CHAPTER 3- RESPIRATORY PATHOLOGIES

MIDTERM?

Ventilation

Movement of air in and out of the lungs

Diffusion

Exchange of gases (O₂ and CO₂) between lungs and blood

Upper Respiratory Tract

Nose, mouth, pharynx, larynx

Lower Respiratory Tract

Trachea, bronchi, alveoli, lungs

Parietal pleura

Lines the chest cavity

Visceral pleura

Covers the lungs

Anterior mediastinum

Contains thyroid and thymus

Middle mediastinum

Contains heart, great vessels, esophagus, trachea

Posterior mediastinum

Contains descending aorta and spine

Bony support for breathing

Ribs, sternum, thoracic vertebrae

Sinuses at birth

Maxillary and ethmoid

Frontal sinus development

Develops by 10 years old

Sphenoid sinus development

Develops in adolescence

Most common chest exam

Chest X-ray

Chest radiography shows

Lungs, bones, pleura, mediastinum

Pneumonia pathology type

Additive (harder to penetrate, ↑ exposure)

Emphysema pathology type

Subtractive (easier to penetrate, ↓ exposure)

Importance of consistent exposure

Ensures diagnostic quality images

AEC meaning

Automatic Exposure Control

Standard chest X-ray projections

Erect PA and left lateral

SID for chest X-ray

72 inches (to reduce heart magnification)

AP chest view

Used in mobile or bedside cases

Lateral decubitus chest view

Detects air-fluid levels

Lordotic chest view

Shows apices (where TB often hides)

Oblique chest views

Separate overlapping structures

Right diaphragm higher

Because of the liver

Adequate inspiration on chest X-ray

10 posterior ribs visible

Costophrenic and cardiophrenic angles

Should appear sharp

Pulmonary embolism gold standard

CT angiography (CTA)

Imaging for lung cancer staging

Chest CT (often combined with PET)

Suspicious lung nodule size

Greater than 1 cm

Perfusion scan purpose

Injected radionuclide shows blood flow

Ventilation scan purpose

Inhaled radioactive gas shows air distribution

FDG-PET scan purpose

Shows metabolic activity (benign vs malignant)

Thymus sail sign

Large thymus seen in infants on X-ray

Pneumomediastinum

Air in the mediastinum

Subcutaneous emphysema

Air under the skin, feels like “air bubbles”

Thyroid enlargement effect

Displaces trachea

ET tube proper position

Below vocal cords, above carina

ET tube danger if displaced

Loss of airway patency

Chest tube high placement

Removes air (pneumothorax)

Chest tube low placement

Removes fluid (pleural effusion, hemothorax)

Chest tube collection device position

Must remain below chest level

CVP line tip position

Distal SVC, just above right atrium

CVP line purpose

Fluids, measure central venous pressure

CVP line risks

Arrhythmia, pneumothorax, hemothorax

Swan-Ganz catheter tip

Pulmonary artery

Swan-Ganz catheter purpose

Measures pulmonary wedge pressure, cardiac function

Hickman catheter site and tip

Inserted via subclavian vein, tip in SVC

Hickman catheter use

Long-term chemo or IV therapy

Hickman catheter risk

Higher infection risk

Port-a-Cath

Description: subcutaneous port under clavicle

Port-a-Cath advantage

Lower infection risk, long-term chemo use

IABP purpose

Supports left ventricle, increases coronary blood flow

IABP placement

Descending aorta, below subclavian, above renal arteries

Pacemaker electrode placement

Right ventricle

Pacemaker purpose

Prevents bradycardia/arrhythmia by pacing heart

COPD definition

Group of irreversible airway obstruction disorders

COPD main risk factor

Cigarette smoking

COPD complication

Cor pulmonale (right heart failure)

Chronic bronchitis hallmark

Chronic cough with sputum production

Chronic bronchitis imaging

May show hyperinflation, not specific

Emphysema hallmark imaging

Hyperlucent lungs, flattened diaphragm

Emphysema hallmark symptom

Progressive dyspnea, barrel chest

Asthma cause

Chronic airway inflammation and hyperreactivity

Asthma hallmark

Episodes of cough, wheeze, chest tightness

Pneumoconiosis cause

Inhalation of inorganic dust

Silicosis exposure agent

Silica (mining, sandblasting)

Anthracosis

Black lung disease from coal dust

Asbestosis hallmark imaging

Pleural plaques, diaphragmatic calcifications

Asbestosis complication

Increased risk of mesothelioma

Histoplasmosis source

Soil with bird or bat droppings

Coccidioidomycosis source

Soil in Southwestern USA and Mexico

Lung abscess hallmark imaging

Thick-walled cavity with air-fluid level

Lung abscess symptoms

Fever, foul sputum, pus

Pleurisy main symptom

Sharp pleuritic chest pain

Pleural effusion hallmark

Blunted costophrenic angle on X-ray

Hemothorax

Blood in the pleural cavity

Empyema

Pus in the pleural cavity

Best imaging for sinusitis

Sinus CT

Sinusitis hallmark finding

Air-fluid level in sinuses

Bronchial carcinoid treatment

Surgical resection

Bronchogenic carcinoma

Most common fatal cancer in the US

Bronchogenic carcinoma risk factor

Cigarette smoking

Small cell carcinoma

Most aggressive lung cancer, early metastasis

Metastatic lung disease hallmark

Multiple rounded nodules (“cannonball mets”)

Modern cancer staging imaging

CT + PET (± brain MRI)

Subtractive lung pathology

COPD