Week 1
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| At what point is a cough considered chronic? | 6 weeks
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| Coughing up blood from the lungs | Hemoptysis
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| What is the number one cause for dyspnea? | Anemia
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| What are general causes of dyspnea other than an obstructive or restrictive lung complication? | Anemia, Metabolic Acidosis (compensated for by breathing out CO2), pregnancy, etc.
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| What are cardiac causes for dyspnea? | CHF, pulmonary HPT
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| What pulmonary diseases are identified as Obstructive? | Asthma, COPD, Cystic Fibrosis, Bronchiectasis, Bronchiolitis
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| What pulmonary diseases are identified as Restrictive? | Infections, Occupational disorders, Drugs disorders, Sarcoidosis, Kyphoscoliosis
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| What happens to each of the following in Obstructive Pulmonary Disease? VC, FEV1, FEV1/FVC, RV | VC: decreases
FEV1: decreases
FEV1/FVC: decreases
RV: increases
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| What happens to each of the following in Restrictive Pulmonary Disease? VC, FEV1, FEV1/FVC, RV | VC: decreased
FEV1: decreased
FEV1/FVC: no change
RV: decreases
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| What identifies a cough as productive? | If something is coughed up
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| What are the 3 common causes of chronic cough? | Post Nasal Drip
Reflux
Asthma
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| What are the two possible sources for hemoptysis? How do they differ? | Pulmonary circulation which is low pressure and develops slowly.
Bronchial circulation which comes directly off the aorta has high pressure and is the cause of quick and dangerous bleeds.
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| If an individual has a hemoptysis caused by a bronchial circulation bleed roughly how much blood will be coughed up? | about 600ml/day
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| What conditions would be responsible for pulmonary or bronchial hemoptysis? | Pulmonary: Lung infx, Bronchitis, Small Pulmonary embolism.
Bronchial: Cancer, Mycetoma, Vasculitis
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| Why don't small pulmonary embolisms cause lung infarcts? | Because of two blood sources in the lungs, and anastomoses between the two, should the pulmonary circulation be clogged the bronchial circulation can substitute.
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| What conditions tend to be found in the lungs of smokers? | COPD
Lung Cancer
Interstitial Pulmonary Fibrosis
Desquamatous Interstitial Pulmonitis
Eosinophilic Granuloma
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| What pulmonary conditions can be related to an individual's occupation? | Asthma
Pneumoconioses from asbestos, silica, mining
Farmer's lung
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| What pulmonary conditions tend to run in families? | Asthma & allergies
Cystic Fibrosis
Emphysema (alpha antitrypsin deficiency)
Pulmonary Embolism (thrombophilias)
Sarcoidosis
Pulmonary HPT
Bronchiectasis
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| What is normal for FVC, FEV1, and FEV1/FVC? | FVC: >80%
FEV1: >80%
FEV1/FVC: >70%
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| If the FEV1/FVC ratio is less than 70% what is this indicative of? | Obstructive Disease
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| How does the right bronchus differ from the left bronchus? | Right is wider, steeper, shorter and tends to be the location that foreign bodies get stuck.
The left is narrower, longer, and horizontal
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| What makes up the acinus of the lung? | Distal to the terminal bronchiole. It is made up of Respiratory bronchiole, alveolar duct, alveolus.
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| What type of cells are found proximal to the respiratory bronchioles in the airways? | Pseudostratified ciliated columnar epithelium
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| What makes up the defense mechanism in the major airways? | Mucin and cilia
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| Type II pneumocytes produce 4 types of surfactant. What does each do? | A & D set off innate immunity
B & C reduce surface tension
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| When does a baby's body begin making surfactant | Week 28
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| A state in which the lung, in whole or part, is collapsed or without air? | Atelectasis
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| What are the four types of atelectasis | Resorption
Compression
Contraction
Loss of surfactant (neonatal)
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| What is the cause of resorption atelectasis? | complete airway obstruction. The distal trapped air is reabsorbed through pores of kohn leading to collapse of portion of the lung.
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| What type of atelectasis is the most common cause of fever 24-36 hrs following surgery? | resorption atelectasis
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| resorption atelectasis results in what clinical findings? | Ipsilat. deviation of the trachia and diaphragm elevation. Absent breath sounds and vocal vibrations (tactile fremitus) in that region.
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| What is the cause of compression atelectasis? | Air or fluid accumulation in the pleural cavity leading to collapse of the underlying lung.
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| What clinical findings are associated with compression atelectasis? | trachea and mediastinum shifting away from the affected side
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| What are the two components of surfactant? | Lipoproteins (lecithin & phosphatidylylycerol) and surfactant proteins
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| What hormones increase surfactant production? Decrease it? | Increase = cortisol and thyroxine
Decrease = insulin
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| What conditions/situations might lead to RDS development in babies? | Prematurity
Maternal diabetes
Cesarean section (stress of vaginal birth increases cortisol which increases surfactant)
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| How do alveoli begin to appear histologically in neonatal atelectasis? | Become smaller due to the genesis of hyaline membranes forming
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| What clinical findings are found in neonatal atelectasis? | distress
respiratory acidosis
ground glass appearance on Xray
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| What is the danger of respiratory acidosis in neonates? | acidosis is a negative inhibitor of surfactant production. It also leads to vasoconstriction and then endothelial and epithelial damage. Hyaline formation begins at this point.
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| What is the cause of contraction atelectasis | fibrotic changes (not reversible)
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| How is acute and chronic pulmonary edema differentiated histologically? | Acutely it will appear as a pink fluid in the alveoli; however, in chronic edema heart failure cells are present
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| What are the injuries that can result in pulmonary edema? | Cardiac complications that increase hydrostatic pressure or a nephrotic/liver complication that decreases osmotic pressure.
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| What type of fluid is found in pulmonary edema? | transudate (little protein)
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| What is the cause of ARDS? | Non cardiogenic pulmonary edema resulting from acute alveolar capillary damage. Most commonly:
Sepsis
Lung infection
Gastric aspiration
Trauma
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| What is the prognosis of ARDS? | 60% mortality rate
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| What cells and cytokines are involved in ARDS? | Neutrophils being attracted into alveoli
Macrophages secreting PAF, Leukotrienes, Proteases, TNF, IL-8
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| In ARDS what is mainly seen in: first 24 hours first week second week | First 24 hours: edema
First week: formation of hyaline membrane
second week: interstitial inflammation and fibrosis
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