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Bloc B - Respiration > ILD Oct11 M1 > Flashcards

ILD Oct11 M1 Flashcards

1
Q

acinus def

A

everything distal to terminal bronchiole

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2
Q

lobule def

A

lung parenchyma surrounded by intralobular septae (acini of 1 terminal bronchiole)

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3
Q

how many acini per lobule

A

6-8

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4
Q

what is found in an acini

A

1st, 2nd and 3rd order respiratory bronchioles, alveolar duct, alveolar sac

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5
Q

primary lobule def and how many per acinus

A

lung unit distal to resp bronchiole (ducts, sacs, alveoli). 30-50 per acinus

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6
Q

secondary lobule (lobule) arterial, venous and lymphatic supply

A

centrilobular artery running parallel to centrilobular bronchiole
pulmonary veins + lymphatics run in interlobular septum

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7
Q

parenchyma def and contents

A

region involved in gas exchange

  • alveolar airspace
  • alveolar wall (type 1 and type 2 cells, capillaries, alv-cap BM, interstitial tissue)
  • CT surrounding small vessels and lymphatics
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8
Q

non-parenchymal structures (give some)

A

large airways, large blood vessels, pleura, chest wall

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9
Q

Interstitial tissue surround small arteries and small bronchi: what it connects to

A

connects directly with alveolar interstitium of alveolar septum

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10
Q

function of the interstitial tissue of the lung

A

supporting framework for airways, vessels and alveolar airspaces

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11
Q

two interconnected compartments of lung interstitial tissue and do they connect

A

parenchymal and non parenchymal compartment of lung IS tissue. They connect

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12
Q

parenchymal lung IS tissue: where

A

in alveolar wall and surrounding small vessels and lymphatics

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13
Q

non-parenchymal lung IS tissue: where

A

pleura, interlobular septa, surrounding large vessels and airways

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14
Q

how big is the lung parenchymal IS

A

barely (not) visible on histology slide of alveolar duct

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15
Q

3 spaces that can be involved in ILD

A

parenchymal IS, non-parenchymal IS, alveolar airspace

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16
Q

ex of disease affecting parenchymal interstitium

A

pneumocytosis pneumonia

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17
Q

ex of diseases (2) affecting non parench IS

A

sarcoidosis

edema

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18
Q

condition where dyspnea is worse when lying down

A

orthopnea

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19
Q

Moderate oedema or interstitial pulmonary oedema (non-parenchymal disease) (filling with gelatinous apperance) symptoms examples

A

dyspnea, orthopnea, RR 14, O2 sat 90%, mild resp distress, still able to speak in full sentences

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20
Q

interstitial pulmonary edema (moderate) CXR findings

A

Extra lines in the lung fields running straight to pleura: Kerley B lines.
Heart bigger
Larger pericardiac silouhette

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21
Q

interstitial pulmonary edema (moderate) CT findings

A

Kerley B lines (1 cm in length, go right out to the pleura)

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22
Q

what kerley B lines are or represent

A

interlobular septa

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23
Q

gross histology of interlobular septa in interstitial pulmonary edema (moderate)

A

1mm thickness, gelatinous appearance, loose. Fluid within. Loose appearance joins with IS tissue around bronchus and pulm artery

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24
Q

alveolar pulmonary edema (severe) symptoms examples

A 
severe dyspnea, sitting up doesn't relieve. always breathless, coughin up (with small amounts of frothy pink sputum)
RR 30 
O2 sat 82
cyanosis
speak max 3-4 words at a time
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25
Q

alveolar pulmonary edema CXR findings

A

more white radioopacities in both lungs

radiolucent linear lines (airways)

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26
Q

name of radiolucent linear lines (airways) seen on severe (alveolar pulmonary) edema on CXR

A

Air bronchograms

black lines, transparent to X-ray

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27
Q

why see air bronchograms in CXR of alveolar pulmonary edema

A

No disease in airways so are radiolucent (let X ray through and appear black) bc disease in airspace

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28
Q

name of pattern seen on CXR of alveolar pulmonary edema and explanation

A

Acinar pattern. bc airspaces filled with something (fluid in case of edema)

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29
Q

Acinar pattern: what is the differential or what can be filling the airways

A

fluid, pus (pneumonia), blood (alveolar hemorrhage), pissou

30
Q

alveolar pulmonary edema appearance on gross histology

A

lung parenchyma grey instead of red. greyish tissue goes 1 cm around edge of bronchial wall
Alveolar airspaces filled or obliterated

31
Q

3 categories of edema

A

early pulmonary edema
interstitial pulmonary edema (non parenchymal)
alveolar pulmonary edema (parenchymal)

32
Q

early pulm edema: pulm capil wedge pressure + CXR findings

A

13-18 mmHg. Engorged blood vessels, resulting in redistribution

33
Q

interstitial pulmonary edema: pulm capil wedge pressure + CXR findings

A

18-25 mmHg. Kerley B lines. Thickened fissures

34
Q

alveolar pulmonary edema: pulm capil wedge pressure + CXR findings

A

more than 25mmHg. Air bronchograms + Consolidation

35
Q

redistribution meaning on X-ray

A

normally, see vessels in airways better on lower parts of lungs. If pressure increase bc of left heart failure, redistribution of blood towards top of X-ray

36
Q

mechanism of edema in left heart failure

A

increase in pressure in pulm circulation and so in pulm capillaries too. Fluid leaks to alveolar airspace

37
Q

why initially non parenchymal IS affected in edema and only severe edema affects parenchymal

A

initial leak in alveolar airspace is sucked in non parenchymal IS (making interlobular septa and perivascular IS thick) to keep gas exchange
At certain point, this capacity is surpassed

38
Q

Name of phenomenon when airspaces are filled with fluid

A

Consolidation

of whole lobule or acinus

39
Q

Treatment to edema

A

Diuretic to mobilize fluid (diuretic = makes you pee)

40
Q

Pneumonia def

A

lung infection with bacteria, virus or fungus

41
Q

pneumonia symptoms examples

A

slowly progressive dyspnea, low grade fever (38.2)

42
Q

pneumonia CXR findings

A

fluffyness. Cloudy white appearance.

43
Q

interstitial pneumonia histology of the alveoli

A

Thicker alveolar septum. Lymphocytes.

Might see something inside alveolar airspace if is also involved

44
Q

what interstitium do we mean to be affected when say interstitial pneumonia

A

parenchymal interstitium

45
Q

Normal CT: what we can see

A

vessels, airways, intralobular septum

46
Q

Abnormal CT: what can be seen

A

Parenchymal, IS or airspace disease with variety of patterns (whitening of parenchyma area, complete whitening is consolidation), etc.

47
Q

Sarcoidosis example of symptoms

A

painful red eye, blurred vision

48
Q

sarcoidosis X ray findings

A 
enlarged hilar lymph nodes on both sides (bilateral hilar adenopathy)
interstitial pattern (kerley B lines but not exactly)
49
Q

lymphadenopathy definition

A

disease of the lymph nodes, in which they are abnormal in size, number, or consistency.

50
Q

Low magnif histo stain finding in sarcoidosis

A

Normal parenchyma. non parenchymal IS surrounding vessels is involved (appears pink)

51
Q

higher magnif histo stain finding in sarcoidosis

A

non necrotizing granuloma. middle cells have elongated nuclei + lightly eosinophilic center

52
Q

Important cell type found in non parench IS in sarcoidosis

A

Epitheloid histiocyte (activated macrophage)

53
Q

sarcoidosis: bands of pinker tissue that is hypocellular, in the granulomas: what is it + shows what

A

collagen. shows fibrosis

54
Q

how sarcoidosis heals (2)

A

treatment or by itself, giving fibrosis

55
Q

from inside to outside of granuloma, how epitheloid histiocyte number varies. in sarcoidosis

A

more on outside than inside

56
Q

sarcoidosis affects what system specifically

A

multi-system disease

57
Q

what percentage of patients with sarcoidosis have their lungs affected

A

95%

58
Q

3 names of the variants of sarcoidosis

A

Loefgren’s syndrome
Uveo-parotid fever (Heerfordt’s syndrome)
Lupus Pernio

59
Q

Loefgren’s syndrome symptoms

A

fever, polyarthritis, erythema nodosum, abnormal CXR

60
Q

polyarthritis def

A

arthritis affecting 5 or more joints simultaneously

61
Q

erythema nodosum def

A

inflammation of fat cells under skin

62
Q

Uveo-parotid fever (Heerfordt’s syndrome) symtpoms

A

fever, enlarged parotid and uveitis

63
Q

Lupus pernio symptoms

A

Violaceous papules on nose, lips and cheeks

64
Q

3 tests to diagnose sarcoidosis

A

CXR, bronchoscopy, pulmonary function tests (PFTs)

65
Q

what bronchoscopy allows in sarcoidosis

A

confirm diagnosis with trans-bronchial or lymph node biopsy

66
Q

what PFTs show in sarcoidosis

A

mixed restrictive obstructive pattern

67
Q

how many stages to sarcoidosis

A

4

68
Q

1st stage of sarcoidosis

A

hilar lymph nodes enlarged

69
Q

2nd stage of sarcoidosis

A

hilar adenopathy + parenchymal involvement

70
Q

3rd stage of sarcoidosis

A

lymph nodes back to normal and disease persists

71
Q

4th stage of sarcoidosis

A

lung destruction starts, fibrosis, bronchiectasis, airways pulled open by fibrotic lung

72
Q

treatment of sarcoidosis

A

Often not needed
steroids help improve
less often: chemo, anti-malarial agents, anti TNF agents. lung transplant

Bloc B - Respiration (36 decks)

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