Final Exam Lungs Cont. Flashcards
Chronic interstitial lung diseases appearance on x-ray
Ground glass shadows
Honeycomb lung
Chronic intestinal Lung disease MC to produce
Reduced FVC
Occupation related lung disease least likely to be associated with lung cancer
Coal worker’s pneumoconiosis
Widespread interstate fibrosis and Velcro-like crackles observed in
Idiopathic pulmonary fibrosis
Idiopathic pulmonary fibrosis MC in
Males
Age >55 years
Prognosis for idiopathic pulmonary fibrosis
Poor
<5 years
Non-neoplastic lung reactions
Pneumoconioses
Traditional pneumoconioses
Coal
Silica
Asbestos
MC worldwide pneumoconiosis
Silicosis
Asbestos is risk for
Mesothelioma
Simple coal workers pneumoconsiosis
Macrophages
Little to no dysfunction
Progressive massive fibrosis (PMF)
Massive black Scars
Pulmonary HTN
Anthracosis
Pigment accumulates in lungs
Asymptomatic
City dwellers and smokers
Coal worker’s pneumoconiosis MC affects what part of lung
Upper lobes
Inhalation of silica crystals, often from quartz results in
Silicosis
MC pneumoconiosis
Silicosis
Silicosis destroys
Alveoli
“Whirled” appearance in middle and upper lobes indicates
Silicosis
Egg-shell calcifications observed in
Silicosis
Asbestos MC affects what part of lung
Lower lungs/ pleura
Histological appearance indicative of asbestos
Ferruginous bodies
Erythema nodosum observed in
Sarcoidosis
Sarcoidosis
Multisystem inflammatory disorder
Noncaseating granulomas and bilateral hilar lymphadenopathy indicates
Sarcoidosis
MC population for sarcoidosis
African Americans
Age 20-40
MC non smokers and females
MC sarcoidosis symptom
Asymptomatic
Most PE originate as
DVTs
Prognosis of sarcoidosis
70% recover
20% moderate dysfunction
10% PMF
Percent of PEs causing infarction
10%
Rare
Saddle embolism
Clots at Pulmonary artery bifurcation
> 60% occlusion
Up to 80% of PEs are
Clinically silent
Pulmonary HTN
> 30/20
Normal pulmonary BP
15/20
Pulmonary HTN can be due to
Decrease in cross-sectional area of pulmonary arteries
Increase in blood volume
Vascular changes from pulmonary HTN affect
Entire arterial tree
Primary pulmonary HTN
Idiopathic
10% Familial
Primary pulmonary HTN MC in
Young adult females
Prognosis of primary pulmonary HTN
Poor
Cor pulmonale 2-5 years
Hypothesis for primary pulmonary HTN
Endothelial dysfunction, vascular fibrosis, smooth muscle hyperplasia
Goodpasture Syndrome
Antibodies against lung and kidney collagen
HS type 2
Hemoptysis
Hematuria
Diffuse alveolar hemorrhage syndromes
Group of diseases that cause pulmonary hemorrhage
3 things that all DAHS have
Hemoptysis
Anemia
Diffuse pulmonary edema
Goodpasture MC affects
20-30 yo males
60-70 yo females
7th MC cause of death in US
Pneumonia
Smoking effect on preventing pulmonary infections
Lower mucociliary clearance
Lower immune chemotaxis
Alcohol effect on pulmonary infections
Lower cough and epiglottic reflexes
Intrinsic factors for pulmonary infection
Defects in cell-mediated immunity
Defects in adaptive immunity
Alveolar inflammation from infection
Pneumonia
Alcoholics MC to get what pneumonia
Klebsiella pneumoniae
Acute bacterial pneumonia includes
Bronchopneumonia
Lobar pneumonia
Bronchopneumonia
Multiple lobes
Patchy, well developed lesions
Lobar pneumonia
Single lobe, homogenous consolidation
Abrupt radiopacity
___ in upper airway and ___ in lower airway
IgA
IgG
90% of lobar pneumonia cases are from infection with
Strep pneumoniae
Community acquired acute pneumonia MC from
Strep pneumoniae
Mucopurulent sputum appearance in community acquired acute pneumonia
Yellow/ greenish
Risk factors for community acquired acute pneumonia
Diabetes CHF COPD Immunosuppressive Reduced splenic function
Pattern of community acquired acute pneumonia MC
Lobar, possible bronchopneumonia
Staph Aureus infects
Kids, after viral URTI
Klebsiella pneumoniae infects
Alcoholics or debilitated
Pseudomonas aeruginosa infects
Burn patients
Chemo therapy
CF
Best to classify pneumonia by ___ or ___
Microbes
Clinical setting
Legionella pneumophila
Aquatic
Spread via inhalation/ aspiration
Legionnaire disease
Pneumonia due to legionella
Symptoms of Legionnaries
Dyspnea
Fever
Aches
Legionnaries Disease MC in
Transplant recipients
Legionella can cause 2 diseases
Legionnaire
Pontiac Fever
Pontiac Fever
Mild URTI
Spontaneously resolves
During sleeping, aspiration of ___ occurs with community acquired acute pneumonia
Strep pneumoniae
Features of “atypical” pneumonia
Moderate sputum
Modestly high WBCs
No physical exam bindings to support lung consolidation
Minimal pulmonary infiltrates
Community acquired atypical pneumonia: edema confined to
Alveolar septa
Absence of consolidation on x-ray
Legionnaries disease _____ lethal
30-50%
Community acquired atypical pneumonia caused by same microbes as
Common cold
Mycoplasma pneumonia (MC)
Influenza A, B, RSV, rhinovirus
Community acquired atypical pneumonia may be lethal if advanced due to
Low mucociliary clearance
Alveolar necrosis
Variable features of community acquired atypical pneumonia
Malaise
HA
Non-productive cough
Chest cold
Community acquired atypical pneumonia aka
Walking pneumonia
Subjective distress not matching objective findings is indicative of
Walking pneumonia
Hospital acquired pneumonia MC caused by
Bacteria
Staph aureus
E. coli
Nosocomial
Hospital acquired
Aspiration pneumonia
Inhalation of foreign material (vomitus)
Hospital acquired pneumonia develops
48 hours after hospitalization
Hospital acquired pneumonia occurs in patients with
Severe co-morbidities
Aspiration pneumonia occurs after
Debilitation
Stroke, stupid, physical disabilities, dysfunctional gag reflex)
Dysfunction gag reflex MC due to
Alcohol
Aspiration pneumonia MC due to
Strep pneumoniae
Staph aureus
H. Influenzae
Aspiration pneumonia is ___ ___ and ____
Acute
Severe
Necrotizing
If aspiration pneumonia is not lethal, __ forms in lungs
Abscess
Lung abscess cavitation MC on which side
Ride side of lung
Lung abscess can be due to 3 things
Aspiration
Bronchial obstruction
Hematogenous spread
Chronic granulomatous diseases (bacterial)
Mycobacterium tB
Chronic granulomatous diseases (fungal)
Histoplasma capsulatum
MC cause of infectious death worldwide (6%)
TB
Cases of TB in US
10,000 per year
TB transmitted via
Respiratory droplets
TB tubercles are filled with
Caseous necrosis
TB infection is what type of HS
Type 4
TB infection is ___, post infection
Delayed, 2-4 weeks
+ TB test occurrence
10% US
80% Asian/African
TB disease
Re-infection
Tissue destruction
Tuberculin Test aka
PPD
Mantoux
Disease of TB MC from deactivation of
Dormant lesions
Ghon Focus
Subpleural caseous granulomas (1-2 cm)
Ghon Complex
Subpleural and lymph node regions have granulomas (tuberculoma)
Ranke complex
Calcification and fibrosis of hilar nodes
Visible on radiographs
Ghon focus and complex and ranke complex indicative of
TB
In US, ___ of infected individuals with TB develop disease
3-15%
Most TB infections are
Controlled
TB DISEASE must result from
Re-infection
Infected people with TB are not
Contagious
Miliary TB
Pulmonary lymphatic and hematogenous spread
Accelerated with HIV
Miliary TB can spread to
Nearly every organ
*vertebrae = Pott’s Disease
Lymphadenitis from miliary TB MC found
Cervical nodes
Cervical node lymphadenitis in miliary TB MC form of
Extrapulmonary TB
Symptoms of Pott’s disease
Back pain
Paraesthesia
LE weakness
Low-grade afternoon fever, nigh sweats, hemoptysis are symptoms of
TB (disease)
MC opportunistic viral pathogen in AIDS patients
CMV
Owl’s eye appearance (cellular gigantism) on histological slides
CMV
Hamartoma
Coin lesion
Solitary pulmonary nodule
MC lung tumor, benign
Hamartoma
___ common site of metastasis
Lungs
Most bronchogenic carcinomas arise from
Bronchial epithelia
Bronchogenic carcinoma is ___ and ___
Common and lethal
Occurrence of lung cancer
1 in 15 males
1 in 17 females
Pulmonary cancer-related death
Males 29%
Females 26%
MC ages for pulmonary carcinomas
50-70
Risk factors for bronchogenic carcinoma
Age
Smoking
Asbestos
Radon
If pulmonary carcinomas localized….
45% 5 year survival
If pulmonary carcinomas Mets…
15% 5 year survival
Early Mets in 50% of all cases
MC type of lung Ca
Adenocarcinoma
4 types of lung cancer
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Small cell carcinoma
2 types of lung cancer linked with smoking
Squamous cell carcinoma
Small cell lung cancer
Common sites of Mets from primary pulmonary Ca
Brain
Liver
Bones
Adrenals
Non-small cell lung Ca includes
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Lung Ca of pulmonary apex
Pancoast tumor
MC non-small Cell Lung Ca
5% of all lung ca
Pancoast tumor
Pancoast tumor can cause possible osseous destruction in
Upper ribs
Thoracic vertebrae
Pancoast Syndrome
Neurologic destruction
Stellate ganglion
Brachial plexus
Adenocarcinoma MC in
Non-smokers
Women
Hallmarks of pancoast tumor
Shoulder pain
C8-T2 radicular pain
Horner syndrome
Horner syndrome
Ptosis
Miosis
Anhidrosis
Pancoast tumor aka
Superior sulcus tumor
General symptoms of all pulmonary carcinomas
Chronic cough Hemoptysis Chest pain SVC syndrome Pleural effusion
Primary pleural lesions are
Rare
2 types of primary pleural lesions
Bacterial infections
Mesothelioma
Secondary pleural lesions
Pleuritis
Emphysema
Lung ca
TB
Space between visceral pleura and parietal pleura
Pleural cavity
Transudate
Protein poor
MC cause of pleural effusion
Heart failure
Exudate
Protein rich
Exudate occurs due to
Inflammatory conditions
Transudate occurs MC due to
Heart failure
Transudate =
Hydrothorax
Exudate =
Pleuritis
Pleural effusion
Fluid in pleural cavity
Types of pleural effusion
Transudate
Exudate
Pus in pleural space
Empyema
Causes of pleural exudate
Bacterial infections Viral infections Tumor invasion Pulmonary infarction SLE, RA, thoracic surgery
Air within pleural cavity
Pneumothorax
Spontaneous pneumothorax
Idiopathic
Slender habitus
Males
Tension pneumothorax
Air accumulates and shifts mediastinum
Vascular compression
Medical emergency
Secondary pneumothorax
Due to trauma or pathology
- rib fracture
- emphysema
Tension pneumothorax can lead to
Cardiogenic shock
Hemothorax
Blood in pleural cavity
Coagulates
Can be lethal
Chylothorax
Lymphatic fluid (chyle) in pleural cavity
Milky-white
Major lymphatic obstruction
Firm mass
Yellow white
Both describe
Mesothelioma
Locally invasive but rarely Mets describes what lung pathology
Mesothelioma
Mesothelioma has a very long ___
Latency
25-40 years
Cancer of mesothelial cells from asbestos exposure
Mesothelioma
Prognosis for mesothelioma
4-18 months post diagnosis
Very poor
Vocal cord polyp
Small round nodules on vocal cords
Vocal cord polyps is due to chronic irritation, observed commonly in
Smokers
Singers
Laryngeal papilloma
Raspberry-like growth on vocal cords
MC recur after excisions
Laryngeal papilloma
Characteristics of laryngeal carcinoma
Pearly gray
Wrinkled
Ulceration
Necrosis
2% of all Ca
Carcinoma of larynx
Laryngeal papilloma can be due to
HPV 6
HPV 11
Carcinoma of larynx type
Squamous cell carcinoma
1/3 of larynx ca is
Fatal
Death from Larynx ca MC from
LRTI
Widespread Mets
Risks for larynx ca
>40 yo Smoking Alcohol Males Asbestos Irradiation
Supraglottic laryngeal ca
20-40% cases
30% Mets by diagnosis
Glottis laryngeal ca
60-70% cases
10% Mets by diagnosis
Subglottic laryngeal ca
Very rare
Types of laryngeal ca
Supraglottic
Glottic
Subglottic
