| Question | Answer |
| 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 |
