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Pulmonary Path I

Week 1

At what point is a cough considered chronic? 6 weeks
Coughing up blood from the lungs Hemoptysis
What is the number one cause for dyspnea? Anemia
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.
What are cardiac causes for dyspnea? CHF, pulmonary HPT
What pulmonary diseases are identified as Obstructive? Asthma, COPD, Cystic Fibrosis, Bronchiectasis, Bronchiolitis
What pulmonary diseases are identified as Restrictive? Infections, Occupational disorders, Drugs disorders, Sarcoidosis, Kyphoscoliosis
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
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
What identifies a cough as productive? If something is coughed up
What are the 3 common causes of chronic cough? Post Nasal Drip Reflux Asthma
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.
If an individual has a hemoptysis caused by a bronchial circulation bleed roughly how much blood will be coughed up? about 600ml/day
What conditions would be responsible for pulmonary or bronchial hemoptysis? Pulmonary: Lung infx, Bronchitis, Small Pulmonary embolism. Bronchial: Cancer, Mycetoma, Vasculitis
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.
What conditions tend to be found in the lungs of smokers? COPD Lung Cancer Interstitial Pulmonary Fibrosis Desquamatous Interstitial Pulmonitis Eosinophilic Granuloma
What pulmonary conditions can be related to an individual's occupation? Asthma Pneumoconioses from asbestos, silica, mining Farmer's lung
What pulmonary conditions tend to run in families? Asthma & allergies Cystic Fibrosis Emphysema (alpha antitrypsin deficiency) Pulmonary Embolism (thrombophilias) Sarcoidosis Pulmonary HPT Bronchiectasis
What is normal for FVC, FEV1, and FEV1/FVC? FVC: >80% FEV1: >80% FEV1/FVC: >70%
If the FEV1/FVC ratio is less than 70% what is this indicative of? Obstructive Disease
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
What makes up the acinus of the lung? Distal to the terminal bronchiole. It is made up of Respiratory bronchiole, alveolar duct, alveolus.
What type of cells are found proximal to the respiratory bronchioles in the airways? Pseudostratified ciliated columnar epithelium
What makes up the defense mechanism in the major airways? Mucin and cilia
Type II pneumocytes produce 4 types of surfactant. What does each do? A & D set off innate immunity B & C reduce surface tension
When does a baby's body begin making surfactant Week 28
A state in which the lung, in whole or part, is collapsed or without air? Atelectasis
What are the four types of atelectasis Resorption Compression Contraction Loss of surfactant (neonatal)
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.
What type of atelectasis is the most common cause of fever 24-36 hrs following surgery? resorption atelectasis
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.
What is the cause of compression atelectasis? Air or fluid accumulation in the pleural cavity leading to collapse of the underlying lung.
What clinical findings are associated with compression atelectasis? trachea and mediastinum shifting away from the affected side
What are the two components of surfactant? Lipoproteins (lecithin & phosphatidylylycerol) and surfactant proteins
What hormones increase surfactant production? Decrease it? Increase = cortisol and thyroxine Decrease = insulin
What conditions/situations might lead to RDS development in babies? Prematurity Maternal diabetes Cesarean section (stress of vaginal birth increases cortisol which increases surfactant)
How do alveoli begin to appear histologically in neonatal atelectasis? Become smaller due to the genesis of hyaline membranes forming
What clinical findings are found in neonatal atelectasis? distress respiratory acidosis ground glass appearance on Xray
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.
What is the cause of contraction atelectasis fibrotic changes (not reversible)
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
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.
What type of fluid is found in pulmonary edema? transudate (little protein)
What is the cause of ARDS? Non cardiogenic pulmonary edema resulting from acute alveolar capillary damage. Most commonly: Sepsis Lung infection Gastric aspiration Trauma
What is the prognosis of ARDS? 60% mortality rate
What cells and cytokines are involved in ARDS? Neutrophils being attracted into alveoli Macrophages secreting PAF, Leukotrienes, Proteases, TNF, IL-8
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
Created by: Jackfrostmd