Pulmonary Module 4 Quiz

Pulmonary - Module 4

• Dyspnea: The feeling of breathing discomfort. It can be caused by various pulmonary conditions, like pleural effusion, pneumothorax, asthma, pneumonia, or pulmonary embolism.
• Cough: A protective reflex clearing the lower airways. It can be acute (2-3 weeks) or chronic (longer than 3 weeks). Coughing up bloody sputum is called hemoptysis.
• Abnormal Breathing Patterns:
  • Hyperpnea (Kussmaul respirations): Increased respiratory rate and large breaths, often due to strenuous exercise or metabolic acidosis.
  • Labored breathing: Increased work of breathing, often due to airway obstruction.
  • Restricted breathing: Reduced lung or chest wall compliance, like in pulmonary fibrosis.
  • Hyperventilation: Increased ventilation exceeding metabolic demands.
  • Hypoventilation: Inadequate alveolar ventilation compared to metabolic needs.
• Cyanosis: A bluish discoloration of skin/mucous membranes due to high levels of deoxygenated hemoglobin.
• Hypercapnia: Increased PaCO2 (carbon dioxide) in the blood, often from hypoventilation.
• Hypoxemia: Decreased PaO2 (oxygen) in the blood, from problems in oxygen delivery or diffusion.
• Acute Respiratory Failure: Hyoexemia or hypercapnia with a pH less than 7.25, caused by lung, airway, or chest wall damage or systemic issues.
• Pulmonary Tuberculosis (TB): Infection caused by Mycobacterium tuberculosis. Spread by airborne droplets. In healthy individuals, the body contains the bacteria, leading to latent TB infection (LTBI) with no symptoms.
• Risk Factors for TB: Immigration from high-prevalence areas, crowded environments, substance abuse, lack of healthcare access, and immunocompromised status (AIDS, cancer, renal failure, HIV).
• Pathophysiology of TB: Initially, the bacteria lodge in lung's upper lobe, causing localized inflammation in the lungs or lymph nodes causing a tubercle (cheese-like tissue). If the immune response fails, the bacteria reactivate and spread, causing active TB.

Pulmonary Tuberculosis (continued)

• Clinical Manifestations of Active TB: Fatigue, weight loss, low-grade fever, night sweats, frequent cough with purulent sputum. As the disease progresses, dyspnea, chest pain, and hemoptysis can occur.
• Latent TB Infection (LTBI): No noticeable symptoms but can reactivate if the immune system is compromised.

Community-Acquired Pneumonia (CAP) and Hospital-Acquired Pneumonia (HAP)

• Causative organisms: Viruses like influenza and respiratory syncytial virus; bacteria like Streptococcus pneumoniae, Legionella pneumophila, Moraxella catarrhalis, Haemophilus influenzae; and atypical microorganisms like Chlamydophila pneumonia and Mycoplasma pneumoniae. Bacteria from biofilms on endotracheal tubes (VAP).

Acute Bronchitis

• Infection or inflammation of the bronchi, often resolving spontaneously.

Pneumonia

• Viral Pneumonia: Infection of lower airways through inhalation, spread from upper respiratory tract or via blood. Viral infection damages airway and alveolar epithelial cells, can cause cytokine storms (overactive immune response). Common causes is a number of different viruses
• Bacterial Pneumonia: Bacterial colonization of the upper respiratory tracts followed by aspiration of pharyngeal secretions, or inhalation. Bacteria adhere to the upper airway epithelium, evade host defense mechanisms. Bacteria can form biofilms. Common in individuals with weakened immune systems.
• Pathophysiology: Alveolar macrophages are the primary defense cells of the lower respiratory tract, initiating the immune response against pathogens. Inflammation can damage the alveolar-capillary membrane, further aggravated by bacterial toxins.
• Clinical Manifestations: Fever, chills, cough (productive or dry), malaise, pleural pain (chest pain), dyspnea, and hemoptysis (coughing up blood).

Cystic Fibrosis

• Genetic disorder causing thick mucus in lungs, pancreas, and other organs. Mutations in the CFTR gene affect chloride transport, leading to imbalances in water and electrolytes.
• Clinical Manifestations: Chronic cough, excessive sputum production, recurrent and/or severe pneumonia, salty sweat, chronic sinusitis, nasal polyps, malnutrition, and intestinal obstruction.

Chronic Obstructive Pulmonary Disease (COPD)

• Respiratory disease characterized by persistent airflow limitation due to airway and/or alveolar abnormalities. Typically caused by noxious particles/gases.
• Types: Chronic Bronchitis, Emphysema.
• Chronic Bronchitis: Mucus hypersecretion and chronic productive cough (at least three months of the year for two consecutive years).
• Emphysema: Damage to alveolar walls, resulting in abnormal enlargement of air sacs. Commonly caused by cigarette smoke.
• Clinical Manifestations: Dyspnea (shortness of breath) on exertion, productive cough, wheezing, barrel chest.

Asthma

• Chronic inflammatory disease, causing intermittent airway obstruction, characterized by bronchospasm, inflammation, and mucus production triggered by allergens.
• Pathophysiology: Airway epithelial exposure triggers antigen activation of innate and adaptive immune responses. Mast cells release inflammatory mediators like histamine and leukotrienes that lead to bronchospasm, inflammation, and mucus secretion.

Pulmonary Embolism (PE)

• A blood clot (or other embolus) obstructing part of the pulmonary vasculature. Often originates from a deep vein thrombosis (DVT) in the lower extremities.
• Clinical Manifestations: Can present with nonspecific symptoms, including chest pain, shortness of breath, tachycardia, tachypnea and unexplained anxiety

Pulmonary Hypertension (PH)

• Mean pulmonary artery pressure greater than 25 mmHg at rest. Endothelial dysfunction with overproduction of vasoconstrictors and reduced vasodilation can lead to inflammation and vascular remodeling/arteriolar narrowing.

Acute Bronchitis and Community-Acquired Pneumonia

• Clinical Manifestations: Similar symptoms (fever, cough, cough productive or dry, pleuritic pain, or dyspnea)
• Causative organisms: Many causative organisms include both bacteria and viruses.
• Pathophysiology: Some bacteria are capable of forming biofilms on endotracheal tubes leading to ventilator-associated pneumonia in hospitalized patients. Viral infections are associated with cytokine storm (excessive immune response that can damage the alveoli and endothelial linings for prolonged periods).

Other Conditions (Infections in Children)

• Respiratory Infections in Children: Includes bronchiolitis, croup, acute epiglottitis, tonsillitis, and pneumonia. Various viral and bacterial infections trigger inflammatory response.

Lung Cancer

• Non-small cell lung cancer (NSCLC): More common, including squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Risk factors including smoking, air pollution, and occupational hazards.
• Small cell lung cancer (SCLC): Highly aggressive, rapidly growing.
• Pathophysiology: Cancers are triggered by carcinogens' in tobacco smoke or other sources (air pollution) that cause mutations in bronchial mucosa cell growth and differentiation.

Bronchial Epithelial Changes

• Epithelial cells undergo changes, including metaplasia, carcinoma in situ and invasive carcinoma.
• Tumor invasion of surrounding tissues, leading to metastasis to distant locations, including brain, bone marrow, and liver.

Other Information

• Cor Pulmonale: Right ventricle enlargement due to pulmonary hypertension.
• Hypoventilation: Insufficient alveolar ventilation leading to increased carbon dioxide (PaCO2)

Test your knowledge on pulmonary concepts such as dyspnea, cough, and abnormal breathing patterns. This quiz covers various pulmonary conditions and their clinical significance, including hyperventilation and cyanosis. Understand lung mechanics and respiratory-related terminologies.