Respi Assessment Flashcards
Unilateral or bilateral bony (90% of cases) or membranous (10% of cases) septum between the nose and the pharynx
Choanal Atresia
Nonneoplastic tumefactions tgat develop as a response to chronic inflammation
Nasal polyps
The most common polyp.
Most often seen in adults with a history of IgE-mediated allergies. Nasal smear shows numerous Eosinophils
Allergic polyps
excessive snoring with intervals of breath cessation (apnea)
Obstructive Sleep Apnea (OSA)
Most common cause of OSA where Pharyngeal muscles collapse due to the weight of tissue in the neck.
Obesity
Other causes of Obstructive Sleep Apnea (OSA)
- tonsillar hypertrophy
- nasal septum deviation
- hypothyroidism
- acromegaly
Excessive snoring with episodes of apnea. Daytime somnolence often simulating narcolepsy
Obstructive Sleep Apnea (OSA)
PaO2 and O2 saturation (Sa O2) decrease and
PaCO2 increases (respiratory acidosis) during apneic episodes.
Obstructive Sleep Apnea (OSA)
Inflammation of the mucous membranes lining one or more of the paranasal sinuses.
Sinusitis
Most common malignant tumor of the nasopharynx. Male dominant
Increased in Chinese (common in adults) and African populations (common in children). Causal relationship with Epstein-Barr virus (EBV)
Nasopharyngeal (NP) Carcinoma
Occurs followed by right ventricular hypertrophy (RVH) the right ventricle becomes hypertrophied (called cor pulmonale).
Pulmonary hypertension (PH)
Hypoxemic stimulus for erythropoietin release leads to RBC hyperplasia and secondary polycythemia.
Secondary polycythemia
Location of Sinusitis
• Adult
Children
Adults- maxillary sinus
Children - ethmoid sinus
Causes of Sinusitis
- Upper respiratory infections (URIs); e.g., viral, bacterial (S. pneumoniae)
- Deviated nasal septum
- Allergic rhinitis, barotrauma, and smoking cigarettes
Pathologic findings of Nasopharyngeal (NP) Carcinoma
- Squamous cell carcinoma (SCC), nonkeratinizing squamous carcinoma, or undifferentiated cancer
- Metastasizes to cervical lymph nodes (70% of cases)
Treatment for Nasopharyngeal (NP) Carcinoma
Radiotherapy
Risk factors Laryngeal carcinoma
•Cigarette smoking (most common cause)
• Alcohol (synergistic effect with smoking)
• Squamous papillomas and papillomatosis
-Human papillomavirus types 6 and 11 association.
- Majority located on true vocal cords
• Majority are keratinizing SCCs
Persistent hoarseness often associated with cervical lymphadenopathy
Laryngeal carcinoma
Upper Respiratory Tract disease
- Choanal Atresia
- Obstructive Sleep Apnea (OSA)
- Sinusitis
- Nasopharyngeal (NP) Carcinoma
- Nasal polyps
Loss of lung volume due to inadequate expansion of the airspaces (collapse)
Atelectasis
Airway obstruction by thick secretions prevents air from reaching the alveoli. Obstruction occurs in bronchi, segmental bronchi, or terminal bronchioles.
Resorption Atelectasis
Causes of obstruction
of Resorption Atelectasis
- Mucus or mucopurulent plugs after surgery
- Aspiration of foreign material
- Centrally located bronchogenic carcinoma
Cause of alveolar collapse
Lack of air and distal resorption of preexisting air. Following obstruction, circulating blood in the pulmonary capillary absorbs the preexisting air in the peripheral alveoli, leading to alveolar collapse and an airless state within a few hours.
Fever and dyspnea
Symptoms occur within 24 to 36 hours of collapse.
Absent breath sounds
Absent vocal vibratory sensation (tactile fremitus) Alveoli are collapsed.
Clinical findings of Atelectasis
Treatment for Atelectasis
- Incentive spirometry after surgery
- CPAP by face mask
- Positive end-expiratory pressure (PEEP) on mechanical ventilation
Air or fluid in the pleural cavity under increased pressure collapses small airways beneath the pleura
Compression Atelectasis
Examples of Compression Atelectasis
- Tension pneumothorax where air compresses the lung
* Pleural effusion where fluid compresses the lung
Atelectasis due to loss of surfactant.
Tension pneumothorax
Synthesize surfactant which is stored in lamellar bodies
and synthesis begins in 28th week of gestation.
Type II pneumocytes
Has a decreased surfactant in the fetal lungs caused by prematurity (most common cause), maternal diabetes (poorly controlled)
[Fetal hyperglycemia increases insulin release.], Cesarean section (C-section) from lack of stress-induced increase in cortisol from a vaginal delivery
Respiratory distress syndrome (RDS) in newborns
Widespread atelectasis results in _____ from Perfusion without ventilation.
Collapsed alveoli are lined by hyaline membranes
Derived from proteins leaking out of damaged pulmonary vessels.
massive intrapulmonary shunting.
Respiratory difficulty begins within a few hours after birth.
Grunting
Tachypnea
Intercostal retractions
Infants develop hypoxemia and respiratory acidosis.
Respiratory distress syndrome (RDS) in newborns
Diagnosis of Respiratory distress syndrome (RDS) in newborns
Chest radiograph shows a “ground glass” appearance
• Increased hydrostatic pressure (HP) in pulmonary capillaries
- Left-sided heart failure, volume overload, and mitral stenosis
• Decreased oncotic pressure (OP)
- Nephrotic syndrome and cirrhosis
Edema due to alterations in Starling pressure (transudate)
Edema due to microvascular or alveolar injury
exudate
Noncardiogenic pulmonary edema resulting from acute alveolar-capillary damage.
Adult Respiratory Distress Syndrome (ARDS)
Due to direct injury to the lungs or systemic diseases
Adult Respiratory Distress Syndrome (ARDS)
Hyaline Membrane Disease
Main causes are:
Severe Acute Respiratory Syndrome (SARS)*
Hantavirus
Severe Acute Respiratory Syndrome
Other causes of SARS
- heroin
- smoke inhalation
- acute pancreatitis
- cardiopulmonary bypass
- disseminated intravascular coagulation
- amniotic fluid embolism
- fat embolism
Arrange the following regarding the pathogenesis of the SARS
- Cytokines are chemotactic to neutrophils.
- Neutrophils transmigrate into the alveoli through pulmonary capillaries.
- Capillary damage causes leakage of a protein-rich exudate producing hyaline membranes.
- Neutrophils damage type I and II pneumocytes.
- Decrease in surfactant causes atelectasis with intrapulmonary shunting.
- Cytokines are chemotactic to neutrophils.
- Neutrophils transmigrate into the alveoli through pulmonary capillaries.
- Capillary damage causes leakage of a protein-rich exudate producing hyaline membranes.
- Neutrophils damage type I and II pneumocytes.
- Decrease in surfactant causes atelectasis with intrapulmonary shunting.
Important to distinguish ARDS from cardiogenic pulmonary edema, where PA wedge pressure is
> 18 mm Hg
Bilateral interstitial infiltrates initially
Progresses to widespread alveolar consolidation with air bronchograms (80%)
SARS Corona Virus
Treatment for SAR COV
- Treat underlying disease
- Hemodynamic monitoring
- Mechanical ventilation
- Nitric oxide inhalation, corticosteroids
Sixth leading cause of death in the United States that the majority are caused by bacterial pathogens.
Most often due to Streptococcus pneumoniae (50%– 75% of cases)
Typical community-acquired pneumonia
Microaspiration of oropharyngeal contents during sleep
• Inhalation of aerosol drops ranging in size from 0.5 to 1 µm
• Bloodstream infection
Typical community-acquired pneumonia
It begins as an acute bronchitis and spreads locally into the lungs. The lower lobes or right middle lobe are usually involved. The lung has patchy areas of consolidation
with noted microabscesses
Bronchopneumonia
Complete or almost complete consolidation of a lobe of lung
Loba pneumonia
Syages of Lobar Pneumonia
- Congestion (1st 24hrs)- the affected lobe is red, heavy and boggy. It is vascular dilation and avoelar exudate contain bacteria in microscope
- Red hepatization (day 2-3)- red firm lobe (liver-like consistency). Avoelar exudate contains neutrophil, erythrocytes, fibrin
- Gray hepatization (4-6 days) Gray-brown firm lobe. Same with #3 but RBC disintegrate
- Resolution- restoration of normal architect. Enzymatic digestion of exudate
Signs of consolidation (alveolar exudate)
- Dullness to percussion
- Increased vocal tactile fremitus
- Sound is transmitted well through alveolar consolidations.
- Late inspiratory crackles
- Bronchial breath sounds, bronchophony and egophony
gold standard screen in
Patchy infiltrates (bronchopneumonia) or lobar consolidation with a sensitivity 50% to 85%
Cgest radiograph
Usually caused by Mycoplasma pneumoniae
Atypical community-acquired pneumonia
Clinical findings of Atypical community-acquired pneumonia
•Insidious onset, low-grade fever
• Nonproductive cough
• Chest pain
• Flu-like symptoms
- Pharyngitis, laryngitis, myalgias, headache
•
No signs of consolidation
Mononuclear infiltrate and alveolar spaces usually free of exudate
Patchy interstitial pneumonia
Gram-negative bacteria- Pseudomonas aeruginosa (respirators), Escherichia coli
Gram-positive bacteria (e.g., Staphylococcus aureus)
Nosocomial pneumonia
Common opportunistic infections of
Pneumonia in immunocompromised hosts
• Cytomegalovirus
• Pneumocystis jiroveci
-
TMP-SMX is used for prophylaxis and treatment.
• Aspergillus fumigatus
Contracted by inhalation of Mycobacterium tuberculosis and the
Organism resides in phagosomes of alveolar macrophages
Tuberculosis (TB)
Virulence factor
Of Strict aerobe, acid-fast TB
Cord Factor
Purified protein derivative (PPD) intradermal skin test
Does not distinguish active from inactive disease
Screening of TB
Responsible for positive PPD
Protein in cell wall
Chromosome mutations involving mycolic acid
Chromosome mutations involving catalase peroxidase
Drug resistance in TB
Does not distinguish active vs inactive TB
PPD
Nodes: Subpleural location
- Upper part of the lower lobes or lower part of the upper lobes
- Ghon focus (caseous necrosis) in periphery
- Ghon complex (caseous necrosis) in hilar lymph
Secondary (reactivation) TB
- Due to reactivation of a previous primary TB site
- Involves one or both apices in upper lobes
- Ventilation (oxygenation ) is greatest in the upper lobes.
- M. tuberculosis is a strict aerobe. Reactivation TB: upper lobe cavitary lesion(s)
Complications of Cavitary lesion due to release of cytokines from memory T cells
Miliary spread in lungs due to invasion into the bronchus or lymphatics
Clinical findings
of Cavitary lesion due to release of cytokines from memory T cells
- Fever
- drenching night sweats
- weight loss TB: drenching night sweats
- weight loss
extrapulmonary site TB
Kidneys
- Spread is due to invasion of pulmonary vein tributaries.
- Kidney is the most common extrapulmonary site.
- Adrenal involvement may result in Addison disease.
Miliary spread to extrapulmonary sites
Granulomatous hepatitis, spread to vertebrae (Pott disease) TB in vertebrae
Pott disease
Cavitary lesion treatment
• Isoniazid + rifampin + pyrazinamide
• Noninfectious in 2 to 3 weeks (3) Treat for additional 9 to 12 months
- Atypical mycobacterium
- Most common TB in AIDS (often disseminates)
- Occurs when CD4 helper T cell (T H) count falls < 50 cells/mm3 MAC: MC TB in AIDS
Mycobacterium avium-intracellulare complex (MAC)
Treatment for Mycobacterium avium-intracellulare complex (MAC)
• Clarithromycin + rifabutin + ethambutol
It is cuased most often due to aspiration of oropharyngeal material (e.g., tonsillar material)
Lung abscess
Risk factos for Lung Abscess
- Alcoholism
- Loss of consciousness
- Recent dental work
- Microbial pathogens
- Aerobic and anaerobic streptococci
Staphylococcus - Prevotella
- Fusobacterium
- Anaerobes in 60% of cases Lung abscesses: mixed aerobic/ anaerobic infection
From 10% to 15% of abscesses are behind a bronchus obstructed by cancer.
Obstructive lung neoplasia
Infective endocarditis
Septic embolism
Spiking fever and productive cough (foul-smelling sputum) are common.
Chest imaging shows cavitation with an air-fluid level
Lung Abscess
Treatment for Lung Abscess
- Clindamycin
* Bronchoscopy if it does not resolve
term applied to peripheral lung nodule < 5 cm
Solitary Pulmonary Nodule
Etiology of Lung Tumor
- Granuloma
- Primary lung CA
- Bronchial Carcinoid
Patients less than 35 years old risk:
Patients more than 50 years old risk:
Patients less than 35 years old risk: < 1%
Patients more than 50 years old risk: 50 to 60%
The source of the most common lung tumor that is metastatic and appears as multiple lesions.
Breast
Clinical Findings of Lung CA
Cough (75%)
Weight Loss
Hemoptysis
Produces Horner syndrome which is a superior sulcus tumor. The tumor is usually a primary SCC located at the extreme apex of the lung.
Pancoast Tumor
Is the most common fatal cancer in both men and women worldwide.
Primary Lung Cancer
The most common cause of lung cancer
Smoking
Most common oncogenes
- KRAS
- MYC family
- HER-2/ neu
- BCL-2
- EGFR (Epidermal Growth Factor Receptor)
Classification of Lung Cell
Small Cell Carcinoma (15%)
Non Small Cell Carcinoma (85%)
