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Systems Pathology Final > Lungs Part 2 > Flashcards

Lungs Part 2 Flashcards

1
Q

What is a chronic Intersitial Lung disease?

A

group of disorders that have decreased compliance

diffuse, bilateral, patchy fibrosis

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2
Q

What does the lung look like during an MRI if they have chronic interstitial lung disease?

A

they have “ground glass shadows” and “honeycomb lung”

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3
Q

Do we know the cause of chronic intersitial lung diseases?

A

most commonly, no

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4
Q

What is the hallmark feature of intersitial lung disease?

A

reduced compliance

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5
Q

What does damage to alveolar epithelium and interstitial vasculature do in chronic interstitial lung disease?

A

leads to hypoxia, dyspnea and pulmonary HTN (cor pulmonale), respiratory failure

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6
Q

What is idiopathic pulmonary fibrosis characterized by?

A

progressive bilateral interstitial fibrosis, can result in severe hypoxemia and cyanosis

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7
Q

What are the symptoms of idiopathic pulmonary fibrosis?

A

nonproductive cough, velcro-like crackles (rales)

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8
Q

Who is affected the most with idiopathic pulmonary fibrosis?

A

males, MC greater than 60 years

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9
Q

What is the survival rate for those with idiopathic pulmonary fibrosis?

A

less than 3 years

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10
Q

What is the treatment for idiopathic pulmonary fibrosis?

A

lung transplant

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11
Q

What is the radiologic and histologic pattern of fibrosis referred to as?

A

usual interstitial pneumonia

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12
Q

What is pneumoconiosis?

A

a non-neoplastic lung reaction to inhalation of mineral dusts

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13
Q

Who usually gets pneumoconiosis?

A

those who work where there is mineral dusts, fums and vapors

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14
Q

What are the 3 most common mineral dusts that contribute to pneumoconiosis?

A

coal dust, silica, asbestos

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15
Q

Is there an increase in cancer with coal worker’s pneumoconiosis?

A

no, coal mining has decreased since the 1800s

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16
Q

Which is the most common pneumoconiosis?

A

silicosis

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17
Q

Is silicosis a risk for lung cancer?

A

yes

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18
Q

What jobs can contribute to silicosis?

A

sandblasting, rock mining, rock quarries, ceramics, cutting stone

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19
Q

What kind of cancer are people who work with asbestos at risk for?

A

mesothelioma

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20
Q

What are the jobs that contribute to mesothelioma?

A

asbestos insulation, mining, milling

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21
Q

What are the different types of coal worker’s pneumoconiosis?

A

anthroacosis, simple coal worker’s pneumoconiosis, progessive massive fibrosis

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22
Q

What is anthracosis?

A

a pigment (carbon) that accumulates in the lungs

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23
Q

Does anthracosis have symptoms?

A

no, asymptomatic, no inflammation or dysfunction

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24
Q

Who gets anthracosis?

A

most city dwellers and smokers

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25
Q

Describe simple coal worker’s pneumoconiosis.

A

an accumulation of macrophages, little-to-no dysfunction, coal macules/nodules

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26
Q

What is progressive massive fibrosis?

A

massive black scars on the lungs that have extensive fibrosis and decreased lung function with pulmonary HTN (cor pulmonale)

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27
Q

What is the most common chronic occupational disease in the world?

A

silicosis

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28
Q

What is silicosis caused by?

A

inhalation of crystalline silica from occupational settings

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29
Q

Which kind of silica is the most toxic and fibrogenic?

A

crystalline forms (quartz, cristobalite, tridymite)

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30
Q

What does silicosis do to the lungs?

A

destroys alveoli which causes hypoxia/dyspnea
pulmonary HTN which causes cor pulmonale
possible progressive massive fibrosis

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31
Q

What is cor pulmonale?

A

abnormal enlargement of the right side of heart as a result of a disease of the lungs

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32
Q

People who have silicosis are at a bigger risk for what?

A

lung cancer, tuberculosis

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33
Q

When is silicosis most commonly detected?

A

on routine X ray, if it is caught late, the patient is experiencing dyspnea

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34
Q

What do you see on X rays for silicosis?

A

egg shell calcifications, Hilar lymph nodes, upper lung fields

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35
Q

What can asbestos cause?

A

asbestosis, fibrotic pleural plaques, pleural effusion, mesothelioma, bronchogenic carcinoma, laryngeal carcinoma

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36
Q

What is the MC effect of asbestos?

A

fibrotic pleural plaques

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37
Q

When exposed to asbestos, you have a ___x increase of contracting mesothelioma.

A

1000

38
Q

When exposed to asbestos, you have a 5x increase of contracting what?

A

bronchogenic carcinoma

39
Q

When exposed to asbestos and smoking, what is your cancer risk?

A

50x more than normal

40
Q

Who can receive asbestos exposure?

A

family members of workers

41
Q

What is asbestosis?

A

a result of asbestos exposure that causes interstitial fibrosis and begins in lower lungs/pleura

42
Q

What distinguishes usual interstitial pneumonitis from asbestosis?

A

asbestos bodies

43
Q

What are asbestos bodies?

A

small brown nodules

44
Q

What are the signs and symptoms of asbestosis?

A

progressive cough and dyspnea, possible cor pulmonale

45
Q

When does one typically see asbestosis?

A

10-20 years after exposure

46
Q

What does asbestosis give one the increase risk of?

A

mesothelioma and lung cancer

47
Q

What kind of disorder is sarcoidosis?

A

multisystem disease of unknown etiology characterized by noncaseating granulomas in many tissues and organs

48
Q

Which organs does sarcoidosis most commonly involve?

A

lungs, skin, eyes, liver, spleen

49
Q

Within the lungs, where does sarcoidosis take place?

A

hilar lymph nodes 90% of the time (bilaterally)

50
Q

Within the skin, where does sarcoidosis take place?

A

erythema nodosum 25% of the time

51
Q

When you biopsy, what do you find that is indicative of sarcoidosis?

A

noncaseating granulomas

52
Q

What is the most common symptom of sarcoidosis?

A

asymptomatic

53
Q

If there are symptoms of sarcoidosis, what would they be?

A

substernal chest pain, dry cough, fever, dyspnea

54
Q

Who are more commonly going to get sarcoidosis?

A 
African Americans (10x), Danish, Swedish
age 20-40 years MC among non-smokers and females
55
Q

What percent of people recover from sarcoidosis?

A

70%

56
Q

What percent of people have moderate dysfunction from sarcoidosis?

A

20%

57
Q

10% of people who contract sarcoidosis develop what?

A

progressive pulmonary fibrosis and possible cor pulmonale

58
Q

What is the treatment for sarcoidosis?

A

watchful waiting, corticosteroids, lung transplant

59
Q

How does a pulmonary embolism occur?

A

clot–>embolism–>lodges in pulmonary artery–>pulmonary infarction

60
Q

What is the morbidity for pulmonary embolisms in the US?

A

50,000 deaths/year

61
Q

What do most pulmonary embolisms start as?

A

deep vein thrombosis in popliteal or femoral veins

62
Q

How many pulmonary embolisms are diagnosed before death?

A

~25%

63
Q

What are the risks with pulmonary embolisms?

A

immobility, dehydration, trauma, lupus surgery, congestive heart failure, oral contraception, metastasis, burns, fracture, hypercoagulabilities

64
Q

If people have a pulmonary embolism, what percent of people have recurring pulmonary embolisms?

A

30%

65
Q

What are the consequences of pulmonary embolisms?

A

increased pulmonary artery pressure (HTN)

tissue ischemia and infarction

66
Q

What are the steps of a pulmonary embolism?

A

sudden pulmonary HTN–>diminished cardiac output–>acute cor pulmonale–>hypoxia/death

67
Q

Cardiogenic shock is associated with what disease?

A

pulmonary embolism

68
Q

What percent of PE cause an infarction?

A

~10%, rare

69
Q

Why is a pulmonary embolism that causes an infarction so rare?

A

because there is dual blood supply (pulmonary and bronchial arteries)

70
Q

Along with a pulmonary embolism, what else increases the chances of an infarction?

A

decreased pulmonary blood supply or decreased cardiac function

71
Q

What is the name of a large pulmonary embolism?

A

saddle embolism

72
Q

How much of the arterial supply does a saddle embolism take up?

A

occlusion of greater than 60% of pulmonary arterial supply, which causes circulatory collapse and shock

73
Q

What percent of pulmonary embolisms are clinically silent?

A

60-80%

74
Q

Why are most pulmonary embolisms clinically silent?

A

because they are small and readily removed by body and the bronchial arteries provide collateral blood supply

75
Q

How can you prevent a pulmonary embolism?

A

walk after surgery, birth or inactivity, elastic stockings, pneumatic compression, isometrics

76
Q

What does a large embolus do?

A

straddles the pulmonary artery bifurcation and produces acute cor pulmonale

77
Q

What are the symptoms for the remaining 15-35% that actually have symptoms of a pulmonary embolism?

A

sudden onset dyspnea (MC), cough, chest pain (worse with breathing), hemoptysis, cyanosis, collapse

78
Q

How do you diagnose a pulmonary embolism?

A

clinical features, D-dimer (clot breakdown), CT pulmonary angiogram, electrocardiogram

79
Q

What is a normal pulmonary blood pressure?

A

1/8 of systemic blood pressure

15/10

80
Q

What is the measure of pulmonary HTN?

A

1/4 of systemic blood pressure

30/20

81
Q

pulmonary HTN is secondary to what?

A

decrease in cross-sectional area of pulmonary vascular bed or increased pulmonary vascular blood flow (left to right shunt [VSD], congestion [mitral valve senosis])

82
Q

What age can pulmonary HTN occur?

A

any age, mechanisms vary by age

83
Q

What origins do pulmonary HTN commonly have?

A

pulmonary or cardiac origin

84
Q

What vascular alterations occur throughout the pulmonary tree?

A

atherosclerosis, smooth muscle hypertrophy

85
Q

What type of pulmonary HTN has no pulmonary pathology?

A

primary pulmonary hypertension

86
Q

How do you diagnose primary pulmonary HTN?

A

exclusion of other diseases

87
Q

What percent of primary pulmonary HTN is genetic?

A

6%

88
Q

What is the probable underlying basis for most forms of pulmonary HTN?

A

pulmonary endothelial cell and/or vascular smooth muscle dysfunction

89
Q

Who most commonly contracts primary pulmonary HTN?

A

young adult females

90
Q

What are the symptoms of primary pulmonary HTN?

A

dyspnea, fatigue, exertional syncope, angina, possible severe respiratory insufficiency/cyanosis, decompensated cor pulmonale

91
Q

What is the treatment for primary pulmonary HTN?

A

lung transplant

92
Q

What kind of prognosis does primary pulmonary HTN have?

A

poor prognosis

Systems Pathology Final (5 decks)

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