This site is 100% ad supported. Please add an exception to adblock for this site.

Pathology Test 2

Start Studying!

Terms

undefined, object
copy deck
role of respiratory system
Major role of the respiratory system is oxygenation of blood and the removal of the body’s waste products in the form of carbon dioxide.
respiratory system is controlled by the____
Controlled by a center in the medulla at the base of the brain

⬢ Lungs have 2 blood suppliers:
bronchial circulation

pulmonary circulation
the respiratory system begins and ends where?
⬢ Begins at the nostril openings and extends to the alveoli of the lungs.

The _____ is lined with olfactory epithelium in the sphenoethmoid recess and with
respiratory epithelium in the lower part.
nasal cavity
the ____ is the 2nd part of the respiratory tract. Starts at the base of the skull and extends to the esophagus
pharynx
3 parts of pharynx
nasopharynx

laryngopharynx

oropharynx
The ____ is located at the base of the tongue.
larynx
The larynx is made up of __cartilages.
9
The trachea is approximately ___ cm long.
⬢ Located in ____ of the esophagus
⬢ There are ____C-shaped rings that prevent collapse.
⬢ At the level of approx. ___ it branches into the right and left bronchi (primary bronchi).


12;front;16-20;T4
Primary Bronchi
• LEFT – longer than right, forms a ____
• RIGHT – _____than left, forms almost straight line, most likely for ETT to go into
sharp angle; larger diameter;
Branch of primary bronchi; 3 for right side; 2 for left; one for each lobe of the lung
secondary bronchi

⬢ branch off secondary bronchi
⬢ 10 per lung because there are 10 bronchopulmonary segments per lung
tertiary bronchi
⬢ Smaller branches of tertiary bronchi
bronchioles
Terminal bronchiole is ___ involved in gaseous exchange.
not
______branches off the terminal bronchiole and is the 1st site of diffusion
of O2 in the blood.
Respiratory bronchiole
Branch off respiratory bronchioles
alveolar ducts
Cluster of alveoli is termed the ______
acinus
_______ per lung and each segment has a branch from the tertiary bronchi.
10 bronchopulmonary segments
The _____ is a depression on the medial surface of the left lung.
Cardiac Notch

⬢ Made of blood vessels, the bronchial tree, and nerves entering the lungs
hilum
pressure in lungs decreases, volume increases, external intercostal
muscles cause ribs to elevate and the size of the chest cavity increases, and diaphragm
goes down when contracted
inspiration
a passive movement, ribs fall down, and diaphragm goes up
expiration
Intubation - Large plastic tube inserted through the patient’s nose (or mouth) into the
trachea
Maintains the airway when patient is unable to breathe on their own
ETT tube
⬢ 5-7cm above the carina
ETT tube
If ETT tube is too high what happens?
air enters stomach
ETT tube is too low
usually into RT main bronchus leads to atelectasis of left lung
Large plastic tube inserted through the chest wall between the ribs to drain air and/or fluid
⬢ For pneumothorax, hemothorax
CT tube
Central Venous Catheters (CVP or CVL)
⬢ Usually inserted in the _______, but can placed through the jugular, antecubital, or
femoral vein.
subclavian vein
Provides an alternative injection site and used for infusion of massive fluids
CVL or CVP
Swan-Ganz Catheter
⬢ Usually inserted in the ___but can also be inserted in other areas.
⬢ Evaluates ____
⬢ Seen on post-op heart patients or post-procedure cath patients
subclavian; cardiac function;
Hickman Catheter
⬢ Usually inserted in the ______
⬢ Tip lies in _____
⬢ Used for multiple tapping for injections such as in ____
subclavian;SVC (superior vena cava); chemotherapy

⬢ Method of choice for maintaining cardiac rhythm in patients with heart block or
bradyarrhythmias.
⬢ Tip should be positioned at the apex of the right ventricle.
⬢ Slight overexposure of CXR is necessary to demonstrate both the generat
Transvenous Cardiac Pacemakers
(ARDS stands for:
acute respiratory distress syndrome
Adult respiratory distress syndrome (ARDS)

Patients that have a variety of medical and surgical disorders but
______
no major underlying lung
disease.
ARDS

Most often in nonthoracic trauma with ______
hypotension and shock (“shock lung”)
ARDS can occur: 3 ways
Acid-aspiration, severe infection (sepsis), drug overdose
ARDS

⬢_____ cases worldwide with 40-60% mortality rate
⬢ Harder to penetrate so what?
150,000 ;additive pathology, increase technique!!!
Pulmonary disorder with increased mucus production in bronchi, causing hyperventilation
of the lungs
asthma
Asthma
⬢ Recurrent attacks of ___and ___
dyspnea and wheezing
Asthman

Difficulty in expiration due to spasmodic constriction of the ______
⬢ Chronic, but treatable
⬢ Can be fatal with no treatment during attack
⬢ Sensitive to _____and ____
bronchi; emotional stress and allergens
Three types of asthma:
1. extrinsic
2. intrinsic
3. mixed
1. Extrinsic –
2. Intrinsic –
3. Mixed –

- caused by allergies

-secondary to bronchial infections from tonsils, adenoids, and sinuses

-a combination of extrinsic & intrinsic
Asthma

-_____ adults and _____ in U.S.
⬢ More common in males until puberty, then more common in females
⬢ Treated with



14 million and 6 million;
corticosteroids such as breathing treatments and inhalers
Chronic asthma leads to thickening of bronchial walls with prominence of interstitial
markings = “dirty chest”
asthma
⬢ A collapse of lung tissue
⬢ Incomplete expansion of the lung as a result of partial or total collapse
⬢ Iatrogenic cause such as improper placement of ETT tube
⬢ NOT a disease, but rather a sign of a disease
atelectasis
Radiographic appearance
⬢ Harder to penetrate
⬢ Plate-like streaks
⬢ Elevation of ipsilateral (on the same side) hemidiaphragm
⬢ Displacement of the heart, mediastinum, and hilum toward the atelectatic segment




atelectasis
⬢ Neoplasms of low-grade malignancy that account for about 1% of all bronchial neoplasms
⬢ Men = Women
⬢ Appear in younger ages than bronchogenic carcinoma


⬢ Hemoptysis, recurrent PN
⬢ In same glandular structures in the bron
bronchial adenoma
⬢ 80% occur centrally in major or segmental bronchi and cause obstruction
⬢ Peripheral atelectasis and pneumonitis due to bronchial obstruction
⬢ Will see portion of lung with increased density and loss of volume
⬢ If too small, may not o
bronchial adenoma
⬢ Permanent abnormal dilatation of one or more large bronchi as a result of destruction of
the elastic and muscular components of the bronchial wall.
⬢ Chronic productive cough, recurrent episodes of acute PN and hemoptysis
⬢ Involves the b
bronchiectasis
• Coarseness and loss of definition of interstitial markings caused by peribronchial fibrosis
and retained secretions
• Advanced disease = oval or circular cystic spaces develop up to 2cm and often contain airfluid
levels= “honeycomb” pat
bronchiectasis

􀂾The most common primary malignant lung neoplasm
􀂾Precise cause is unknown
• Linked to smoking and inhalation of carcinogens such as air pollution, exhaust fumes,
and industrial fumes.
􀂾Major form is the solitary pulmonary nodul
bronchogenic carcinoma
􀂾Symptoms include cough, shortness of breath, wheezing, bloody sputum, weight loss,
chest pain, hoarseness, muscle weakness and/or difficulty walking or with coordination,
and possible alteration of hormones leading to disorders such as gynecomas
bronchogenic carcinoma
Non-small cell carcinomas
• Make up 80% of all lung cancers
􀂉 Small-cell (oat cell) carcinomas
bronchogenic carcinomas
⬢ Bulky enlargement of hilar lymph nodes, often bilaterally
⬢ Resemble oats under microscope
⬢ Most aggressive form (grow rapidly, spread early and vastly = metastases)
bronchogenic carcinoma
arises in the major central bronchi and causes gradual narrowing of the bronchial lumen
squamous cell carcinoma(non-small cell)
Flattened appearance of tumor cells
⬢ Also called epidermoid cancer
⬢ Accounts for 30% of cases
⬢ Arises in major central bronchi
⬢ Causes gradual narrowing of the bronchial lumen
Squamous Cell (non-small)
Arise in the periphery of the lung
⬢ Accounts for 35% of cases
adenocarcinoma
Least common type of lung cancer

Bronchiolar (alveolar cell) carcinoma
includes several conditions in which chronic obstruction of the airways leads to an
ineffective exchange of respiratory gases and makes breathing difficult.
COPD
Chronic bronchitis, Emphysema, Asthma, and Bronchiectasis
COPD
factors that can cause COPD
􀂾Smoking, infection, air pollution and occupational exposure to harmful
substances(asbestos)


Chronic inflammation of the bronchi
chronic bronchitis
􀂾 The walls of the bronchi and bronchioles thicken and produce viscous mucus. Over an
extended period, the mucous glands become hyperplastic.
􀂾 Either result of resp. infection or long-term exposure to air pollution or cigarette smoking
chronic bronchitis
Viral infection in young children
􀂾Inflammatory obstructive swelling localized to the subglottic portion of the trachea
􀂾Edema causes inspiratory stridor or a “barking cough”
􀂾Whistling or wheezing in inspiration and expiration
ô€
croup
􀂙Mucoviscidosis
􀂙Hereditary – defective gene in the middle of chromosome
􀂙Most common clinically important genetic disorder among Caucasian children.
􀂙50% die before the age of 15.
􀂙Secretion of excessively viscous mucus by a
cystic fibrosis
Glands that secretes a substance out through a duct, include the salivary glands,
sweat glands and glands within the gastrointestinal tract. The exocrine glands are the
"glands of external secretion." )
􀂙Thick mucus is secreted by mucosa in th
cystic fibrosis
􀂙Respiratory infections are common because bacteria normally carried out of lungs is
trapped.
􀂙Pancreatic enzymes are prevented from entering duodenum = digestion is impaired =
child fails to gain weight = bulky, foul smelling stools = 10%
cystic fibrosis

􀂙Sweat glands = excessive perspiration = loss of large amounts of Na+, K+, and
chloride(2-3x normal) = susceptible to heat exhaustion = presence of excessive chloride
on the skin is the basis for the “sweat test”-
􀂙However, 90% of
cystic fibrosis
⬢ Thick-walled bronchi containing mucous and trapped air
⬢ Irregular thickening of the linear markings throughout the lungs
⬢ Hyperinflation of the lungs
⬢ Resembles severe chronic lung disease in adults
cystic fibrosis
􀂙Obstructive and destructive
􀂙Increased volume of air in lungs
emphysema
􀂙Closely associated with heavy cigarette smoking, chronic bronchitis, air pollution, and longterm
exposure to respiratory tract irritants.
emphesyema
􀂙Distention of distal air spaces as a result of the destruction of alveolar walls and the
obstruction of small airways (air becomes trapped in lungs, sometimes start to pop)
􀂙Destruction of alveoli leads to large air-filled spaces called bulla
emphesyma
􀂙Surface area for gas exchange decreases = oxygen into bloodstream decreases = heart
tries to compensate for lack of oxygen = ____
cardiomegly
with this disease, Bullae may rupture = air enters pleural space (spontaneous Px) = collapse of lung
(atelectasis)


emphesyma
􀂙 with this disease, In urine tests( Urinalysis), Na+ and pH are decreased
emphesyma
􀂙Hyperinflation of lungs
􀂙Alterations in pulmonary vasculature

􀂙Bullae formation
􀂙Flattening of diaphragmatic domes
􀂙Increased size and lucency of retrosternal air spaces
􀂙Increase in AP diameter of the chest = “barr
emphesyma
􀂙The presence of infected fluid or pus in the pleural space
􀂙Usually the result of an adjacent infection (such as bacterial PN, subdiaphragmatic
abscess, lung abscess, esophageal perforation) or may also occur after thoracic surgery,
trauma
empyema

􀂙 Caused by a fungal infection
􀂙 From birds, especially in the South (poultry farms like ConAgra)
histoplasmosis
symptoms for histoplasmosis are: Primary acute form:
1. mild resp. tract illness
(lower lung and 2. headache
hilar lymph nodes) 3. general malaise
4. anorexia
5. cough
6. chest pain
Histoplasmosis Progressive form:
Progressive form: 1. hepatomegaly
2. lymphadenopathy
3. anorexia
4. fever
chronic form of histoplasmosis:
Chronic form: 1. mimics Tuberculosis
(upper lobe) 2. productive cough
3. dyspnea
4. hemoptysis
o Also known as RDS (Respiratory Distress Syndrome)
o The leading cause of infant mortality
o 50% die within the first 24 hrs. of life
o Due to a lack of surfactant (chemical detergent secreted by the alveoli and decreases the
surface tension
hyaline membrane disease
􀂙 Bacteria is found naturally in the environment, especially in warm water and potting soil.
It grows best in hot tubs, cooling towers, hot water tanks, large plumbing systems, and
air conditioners of large buildings.
􀂙 Does not usually occ
legionares disease
􀂙In Pontiac Fever, symptoms last for ______ days, but there is NO pneumonia. This is the
milder form of the disease.
􀂙Symptoms for Legionnaire’s occur 2-14 after exposure and include:
1.High fever
2.Chills
3.Dry cough
4.Muscle ac
2-5 days
􀂙 Those at risk for contracting Legionnaire’s disease are:
1. Over age 65
2. Smokers
3. Have chronic lung disease (emphysema)
4. Male
5. Excessively consume ETOH
6. Immunocompromised
7. Have kidney failure
8. Diabetic
9. Organ transplants
10.gardening
􀂙Legionnaire’s will appear as a _______ on a chest x-ray.

􀂙Sputum, blood, and urine samples are needed to conclusively find evidence of the
bacteria.
pneumonia;
An accumulation of fluid in the pleural space
pleural effusion
Common causes are: pleural effusion
1. CHF

2. Pulmonary embolism

3. Infection

4. Pleurisy

5. Neoplastic disease

6. Connective tissue disorders

7. Abdominal disease, such as recent surgery, ascites, subphrenic abscess, and
pancreatitis
􀂙
The pulmonary changes taking place following inhalation of dusts of particulate material.
Pneumoconiosis
There are 3 types of pneumoconiosis:
2. Asbestosis
3. Anthracosis
1. Silicosis

􀂙The inhalation of silica particles or silicon dioxide (crystalline silica)
􀂙The most common work-related lung disease
􀂙Mining, foundry work, and sand-blasting
􀂙Quartz dust is the second most common element in the Earth’s crust
silicosis

􀂙The symptoms are similar to asthma but the development of the symptoms is different.
asbestosis
symptoms of asbestosis
􀂙Symptoms include: 1. shortness of breath
2. decreased ability for physical exertion
3. coughing
4. chest pain
5. sometimes finger clubbing
􀂙The _____ causes a scarring of the lung tissue and diminished breathing capacity due to
a stiffness in the lung tissue.
􀂙____is a rare cancer of the membranes lining the chest and abdominal cavities.
It can be caused by asbestos exposure.<
asbestos;Mesothelioma
􀂙“Black Lung” or “Miner’s Lung”
􀂙From inhalation of coal dust or anthracite
􀂙Collects in the walls of the respiratory bronchioles causing weakened musculature and
dilatation.
􀂙Deposits of anthracite cause lung to turn
Anthracosis
Inflammation of the lung that can be caused by a variety of organisms, most commonly
bacteria and viruses and also aspiration
pneumonia
types of pneumonia
Alveolar pneumonia
􀂾 Bronchopneumonia
􀂾 Interstitial pneumonia
􀂾“air-space” pneumonia or pneumococcal pneumonia
􀂾caused by the bacteria Streptococcus pneumoniae. S. pneumoniae, also called
pneumococcus
􀂾Inflammatory exudates (pus, fluid) that replaces air in the alveoli = affected part appears s
Alveolar pneumonia
􀂾Staphylococcal infection (staph is everywhere)
􀂾Originates in the bronchi or the bronchiolar mucosa and spreads to adjacent alveoli
􀂾Bronchial inflammation causing airway obstruction leading to atelectasis with loss of lung
Volume
Bronchopneumonia
􀂾Most commonly produced by viral and mycoplasmal infections (mycoplasma is a minute
organism like a bacterium. microorganism of a genus considered to be the smallest known
living cells. Some species cause respiratory diseases in animals and human

Interstitial pneumonia
􀂾The aspiration of esophageal or gastric contents into the lungs

􀂾Esophageal material = Occurs in patients with esophageal obstruction (tumor, stricture,
Achalasia (stricture), diverticula (Zenker’s), or neuromuscular swallowing disturba
Aspiration pneumonia
􀂾 The presence of air in the pleural space resulting in a partial or complete collapse of the
lung
pnemothorax
pnemo results from:

􀂾 Results from:
1. Complication of emphysema
2. A spontaneous event
3. Trauma
a. Stabbing
b. GSW
c. Rib Fx
4. Iatrogenic causes
a. Lung Bx
b. Line placement
c. Thoracentesis
5. Complication of hyaline membrane disease and prolonged ventilation
􀂾 Symptoms include sudden severe chest pain and shortness of breath
􀂾Hyperlucent area (area more lucent because of air)
􀂾Absence of pulmonary markings (how they determine the pneumo)
􀂾The hallmark is the visceral pleural line
􀂾 Difficult to identify in supine position ( air fluid levels are unable to
pneumo

􀂾Up to 1/3 of patients with Ca develop


pulmonary mets

􀂾Develop from hematogenous or lymphatic routes (lymph nodes)
􀂾Most common from musculoskeletal sarcomas(bone cancer), myeloma, breast Ca, urogenital tract,
thyroid, and colon
􀂾Breast Ca, esophageal, or stomach cancer may directly ext
pulmonary metastases
appear as multiple, well circumscribed, round or oval
Nodules
hematogenous mets
􀂾 Fine miliary nodules(highly vascular tumors) to huge, well-defined masses (cannonball
lesions)
mets
coarsened interstitial markings that have an irregular contour and
are poorly defined = prominent in lower lobes and may simulate pulmonary edema
􀂾Lymphangitic mets =
􀂾May be a solitary metastatic nodule that is hard to differentiate from primary lesion
Hematogenous metastases. Multiple, well-circumscribed nodules scattered diffusely
throughout both lungs. (May use ____
BB’s)
􀂾Caused by Mycobacterium tuberculosis, a rod-shaped bacterium with a protective waxy
coat that permits it to live outside the body for a long time (also Hep B can be alive outside surface for a week)
tb
􀂾Spreads through droplets in the air and inhaled from dried sputum that has turned to
dust, drinking the milk of infected cows, through the skin(rare)
TB
Killed by direct sunlight, but survives in dark
TB
􀂾Primarily a disease of the lungs, but can spread to GI & GU tracts and skeletal systems
TB
􀂾Read your text to see how TB forms
SDFD
_____ was traditionally considered to affect children and young adults, but can
actually affect any age
􀂾Primary TB
______is reactivation. Previously dormant that has been reactivated often due to
decrease in immunity
􀂾Secondary TB
􀂾 ____ refers to spreading by way of bloodstream
MILIARY TB
PULmonary disease accounts for 90% of all deaths from __
TB
Primary TB
4 basic patterns
1. Infiltrate may be seen as a lobar or segmental air-space consolidation that is usually
homogenous, dense, and well-defined
2. Associated enlargement of hilar or mediastinal lymph nodes is common
3. Combination of focal parenchymal lesion and enlarged hilar or mediastinal lymph nodes
produces the classic primary complex (the Ghan lesion)
4. Pleural effusion is common, especially in adults, and most are unilateral
5.
Primary tuberculosis. Enlargement of right hilar lymph nodes without discrete parenchymal
infiltrate.
Primary tuberculosis. Unilateral right tuberculous pleural effusion without parenchymal or
lymph node involvement
􀂾The inability of the heart to propel blood at a rate and volume sufficient to provide an
adequate supply to the tissues
congestive heart failure
􀂾Causes include heart defect, hypertension, or any obstructive process that abnormally
increases the peripheral resistance to blood flow
chf
􀂾Left-sided heart failure = _______and ____ edema = caused by ____,____ , and ____ (what we commonly see)
cardiomegaly and pulmonary;

CAD; valvular;HTN
disease
􀂾Right-sided failure = _____ = caused by _____
, ______, ____ (swelling of extremities)
dilatation of the right ventricle and right atrium;

pulmonary vascular stenosis;emphysema; PE
􀂾Left-sided = classic cardiomegaly = redistribution of pulmonary venous blood flow,
interstitial edema, alveolar edema, and pleural effusions
chg
􀂾 Potentially fatal
􀂾Most common pathological process involving the lungs of hospitalized patients
Pulmonary Embolism
􀂾More than ____% of PE are from DVT from lower extremities (ADL-activities of daily living)
􀂾Most PE occur in ______ due to preferential blood flow to these regions
􀂾Consequences depend on size of PE and state of pulmonary circulation
ô€
95; lower lobes of lungs;chest pain, shortness of breath, possibly pink frothy foam
Affects about 50% of infants
rsv
Attacks lower respiratory tract and caused necrosis of respiratory epithelium of the bronchi
and bronchioles = necrotic material and edema causes bronchial obstruction = interstitial
PN
RSV

􀂾Sympoms are: (FOR RSV)
cold or flu-like
HOW DOES RSV SPREAD?
􀂾Spread through droplets from the nose or throat
MONTHES FOR RSV
􀂾Late fall, winter, early spring (October-February)
􀂾Must use PPE
􀂾Treatment includes ribavirin (antiviral drug) and antibiotics and respiratory treatments with
bronchial dialators such as Xopenex and Albuterol.
􀂾 Ribavirin is administered through nebulizers or a fine mist. Can cause birt
RSV
􀂾Severe acute respiratory syndrome
􀂾 Febrile severe lower respiratory illness caused by infection with a novel coronovirus (SARSCoV)
􀂾Winter of 2002-spring 2003 >8000 SARS cases but nearly 800 deaths
􀂾Unexplained PN, travel to SARS-af
SARS
SYMPTOMS FOR SARS
Symptoms are:
1. Fever
2. Cough
3. Shortness of breath
4. Difficulty breathing
5. Atypical pneumonia
􀂾 Presently, there is no readily available lab test to definitely diagnose SARS-CoV
􀂾Chest CT may show infiltrate before plain radiograph
􀂾Chest CT should be considered in patients suspicious for SARS-CoV with a neg. CXR 6 days
after onset of symptoms
􀂾Patient should remain in isolation
􀂾CXR should be repeated on
SARS
Start Studying!

Deck Info

137

huffmajl

permalink