3.6.3. Lung Pathology - ADDITIONAL STUFF NOT IN PATHOMA

Question 1

Subclassifications of pulmonary edema

Answer 1

Can be subclassified into cardiogenic or non-cardiogenic

Question 2

Non-cardiogenic → due to _______.

Answer 2

Non-cardiogenic → due to alveolar wall injury

injury to capillary endothelial cells and/or alveolar epithelial cells

Question 3

Recall: Edema caused by __________________.

Answer 3

Recall: Edema caused by a change in pressure differential at exchange points

Question 4

congestion of capillaries create a ___ ____ appearance

Answer 4

congestion of capillaries create a foggy red appearance

Question 5

For ARDS, xray signs tend to be more prominent in the ____ portion of the lungs

Answer 5

lower

Question 6

What is DAD

Answer 6

Diffuse alveolar Damage

Seen in ARDS

Question 7

What is paraseptal emphysema?

Answer 7

A magical third type that the boards don’t care about but USUHS does.

Occurs in young adults with spontaneous pneumothorax (this is the emphysema related to the rupturing bleb we heard about)

That “bleb” can be a large bullae greater than 1cm in diamter and is more severe in the upper lung

Question 8

Sarcoidosis is an example of this type of hypersensitivity

Answer 8

Type IV

Question 9

80% of mesothelioma cases have this genetic abnormality

Answer 9

80% of cases have homozygous deletion of CDKN2A/INK4a on Chrom 9p

Question 10

Asbestos vs. Silicon and coal

Answer 10

Asbestos is from the roof (common in insulation) but affects the base (lower lobes). Silica and coal are from the base (earth) but affect the roof (upper lobes)

Question 11

What is rhinosinusitis and how does it present?

Answer 11

obstructive sinus drainage into nasal cavity -> inflammation and pain over affected area (typically maxillary sinus in adults)

Question 12

Most common cause of rhinosinusitis

Answer 12

most common cause is viral URI; may cause superimposed bacterial infection caused by S. pneumoniae, H. influenzae, or M. catarrhalis

Question 13

Virchow Triad

Answer 13

stasis

hypercoagulability (e.g. defect in coagulation cascade proteins, most commonly factor V Leiden)

endothelial damage (exposed collagen triggers clotting cascade)

Question 14

What does Virchow Triad predispose people to?

Answer 14

DVT

Question 15

What is the Homan sign?

Answer 15

Homan sign - dorsiflexion of foot -> calf pain

Question 16

Drugs used for a DVT

Answer 16

use heparin for prevention and acute management; use warfarin for long-term prevention of DVT clearance

Question 17

Types of emboli that can lead to DVT

Answer 17

FAT BAT (Thank you FA)

fat: associated with long bone fractures and liposuction: presents as triad of hypoxemia, neurologic abnormalities, and petechial rash

amniotic fluid: fluid emboli that can lead to DIC esp. postpartum

thrombus

bacteria

air: nitrogen bubbles precipitate in ascending divers; treat with hyperbaric oxygen

Tumor

Question 18

Presentation for sleep apnea

Answer 18

repeated cessation of breathing > 10 sec. during sleep -> disrupted sleep -> daytime somnolence. Normal PaO2 during the day.

Question 19

Nocturnal hypoxia

Answer 19

Nocturnal hypoxia -> systemic/pulmonary hypertension, arrhythmias (atrial fibrillation/flutter), and sudden death

Question 20

What is central sleep apnea

Answer 20

Central sleep apnea: no respiratory effort

Question 21

Obstructive sleep apnea

Answer 21

Obstructive sleep apnea: respiratory effort against airway obstruction. Associated with obesity and loud snoring

Question 22

Obesity hypoventilation

Answer 22

Obesity hypoventilation syndrome: obesity (BMI > 30 kg/m^2)-> hypoventilation -> decreased PaO2 and increased PaCO2 on waking hours

Question 23

What paraneoplastic syndromes can be caused by Small Cell Carcinoma?

Answer 23

Cushings

Hyponatremia

Question 24

What is a pancoast tumor and what does it cause?

Answer 24

Carcinoma that occurs in the apex of lung and may affect cervical sympathetic plexus, causing Horner syndrome (ipsilateral ptosis, miosis, and anhidrosis), SVC syndrome, sensorimotor deficits, and hoarseness.