Drexel ACE N339 Exam #3
What are the four major types of pulmonary malignancies? - ANS-1) Squamous Cell Carcinoma:
20-35% of cases
2) Adenocarcinoma: 35-40% of cases
3) Large Cell Carcinoma: 5-10% of cases
4) Small Cell Carcinoma: 15-20% of cases
What is the major cause of lung cancer? - ANS-Smoking.
What are the manifestations of pulmonary malignancies? - ANS-Weight loss, anemia, dyspnea,
hemoptysis, cough, chest pain, and increased sputum production.
How are pulmonary malignancies treated? - ANS-Surgery, chemotherapy, radiation therapy,
laser therapy, and tissue-specific therapies for airway lesions.
Hemoptysis - ANS-Bloody sputum.
Squamous Cell Carcinoma - ANS-20 to 30% of cases. A cancerous disorder that affects the flat
epithelial cells that line airways. Cancer causes them to slough off into the sputum which makes
it easy to diagnose. It metastasizes to regional lymph nodes and to the hilus of the lungs.
Adenocarcinoma - ANS-35 to 40% of cases. A cancer that mutates the glandular cells in the
periphery of the lungs. It is hard to detect early and it can metastasize to distance organs.
Large Cell Carincoma - ANS-10 to 15% of cases. This cancer develops in the periphery of the
lungs. It is characterized by large mutated pulmonary cells. Can metastasize to distant organs.
Small Cell Carcinoma - ANS-15 to 20% of cases. This pulmonary malignancy is the most
resistant to treatment and is the most rapidly growing tumor and most malignant.
Asthma - ANS-It is the most common chronic disease in childhood. It is characterized by airway
obstruction, airway inflammation, and increased airway responsiveness to stimuli.
There are 3 types of asthma:
1) Exercise induced asthma
2) Drug-induced asthma
3) Allergic asthma
Allergic Asthma - ANS-Allergic form is usually the worst type. It is an allergic reponse to an
allergen/stimuli. The allergen triggers msat cell degranulation and the release of histomines and
leukotrienes. These trigger bronchospasms which narrow the airway and recruit more
,inflammatory cells. Airway inflammation leads to increased permeability which leads to edema,
impaired mucociliary function, and epithelial injury.
Chronic Asthma - ANS-Constant inflammation causes hypertrophy of mucus glands which
secrete an increased amount of thick mucus which causes the narrowing of the lumen of the
airway. Hypertrophy of the smooth muscle also occurs which causes an increased contraction to
the stimuli and more sensitive bronchospasms.
Exercise Asthma - ANS-Occurs most often in heat loss conditions or water loss conditions. It is
associated with mast cell degranulation.
Drug Asthma - ANS-Drugs affect the arachidonic acid pathway. A greater amount of leukotrines
being released causes bronchoconstriction.
Acute Bronchitis - ANS-Acute inflammation of the trachea and bronchi typically caused by the
flu or certain bacteria. Acute bronchitis can also be caused by smoke inhalation, inhalation of
irritant chemicals, and allergic reactions. Bronchitis is much more severe in children because the
lumen is already much narrower to begin with. The inflammation causes the narrowing of
airways making it harder to breath.
Inflammation causes:
1) Capillary Dilation and increased permeability.
2) Exudation of fluid causes swelling
3) Increased mucus production blocks airway.
4) Loss of mucociliary escalator makes it hard to cough mucus up.
Symptoms include cough, low grade fever, chest pain, and dyspnea.
Chronic Bronchitis - ANS-AKA Type B COPD is caused by smoking 90% of the time which
causes repeated airway infections, and inhalation of phsyical and chemical irritants. Repeated
airway infection can also be due to genetic predisposition. It causes hypersecretion of bronchial
mucus and a chronic recurrent productive cough. Patient's may be termed "Blue Bloater" which
is characterized by decreased oxygen saturation causing cyanosis, and edema/ascites
associated with right-sided heart failure.
Congestion of lungs causes pulmonary hypertension, which causes right-sided heart failure,
hepatomegaly, backed up hepatoportal vein causing ascites, dyspnea, cyanosis, and increased
mucus secretion.
Emphysema - ANS-AKA Type A COPD is characterized by destructive changes of the alveolar
walls and elastin degradation and abnormal enlargement and inflation of distant air sacs.
Cigarette smoking is the major cause of emphysema. Other causes include air pollution, alpha-1
antitrypsin deficiency, and exposure to certain environments. Emphysema develops over a long
period of time and is seen more frequently in adults over the age of 50.
, The release of proteolytic enzymes and elastase breakdown lung tissue and cause collapse of
airways. The breakdown of the alveolar beds and walls causes decreased ventilation and
perfusion. Normally alpha-1 antitrypsin neutralizes elastase, but smoking decreases the amount
of this protein reducing radial traction.
Radial Traction - ANS-Nearby alveoli are attached like springs and help to hold the airway open;
in emphysema (decreased alveoli) there is reduced radial traction and the airways are more
likely to collapse.
Manifestations of Ephysema - ANS-1) Pursed lip breathing: the back pressure created by
pursing the lips helps keep airways from collapsing.
2) Sternocleidomastoid Hypertrophy: accessory muscle breathing causes hypertrophy.
3) Tripod position and barrel chest.
4) Clubbing of fingers due to lack of oxygen and increased vasodilation to periphery.
Bronchiectasis - ANS-Abnormal dilation of the bronchi. It is characterized by recurrent infection,
and inflammation of bronchial walls, which lead to persistent dilation of medium-sized bronchi
and bronchioles. There is also copious amounts of infected or purulent mucus exodate.
Bronchiolitis - ANS-This is due to the obstruction of the smallest bronchioles due to widespread
inflammation and inflammatory mediators. Inflammation may induce fibrosis which narrows the
airway even more. It is severe in children.
Cystic Fibrosis (CF) - ANS-An autosomal recessive disorder of the exocrine glands. CF affects
chloride ion channels which causes hypersecretion of thickened mucus. This mutated Cl-
channel causes Na+ and H2O resorption. Primarily affects the pancreas, intestinal tract, sweat
glands and lungs. Mucus glands in GI tract enlarge causing hypersecretion causing decrease
enzyme release needed for digestion leading to increased protein/fat in stool. Thick mucus
causes airway obstruction, atelectasis, and hyperinflation of lungs. Increases risk to pulmonary
infection and may lead to chronic bronchitis.
Heart-lung or lung transplantation is the only definitive treatment.
"Salty Kisses" due to high salt content in sweat.
Acute Tracheobronchial Obstruction - ANS-Air obstruction due to foreign object being aspirated.
Ex. choking on food. Immediate treatment is required. Other causes include larygospasms,
trauma, epiglottis swelling, and swelling from smoke inhalation.
Individuals become tachycardic due to no O2 enterying lungs. Become cyanotic and rapidly
lapse into unconsciousness if untreated.
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