

A 
Persistent hypoxemia:  
Development of hypercarbia
Fibrosing alveolitis
Further decrease in pulmonary compliance
Pulmonary hypertension
Surfactant dysfunction
67
Q

1st tests to order for ARDS?

A 
CXR
ABG
CVP
CBC
Sputum/blood Culture
UA
Lipase
68
Q

What tests would you order to rule out cardiogenic pulmonary edema in a ARDS workup?

A

BNP: BNP < 100 pg/mL bilateral infiltrates & hypoxemia suggests ARDS/ALI
Echocardiogram normal in ARDS
Pulmonary artery catheterizatioin

69
Q

What is Lung Injury Prediction Score(LIPS)?

A

Identifies who is unlikely to develop ALI/ARDS based on a point system grading the predisposing conditions

Alerts clinicians to implement prevention strategies for those at risk

Under further investigation and current studies are being done to improve the prediction scoring system

Pathophys (15 decks)

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