PULM - Patho Exam 4 "rapid fire"

dyspnea

subjective feeling of uncomfortable breathing

severe dyspnea

flaring nostrils, accessory muscles, retraction of intercostal spaces

paroxysmal nocturnal dyspnea

seen in HF and pulmonary disease

cough

receptor stimulation transmitted via the vagus nerve to the medulla

chronic cough

cough for more than 3 weeks

peripheral cyanosis

cyanosis from poor circulation

central cyanosis

cyanosis from decreased arterial oxygen

pleural pain

sharp or stabbing

low V/Q

inadequate ventilation of a well perfused area of the lung

very low V/Q

shunting

high V/Q

poor perfusion to well ventilated areas

hypercapnic resp failure

d/t poor alveolar ventilation

hypoxemia resp failure

d/t poor exchange of oxygen

chest wall restriction

results in decreased tidal volume; pulmonary test shows reduced FVC

neuromuscular disease

most common cause of hospital administration d/t hypercapnia and hypoventilation

pneumothorax

sudden pleural pain; collapsed lung

tension pneumothorax

flap-valve leak allows air to enter pleural space = total lung collapse and shift of mediastinal viscera

tension pneumothorax

treatment is needle decompression

open pneumothorax

open wound of chest; air moved in and our of chest wall

empyema

Infected pleural effusion that causes pus in the pleural cavity; treatment = antimicrobials and drainage w/ chest tube

restrictive lung disorders

decreased FVC, normal FEV1/FVC ratio

aspiration

most common site = right lower lobe

aspiration

sudden onset of choking and cough

atelectasis

collapse of lung tissue; treatment with incentive spirometer

absorption atelectasis

Gradual absorption of air from obstructed or hypo-ventilated alveoli or from inhalation of concentrated oxygen or anesthesia; air can’t reach distal airways and there is a lack of collateral ventilation through Pores of Kohn

bronchiectasis

persistent abnormal dilation of the bronchi; on CT - airway diameter > accompanying vessel

bronchiectasis

chronic productive cough w/ foul smelling purulent sputum

bronchiolitis

inflammation of bronchioles; most common in children

bronchiolitis obliterans

late stage fibrotic disease of the airways that causes permanent scarring; common after lung transplant

pulmonary fibrosis

fibrous or connective tissue buildup in the lung; dyspnea on exertion

idiopathic pulmonary fibrosis

chronic inflammation of interstitial lung tissue at alveoli that disrupts the membrane; most common idiopathic lung disorder

pneumoconiosis

abnormal condition of dust in the lungs; deposition of dust in the lungs causes a release of pro-inflammatory cytokines -> chronic inflammation -> scarring of alveolar-capillary membrane -> pulmonary fibrosis

hypersensitivity pneumonitis

inhalation of offending agent = type III immune response by alveolar macrophages and IgG production

oxygen toxicity

treatment = reduction of inspired oxygen concentration to less than 60% as soon as tolerated

pulmonary edema

excess water in lung from disturbances of capillary hydrostatic, oncotic, and capillary permeability

pulmonary edema

most common cause = left-sided heart failure

pulmonary edema

physical exam = inspiratory crackles, dullness to percussion at lung bases, ventricular dilation (S3 gallop)

ARDS

1. influx of inflammatory cells

2. damage to alveolar cells

3. damage to endothelial cells

4. disruption of alveolar-capillary membrane

5. pulmonary edema and hemorrhage (exudative)

6. proliferation of pneumocytes, fibroblasts, myofibroblasts, formation of hyaline membrane (proliferative)

7. fibrosis and tissue remodeling (fibrotic)

obstructive pulmonary disease

unifying symptom = dyspnea

unifying sign = wheezing

asthma

chronic inflammatory disorder of bronchial mucosa

asthma

early = IgE causes mast cells to degranulate, releasing a large number of inflammatory mediators

asthma

late = chemotactic recruitment of lymphocytes, eosinophils, and neutrophils occurs

pulsus paradoxus

decrease in systolic BP > 1- mmHg during inspiration

status asthmaticus

bronchospasm not reversed by usual means; life threatening

COPD

chronic bronchitis + emphysema

COPD

3rd leading cause of death in the US, 6th worldwide

COPD

decreased elastic recoil on expiration

chronic bronchitis

chronic productive cough that lasts at least 3 months of the year and for at least 2 consecutive years

chronic bronchitis

"blue bloaters" (increased pCO2, decreased O2 = cyanosis)

chronic bronchitis

airways collapse early in expiration trapping air in lungs

emphysema

Abnormal permanent enlargement of the gas-exchange airways accompanied by the destruction of the alveolar walls without obvious fibrosis

emphysema

"pink puffers" (tachypnea w/ prolonged expiration, pursed lips)

emphysema

destruction of the alveoli occurs through breakdown of elastin in the septa as a result of an imbalance between proteases and anti-proteases, oxidative stress, and apoptosis of the lung's structural cells

centriacinar emphysema

most common emphysema; septal destruction in respiratory bronchioles and alveolar ducts

panacinar emphysema

emphysema associated with alpha-1 antitrypsin deficiency

respiratory tract infections

most common cause of short-term disability in the US

pneumonia

Infection of lower respiratory tract caused by viruses, bacteria, fungi, protozoa, and parasites

pneumonia

6th leading cause of death in the US

viral pneumonia

proceeded by viral upper respiratory tract infection

viral pneumonia

virus destroys ciliated epithelia cells, invades goblet cells and bronchial mucus glands -> sloughing of destroyed bronchial epithelium occurs throughout the respiratory tract -> prevents clearance of mucus, bronchial walls becomes edematous and infiltrated by leukocytes

tuberculosis

caused by mycobacterium tuberculosis; leading cause of death from a curable infection

acute bronchitis

acute infection/inflammation of the airways; nonproductive cough in paroxysms aggravated by cold, dry, dusty air

pulmonary embolism

sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, unexplained anxiety

PAH

mean pulmonary artery pressure above 25 mmHg at rest leads to right sided heart failure

PAH

overproduction of vasoconstrictors and decreased production of vasodilators; remodeling; resistance to pulmonary artery blood flow; workload of right ventricle increases leading to right ventricular hypertrophy

lung cancer

Most frequent cause of cancer death in the US

adenocarcinoma

most common type of lung cancer; tumor arises from goblet cells

large cell carcinoma

large tumors in proximal or peripheral lung tissue; radiation and chemo are NOT helpful

small cell carcinoma

lung cancer with the worst prognosis and usually presents in its metastatic state

neuroendocrine lung cancer

typically from small cell carcinoma and squamous cell carcinoma; releases hormone-like substances