Pathophysiology- Ch 19

Front 1

What is the most common type of primary malignant lung tumor?

Back 1

Bronchiogenic carcinoma (arises from the bronchial epithelium)

Front 2

What is the "worst" kind of lung cancer you can get?

Back 2

Squamous cell carcinoma

Front 3

What types of cancer are typically found on the periphery of the lung?

Back 3

adenocarcinomas and bronchoalveolar cell carcinomas

Front 4

What stimulates a cough in a lung cancer patient?

Back 4

Inflammation and bleeding surrounding the tumor (can also cause hemoptysis and secondary infections)

Front 5

Describe the change of epithelial cells that occurs in the case of smoking

Back 5

Metaplasia. (ciliated, pseudostatified columnar epithelium changes to statified squamous epithelium)

Front 7

Excessive inflammation and erosion of the plueral membrane (due to a tumor) could lead to what other complications?

Back 7

Pleural effusion, hemothorax, and pneumothorax

Front 8

What is it called when a tumor cell secretes hormones or hormonelike substance? Why is this a bad thing? Which lung disease is this associated with?

Back 8

Paraneoplastic syndrome. Tumor can secrete hormones such as ADH, ACTH, which complicate diagnosis and treatment or even lead to an endrocrine disorder. Associated with lung cancer

Front 9

Which type of lung cancer would have the best chance of resecction?

Back 9

Adenocarcinomas and bronchoalveolar cell carcinomas (because they are found on periphery of lung- problem is, they metastasize quickly)

Front 10

What is the most common sign of lung cancer?

Back 10

Cough

Front 11

Why would a lung cancer patient be hoarse?

Back 11

If tumor compresses the laryngeal nerve

Front 12

What is atelectasis?

Back 12

The collapse or nonaeration of all or part of the lung

Front 13

Why would a lung cancer patient exhibit facial or arm edema and headache?

Back 13

If tumor compresses the superior vena cava (blood will backflow into the upper systemic region instead of to the right side of the heart)

Front 14

Name some systemic signs of cancer

Back 14

Weight loss, anemia, fatigue

Front 15

What might chronic anemia that does not respond well to treatment indicate?

Back 15

Cancer

Front 16

Why would a lung cancer patient experience dysphagia?

Back 16

If tumor compresses the esophagus

Front 17

The passage of food, fluid, emesis or other foreign material into the trachea and lungs is called

Back 17

Aspiration

Front 18

In which type of patients is aspiration most common?

Back 18

Children and individuals eating or drinking while lying down (common in hospitalized patients); infants with cleft lip or palate

Front 19

What anatomical structure prevents aspiration?

Back 19

Epiglottis

Front 20

Where would an obstruction be located if the patient is wheezing?

Back 20

Lower respiratory tract (usually aspirate is a liquid)

Front 21

Where would an obstruction be located if the patient exhibits stidor?

Back 21

Upper respiratory tract

Front 22

If microbes are present in aspirate, what would be a potential complication?

Back 22

Pulmonary abcess

Front 23

Name a compensation mechanism of the heart in response to aspiration?

Back 23

Tachycardia

Front 24

Sometimes a solid aspirated object creates a ball-valve effect. What does this lead to?

Back 24

Ball moves up during during inspiration but closes during expiration, leading to a build up of air in the area distal to the obstruction

Front 25

Obstructive sleep apnea is a result of ___________ tissue collapse during sleep

Back 25

pharyngeal tissue

Front 26

What is a CPAP machine and what might it be used for?

Back 26

Continuous positive airway pump. Used as a treatment for obstructive sleep apnea

Front 27

Repeated and momentary cessation of breathing while sleeping=

Back 27

obstructive sleep apnea

Front 28

Obstructive sleep apnea is most common in which patients?

Back 28

Obese, men, aged-population

Front 29

Why are obese patients at such a high risk for obstructive sleep apnea?

Back 29

Fat compresses the diaphragm

Front 30

What causes a person with obstructive sleep apnea to suddenly wake up and start breathing? What if this patient has COPD as well?

Back 30

Sudden hypercapnia, unless the patient has COPD, in which case the sudden hypoxemia would wake patient

Front 31

Asthma is caused by an obstruction where?

Back 31

In the bronchioles

Front 32

What type of asthma is characterized by acute episodes triggered by type I hypersensitivity reactions?

Back 32

Extrinsic

Front 33

If a patient's hyperresponsive tissue intiates an asthma attack, which type of asthma does that pt probably have?

Back 33

Intrinsic

Front 34

Which type of asthma would a child most likely have?

Back 34

Extrinsic

Front 35

Which type of asthma would an adult most likely have?

Back 35

Intrinsic

Front 36

Name the three physiological changes that occurs in the bronchioles as a result of asthma

Back 36

Edema, bronchioconstriction, increased secretion of thick mucus

Front 37

Which branch of the autonomic nervous system is responsible for bronchoconstriction?

Back 37

Parasympathetic NS

Front 38

What is pulsus paradoxus? In which condition is it most common?

Back 38

When pulse differs on inspiration and expiration. Asthma

Front 39

Air trapping would cause respiratory (alkalosis/acidosis)

Back 39

Acidosis

Front 40

Hyperventilation would cause respiratory (alkalosis/acidosis)?

Back 40

Alkalosis

Front 41

Hypoventilation would cause respiratory (alkalosis/acidosis)?

Back 41

Acidosis

Front 42

Which treatments would be used in acute asthma attacks?

Back 42

Bronchodilators (inhalers), glucocorticoids, breathing techniques

Front 43

Prophylaxis for asthma

Back 43

Leukotriene receptor antagonists and cromolyn sodium inhalers

Front 44

Which heart condition would most likely be caused by COPD?

Back 44

cor pulmonale

Front 45

What is the damaged part in emphysema?

Back 45

Alveolar walls and septae

Front 46

A person with low levels of alpha1-antitrypsin would be suspectible to which lung disease?

Back 46

emphysema

Front 47

Residual volume in the alveoli (increases/decreases) with emphysema?

Back 47

Increases

Front 48

Emphysema causes difficulty with (inspiration/expiration)? This causes respiratory (acidosis/alkalosis)

Back 48

Expiration; acidosis

Front 49

Barrel chest is characteristic of which lung disease?

Back 49

Emphysema

Front 50

What happens when the pleural membrane surrounding large blebs ruptures?

Back 50

Pneumothorax

Front 51

Why would you perform lung reduction surgery on an emphysema patient?

Back 51

To decrease air trapping and improve expiration

Front 52

Chronic bronchitis is differentiated by significant changes in the ________.

Back 52

Bronchi

Front 53

Air pollution is most likely to cause which COLD?
1-Emphysema
2-Chronic Bronchitis
3-Asthma

Back 53

2- Chronic bronchitis

Front 54

which lung disease always appears as a secondary condition and is characterized by irreversible abnormal dilation of the medium-sized bronchi?

Back 54

Bronchiectasis

Front 55

Describe the dilation that occurs during bronchiecstasis

Back 55

saccular or elongated

Front 56

Why is it so important to vaccinate a patient with a COLD?

Back 56

to prevent bronchiecstasis

Front 57

kyphosis or scoliosis is a major factor in which type of lung disease?

Back 57

Restrictive Lung Disorder (caused by an abnormality of the chest wall)

Front 58

Chronic restrictive disease resulting from long-term exposure to irritating particles

Back 58

Pneumoconioses

Front 59

Pulmonary edema could occur due to which heart condition?

Back 59

Left-sided heart failure

Front 60

What is it called when fluid collects in the alveoli and interstitial area?

Back 60

Pulmonary edema

Front 61

What sound would you hear in a patient with pulmonary edema?

Back 61

Rales

Front 62

Why does pulmonary edema occur frequently in hospital settings?

Back 62

Patients are pumped with TOO much fluid in efforts to avoid hypovolemia

Front 63

Hypoproteinemia could cause what in the lungs?

Back 63

Low levels of plasma proteins will cause a decreased osmotic pressure, leading to INFLAMMATION, or pulmonary edema

Front 64

A frothy, blood-tinged sputum would indicate which lung disorder?

Back 64

Pulmonary edema

Front 65

What is the most common cause of a pulmonary embolus?

Back 65

DVT (breaks off and moves to right side of heart where it is pumped directly to the lungs)

Front 66

How would a large embolus affected the cadiovascular system? What effect would this have on cardio output? What type of shock would it lead to?

Back 66

Tachycardia, eventually leading to cor pulmonale; decreased cardio output; hypovolemic shock due to decreased blood volume

Front 67

What risk factors are associated with DVT's?

Back 67

Immobility; childbirth, congestive heart failure; cancer

Front 68

What are TEDS?

Back 68

Thromboembolic deterent stockings

Front 69

Which is altered in atelectasis, perfusion or ventilation?

Back 69

Both are decreased, which in turn, decrease diffusion of oxygen in to the blood

Front 70

Pleurisy is often associated with which type of pneumonia?

Back 70

Lobar

Front 71

The presence of excessive fluid in the pleural cavity

Back 71

Pleural effusion

Front 72

An exudate effusion would indicate the presence of __________. What systemic effect would this likely have?

Back 72

Bacteria; Fever

Front 73

A transudate effusion would indicate...

Back 73

Could be a virus, just water (hydrothorax or maybe hemothorax)

Front 74

Thoracocentesis is a treatment for which type of lung disorder?

Back 74

Pleural effusion

Front 75

Air in the pleural cavity

Back 75

Pneumothorax

Front 76

Which type of pneumothorax is spontaneous, and maybe due to a ruptured emphysematic bleb?

Back 76

Closed

Front 77

what type of pneumothorax would be caused by a stab wound?

Back 77

Open

Front 78

What is the worst kind of pneumothorax? It is (open/closed) during inspiration and (open/cloesd) during expiration?

Back 78

Tension. Open during inspiration (air comes in, creating pressure); closed during expiration (flap closes, traps air)

Front 79

What causes flail chest?

Back 79

fractured ribs

Front 80

What happens in flail chest during inspiration?

Back 80

Instead of going out, fractured ribs move inward creating more damage.

Front 81

What is the major problem in IRDS?

Back 81

Low production of surfactant (by type II pneumocytes).

Front 82

In which part of your respiratory tract would you find microbiota?

Back 82

Upper respiratory tract (lower is sterile)

Front 83

What part of the respiratory tract is responsible for the warming and moistening of air?

Back 83

Nasal cavity

Front 84

What type of respiratory cell secretes mucus?

Back 84

Goblet cell

Front 85

Another name for your adenoids? What would inflammation of them cause?

Back 85

Pharyngeal Tonsils; Obstruction of air through the Nasopharynx --> air not being filtered as well and mouth breathing--> dry mouth and risk of caries (because normal salivary function is lost)

Front 86

Lymphoid tissue in the posterior portion of the oral cavity

Back 86

Palatine tonsils (What you would typically call your "tonsils")

Front 87

Common passage for air and food

Back 87

Oropharynx

Front 88

Describe the structure of the trachea

Back 88

2/3 C-shaped cartilage rings; 1/3 trachialis (smooth) muscle

Front 89

Surfactant-secreting cells

Back 89

type II pneumocytes (septal cells)

Front 90

Macrophages of the lung

Back 90

Dust cells

Front 91

Site of gas exchange

Back 91

Alveoli

Front 92

Inspiration and expiration depend on _________ gradient

Back 92

Pressure gradient (Boyle's law: pressure moves from high to low)

Front 93

Inspiration occurs when the __________ pressure is higher than the ___________ pressure

Back 93

Atmospheric; Alveolar (intrapulmonary)

Front 94

ventilation that requires energy

Back 94

Inspiration (quiet or forced); forced expiration

Front 95

Expiration occurs when the __________ pressure is higher than the __________ pressure

Back 95

Alveolar (intrapulmonary); atmospheric

Front 96

Inspiration or expiration? Diaphragm moves downward

Back 96

Inspiration

Front 97

Inspiration or expiration? Diaphragm contracts

Back 97

Inspiration

Front 98

Inspiration or expiration? Diaphragm moves upward

Back 98

Expiration

Front 99

Inspiration or expiration? Diaphragm relaxes

Back 99

Expiration

Front 100

Inspiration or expiration? Intrapleural pressure becomes negative

Back 100

BOTH. In both inspiration and expiration the intrapleural pressure is negative. It becomes MORE negative in inspiration

Front 101

Inspiration or expiration? Intrapulmonic pressure becomes positive

Back 101

Expiration

Front 102

Inspiration or expiration? Intrapulmonic pressure becomes negative

Back 102

Inspiration

Front 103

First step in inspiration or expiration=

Back 103

Contraction or relaxation of muscles (thorax and lungs must expand before air can enter the lungs; it is NOT the air moving in that makes them expand)

Front 104

The amount of air exchanged with quiet inspiration and expiration

Back 104

Tidal volume

Front 105

Volume of air remaining in the lungs after maximum expiration

Back 105

Residual volume

Front 106

Maximum amount of air that can be moved in and out of the lungs with a single forces inspiration and expiration

Back 106

Vital capacity

Front 107

Vital capacity + residual volume=

Back 107

Total lung capacity

Front 108

Total volume of air in the lungs after maximum inspiration

Back 108

total Lung capacity

Front 109

Maximal volume of air inspired following a passive expiration

Back 109

Inspiratory reserve

Front 110

Maximal volume of air expired following a passive expiration

Back 110

Expiratory reserve

Front 111

Where are the primary control centers for breathing located? What do they respond to?

Back 111

In the medulla and the pons (pons is mostly a back-up for the medulla); Hypercapnia or a decrease in pH

Front 112

Where are peripheral chemoreceptors located? what do they respnod to?

Back 112

Carotid bodies and aortic arch; Hypoxemia and decreased pH

Front 113

Flow of gases between alveolar air and the blood (external or internal respiratino)

Back 113

external

Front 114

Four factors affected gas exchange

Back 114

1) Partial pressure gradients
2) Thickness of alveolar wall
3) Surface area
4) Ventilation-perfusion ratio (need to match for maximum exchange)

Front 115

What is a septal cell?

Back 115

Type II pneumocyte (secretes surfactant)

Front 116

describe blood in the pulmonary artery

Back 116

high CO2; low O2

Front 117

Describe blood in the pulmonary vein

Back 117

High O2; low CO2

Front 118

What percentage of oxygen is dissolved in the plasma? Where is the rest?

Back 118

1% ; bound (reversibly) to hemoglobin

Front 119

When all four heme molecules in hemoglobin have taken up oxygen, the hemoglobin is termed _____________.

Back 119

Fully saturated

Front 120

What is the most common form of CO2 in the blood?

Back 120

Bicarbonate ion (HCO3-)

Front 121

What enzyme must be present for the transition of CO2 to carbonic acid and bicarbonate ion?

Back 121

carbonic anhydrase

Front 122

reflex response to irritation in the upper respiratory tract

Back 122

sneezing

Front 123

reflex response due to irritation in the lower respiratory tract

Back 123

coughing

Front 124

Deep rapid respiration that is typical in acidosis

Back 124

Kussmaul respiration

Front 125

Difficulty breathing while lying down

Back 125

Orthopnea

Front 126

Pleural pain results from inflammation or infection of ____________ pleura

Back 126

Parietal

Front 127

What would you call the swelling of the larynx, supraglottic area, and epiglottis? who is most commonly effected?

Back 127

Epiglottitis; Children ages 3-7 (child will often sit in a tripod position, drool and have high anxiety because they can't breath)

Front 128

Inflammation of the bronchi and bronchioles? which microbes is causative agent?

Back 128

Bronchiolitis; RSV (respiratory syncytial virus)

Front 129

Pneumonia that is typically caused by one bacterium and usually only affects one lobe

Back 129

Lobar pneumonia

Front 130

Pneumonia that is caused by multiple bacteria

Back 130

Bronchopneumonia

Front 131

Rusty sputum might indicate

Back 131

Lobar pneumonia

Front 132

yellow- green sputum might indicate which type of pneumonia?

Back 132

Bronchopneumonia

Front 133

Causative agent of PAP

Back 133

Mycoplasma or influenza virus

Front 134

pneumonia with a high fever

Back 134

Lobar pneumonia

Front 135

Chemoreceptors detect changes in __________ , ___________, and __________ in the blood or CSF.

Back 135

Carbon dioxide
Hydrogen ions (pH)
Oxygen

Front 136

Hypercapnia (increases/decreases) pH?

Back 136

decreases

Front 137

Hypocapnia may be caused by ___________. This would cause respiratory (acidosis/ alkalosis)?

Back 137

Hyperventilation ; Alkalosis

Front 138

Flow of gases between the alveolar air and the blood is what type of respiration?

Back 138

External

Front 139

Which bronchus is longer?

Back 139

Left

Front 140

Which bronchus is wider?

Back 140

Right

Front 141

Which bronchus is straighter?

Back 141

Right

Front 142

Bronchodilation results from (PSNS / SNS) innervation?

Back 142

SNS

Front 143

Resting shape of the diaphragm?

Back 143

Dome-shaped

Front 144

The membrane that is attached to the outer surface of the lung is the ___________ pleura. The membrane that lines the thoracic cavity is called the ___________ pleura. The intrapleural space remains __________ compared to the atmospheric pressure (why?)

Back 144

Visceral
Parietal
Negative
the negative pressure that is maintained in the intrapleural space helps hold the membranes in close proximity and helps promote respiration.

Front 145

oxygen that is bound to hemoglobin

Back 145

Oxyhemoglobin

Front 146

Which type of respiration? Oxygen is diffuses into the interstitial fluid and cells

Back 146

internal respiration

Front 147

Oxygen attaches to which part of the hemoglobin?

Back 147

Heme (iron portion)

Front 148

CO2 attaches to which part of the hemoglobin?

Back 148

The globin protion (NOT the heme)

Front 149

CO2 is toxic to our body. How does the body typically carry it, what is the intermediate in this reaction, what is the enzyme that facilitates?

Back 149

Bicarbonate ion (HCO3-)
Carbonic acid (H2CO3)
carbonic anhydrase

Front 150

Irritation due to nasal discharge causes ___________.

Back 150

Coughing

Front 151

A general manifestation of respirartory disease, resulting of large amounts of unoxygenated hemoglobin in blood

Back 151

Cyanosis

Front 152

Is lobar pneumonia bacterial or viral? What is the causative agent?

Back 152

Bacterial
Streptococcus pneumoniae

Front 153

Describe the exudate in lobar pneumonia.

Back 153

Rusty sputum (inflammation and vascular congestion forms in the alveoli --> fibrin and cells (rbcs, neutrophils) get mixed in and make a consolidated mass--> presence of old rbcs causes the rusty color)

Front 154

What is empyema?

Back 154

infection that spreads to the pleural cavity

Front 155

In which pneumonia is pleurisy most common?

Back 155

Lobar (because most of the time the entire lobe is affected)

Front 156

Diagnose.
Patient has high fever, rales sound in lungs, pleurisy

Back 156

Lobar pneumonia

Front 157

Lobar pneumonia would cause metabolic (acidosis/ alkalosis)?

Back 157

Acidosis (gas exchange is low due to fluid and inflammation of alveolar walls, plus metabolic needs increase with infection)

Front 158

Diagnose. Diffuse pattern of infection and inflammation in both lungs, with moderate fever and insidious onset. Rales in lungs.

Back 158

Bronchopneumonia

Front 159

What is PAP?

Back 159

Primary atypical pneumonia ("walking pneumonia")

Front 160

What are the different causes of viral PAP?

Back 160

Influenza A or B, adenoviruses, and RSV

Front 161

Infections caused by RSV

Back 161

Bronchiolitis (also can be a causative agent of PAP)

Front 162

Pneumonia without rale sounds and cough that is NOT productive

Back 162

PAP (primary atypical pneumonia)

Front 163

Describe the inflammation in PCP. Why is this more dangerous?

Back 163

Diffuse and interstitial (this is why cough is not productive).
More dangerous because there is risk of necrosis in the bronchial epithelium without the person necessarily even knowing they have it

Front 164

How is SARS transmitted?

Back 164

Droplet transmission

Front 165

Diagnose. Child sits in a tripod position, is very anxious, drools and has difficulty swallowing

Back 165

Epiglottitis

Front 166

Lung disease commonly due to pverty and overcrowding.

Back 166

Tuberculosis

Front 167

Causative agent of tuberculosis? What type of test would you do to diagnose TB?

Back 167

Mycobacterium tuberculosis; chest x-ray, acid-fast sputum test

Front 168

Bacterium that can survive in dried spututm for weeks, but can be destroyed by UV light, heat, alcohol, glutaraldehyde and formaaldehyde?

Back 168

Mycobacterium tuberculosis

Front 169

Why doesn't the normal neutrophil response occur in TB?

Back 169

Mycobacterium's cell wall protects the organism from destruction by normal body defenses

Front 170

What is the granuloma in Tb called? What type of necrosis occurs inside?

Back 170

Ghon focus (complex); caseous

Front 171

What type of immune response does M. tuberculosis cause once migrating to lymph nodes?

Back 171

Type IV (cell-mediated)

Front 172

Tubercle formation is characteristic of (primary /secondary) tuberculosis infection.

Back 172

Primary

Front 173

When is tuberculosis contagious?

Back 173

During primary infection if the cell-mediated immunity is inadequate, or once resistance is reduced (stress, malnutrition, HIV, age)

Front 174

Cavitation refers to the _____ form in tuberculosis/

Back 174

Active

Front 175

Rapidly progressive form of tuberculosis more common in childern < 5 yoa. Involes movement of TB to other bodily tissues. Is this contagious?

Back 175

Miliary (extrapulmonary) tuberculosis; Not contagious

Front 176

Form of tuberculosis that would make you more susceptible to measles

Back 176

Miliary (extrapulmonary) tuberculosis

Front 177

Fungal infection in the lungs

Back 177

Histoplasmosis

Front 178

Infection caused by spores that may resemble TB

Back 178

Histoplasmosis

Front 179

Infection caused by spores that causes flulike syptoms and severe acute respiratory distress. What causes shock associated with this?

Back 179

Anthrax ; release of toxins from B. anthracis

Front 180

What is recommended for someone who works closely with Anthrax?

Back 180

Animal vaccine

Front 181

What is the causative agent for cystic fibrosis?

Back 181

None. Inherited disorder causes by a defect on chromosome seven. However, infected persons are more susceptible to infections caused by P. aeruginosa and S. aureus

Front 182

Primary effects of cystic fibrosis are seen in which two organs?

Back 182

Lungs and pancreas

Front 183

Disease in which tenacious mucus is formed from the exocrine glands

Back 183

Cystic fibrosis

Front 184

Where is the obstruction in cystic fibrosis ?

Back 184

In the bronchi and bronchioles

Front 185

cystic fibrosis causes (temporary / permanent) damage to the bronchial walls

Back 185

permanent

Front 186

Meconium ileus is common in which disease?

Back 186

cystic fibrosis

Front 187

What effects does cystic fibrosis have on the reproductive system?

Back 187

Females- obstruction of the cervix
Males- obstruction of the vas deferens

Front 188

What is a sign of malabsorption in a cystic fibrosis patient?

Back 188

steatorrhea, abdominal distention

Front 189

Diagnose. Chronic cough and the production of copious amounts of purulent foul-smelling sputum

Back 189

Bronchiectasis

Front 190

A secondary lung infection that arises from recurrent inflammation and infection

Back 190

Bronchiectasis

Front 191

GIve an example of each of the following types of atelectasis:
Obstructive (resorption)
Compression
Increased surface tension
Fibrotic tissue in lungs of pleura

Back 191

Aspiration
Tumor
Pulmonary edema
Emphysema

Front 192

Hydrothorax could be caused by increased ____________ pressure or decreased ____________ pressure.

Back 192

Hydrostatic ; osmotic

Front 193

Simple or spontaneous pneumothroax is due to

Back 193

a tear on the surface of the lung

Front 194

Lung disorder usually related to premature birth

Back 194

IRDS (infant respiratory distress syndrome)

Front 195

What is the problem in IRDS?

Back 195

Lack of surfactant in the alveoli

Front 196

In which lung condition would you find a hyaline formation around the alveoli?

Back 196

IRDS

Front 197

What is the problem in ARDS?What does this cause- metabolic acidosis or alkalosis? REspiratory acidosis or alkalosis?

Back 197

Injury to the alveolar wall and capillary membrane which leads to the release of chemical mediators into tissues. Respiratory and metabolic acidosis.