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Flashcards in DEVINE Deck (66):
1

ATELECTASIS

collapse of lung w/absorption of air from alveoli

2

resorptive type

obstruction/block of bronchus by foreign body/mucous/tumor

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most common cause of dyspnea

resorptive type - 1st 24hrs postop

4

compression type

mechanical collapse: pneumothorax, pleural effusion

5

ARDS

capillaritis = increased permeability>>inflammation>widened gap jxn>exudation>neutrophils mediate injury

SARS/influenza
micro=diffuse alveolar damage
permits exudation fr injured vessles into alveoli w/formation of HYALINE MEMBRANES

INCREASED CAP PERMEABILITY

6

ARDS clinical

rapidly progressive dyspnea w/hypoxemia. poor response to O2 therapy

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ARDS causes

local: inhalation smoke/chemicals; near drowning; aspiration of gastric contents, pulm infections, radiation

**SYSTEMIC: systemic inflamm response. septic shock, trauma, narcotics, surgery

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spirometry: obstructive

decreased FEV1

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spirometry: restrictive

decreased FVC

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obstructive disease

block air, destruction of elastic fibers
most common
low O2, normal pH

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obstructive disease CAUSES

parenchymal disease of lung (decreased FEV1)
asthma
emphysema
chronic bronchitis/bronchiolitis
bronchiectasis

12

bronchiectasis

bad smelling sputum
PERM. dilation and scarring
persistent &/or sever infection
immotile cilia
cystic fibrosis

13

asthma

smooth muscle hypertrophy
type I: IgE
wheezing

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emphysema

acinus (sac)
airspace enlargement - alveolar wall destruction
tobacco smoke (elastase fr neutrophils...LOSS OF ELASTIC RECOIL)
dyspnea

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bronchiectasis

bronchiole
inflamm scarring

16

pulmonary emphysema

dyspnea. barrel chest
"pink puffer" - malnourished, SOB w/o serious hypoxia. pursed lips, hunched over
may die fr resp failure, pneumothorax fr rupture bullae
secondary pulmonary hypertension w/cor pulmonale

17

bullae

subpleural balloon-like spaces (blebs)
associations w/all forms of pulm emphysema
lung apex
may rupture to produce spontaneous pneumothorax

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intersitial emphysema

air w/in connective tissue of the lung

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CHRONIC BRONCHITIS

prolonged cough productive of sputum (3mo-2yr)
tobacco smoke
submucosal mucous glands/gob cells increased: hyperplasia/trophy
infiltrates of lymphocytes//mucus plugs, incur mucus glands

20

ASTHMA

type 1
pollen, allergy
eosinophils, mast cells, IgE

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asthma detail

IgE formed in response to exposure to allergen.
IgE antibody attaches to mast cells; mast cells release histamines, proteases; vagal receptors stimulated to produce edema and bronchial constriction.
Eosinophils and neutrophils recruited that damage mucosa; leukotrienes elaborated from arachadonic acid that intensify (2nd phase) bronchoconstriction.
Nonatopic type due to exercise, viral infection or aspirin
Morphology of asthma: Bronchi demonstrate edema, infiltrate of eosinophils, increase in mucous glands and smooth muscle hypertrophy

22

asthma clin course

first attack = childhood
recurrent eps of sever dyspnea w/wheezing, chron cough last >hours
may progress to COPD

23

bronchiectasis (ectasis=dilation)

PERMANENT ABNORMAL DILATION OF BRONCHI/BRONCHIOLES due to NECROSIS by INFECTION of WALL

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bronchiectasis causes

CF
persistent cough, smells horrible

25

restrictive lung diseases

decreased FVC (lung vol)
ground glass/reticulo (net) nodular appearance on radiographs
honeycomb lung of increased interstitial fibrosis on biopsy

26

restrictive lung disease causes

lung disease in lupus
scleraderma, RA, other type III systemic immune complex diseases
immune complexes
no cough = no FEV1 = no obstructive

27

RLD pathology

type I pneumocyte injury /activation of macrophages w/producion of fibrogenic cytokines resulting in fibrosis of lung w/decreased compliance

28

interstitial fibrosis

injury, repair, injury, repair
dry/velcro like rub

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pneumonoconisis

chronic fibrosing diseases of the lung due to occupational exposure to inhaled dusts

30

silica

increased risk of TB

31

ASBESTOS

insulation
pleural plaques- CARCINOGENIC
asbestos/ferruginous bodies (looks like a screw)
progressive, involves lower lobes
years after exposure

32

radiation & lung

1-6 mo after radiation
hyaline membranes, responds to corticosteroids

chronic radiation pneumotitis: interstitial fibrosis (permanent)

33

SARCOIDOSIS

multisystem disease characterized by NONCASEATING GRANULOMAS in many tissues & organs
TYPE IV (cell mediated)
GRANULOMAS = ALWAYS TYPE IV
NON TB RELATED

34

laryngeal carcinoma

squamous cell carcinoma
arises from dysplasia>carcinoma in situe
Most associated with tobacco smoking and alcohol abuse May be due to asbestos; radiation

Tumors of the true vocal cords (glottis tumors) cause hoarseness Local growth into tissues of the neck; cure rate 65%
//suffocates one locally; doesn’t metastasis

35

laryngeal papillomas

Benign HPV-related neoplasm(s) of vocal cords, larynx
May be multiple and may recur, esp. in children

36

laryngeal nodules

nonneoplastic reactive proliferation of vocal cord due to voice oversuse, eg "singers nodes"
HOARSENESS

37

mesothelioma

(uncommon, distractor)
most assoc w/ asbestos. no tobacco assoc.
pleural cav: encases lungs, leads to pulm effusion; resp failture
pericardial: encases heart: heart failure
peritoneum: obstructs intestines
not curable
morphology: asbestos body

38

pneumothorax

air in pleural cav due to puncture
secondary to rupture emphysematous bleb in a pt w/emphysema or ruptured cavity

spontaneous pneumothorax: occurs in young adults (tall) due to paraseptal emphysematous bulla/bleb

39

HORNER SYNDROME

pancoast tumor - apex of lung
unilateral enophthalmos (shrunken in eyeball)
ROUND THE HORN, ROUND THE COAST

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SUPERIOR VENA CAVA SYNDROME

tumour grows around VC blocking venous return fr head/arms
head & neck congested
cyanotic
inoperable

41

local effects of lung cancer

obstruction of bronchus: pneumonia
growth into adjacent organ/tissue - esophagous: diff swalling; rib: pain/fracturel recurrent laryngeal nerve (hoarseness) & othrs including SVC and symp ganglia

42

hyperplastic pulm osteoarthopathy

clubbing of distal fingers/arthritis
causes: lung cancer - paraneoplastic,CBD, RL shunt

43

paraneoplastic syndrome

effects related to a neoplasm distal from the tumor
not due to local extension

44

chronic pneumonia

lasts weeks-months
caseating (cheesy) granuloma

45

lung abscess

pus-filled cavity
contains neutrophils, living pyogenic BACTERIA
xray demonstrates air-fluid level

46

atypical pneumonia

viral infection
interstitial pneumonia w/lymphocytic response
no alveolar exudates, no consolidation
no sputum

47

aspiration pneumonia

due to anesthesia, no gag reflex
mixture of microbes + gastric acid
high death rate

48

morphology of lobar pneumonia

Congestion>red hepatization>gray hepatization>resolution (good) or organization (scar)

49

goodpasture syndrome

TYPE2 hypersensitivity
develops following injury exposing basement membrane: resp infection in someone exposed to solvents

pt produces anti-glomerular basement membrane antiB that cross reacts w/basement membranes in the lung

50

destruction of centriacinar septae

tobacco smoke

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destruction of panacinar

alpha 1 antitrypsin deficiency

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destruction of irregular septae

aging

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destruction of paraseptal

spontanoues pneumothorax due to bleb rupture

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ectasis

dilation

55

sarcoidosis assoc

gland enlargement/dry eyes & mouth: MICKULICZ DISEASE

56

hemoptysis causes

pulmonary emboli, lung cancer, TB, goodpasture, wegener's granulomatosis

57

wegener's granulomatosis

vasculitis w/cANCA antibodies
causes nasopharyngeal necrosis
eye/oribtal lesions
renal glomerular disease

58

pulmonary hypertension primary

defect in endothelium/SM
young women

59

pulmonary hypertension secondary

all chronic lung disease
recurrent pulmonary emboli
l-r shunts of CHD

60

common cause of lobar pneumonia

strep pneumonia

61

common cause of bronchopneumonia in COPD

h. influenza

62

lobar

confluent via alveolar pores
large dose virulent organisms
more common in alcoholics, smokers

63

bronchial

patchy, spread from bronchioles
elderly & very young
follows resp. infection/aspiration

64

LOBAR

CRGR

65

aenocarcinoma "non small"

more common in women
may arise in scar: stab= cancer later
trousseau syndrome

66

small cell carcinoma - neuroendocrine

aggressive local growth
adh production