Week 4/5 Flashcards
1
Q
Atelectasis - what is it? - common causes of resorption atelectasis
A
- incomplete expansion of the lungs or collapse of previously inflated lung, producing areas of relatively airless pulmonary parenchyma - bronchial asthma, chronic bronchitis, bronchiectasis, and post op states; foregin body aspiration; bronchial tumors
2
Q
Types of Atelectasis and mediastinal shift - resorption - compression - contraction
A
- complete obstruction of an airway because of excessive excretions -> air resorbed from dependent alveoli –> collapse; mediastinal goes towards the impingement - significant volumes of fluid (transudate, exudate, or blood), tumor, or air accumulate within the pleural cavity; medistinal shift is away from liquid - focal/ generalized pulmonary or pleural fibrosis prevents full lung expansion
3
Q
Pulmonary edema - discuss how pt with CHF develop pulm edema - How to develop Pulmonary edema that is non-cardiogenic - Specifics of pneumonia - explain ARDS
A
- hemodynamic pulm edema: due to increase hydrostatic pressure on venule side of capillary; fluid accumulates initially in basal regions of lower lobes because hydrostatic pressure is greatest in these sites - due to injury in alveolar septa; primary injury to vascular endothelium or damage to alveolar epithelial cells which produces inflammatory exudate that leaks into the interstitial space and alveoli - edema remains localized - when diffuse alveolar edema is an important contributor to acute respiratory distress syndrome
4
Q
Acute Lung Injury - also known as? - sxs - four most common causes
A
- noncardiogenic pulmonary edema - abrupt onset of significant hypoxemia and bilateral pulmonary infiltrates w/ absence of cardiac failure - infection, trauma, inhaled/chemical injury - hematologic
5
Q
How can sepsis or head injuries damage the alveoli?
A
- sepsis: bacterial endotoxins can cause a defect in permeability - head injuries: increase in microvascular permeability and/or pulmonary vasoconstriction ad left ventricular dysfunction
6
Q
Discuss how clinical presentation of acute lung injury is related pathologically to ARDS - sxs - pathway of dx
A
- tachypnea, dyspnea, cyanosis - pneumocyte injury -> endothelial activation (alveolar macrophages, TNF, inflamm mediators) -> adhesion and extravasion of neutrophils -> increased recruitment and adhesion of leukocytes -> more endothelial injury and local thrombosis -> accumulation of intra-alveolar fluid into hyaline membranes -> diffuse alveolar damage
7
Q
Why does mechanical ventilation often not work in patients with acute lung injury?
A
- ventilation/perfucion mismatch occurs because the functional abnormaltiies are not evenly distributed throughout the lung - Some areas are collapsed and others have normal levels of ventilation - Poorly aerated regions continue to be perfuse -> V/Q mismatch and hypoxemia
8
Q
20 year old male with w/ hemoptysis, hematuria, and elevated serum creatine compatible with acute renal failure…. - syndrome - targets - how does this manifest? - prognosis if untreated? - iron stain - IgG - Treatment
A
- Good pasture syndrome: encironmental insult unmasks normally hidden epitopes that form ani-collagen antibodies - non-collagenous domain of the alpha 3 chain of collagen IV in basement membranes of kidney glomeruli and lung alveoli - rapidly progressive glomerulonephritis –> renal failure and hematuria; necrotizing hemorrhagic interstitial pneumonitis –> hemoptysis and focal pulmonary consolidations on CXR - uremia (elevated level of urea in blood) is cause of death - positive in lung; supports dx of goodpastures by confirming presence of hemosiderin-laden macrophages in alveoli - linear IgG deposition along pulmonary capillary basement membrane is virtually diagnostic of good pastures - intensive plasmapharesis bc it removes circulating Anti-GB< antibodies and chemical mediators of immunologic injury
9
Q
Pleural Effusion - what is it?
A
- excess accumumlation of fluid between pleural layers causes restricted lung expansion during inspiration
10
Q
What is the mechanism and physiology behind nephrotic syndrome
A
- M: decreased oncotic pressure - damage to the glomerulus –> loss of plasma protein –> loss beyond synthetic capacity of liver –> hypoalbuminemia –> decreased intravascular colloid osmotic pressure –> increased fluid into interstitial spaces –> pleural effusion
11
Q
What is the mechanism and physiology behind carcinomatosis
A
- decreased lymph drainage - multiple tumors –> block lymph drainage –> buildup of lymph fluid –> rupture of lymph ducts –> pleural effusion
12
Q
What is the mechanism and physiology behind atelectasis
A
- increased negative intrapleural pressure - pleural effucion –> increase pressure on lung –> decrease lung volume to less than resting –> loss of contact between visceral and parietal pleura –> atelectasis
13
Q
What is the mechanism and physiology behind pneumonia
A
- increased vascular permeability - lung infection –> pneumonia –> inflamm mediators –> increased vascular permeability –> pleural effusion
14
Q
What is the mechanism and physiology behind congestive heart failure
A
- increased hydrostatic pressure - CHF -> pasive congestion in pulmonary circulation -> increased hydrostatic pressure in lungs -> increased fluid into interstitial spaces -> pleural effusion
15
Q
- What is this?
- where are the bronchi? how many?
- structure of bronchi
- epithlium in lumen
- types of cells (4)
- type of cartilage
A
- Lung tissue
- black boxes; 3
- large lumen, lined by respiratory epi and rich hyaline cartilage
- respiratory epithelium; psuedostratified ciliated columnar epi with goblet cells
- goblet cells, epithelia, smooth muscles, neuroendocrine cells
- hylaine cartilage
16
Q
- What is this?
- what is found in the lamina propria/submucosa?
- type of cartilae found here
- smooth muscle cells?
A
- lung tissue
- seromucous glands, cartilage, smooth muscle
- bronchial (hyaline)
- yes
17
Q
- what is the difference between a bronchi and bronchiole?\
- what is a pulmonary lobule?
- what is a pulmonary acinus?
A
- bronchi: columnar epi with many goblet cells and removes FB’s; bronchioles: cuboidal epi with few goblet cells, cartilage plates and muscous glands absent
- terminal bronchiole
- starts at the respiratory bronchiols, includes alveolar ducts and sacs also
18
Q
What is this?
- what is difference between the 2?
- waht are the non-ciliated secretory cells called?
A
- terminal bronchial on left and respiratory bronchiole on right
- more smooth muscle at the terminal bronchiole and it goes into a respiratory bronchiole but respiratory bronchiole is the beginnig of where there is air exchange
- club cells
19
Q
Trace the path of air flow from terminal bronchiole to the alveoli
- waht happens to epi from bronchioles to alveoli
A
- terminal bronchiole -> respiratory bronchiole -> alveolar duct -> alveolar sac -> alveoli
- simple cuboidal -> Type I and II alveolar cells
20
Q
What is this?
- describe histo
- function
A
- club cell
- non ciliates, non mucous secreting
- secretes surfactant, antimicrobial peptides, SER enxyes, and repairs airway damage
21
Q
What is this?
- functions of Type I alveolar cells, Type II alveolar cells, Alveolar macrophages, Dendritic cells, Stromal cells
- What type of connective tissue do stromal cells produce?
- what happens in emphysema
A
- alveolar cells
- Type I alveolar cells: gas exchange
- Type II alveolar cells: surfactant
- Alveolar macrophages: phagocytosis
- Dendritic cells: APC
- Stromal cells: support
- Elastic and Reticular fibers
- elastic and reticular fibers decrease which allows for compliance to increase and elasticity to decrease
22
Q
Alveoli Structure and Function
- what is priduced by II alveolar cells? How do they make it and store it?
A
- surfactant; lamellar bodies
23
Q
What is this?
- types of cells indicated by arrow? function?
A
- Visceral pleura
- Meothelial cells -> secrete pleural serous fluid
24
Q
Imaging modality anf view depicted?
- how was the patient positioned?
A
PA and Lateral chest xray
- patient is standing, back is to x-ray machine and front is to plate
25
Q
What are the imaging modaloty and view depicted?
- How was patient poisitioned
A
- AP/ Frontal CXR
- Patient supine, x-ray machine to chest, the board on the back
26
Q
- Imaging modality, body part, orientation, and window?
- Identify the major airway structures
- whay can’t you see the heart?
A
- ST chest, coronal. lung window
- becase it is a lung window and the heart has a higher density thatn the lungs allowing them to be separated
27
Q
- imaging modality, and view?
- age of patient? how?
- abonrmalities in the lungs?
- how many support devices are there?
- are all support devices properly placed?
A
- AP, fronatl CXR
- infacnt because you can see the thymus, the ribs are mor horizontal, the ribcage has a trapezoid shape and there are ossification areas
- R: hypertranslucent= hyperinflation; L: pneumothroax
- Endotracheal tube, nasogastric tube, ECG leads
- No, the ETT is in the right main bronchus
28
Q
- Imaging modality and views
- dx? why?
A
- Frontal and lateral chest xray in an infant
- Foreign body in esophagus because in lateral x-ray you can see the strip of air in front of esophagus meaning that the trachea is clear
29
Q
What are the imaging modality, boday part, orientation and window depicted?
- which lung is this?
- name the fissure(s)
A
- CT chest, sagittal, lung window
- right lung
- horizontal on left and oblique on right
30
Q
imaging modality, body part, orientation and window?
- describe the abnormalities?
A
- CT chest/ axial. lung window
- Large right pneumothroax
31
Q
- imaging modality and views depicted?
- relative age and sex of patient? Explain.
- Major abnormalities? Explain.
A
- PA and lateral CXR
- Elderly female because there is degenerative changes in the spine and breast tissue
- Sever pulmonary hyperinflation because there is diaphragmatic flattening on both the PA and lateral views; increased AP dimension of the ches as well as increased retrosternal clear spacr on the lateral view
32
Q
- 52 year old previously healthy woman comes into clinic complainging of fatigue, cough, and left sided chest pain. Temp of 101.7 and diminished breath sounds in left base anteriorly.
- What imaging do you order and why?
- describe the abnormality
- dx?
A
- 2 view chest x-ray because she has chest pain and diminished breath sounds; also is is relatively inexpensive and readily availabke making it a good screening test
- airspace infiltrates in the lingula
- Lingular pneumonia
33
Q
22 year old previously healthy woman comes into clinic with recent onset of shortness of breath and left sided chest pain. BP of 88/54 and diminished breath sounds in left side of chest diffusely.
- what imaging do you order and why?
- what in the imaging modality and view depicted? why?
- abnormality? explain.
- emergency?
A
- CXR, because of shortness of beath and dimnished breath sounds
- AP upright CX becuase of the patient instability
- large left pneumothorax; lung of chest wall injury allows air into pleural space but not out, so air accumulate and compresses the lung
- yes
34
Q
Lines of pleural reflection
- what is it
- sternal
- costal
- vertebral
A
- abrpt lines where the parietal pleura changes direction as it passes from one wall of the pleural cavity to another
- occur where the costal pleura is continuous with the medistinal pleura anteriorly (asymmetrical due to heart)
- sharp continuations of the sternal lines, occur where the costal pleura becomes continuous with diphragmatic pleura inferiorly
- where costal pleura becomes continuous with the mediatinal pleura posteriorly
35
Q
Boundaries of pleural cavity
- prdeict how these landmarks change with inspiration and expiration
A
- Anterior midline: R 6th rib and L 4th rib
- Scapular line: 12th rib
- Miclavicular line: 8th rib
- Midaxillary line: 10th rib
- the inferior borders of the lungs move farther into the pleural recesses during deep inspiration and retreat from them during expiration
36
Q
Distinguish between the parietal and visceral pleura
- where do they become continuous with eachother?
A
- parietal: lines the pulmonary cavities adheing to the thoracic wall, mediastinum and diaphragm; is thockers than the visceral and separated from the surfaces it covers
- visceral: cloasely covers the lungs and adheres to all of its surfaces; including the horiztonal and oblique fissures; cannot be dissected from surface of the lung
- hilum of the lung: where structures making up the root of the lung (bronchioles, arteries and veins) enter and leave the lung
37
Q
4 prts of parietal pleurae and explain why they have different names
A
- cervical: covers apex of lung; attaches to 1st rib and TP of C7
- costal pleurae: covers the internal surface of the thoracic wall
- Diphragmatic pleurae: covers the superior surface of the diaphragm
- Mediatinal: covers the lateral aspects of the mediastinum, the partition of organs separating the pulmonary cavities and their pleural sacs
38
Q
What is mediastinal pleura continuous with?
A
- cervical pleurae at root of neck
- costal pleura andteriorly and posteriorly
- diaphragmatic pleura inferiorly
- Visceral pleura at hilum
39
Q
Potential spaces in the pulmonary cavities
- pleural cavity, describe
- what happens in hemo and pneumo thorax?
A
- pleural cavity contrain a capillary layer of serous pleural fluid which lubricates the pleuaral surfaces and allows the layers of pleura to slide over eachpther during respiration –> surface tension of the pleural fluid provides the cohesion that keeps the lung surface in contact with the thoracic wall
- blood enters the pleural cavity( chest wound- intercostal vessel) or air enters the pleural cavity (penetrating wound or fupture of pulmonary lesion)
40
Q
costodiaphragmatic vs costomediatinal recesses
A
- costodiaphragmatic: pleura lined gutters which surround upward convexity of the diaphragm where the peripheral diaphragmatic pleura is in contact with the lowermost costal pleura
- costomediastinal: similar but smaller, located posterior to the sternum where the costal pleura is in contact with the mediastinal pleura.
41
Q
Where would you do a midaxillary thoracentesis and why?
A
- 9th intercostal space at the midaxillary line during expiration because avoids inferior border of lung, angled upward to avoid penetrating the deep side of the recess, superior to the rib and high enough to avoid intercostal nerves and vessel, and patient must be upright to allow for fluid to accumulate in the diaphragmatic recess
42
Q
Distinguish between the left and right lung
- fissures
- lobes
- additional features
A
- R: 2 (oblique and horizontal); L: 1: oblique
- R: 3 (superior, middle, inferior); L: 2 (superior and inferior)
- R: heavier, shorter, wider, left pulmonary artery is anterior to bronchus; L: cardia notch, lingula, left pulmonary artery is superior to bronchus
43
Q
Features common in both lungs
A
- grooves for vessels,
- hilum
- oblique fissures
- pulmonary ligament
44
Q
Describe the hilum of the lung
A
- pulmonary arteries, veins, lymoh and bronchi enter/exit the lung
45
Q
Innervation of parietal pleura vs visceral pleura
A
- pariteal costal and cervical: intercostal
- mediastinal: phrenic
- diaphragmatic: phrenic and intercostal
- visceral is vagus
