LUNG 2 Flashcards
1
Q
- a sudden blockage in a pulmonary
artery that is most often caused by an embolism
of a thrombus usually located in the deep vein of
the leg (MC) or other distant site.
A
Pulmonary embolism (PE) or thromboembolism
2
Q
3
rd main cause of CV death
A
Pulmonary embolism (PE) or thromboembolism
3
Q
Virchow’s triad
A
hypercoagulability, vessel injury and
stasis
4
Q
Respiratory compromise due to
A
lack of
perfusion
5
Q
Hemodynamic compromise due to
A
pulmonary-arterial resistance that is
called cor pulmonale
6
Q
o Clinically silent (60 to 80%) o Pulmonary hemorrhage or infarction (dyspnea, tachypnea, pleuritic pain, friction rub, signs of effusion, cough and wheezing)
A
Small vessel emboli:
7
Q
Main manifestation of medium-sized artery embolus
A
Medium sized artery embolus
8
Q
Large vessel obstruction (pulmonary artery):
A
o Sudden death, cor pulmonale or CV
collapse
9
Q
ACUTE HEMORRHAGIC PULMONARY INFARCT is located in
A
Located in lower lobes because perfusion is
greater in the lower lobe
10
Q
Raised, red-blue (early)→red-brown wedge
shaped
Also called “septic infarcts”
A
ACUTE HEMORRHAGIC PULMONARY INFARCT
11
Q
▪ Cause CV collapse, and right sided heart failure
▪ If untreated, it can cause sudden cardia death
A
SADDLE EMBOLUS
12
Q
Diagnosis of saddle embolus
A
o Chest radiography (nonspecific signs-effusion, etc.)
o Perfusion radionuclide scan (V/Q scan)
o Computed tomography pulmonary
angiogram (CTPA- spiral CT)
o Pulmonary angiogram
o D-dimer
o Cardiac panel is also used by some institution (cardiac enzymes)
13
Q
▪ Most commonly employed imaging because of non-invasiveness ▪ look for “cut-off” sign (abrupt hypo vascularity) sign ▪ after the dye has been seen in the main pulmonary artery there is loss of trachea-bronchial supply
A
Computed tomography pulmonary
angiogram (CTPA- spiral CT)
14
Q
▪ Gold standard
▪ Direct visualization of pulmonary
artery
A
Pulmonary angiogram
15
Q
▪ Highly sensitive, used for screening
A
D-dimer
16
Q
Prognosis of ACUTE HEMORRHAGIC PULMONARY INFARCT
A
Prognosis:
o Case fatality 1 month after diagnosis is
12%
o Recurrence rate is 1-6% during the first 6 months
17
Q
In pulmonary hypertension, the mean pulmonary artery pressure is
A
≥25 mmHg at
rest
18
Q
Pulmonary HTN pathophysiology
A
▪ Bone morphogenetic protein receptor type 2
(BMPR2) signaling pathway
o Mutations -> SMC Hyperplasia
o Seen in 75% of familial cases
▪ Activin receptor-like kinase 1 (ALK1) and
endoglein
▪ Drugs & Toxins (“Phen-Phen”)
19
Q
Pulmonary HTN morphology
A
▪ Right ventricular hypertrophy ▪ Medial hypertrophy of the pulmonary muscular and elastic arteries o More characteristic of pulmonary hypertension. o Causes complete obliteration of the lumen that leads to hypertension ▪ Atherosclerosis ▪ Plexiform lesions o Tuffs of capillary formation that have developed secondary to pulmonary hypertension. ▪ Atheromatous lesions
20
Q
Pulmonary HTN is more common in ________ aged ___
A
women; 20-40 yrs of age
21
Q
Most common presenting symptom of Pulmonary HTN
A
Exertional dyspnea
22
Q
Clinical features of Pulmonary HTN
A
▪ Exertional dyspnea ▪ Chest pain ▪ Severe respiratory distress ▪ Cyanosis ▪ Right ventricular hypertrophy ▪ Cor Pulmonale (Right-sided heart failure)
23
Q
Diagnosis for pulmonary HTN
A
▪ Right heart catheterization
▪ Transthoracic echocardiogram
▪ ECG
24
Q
Gold standard in diagnosing Pulmonary HTN
o Invasive
A
Right heart catheterization
25
Diagnosing technique wherein it shows resistance to airflow
Transthoracic echocardiogram
26
Treatment for mild cases (Pulmonary HTN)
Vasodilators
27
Treatment for severe cases (Pulmonary HTN)
Lung transplant
28
Is a dramatic complication of some interstitial lung
| disorders
Diffuse Pulmonary Hemorrhage
| Syndromes
29
▪ Rare disease of children characterized by
Intermittent diffuse alveolar hemorrhage
▪ Cough & hemoptysis
Idiopathic pulmonary hemosiderosis
30
Diffuse Pulmonary hemorrhage syndromes
Idiopathic Pulmonary Hemosiderosis
Goodpasture Syndrome
Polyangiitis with Granulomatosis
31
▪ Anti-GBM Ab Disease with Pulmonary
Involvement
▪ Antibodies against a3 chain of collagen IV
▪ Renal disease + Pulmonary hemorrhage
▪ Rapid and progressive pulmonary hemorrhage
Goodpasture syndrome
32
▪ “Wegener Granulomatosis”
| ▪ Immune disease typically presenting with hemoptysis
Polyangiitis with Granulomatosis
33
Important features of Polyangiitis with granulomatosis
Capillaritis and scattered,
| poorly formed granulomata
34
▪ Portal of Entry
| pulmonary infection
o Inhalation
o Aspiration
o Hematogenous spread
o Direct spread
35
▪ Compromised local pulmonary defense
o Loss or suppression of the cough reflex
o Dysfunction of the mucociliary apparatus
o Accumulation of secretions
o Interference with the phagocytic and
bactericidal activities of alveolar
macrophages
o Pulmonary Congestion and Edema
36
can be very broadly defined as any
| infection of the lung parenchyma
Pneumonia
37
It causes alveoli to be filled with inflammatory
exudates, and can usually result into
consolidation (sort of solidification within the lung)
of lung.
Pneumonia
38
Pneumonia can be assessed using
X-Rays, using
sethescope on auscultation (decrease breath
sounds) or even in PE when doing tactile fremitus
test (Vibrations are increased over areas of
consolidation).
39
Pneumonia clinical features
```
fever and chills,
productive cough with yellow-green (pus) or rusty
(bloody) sputum,
tachypnea with pleuritic chest
pain,
decreased breath sounds,
dullness to
percussion, and
elevated WBC count
```
40
Pneumonia Accdg to anatomic region
o Lobar pneumonia
o Bronchopneumonia ( or Lobular
pneumonia )
o Interstitial pneumonia
41
Pneumonia Accdg to clinical settings
o Community - acquire pneumonia
o Health care - associated pneumonia (
HCAP )
o Ventilator - associated pneumonia ( VAP)
42
PRIMARY ATYPICAL
| PNEUMONIA
VIRAL AND MYCOPLASMAL
| PNEUMONIA
43
NON INFECTIVE PNEUMONIAS
I. Aspiration (inhalation)
pneumonia .
II. Hypostatic pneumonia
III. Lipid pneumonia
44
Bacterial lung infection in otherwise
| healthy individuals that is acquired from the normal environment
COMMUNITY ACQUIRED BACTERIAL
| PNEUMONIA
45
Most common cause of CAP
Streptococcus
pneumoniae or
Pneumococcus
46
```
Most common
bacterial cause in
COPD. It causes life
threatening infections
and meningitis in
children.
```
Haemophilus
| influenza
47
```
Secondary bacterial
pneumonia following
viral respiratory
illnesses. It has high
risk of development
of abscess.
```
S. aureus
48
```
In debilitated and
malnourished people.
Including alcoholics.
Thick mucoid sputum
tinged blood or rusty
sputum.
```
Enterobacteriace
ae (Klebsiella
pneumoniae )
49
Common in patients
| with neutropenia.
Pseudomonas
| aeruginosa
50
Organ transplant
| recipients.
Legionella
| pneumophila
51
Patchy consolidation
bronchopneumonia
52
Usually bilateral basal in location due to gravitation of secretions
Bronchopneumonia
53
Diffuse inflammation
Lobar pneumonia
54
Acute (neutrophilic)
| suppurative exudation
Bronchopneumonia
55
Lobar pneumonia 4 stages
1. Congestion
2. Red hepatization
3. Gray hepatization
4. Resolution
56
Affects extremes of age
| infants or old
Bronchopneumonia
57
o The lung is heavy, boggy, and
red.
o Vascular engorgement, intra-alveolar edema fluid with few neutrophils, and the presence of
bacteria, which may be numerous.
Congestion
58
e initial phase that represents
acute inflammation response to bacterial
infection and it can last for 1-2 days.
Congestion
59
Congestion (microscopically)
microscopy you can see that there
is dilatation and congestion of capillary
walls and edema in air spaces
60
o The lobe is red, firm, and airless.
| o Massive confluent exudation, neutrophils, red cells, fibrin fill the alveolar spaces.
Red hepatization
61
Red hepatization lasts for around
2 days
62
In this
stage RBCS began to lyse and start to
give paler color or grey color on gross
and cut section
Gray hepatization
63
Gray hepatization (Microscopically)
```
e fibrous that
are denser and more numerous
compared to the previous stage, so
cellular exudates of neutrophils also start to disintegrate with bacterial organism
and other pathogens.
```
64
```
o Progressive disintegration of red
cells and the persistence of a
fibrinosuppurative exudate,
resulting in a color change to
grayish-brown
```
Grey hepatization
65
Advanced
organizing pneumonia.The exudates have been
converted to fibromyxoid masses rich in
macrophages and fibroblasts
Resolution
66
the exudate within
the alveolar spaces is broken down by enzymatic
digestion to produce granular, semifluid debris that is resorbed, ingested by macrophages,
expectorated, or organized by fibroblasts growing
into it
Resolution
67
Clinical features of pneumonia
▪ High fever, rigors and productive cough,
occasionally with hemoptysis;
▪ A friction rub and pleuritic chest pain herald pleural involvement
68
The whole lobe is ______ in lobar pneumonia
radiopaque
69
presence of focal opacities in ________
bronchopneumonia
70
Appropriately treated patients may become
afebrile with few clinical signs ______ hours after
the initiation of antibiotics
48 to 72
71
Pneumonia diagnosis
▪ CXR
▪ CBC
▪ Sputum Gm stain
▪ Blood culture (in severe cases)
72
Pneumonia caused by viruses and
intracellular organisms characterized by patchy
inflammatory changes, largely confined to
interstitial tissue of the lungs, usually without any
alveolar exudate and consolidation
COMMUNITY-ACQUIRED VIRAL (ATYPICAL)
| PNEUMONIA
73
the most common
cause of common cold and this common cold can
extend and reach the lower respiratory tract
causing viral pneumonia.
Rhinovirus
74
Other viruses that can
| cause pneumonia are
adenovirus and coxsakie virus
75
influenza viruses of type A infect
humans, pigs,
horses, and birds and are the major cause of
pandemic and epidemic influenza infections.
76
Influenza virus is a ___-stranded RNA virus
single
77
minor mutation. Does not require
| a new vaccine.
Antigen drift
78
major mutation. A new vaccine is
| required
Antigen shift
79
▪ Paramyxovirus
▪ Bronchiolitis and pneumonia in extreme ages and
immunocompromised
METAPNEUMOVIRUS
80
Such infections are clinically indistinguishable
from those caused by human respiratory syncytial
virus and are often mistaken for influenza
METAPNEUMOVIRUS
81
Gross morphology of interstitial type pneumonia
Patchy or diffuse
| Red-blue and congested
82
In microscopic morphology of Interstitial type pneumonia, Inflammatory cells are present in the _______ rather than the alveoli and without consolidation
interstitium
83
predominant feature of Interstitial type pneumonia
Interstitial inflammatory reaction
84
T or F
In interstitial type pneumonia, Mononuclear infiltrate is present, rather than
neutrophils
T
85
T or F
In interstitial type pneumonia, Alveolar spaces are usually free of exudate (pus)
T
86
Clinical features of Interstitial type pneumonia (viral)
▪ Mild to severe upper respiratory tract infections
and continue down to your LRT infection
▪ Myalgias and fever
▪ Dyspnea
▪ Dry cough > productive
▪ Most viral illnesses are mild and spontaneously
resolve
87
Diagnosis (viral)
▪ CXR
▪ CBC
▪ PCR (To identify etiologic agent
88
Pneumonia occurring ≤48 hours of
hospital admission in patients with at least 1 risk
factor for MDR bacteria
HEALTHCARE- ASSOCIATED PNEUMONIA (HCAP)
89
) Pneumonia occurring
≥48 hours of hospital admission. (Prolonged
hospital stay)
HAP
90
Pneumonia occurring >48 hours after
| endotracheal intubation
VAP
91
Gram positive cocci (HCAP)
S. aureus
92
Gram negative rods
Enterobacteriaceae and Pseudomonas spp
93
▪ Non infective in nature
▪ Aspiration of different agents into the lungs
▪ When it becomes infected - Polymicrobial:
aerobes>> anaerobes
Aspiration pneumonia
94
able to aspirate gastric
contents which can present as hemoptysis and
dyspnea secondary to pulmonary hemorrhage
and edema
Chemical pneumonitis
95
aspirate infective material
coming from oropharynx or nasopharynx and can
present as pulmonary necrosis and suppuration.
Bronchopneumonia
96
Histology: Biopsy lung secondary to aspiration
| pneumonia
foreign body type
granulomatous inflammation because of the
foreign materials that had been aspirated
97
Local suppurative process that produces necrosis
| of lung tissue.
Chronic pneumonia
| Lung abscess
98
most common cause of primary lung abscess
Aspiration of infected material
99
develops as a
complication of some other disease of the lung or
from another site.
Secondary lung abscess
100
most common
| microbes introduced in the lung
aerobic and anaerobic streptococci, S. aureus,
| and a host of gram-negative organisms
101
anaerobic organisms normally found in what part of pharynx
Oropharynx
102
common causes of Lung abscess
o Aspiration of infective material
o Antecedent primary bacterial infection
o Septic emboli from infected thrombi or
right sided endocarditis
o Obstructive tumors
o Direct traumatic punctures or spread of
infection from adjacent organs
103
anaerobes
(Bacteroide,
| Fusobacterium, and Peptococcus)
104
primary abscess
single
105
secondary lung abscess
multiple
106
size (lung abscess)
5-6cm
107
Lung abscess microscopic appearance
Suppurative necrosis of the lung parenchyma
| within the central area of cavitation
108
Clinical features of lung abscess
much like those of bronchiectasis and
characteristically include cough, fever,
and copious amounts of foul-smelling
purulent or sanguineous sputum
clubbing due to hypoxemia
109
Complications (lung abscess)
```
o Extension of the infection into the pleural
cavity
o Hemorrhage
o Septic emboli
o Secondary amyloidosis
```
110
causative agent of Histoplasmosis
Histoplasma capsulatum
111
```
▪ Microconidia in bird/bat dropping
▪ Macrophages ingest but cannot kill the
organism without T-cell help
▪ Granulomas with coagulative necrosis
- clinically mimics tuberculosis
```
Histoplasmosis
112
Histoplasmosis
| 3-5 um, thin-walled cyst
silver stain
113
Blastomycosis C.A.
▪ Blastomyces dermatitidis
| ▪ Inhalation of spores in the ground
114
types of blastomycosis
▪ Pulmonary, disseminated, and cutaneous
| blastomycosis
115
type granuloma in blastomycosis
suppurative
116
size and morphology of blastomycosis
▪ 5-15 um, thick-walled yeast with broad-based
budding
▪ Clinically mimics tuberculosis
117
delayed-type of hypersensitivity reaction to the fungus, most remain asymptomatic
coccidiomycosis
118
T or F
Infectivity of C. immitis is that infective
arthroconidia, when ingested by alveolar
macrophages, block fusion of the phagosome
and lysosome and so resist intracellular killing
T
119
Micro morphology of coccidiomycosis
Macrophages or giant cells, thick walled, often
| filled with small endospores
120
Opportunistic infection agents
```
o P. aeruginosa, Mycobacterium species,
L. pneumophila, and Listeria
monocytogenes
o CMV and herpesviruses
o Pneumocystis, Candida, Aspergillus and
Cryptococcus neoformans
```
121
common causes of pneumonia in HIV
o S. pneumoniae, S. aureus, H, infuenza
| and gram-negative rods
122
>200/uL CD-4 T-cell count
Bacteria, including
| tuberculosis
123
50 to 200/uL CD4 T cell count
Pneumocystis
124
<50/uL CD4 Tcell count
CMV and Mycobacterium avium
| comple
