patho chapter 3

How many ribs above the diaphragm after deep inspiration

10 ribs

How many lobes of the lung

5 (3 right, 2 left)

What is the pleura

Is covering that protects the lungs (a double-layered serous membrane to reduce friction of lung movement).

Where does the trachea bifurcate

carina

Endotracheal tube

opens the airway to give oxygen, medicine, or anesthesia

What illnesses do endotracheal tubes support breathing

pneumonia, emphysema, heart failure, collapsed lung, severe trauma

Endotracheal tubes removes

blockages from the airway

Endotracheal tube protect lungs in people who have had

strokes, overdoses, and massive bleeding

ET tip should be ____-___ cm above the carina with head in the neutral position

5-7 cm

Tip will move __ cm with flexion and extension

2c,

if ET is too low:

there will be overinflation of right lung and collapse of left lung

If ET is too high

air enters esophagus

What does this x-ray show?

ET tube

Central Venous Catherters

provides access to give medicine, fluids, nutrients over a long period of time

Central venous catheters measure

central venous pressure

Where is the CVC inserted

it is inserted into subclavian vein with the tip in SVC

PICC line

Peripherally inserted central catheter

PICC lines are for patients with

cancer, chronic disease, and those with long-term antibiotics

Where is PICC line inserted

inserted into a vein in the upper arm and tip is in the SVC

what does this chest x-ray show?

PICC line

Transvenous Cardiac Pacemakers

maintains cardiac rhythm in patiets with heart blockage or bradyarrhythmias

Radiographs for Transverse Cardiac Pacemakers should be

overexposed to visualize the tip of the lead and the generator

Cystic fibrosis

Causes a thick, sticky buildup of mucus in the lungs, pancreas, and other organs

what percent of the morbidity and mortality related to cystic fibrosis occurs as a result of respiratory involvement

90%

More than _______ people in the US have cystic fibrosis

30,000

Daily therapy:

airway clearance, inhaled medicines, pancreatic enzyme supplement

what disease is this chest x-ray?

cystic fibrosis

what disease is this CT scan of the lungs?

cystic fibrosis

Hyaline Membrane Disease

also known as idiopathic respiratory distress syndrome (IRDS)

one of the most common causes of respiratory distress in newborn, primarily premature

hyaline membrane disease

what causes hyaline membrane disease

a lack of surfactant in immature lungs

treatment for hyaline membrane disease

artificial surfactant, positive pressure ventilation

what is this an x-ray of?

hyaline membrane disease (IRDS)

Croup

primarily a viral infection of young children that produces inflammatory obstructive swelling localized to the subglottic portion of the trachea; starts as a cold, then leads to a barky cough, raspy voice.

Croup is more common is _______ than _________

boys than girls

what is this the x-ray of

croup

Epiglottitis

thickening of epiglottic tissue and the surrounding pharyngeal structures; can be life threatening

Epiglottitis is caused by

Haemophilus influenza type B

what is this soft tissue neck x-ray showing?

epiglottitis

Pneumonia

an inflammation of the lung that can be caused by a variety of organisms, most commonly bacteria and viruses

Alveolar Pneumonia

organisms causes an inflammatory exudate that replaces air in the alveoli

Lung appear ___________ when patient has alveolar pneumonia

radiopaque

Is pneomonia an additive or destructive disease?

additive

Bronchopneumonia

inflammation that originates in the bronchi and spreads to adjacent alveoli

Interstitial pneumonia

inflammation involving the walls and linings of the alveoli and interstitial spaces

Anthrax

caused by Bacillus anthracis

What are the three ways to contract anthrax?

Cutaneous, through an opening in the skin (most common).

Inhalation (lungs), usually fatal without prompt treatment.

Gastrointestinal, caused by ingestion of contaminated meat.

Lung Abscess

a necrotic area of pulmonary parenchyma containing purulent (puslike) materials

what is the most common cause of lung abscess?

aspiration

Where are lung abscesses most common

right lung

Tuberculosis

caused by Mycobacterium tuberculosis

Characteristics of mycobacterium tuberculosis

rod-shaped bacterium with a protective waxy coat

what does this chest x-ray show?

tuberculosis

Miliary tuberculosis

dissemination of disease through the bloodstream

Secondary tuberculosis

bacilli remain inactive for years until there is a decrease in the immune system

Where does most of tuberculosis occur

apices of the lungs

What does PPD mean

Purified Protein Derivative

Respiratory Syncytial Virus (RSV) is the most common cause of

bronchiolitis

Severe Acute Respiratory Syndrome

severe and highly contagious viral lung infection with high fever; threatened worldwide epidemic in 2003

Chronic Obstructive Pulmonary Disease (COPD)

chronic obstruction of airways leads to an ineffective exchange of respiratory gases and makes breathing difficult

What causes COPD

smoking, industrial exposure, cystic fibrosis, IV drug use

Chronic Bronchitis

inflammation of the bronchi persisting over a long time

_____ percent chronic bronchitis associated with cigarette smoking

90

Emphysema

destruction in the terminal bronchioles, most often caused by smoking and environmental risk factors

how is someone's chest shaped with emphysema

barrel shapped

is Emphysema an additive or destructive disease?

destructive

Asthma

chronic lung disease that inflames and narrows the airways

Asthma affects more than _______________ people in the US

25,000,000

What are extrinsic causes of asthma

allergens, house dust, pollen, mold, fabrics, foods, chemicals

What are intrinsic causes of asthma?

exercise, heat, cold, and emotional upset

Bronchiectasis

abnormal dilation of the bronchi with accumulation of mucus

bronchiectasis occurs in

post-infection patients and cystic fibrosis patients

what does this CT of the lung show?

bronchiectasis

Sarcoidosis

a multisystem granulomatous disease of unknown cause that is most often detected in young adults

Sarcoidosis mostly affects the

lungs and lymph glands

Pneumoconiosis

a severe pulmonary disease caused by inhalation of irritating particles

Asbestosis

chronic lung disease caused by inhaling asbestos fibers

When do symptoms occur for asbestosis?

10 to 40 years after initial exposure

What is this chest x-ray showing?

asbestosis

What is this CT scan showing ?

asbestosis

Silicosis

caused by inhaling silica dust in the lungs and usually occurs after working in occupations including foundry work, quarrying, ceramics, glass work, and sandblasting

Coal Worker's Pneumoconiosis (Black Lung)

Lung disease from coal dust exposure.

Solitary Pulmonary Nodule (SPN)

-asymptomatic

-incidental finding on CXR

-problematic in that it could represent benign granuloma, small neoplasm, solitary metastasis

Benign SPN

round solid borders on chest x-rays

Malignant Pulmonary Nodule

spiky borders on chest x-rays and popcorn appearance

Lung Screening

Annual CT of chest if: (need all of these) 55-74YO

1) good health

2) 30 pack year smoking history

3) still smoking/quit within last 15 years

Bronchial adenoma

Originate in the glandular structures of the bronchi

Bronchogenic Carcinoma

primary carcinoma of the lung

Where does bronchogenic carcinoma arise from?

mucosa of the bronchial tree

What are common types of bronchogenic carcinoma

non-small cell and small cell (oat cell)

Non-small cell types are

80% of all lung cancers

Small cell are

20% of all lung cancers

Pulmonary Metastases

develops from hematogenous or lymphatic spread

Pulmonary Embolism

A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing obstruction of blood flow.

More than _____ of embolisms arise from deep vein thrombosis in the lower extremities

95%

Vena cava filter

insertion of a filter in the vena cava to prevent further emboli from reaching the pulmonary vasculature

D-dimer

measures a protein fragment released when a clot breaks up

elevated d-dimer indicates

blood-clotting problem

Septic Embolism

a bacterial "shower" that enters pulmonary circulation, then gets trapped in the lung

Septic embolisms arise primarily from

heart, peripheral veins, infected catheters/lines