TEST 5 Flashcards
Chapter 21: Pulmonary Vascular Disease
Explain the difference between a thrombus and embolus.
A clot that forms and remains in a vein is called a thrombus.
A blood clot that becomes dislodged and travels in another part of the body is called an embolus (embolism).
Chapter 21: Pulmonary Vascular Disease
What are the major pathologic or structural changes of the lungs and heart associated with pulmonary embolism? (6)
- Pulmonary hypertension
- Right-heart failure (Cor pulmonale)
- Pulmonary infarction (when severe)
- Alveolar atelectasis
- Alveolar consolidation
- Bronchial smooth muscle constriction (bronchospasm)
Chapter 27: Interstitial Lung Diseases
Goodpasture syndrome is a disease of unknown cause that involves what two organs?
- Lungs
- Kidneys
Chapter 27: Interstitial Lung Diseases
A condition of unknown cause in which the alveoli become filled with protein and lipids.
Pulmonary Alveolar Proteinosis
Chapter 27: Interstitial Lung Diseases
________________ is an intersitial lung disease more commonly seen in African-Americans.
Sarcoidosis
Chapter 27: Interstitial Lung Diseases
What is characterized by infiltration of eosinophils, and, to a lesser extent, macrophages into the alveolar and interstitial spaces?
Chronic Eosinophilic Pneumonia
Chapter 27: Interstitial Lung Diseases
More than ______ disease entities are characterized by acute, subacute, or chronic inflammatory infiltration of alveolar walls by cells, fluid and connective tissue.
180
Chapter 27: Interstitial Lung Diseases
If left untreated, the inflammatory process of ILDs can progress to _________________.
Irreversible pulmonary fibrosis
Chapter 27: Interstitial Lung Diseases
The anatomic alteration of ILD may involve _______________.
- Bronchi
- Alveolar walls
- Adjacent alveolar spaces
Chapter 27: Interstitial Lung Diseases
What are the major pathologic or structural changes associated with chronic ILDs? (7)
- Destruction of the alveoli and adjacent pulmonary capillaries
- Fibrotic thickening of the respiratory bronchioles, alveolar ducts and alveoli
- Granulomas
- Honeycombing and cavity formation
- Fibrocalcific pleural plaques (Abestosis specifically)
- Bronchospasm
- Excessive bronchial secretions (caused by inflammation of airways)
Chapter 27: Interstitial Lung Diseases
Sjogren syndrome is lymphocytic infiltration that primarily involves ____________ and _____________ glands.
- Salivary glands (mouth)
- Lacrimal glands (eyes)
Chapter 27: Interstitial Lung Diseases
What is the most common pulmonary complication associated with rheumatoid arthritis?
Pluerisy with or without effusion
The effusion is generally unilateral (right side)
Men develop pleural complications more often than women.
Chapter 27: Interstitial Lung Diseases
Where is scleroderma most commonly seen?
Women ages 30-50.
Chapter 27: Interstitial Lung Diseases
One of the clinical hallmarks of sarcoidosis is an increase in what three immunoglobulins?
IgM, IgG, IgA
- Also an elevation of the angiotensin converting enzyme (ACE test).
(G.A.M)
Chapter 27: Interstitial Lung Diseases
Polymyositis-dermatomyositis is more often in women than men, at about a ________ ratio.
2:1
Chapter 27: Interstitial Lung Diseases
With appropriate treatment, the 5-year survival rate of good pasture syndrome is ______%
80
Chapter 26: Cancer of the Lung
Define neoplasm.
The abnormal growth of new cells.
Also called tumor.
Chapter 26: Cancer of the Lung
A tumor that originates in the bronchial mucosa is called ______________.
Bronchogenic carcinoma
Chapter 26: Cancer of the Lung
Lung cancer is the __________ most common cause of cancer in both men and women.
Second
Chapter 26: Cancer of the Lung
What is the second leading cause of lung cancer in this country according to EPA?
Radon exposure
Chapter 26: Cancer of the Lung
What is the most common cause of lung cancer?
Cancer sticks - Cigarette smoking
Chapter 26: Cancer of the Lung
Small (oat) cell cancer accounts for about ______% of all bronchogenic carcinomas.
10-15
Chapter 21: Pulmonary Vascular Disease
Although there are many possible sources of pulmonary emboli, what is the most common by far?
Blood clots
Chapter 21: Pulmonary Vascular Disease
What are the three primary factors associated with the formation of DVT?
- Venous stasis
- Hypercoagulability
- Injury to the epithelial cells that line the vessels
Chapter 21: Pulmonary Vascular Disease
Define pulmonary hypertension.
An increase in mean pulmonary artery pressure greater than 25 mm Hg at rest.
Chapter 21: Pulmonary Vascular Disease
Explain what a saddle embolus is.
When a large embolus detaches from a thrombus and passes through the right side of the heart, it may lodge in the burification of the pulmonary artery.
Chapter 21: Pulmonary Vascular Disease
D-dimer values greater than ___________ are considered positive.
500 ng/mL
Chapter 21: Pulmonary Vascular Disease
In some cases, when an embolus disrupts pulmonary arterial blood flow, what may develop?
Pulmonary infarction, that may cause alveolar atelectasis, consolidation and tissue necrosis
In addition, the embolus is thought to activate the release of humoral agents such as serotonin, histamine, and prostaglandins into the pulmonary circulation, causing bronchial constriction.
Chapter 21: Pulmonary Vascular Disease
Bronchial smooth muscle _______________ occasionally accompanies pulmonary embolism.
Constriction
Chapter 21: Pulmonary Vascular Disease
It is believed that embolisms cause the release of cellular mediators such as serotonin, histamine, and prostaglandins from platelets which in turn leads to what?
Bronchoconstriction
Chapter 21: Pulmonary Vascular Disease
An embolus may occur originate from where?
- One large thrombus
- Occur as a shower of small thrombi and may or may not interfere with the right ventricle’s ability to perfuse the lungs adequately.
Chapter 21: Pulmonary Vascular Disease
Why is a saddle thrombus most often fatal?
It blocks the pulmonary blood from returning to the left ventricle and being pumped out to the systemic circulation.
Chapter 21: Pulmonary Vascular Disease
______________ and _______________ are often clinically insidious disorders.
- Deep Vein Thrombosis
- Pulmonary Embolism
Chapter 21: Pulmonary Vascular Disease
By contrast, sudden death is often the first symptom in about ______% of people who have a large pulmonary embolus.
25
Chapter 21: Pulmonary Vascular Disease
What is one of the most common causes of sudden and unexpected death in all age groups?
PE
Chapter 21: Pulmonary Vascular Disease
Because of the subtle and misleading clinical manifestations associated with a PE, the possibility of a blood clot lodged in the lung is often not considered until autopsy in about ________% of cases.
70-80%
Chapter 21: Pulmonary Vascular Disease
In the US, how many individuals die each year from a pulmonary embolism?
100,000
Chapter 21: Pulmonary Vascular Disease
Pulmonary embolism is slightly more frequent in which gender?
More frequent with males than females. Incidence increases with age.
Chapter 21: Pulmonary Vascular Disease
When does the health care practitioner actively work to confirm the diagnosis of a pulmonary embolism?
As soon as the suspicion arises
Chapter 21: Pulmonary Vascular Disease
Where does most pulmonary blood clots originate?
They originate or break away from sites of DVT in the lower part of the body. (E.g, leg, and pelvic veins and inferior vena cava)
Chapter 21: Pulmonary Vascular Disease
Explain what happens when a thrombus or piece of a thrombus breaks loose in a deep vein.
The blood clot (now called an embolus) is carried through the venous system to the right atrium and ventricle of the ❤️ and lodges in the pulmonary arteries or arterioles.
Chapter 21: Pulmonary Vascular Disease
List a few risk factors associated with pulmonary embolism.
Venous Stasis
- Inactivity
- Prolonged bed rest
- Prolonged sitting
- CHF
- Varicose veins
- Thrombophlebitis
Surgical Procedures
- Hip surgery
- Pelvic surgery
- Knee surgery
- Certain obstetric or gynecologic procedures
Trauma
- Bone fractures
- Extensive injury to soft tissue
- Postoperative or postpartum states
Chapter 21: Pulmonary Vascular Disease
What are D-dimer tests for?
Used to check for an increased level of protein fibrinogen.
Chapter 21: Pulmonary Vascular Disease
When are the results for a D-dimer usually available?
1 hr
Chapter 21: Pulmonary Vascular Disease
What should be emphasized about D-dimer tests?
Many conditions can increase a patient’s D-dimer level, including recent surgery so this test is usually used to supplement other clinical information.
Chapter 21: Pulmonary Vascular Disease
How long does an ultrasonography take to perform?
30 mins. or less
Chapter 21: Pulmonary Vascular Disease
Where is ultrasonography most accurate for the diagnosis of blood clots?
Behind the knee or thigh
Chapter 21: Pulmonary Vascular Disease
List some signs and symptoms commonly associated with PE. (13)
- Sudden SOB
- Cardiac arrhythmias
- Weak pulse
- Lightheadedness or fainting
- Anxiety
- Excessive sweating
- Cyanosis
- Cool or clammy skin to the touch
- Cough
- Blood-streaked sputum
- Wheezing
- Leg swelling
- Chest pain that resembles a heart attack
Chapter 21: Pulmonary Vascular Disease
Where is ultrasonography insensitive in detecting DVT?
Below the knee
Chapter 21: Pulmonary Vascular Disease
Although the CXR result for PE is often normal in the patient, it can be used to rule out conditions that mimic a PE, such as what?
- Pneumonia
- Pneumothorax
Chapter 21: Pulmonary Vascular Disease
Infiltrates and atelectasis will be seen in about _______% of pulmonary embolism/infarction cases.
50
Chapter 21: Pulmonary Vascular Disease
An elevated hemidiaphragm will be seen in about _______% of pulmonary embolism/infarction cases.
40
Chapter 21: Pulmonary Vascular Disease
What is becoming the first-line test for diagnosing suspected pulmonary embolism?
Computed Tomography Pulmonary Angiogram - CTPA
Chapter 21: Pulmonary Vascular Disease
______________ provides a clear image of the blood flow the lungs’ arteries.
Pulmonary angiogram
It’s invasive and time consuming (1 hr). It’s only performed when other test failed to provide accurate diagnosis.
Chapter 21: Pulmonary Vascular Disease
What may be used for patients with suspected PE, but their kidneys may be harmed by dyes used in X-ray tests and for women who are pregnant?
MRI
Chapter 21: Pulmonary Vascular Disease
On admission to the hospital for a PE, immediate transfer to an intensive care unit is mandatory.
Just something to know.
Chapter 21: Pulmonary Vascular Disease
Explain the use of fast acting coagulants.
Used to prevent existing blood clots from growing and prevent the formation of new ones.
Chapter 21: Pulmonary Vascular Disease
List some low molecular weight heparins.
- Enoxaparin
- Dalteparin
- Tinzaparin
Chapter 21: Pulmonary Vascular Disease
Heparin and warfarin are given together for how many days?
5-7 days, until blood tests show that the warfarin is preventing blood clotting. Then its discontinued.
Chapter 21: Pulmonary Vascular Disease
What type of anticoagulant is warfarin?
Slow-acting, oral anticoagulant
Chapter 21: Pulmonary Vascular Disease
Brand name for warfarin.
Coumadin, Panwarfarin
Chapter 21: Pulmonary Vascular Disease
What are some thrombolytic agents?
- Streptokinase (Streptase)
- Urokinase (Abbokinase)
- Altepase (Activase)
- Reteplase (Retavase)
Chapter 21: Pulmonary Vascular Disease
What are some preventative measures for developing thrombo-embolic disease?
- Walking
- Exercise while seated
- Drink fluids
- Wear graduated compression stockings
Chapter 21: Pulmonary Vascular Disease
What are the chest assessment findings of a PE? (3)
- Crackles
- Wheezing
- Pleural friction rub (when the pulmonary infarction involves th pleura)
Chapter 21: Pulmonary Vascular Disease
Normally, the pulmonary artery pressure is no greater than _______.
25/10 mm Hg
Chapter 21: Pulmonary Vascular Disease
What are the radiologic findings of a PE?
- Increased density
- Dilation of the pulmonary arteries
- Pulmonary edema
- Pleural effusion (usually small)
- Cor pulmonale
- Hyperradiolucency distal to the embolus
Chapter 21: Pulmonary Vascular Disease
Explain what a inferior vena cava vein filter does.
Placed in the IVC to prevent clots from being carried into the pulmonary circulation.
Chapter 21: Pulmonary Vascular Disease
Pulmonary hypertension is more often among _______ at a ratio of 3:1.
WOMEN
Chapter 26: Cancer of the Lung
Cancer is a general term that refers to abnormal new tissue growth characterized by __________.
progressive, uncontrolled multiplication of cells
Chapter 26: Cancer of the Lung
This type of tumor does not endanger life unless they interfere with the normal function of other organs or affect a vital organ.
Benign tumors
Chapter 26: Cancer of the Lung
What are the major pathologic or structural changes associated with bronchogenic carcinoma? (8)
- Inflammation, swelling and destruction of the bronchial airways and alveoli
- Excessive mucous production
- Tracheobronchial mucus accumulation and plugging
- Airway obstruction
- Atelectasis
- Alveolar consolidation
- Cavity formation
- Pleural effusion
Chapter 21: Pulmonary Vascular Disease
What are some sources of pulmonary emboli’s?
- Fat
- Air
- Amniotic fluid
- Bone marrow
- Tumor fragments
Chapter 21: Pulmonary Vascular Disease
The diagnosis of a pulmonary embolism is primarily based on what?
Clinical manifestations that support the possibility of a PE
Chapter 21: Pulmonary Vascular Disease
An ultrasonography test uses high-frequency sound waves to detect blood clots in the __________.
Thigh veins
Chapter 21: Pulmonary Vascular Disease
What may be used to differentiate among blood (usual), thromboemboli, and tumor emboli in patients with malignancy?
Magnetic Resonance Angiography
Chapter 21: Pulmonary Vascular Disease
Is heparin fast or slow-acting?
Fast
Chapter 21: Pulmonary Vascular Disease
How is heparin administered?
Intravenously to achieve rapid effect.
Chapter 21: Pulmonary Vascular Disease
Why must unfractioned heparin dosing be governed by frequent monitoring of APPT (activated partial thromboplastin time)?
Bleeding from unfractioned heparin can develop.
Chapter 21: Pulmonary Vascular Disease
How long anticoagulants are given varies on what?
Patient’s condition. If PE is caused by a temporary risk factor like surgery, treatment is given for 2-3 months. If the cause is from long-term conditions like prolonged bed rest, its usually given for 3-6 months.
Chapter 21: Pulmonary Vascular Disease
Explain what thrombolytic agents do.
Dissolve blood clots
Chapter 21: Pulmonary Vascular Disease
What are some drugs that alter blood’s ability to clot?
- Over the counter acetaminophens
- Ibuprofens
- Herbal preparations
- Dietary supplements
- Foods that are high in Vitamin K (Broccoli, spinach, leafy greens, liver, grapefruit juice, green tea)
Chapter 21: Pulmonary Vascular Disease
Describe the physical examination of a patient with a pulmonary embolism.
- Increased RR, HR
- Systemic hypotension
- Cyanosis
- Cough and hemoptysis
- Peripheral edema and venous distention
- Chest pain and decreased chest expansion
- Abnormal heart sounds
Chapter 21: Pulmonary Vascular Disease
How does PE increase physiologic dead space?
When an embolus lodges in the pulmonary vascular system, blood flow is reduced or completely absent distal to the obstruction, so alveolar ventilation beyond the obstruction is wasted, dead space and no carbon dioxide-oxygen exchange occurs.
Chapter 21: Pulmonary Vascular Disease
Is ventilation-perfusion ratio distal to a pulmonary embolus high or low?
High
Chapter 21: Pulmonary Vascular Disease
What is normal mean pulmonary artery pressure?
About 15 mm Hg
Chapter 21: Pulmonary Vascular Disease
A.) Most patients with a pulmonary embolism have a mean pulmonary artery pressure greater than ____.
B.) What contributes to this?
A.) 20 mm Hg
B.) - Decreased cross-sectional area of the pulmonary vascular system bc of the embolism
- Vasconstriction induced by humoral agents
- Vasconstriction induced by alveolar hypoxia
Chapter 21: Pulmonary Vascular Disease
List some test used to diagnose pulmonary hypertension.
- Echocardiography
- CXR
- Electrocardiogram
- Chest MRI
- PFTs
- V/Q scan
- Right heart catheterization
Chapter 21: Pulmonary Vascular Disease
Is the right-sided or left-sided heart failure more commonly the cause of pulmonary hypertension?
Left (CHF)
Chapter 21: Pulmonary Vascular Disease
What are some treatment routes for pulmonary hypertension?
- Diuretics: Decrease fluid build up
- Inhaled nitric oxide
- Blood-thinning medications: Prevent clots
- Cardiac glycosides: Help heart pump stronger
Chapter 27: Interstitial Lung Diseases
Interstitial lung disease is also called ___________.
- Pulmonary fibrosis
- Diffuse ILD
- Fibrotic ILD
Chapter 27: Interstitial Lung Diseases
In severe cases, the extensive inflammation associated with ILD leads to what?
- Pulmonary fibrosis
- Granulomas
- Honeycombing
- Cavitation
Chapter 21: Pulmonary Vascular Disease
List some common signs and symptoms of pulmonary hypertension.
- Dyspnea
- Lightheadedness
- Fatigue
- NPC
- Hemoptysis
- Hoarseness
- Fainting and syncope
- Chest pain and decreased chest expansion
- Racing heartbeat
- Pain on the upper right side of the abdomen
- Decreased appetite
- Cyanosis
- Raynaud’s phenomenon
- Fluid in the abdomen
Chapter 27: Interstitial Lung Diseases
During the acute stage of any ILD, the general inflammatory condition is characterized by what?
Edema and the infiltration of a variety of WBCs in the alveolar walls and interstitial spaces
Chapter 27: Interstitial Lung Diseases
During the chronic stage of any ILD, the general inflammatory response is characterized by what?
Infiltration of large numbers of various WBCs and some fibroblasts may be present in the alveolar walls and interstitial spaces.
Chapter 26: Cancer of the Lung
Where is squamous cell (epidermoid) carcinoma commonly located?
Near a central bronchus or hilus and projects into the large bronchi.
Chapter 26: Cancer of the Lung
Which cancer type arises from the mucous glands of the tracheobronchial tree?
Adenocarcinoma (previously called bronchioalveolar carcinoma)
Chapter 26: Cancer of the Lung
Which lung cancer type has the weakest correlation with smoking?
Adenocarcinoma
Chapter 26: Cancer of the Lung
Lung cancer can be divided into what two major categories?
- Non-small cell lung cancer
- Small cell lung cancer
Chapter 26: Cancer of the Lung
Which of the following spreads aggressively and responds best to chemotherapy and radiation?
A. Small cell lung cancer
B. Non-small cell lung cancer
A. Small cell lung cancer
Chapter 26: Cancer of the Lung
SCLC accounts for _______ of all lung cancers in the US.
15-20%
Chapter 26: Cancer of the Lung
NSCLC accounts for ________ of all lung cancers in the US.
75-85%
Chapter 26: Cancer of the Lung
What are the subtypes of NSCLC?
- Squamous cell carinoma
- Adenocarcinoma
- Large cell carcinoma
Chapter 26: Cancer of the Lung
Black men are ____% more likely to develop lung cancer than white men.
20
Chapter 26: Cancer of the Lung
The average age at the time of diagnosis is about _________.
70 years old