Term
| What is atelectasis? What are the three different types? |
|
Definition
| -collapse or incomplete expansion of part or all of the lung -resorption atelectasis: obstruction of airway -compression atelectasis: pleural effusion; pneumothorax -Contraction atelectasis: fibrotic changes |
|
|
Term
| What are diffuse obstructive diseases (airway diseases)? |
|
Definition
-characterized by limitation of airflow, which is usually caused by partial or complete obstruction
-obstruction increases resistance |
|
|
Term
| What are diffuse restrictive (interstitial) diseases? |
|
Definition
-characterized by diffuse and usually chronic involvement of the pulmonary connective tissue, mainly the interstitium in the alveolar walls
-hallmark of these disorders is reduced compliance; reduces expansion of lung, decreased total capacity |
|
|
Term
| In diffuse obstructive disease what respiratory measures are normal or increased? |
|
Definition
total lung capacity
forced vital capacity |
|
|
Term
| What is the hallmark of diffuse obstructive diseases? |
|
Definition
| decreased expiratory flow rate measured by forced expiratory volume at 1 second (FEV1) |
|
|
Term
| In diffuse obstructive diseases, what the ratio of FEV1 to FVC is _________ |
|
Definition
|
|
Term
| In diffuse obstructive diseases, the expiratory obstruction may be anatomic airway __________ or loss of __________/_______ |
|
Definition
narrowing (asthma)
elastic recoil (emphysema) |
|
|
Term
| Name 4 major diffuse obstructive disorders |
|
Definition
-emphysema
-bronchitis
-bronchiectasis
-asthma |
|
|
Term
| In diffuse restrictive diseases the FVC is ________ |
|
Definition
|
|
Term
| In diffuse restrictive diseases, the expiratory flow rate is ________ or __________/___________ |
|
Definition
normal
reduced proportionately |
|
|
Term
| In diffuse restrictive diseases the FEV1 to FVC ratio is _________ |
|
Definition
|
|
Term
| Diffuse restrictive diseases occur in two conditions, what are they? Give examples of each. |
|
Definition
-chest wall disorders with normal lungs: obesity, neuromuscular disorders
-chronic: diffuse interstitial fibrosis, pneumoconioses, sarcoidosis |
|
|
Term
| What is emphysema characterized by? |
|
Definition
| abnormal permanent enlargement of airspaces distal to terminal bronchioles |
|
|
Term
| Centriacinar and panacinar emphysema are usually caused by what? |
|
Definition
centriacinar-smoking
panacinar- a1AT deficiency |
|
|
Term
| Pt's with emphysema are often referred to as _______/_______ |
|
Definition
|
|
Term
In emphysema there is :
-destruction of the airways where?
-Decreased ability to do what?
-How does the patient compensate?
-What are a pt's arterial blood gases like?
-The low CO eventually leads to what? |
|
Definition
-distal to the terminal bronchioles
-oxygenate the blood
-hyperventilation: diaphragmatic breathing, prolonged expiration, pursed lips, barrel-chested
-relatively normal bc of this compensatory hyperventilation
- muscle wasting and weight loss |
|
|
Term
| Define chronic bronchitis? |
|
Definition
| persistent cough with sputum production for at least 3 consecutive months in at least 2 consecutive years |
|
|
Term
| What are two main risk factors for chronic bronchitis? |
|
Definition
smoking (#1)
air pollutants |
|
|
Term
In chronic bronchitis there is often:
-goblet cell __________
-hypersecretion of _______
-bronchiolar wall _________ |
|
Definition
|
|
Term
| Pt's with chronic bronchitis are often known as "__________/______" |
|
Definition
|
|
Term
| "Blue bloaters" have a frequent __________ and ___________, which leads to airway __________. The body responds to this by __________ ventilation and ________ cardiac output. |
|
Definition
cough
expectoration
obstruction
decreasing
increasing |
|
|
Term
| The decreased ventilation and increased CO in chronic bronchitis leads to what three things? |
|
Definition
hypoxemia
hypercapnia
polycythemia |
|
|
Term
| Are chronic bronchitis patients usually thin or obese? |
|
Definition
|
|
Term
| What type of heart failure is usually exhibited in blue bloaters? |
|
Definition
| pt's may have signs of R heart failure (cor pulmonale) such as edema and cyanosis |
|
|
Term
| What is chronic obstructive pulmonary disease (COPD)? |
|
Definition
| a clinical term used for lung diseases characterized by chronic airway obstruction |
|
|
Term
| What is COPD usually a mixture of? |
|
Definition
| Ephysema and chronic bronchitis: they can exist in "pure" forms, but in most cases they coexist |
|
|
Term
| What percentage of adults in the US does COPD effect? It is the _______ leading cause of death in the US |
|
Definition
|
|
Term
| What is bronchiectasis? What causes it? |
|
Definition
-permanent dilatation of bronchi and bronchioles secondary to obstruction and chronic persisting infection
-infection and inflammation destroy smooth muscle in airways, causing permanent dilation |
|
|
Term
| What are three associated conditions with bronchiectasis? |
|
Definition
-obstruction
-hereditary conditions: cystic fibrosis, immunodeficiency, immotile cilia syndromes
-necrotizing pneumonia |
|
|
Term
| Bronchiectasis is the most common complication of __________/___________ |
|
Definition
|
|
Term
| Bronchiectasis usually presents with a severe, persistent ___________ with expectoration of ___________ sputum |
|
Definition
|
|
Term
| The symptoms of bronchiectasis are often episodic following URI or introduction of a new pathogenic agent |
|
Definition
|
|
Term
| Would you see clubbing of the fingers in bronchiectasis? |
|
Definition
|
|
Term
| Severe, widespread bronchiectasis may result in what 4 things? |
|
Definition
-hypoxemia
-hypercapnia
-pulmonary HTN
-(rarely) cor pulmonale |
|
|
Term
| Cystic fibrosis (CF) is an ___________/___________ disorder caused by mutations in what gene? |
|
Definition
autosomal recessive
cystic fibrosis transmembrane conductance regulator (CFTR) gene |
|
|
Term
| What is the CFTR protein? Where is it located? |
|
Definition
| it is a cAMP-regulated chloride channel located in the apical membrane of the epithelial cells affected by the disease |
|
|
Term
| What are the two major features of CF? |
|
Definition
chronic pulmonary disease
malabsorption |
|
|
Term
| CF is prominently a disease of which heritage? |
|
Definition
| Northern Europeans (1 in 2500 white births) |
|
|
Term
| What is the main job of the CFTR protein? |
|
Definition
| it maintains the hydration of secretions within the airways and ducts through the transport of chloride across the cell membrane and inhibition of sodium uptake |
|
|
Term
| What happens in CF patients with mutations in the CFTR gene? |
|
Definition
| the chloride channel is unable to open causing chloride ions to accumulate in the cell. The balance the chloride ions the cells absorb excess sodium. In secretory glands, this leads to decreases in fluid production |
|
|
Term
| Dysfunction of the CFTR can affect many different organs, particularly those that secrete mucus, give a few examples |
|
Definition
-upper and lower respiratory tracts
-pancreas
-biliary system
-male genitalia
-intestine
-sweat glands |
|
|
Term
| What is the pathophysiology in the lung of a pt with CF? |
|
Definition
| dehydrated and viscous secretions in the lungs interfere with mucociliary clearance, inhibit the function of naturally occurring antimicrobial peptides, provide a medium for growth of pathogenic organisms, and obstruct airflow |
|
|
Term
| Mucus secretion and colonizing bacteria in the lung of a pt with CF initiates an __________ reaction. Recurrent cycles of what three things eventually lead respiratory failure? |
|
Definition
inflammation
infection, inflammation, and tissue destruction |
|
|
Term
| Loss of the CFTR chloride transport protein in the pancreatic duct causes what? |
|
Definition
| impairs the hydration of secretions and leads to the retention of exocrine enzymes in the pancreas. Damage of these retained enzymes eventually causes fibrosis of the pancreas |
|
|
Term
| What is the sweat of a CF patient like? |
|
Definition
| increased sodium chloride content, and this is the basis of the historical "salty baby syndrome" and the diagnostic sweat chloride test |
|
|
Term
| When does CF typically manifest? |
|
Definition
early childhood
approx 4% are diagnosed in adulthood |
|
|
Term
| What do most CF infants present with? |
|
Definition
-chronic respiratory complaints
-15-20% present with meconium ileus due to thickened meconium |
|
|
Term
| What do CF patients usually have poor growth? |
|
Definition
| a combo of increased calorie expenditure bc of chronic lung infections and malnutrition and pancreatic exocrine insufficiency |
|
|
Term
| More than 95% of male patients with CF are azoospermic because of what? |
|
Definition
| congenital bilateral absence of the vas deferens (CBAVD) |
|
|
Term
| What is the chief determinant of morbidity and mortality in CF? what is the median surveil age? |
|
Definition
progression of lung disease
33 yoa |
|
|
Term
| What are the typical managements for the pulmonary and pancreatic problems in pts with CF? |
|
Definition
-pulmonary PT and the use of bronchodilators, antibiotics, and mucolytic agents
-oral enzyme replacement for pancreatic insufficiency |
|
|
Term
-Parents of an affected CF child face a ___________% risk of recurrence
-What is the carrier frequency in the white population? |
|
Definition
|
|
Term
| Define asthma. What does it cause? |
|
Definition
reversible bronchoconstriction caused by airway hyper-responsiveness to a variety of stimuli
causes recurrent episodes of wheezing, breathlessness, tightness of chest, cough |
|
|
Term
| What are the two main types of asthma? What are the key inflammatory cells? What contributes to the obstructive nature of the disease? |
|
Definition
-extrinsic (atopic, allergic) 70%
-intrinsic (non-atopic) 30%
-eosinophils are key inflammatory cells
-airway remodeling contributes to the obstructive nature of disease |
|
|
Term
| What causes extrinsic asthma? Who is usually affected? What is the prognosis? |
|
Definition
-caused by helper T cell and IgE mediated immunologic reaction to exogenous allergens
-affects children before age of 10 and lasts for several years
-may improve spontaneously but persists for life in about 50% |
|
|
Term
| What causes intrinsic asthma? whose does it usually effect? |
|
Definition
-most attacks occur at random and may be related to exposure to viral infections, inhaled air pollutants, cold, toxic gases, aspirin, emotional stress, exercise
-begins in adulthood, usually before 40 yoa |
|
|
Term
| What is acute respiratory distress syndrome (ARDS)? What causes it? What does it lead to? How does the pt present? |
|
Definition
-diffuse alveolar damage to epithelium and/or capillary endothelium
-caused by: direct lung injury (pneumonia, aspiration of gastric contents), indirect lung injury (sepsis, severe trauma with shock)
-leads to low O2 levels in the blood
-patient in severe distress, SOB, gasping for air |
|
|
Term
| ARDS is leads to an ___________ permeability of alveolar blood vessels, then causing an accumulation of fluid in the ___________/___________ |
|
Definition
|
|
Term
| In ARDS, there is a formation of a ___________/___________, which attempts to fix the problem but also blocks a lot of ___________/___________ |
|
Definition
hyaline membrane
gas exchange |
|
|
Term
| The lung injury in ARDS is ultimately caused by an imbalance of what? |
|
Definition
| pro- and anti-inflammatory mediators |
|
|
Term
| What is the mortality rate for ARDS? |
|
Definition
60%
most patients who survive acute phase will return to normal respiratory function within one year |
|
|
Term
|
Definition
| Disorders caused by inhalation of mineral dusts, fumes, and various organic and inorganic matter |
|
|
Term
| What is the injury of a pneumoconioses determined by? |
|
Definition
-length of exposure
-physcial/chemical characteristics
-host factors |
|
|
Term
| What are three main subtypes of pneumoconioses? |
|
Definition
-Coal workers' lung disease (anthracosis, simple CW pneumoconiosis, progressive massive fibrosis (PMF))
-Silicosis- most prevalent world wide: (crystalline silica, asymptomatic to PMF)
-Asbestos (asbestosis, pleural disease- fibrous plaques, mesothelioma) |
|
|
Term
|
Definition
A malignant tumor of the mesothelial cells
highly malignant neoplasm with short survival |
|
|
Term
| About 50% of pt's with mesothelioma have an ___________ exposure history |
|
Definition
|
|
Term
| Is smoking related to mesothelioma? |
|
Definition
|
|
Term
| Sarcoidosis is a ______-systemic disease of ___________ etiology. Its defining feature is what? |
|
Definition
multi
unknown
noncaseating granulomas in various tissues |
|
|
Term
| Lung involvement is present in what percentage of sarcoidosis pt's? |
|
Definition
| 90% with formation of granulomas and interstitial fibrosis |
|
|
Term
| What is hypersensitivity pneumonitis? What is it usually caused by? |
|
Definition
-immunologically mediated lung disease that primarily affects the alveoli (allergic alveolitis)
-usually caused by occupational exposure and heightened sensitivity to inhaled antigens |
|
|
Term
| Where do most pulmonary emboli arise from and that are some major risk factors? |
|
Definition
-95% arise from thrombi within veins from the lower legs
-RFs: prolonged bed rest, leg surgery, severe trauma, CHF< oral contraceptives, disseminated CA, hypercoagulability diseases |
|
|
Term
| What are some causes of secondary pulmonary HTN? |
|
Definition
-COPD
-chronic interstitial pulmonary disorders
-chronic HF
-recurrent PE |
|
|
Term
| Name the three different categories of infectious diseases of the respiratory system and give some examples for each |
|
Definition
-URI's: typically affects nose and pharynx (common cold, most common of all respiratory infxns)
-MRS's: infections of larynx, trachea, and major extra pulmonary bronchi (laryngitis, croup, acute epiglottitis)
-Lower respiratory tract: pneumonia, or any infxn of the lung |
|
|
Term
| What is pneumonia defined as? It contributes to what fraction of all deaths in the US? |
|
Definition
any infection in the lung
1/6 |
|
|
Term
| Name 5 predisposing factors for pneumonia |
|
Definition
decreased cough reflex
injury to cilia
decreased function of alveolar macrophages
edema or congestion
retention of secretions |
|
|
Term
| Name 4 routes through which the pathogens responsible for pneumonia can reach the lung parenchyma. |
|
Definition
-inhalation of pathogens in air droplets
-aspiration of infected secretions from the upper respiratory tract
-aspiration of infected particles in gastric contents, food, or drinks
-hematogenous spread |
|
|
Term
| Acute pneumonias are usually caused by what? What are two different categories? |
|
Definition
-bacteria
-Bronchopneumonia: patchy distribution, more than one lobe. (Bronchi, bronchioles, alveoli)
-Lobar pneumonia: diffuse, large portions of pulmonary parenchyma (bronchi, bronchioles, and alveoli) |
|
|
Term
Most community acquired acute pneumonias are lobar or bronchi-?
What is the most common cause in the US? |
|
Definition
|
|
Term
| Haemophilus influenzae is the most common cause of what? |
|
Definition
| acute exacerbation of COPD |
|
|
Term
| Klebsiella pneumonia usually affects who? |
|
Definition
|
|
Term
| Legionella pneumophila usually affects who? |
|
Definition
|
|
Term
| What are some clinical features of acute pneumonias: what do they often follow? what are some systemic signs of infection that show? some local signs of irritation? is there airways obstruction? |
|
Definition
-URIs and onset is abrupt
-high fever, shaking chills, pleuritic chest pain
-productive mucropurulent cough
-airway obstruction shown by dyspnea and tachypnea
*some pts may have hemoptysis |
|
|
Term
| What are 5 complications of acute pneumonias? |
|
Definition
-may extend to pleura, cause pleuritis, and heal as pleural fibrosis
-empyema-pus in pleural space
-abscess formation
-bronchiectasis from chronic lung infection
-interstitial fibrosis with cysts |
|
|
Term
| In community acquired atypical pneumonias, the inflammation is primarily confined to what? |
|
Definition
| alveolar septa with the alveoli generally clear |
|
|
Term
| What is the most common causative organism in community acquired atypical pneumonias? |
|
Definition
|
|
Term
| Describe atypical pneumonias: how much sputum? what is the WBC? alveolar exudates? WHat is the clinical onset look like? |
|
Definition
moderate amounts of sputum, absence of physical findings of consolidation, only moderate elevation of WBC, lack of alveolar exudates
-onset is usually acute with fever, HA, malaise, and alter a cough with minimal sputum |
|
|
Term
| What is the world's foremost cause of death from a single infectious agent? |
|
Definition
|
|
Term
|
Definition
| through inhalation of infected droplets |
|
|
Term
| Describe the tubercular garnulomas |
|
Definition
usually in the lungs but can affect any organ
they undergo caseous necrosis |
|
|
Term
| A primary TB infection in a previously unexposed immunocompetent individual is a ________ infection most often occurring in the ________ and regional ________/________ |
|
Definition
localized (Ghon complex)
lung
lymph nodes |
|
|
Term
| Does the Ghon complex usually heal spontaneously? |
|
Definition
| yes, 95% of the time by calcification |
|
|
Term
| What are two ways that secondary pulmonary TB can come about? |
|
Definition
| reactivation of dormant primary infection, or a re-infection by M. tuberculosis |
|
|
Term
| In secondary pulmonary TB, the bacteria usually spread to the _________of the lung, causing granulomatous ________. These confluent granulomas produce what? |
|
Definition
-apex
-bronchopneumonia
-cavities, which are the source of hemoptysis |
|
|
Term
| What are 2 clinical features in primary TB? |
|
Definition
mild pulmonary disease, low grade fever
clinically unrecognized in over 95% of cases |
|
|
Term
| What are some clinical features of secondary TB? |
|
Definition
-non productive cough, low grade fever, loss of appetite, malaise, night sweats, weight loss
-chest X ray essential for dx
-definitively established by indetifying bacilli in sputum by acid fast stains |
|
|
Term
| What is the most common cancer world wide? |
|
Definition
| carcinomas of the lung (lung cancer) |
|
|
Term
| What are the 4 different histologic subtypes of lung carcinoma? |
|
Definition
-adenocarcinoma (most common)
-SCC
-Large cell carcinoma
-Small cell carcinoma |
|
|
Term
| Non-small cell lung cancers are curable by ________if limited to the lung? |
|
Definition
|
|
Term
| SMall cell lung cancers are all ________ at presentation and best treated by ________ |
|
Definition
|
|
Term
| Approx 15% of lung CAs have no symptoms and are discovered incidentally. What are the symptoms of lung CA related to? |
|
Definition
-bronchial irritation
-local extension into the mediastinum or pleural cavity (pleural effusion)
-distant metastases
-systemic effects of neoplasia
-paraneoplastic syndromes |
|
|
Term
| Pleural disease: Pathological involvement of the pleura is usually..... |
|
Definition
| a secondary complication to an underlying pulmonary disease |
|
|
