Path- approach to pt. with lung cancer

Question 1

accumulation of fluid in interstitial tissues.?

Answer 1

edema

Question 2

are accumulations of fluid in body cavities?

Answer 2

effusions

Question 3

Noninflammatory effusions and edema are protein-poor fluids called?

Answer 3

transudates

Question 4

What type of effusion is common in many diseases, including heart failure, renal disease, and liver failure?

Answer 4

transudates

Question 5

edema and effusions may occur secondary to:

๏ Increased Hydrostatic Pressure

๏ Reduced Plasma Osmotic Pressure

๏ Sodium and Water Retention

๏ Lymphatic Obstruction

Answer 5

Noninflammatory

Question 6

Non-inflammatory Effusions and Edema increase/ decreased Hydrostatic Pressure?

Increases in hydrostatic pressure are mainly caused by disorders that impair venous return.

Answer 6

increased

Question 7

What causes low albumin and subsequent reduced oncotic pressure leading to noninflammatory effusions?

Answer 7

✴ Reduced albumin synthesis occurs in severe liver diseases, eg, end-stage cirrhosis.

✴ Albumin loss occurs in the nephrotic syndrome, where albumin leaks into the urine through abnormally permeable glomerular capillaries.

✴ Plasma protein may be decreased in protein malnutrition.

Question 8

Increased/ decreased salt retention occurs whenever renal function is compromised, eg, primary kidney disorders, and in cardiovascular disorders that decrease renal perfusion.

Increased salt retention, with retention of associated water, leads to both increased/ decreased hydrostatic pressure and increased/ decreased vascular colloid osmotic pressure (due to dilution).

Answer 8

increased; decreased

Question 9

Inflammation-related effusions and edema are protein rich?

Answer 9

exudates.

Question 10

What caused exudates of vessels leading ot effussions and edema?

Answer 10

They are due to increases in vascular permeability caused by inflammatory mediators.*

Question 11

Serous, serofibrinous, fibrinous (and suppurative) fluids may all have an basis, differing only in the intensity and duration of the process.

Answer 11

inflammatory

Question 12

inflammation is marked by the exudation of cell-poor fluid into spaces created by injury to surface epithelia, or into mesothelial-lined body cavities.

Answer 12

Serous

Question 13

Typically, the fluid is/ is not infected by destructive organisms, and does not contain large numbers of leukocytes.

Answer 13

is not

Question 14

A exudate develops when the vascular leaks are large, and/or there is a local procoagulant stimulus.

Answer 14

fibrinous

Question 15

Concerning fibrinous inflammation exudate,

With a large increase in vascular permeability, higher-molecular-weight proteins such as fibrinogen pass out of the blood, and is formed and deposited in the extracellular space.

Answer 15

fibrin

Question 16

A exudate is characteristic of inflammation in the lining of body cavities, such as the meninges, pericardium, and pleura.

Answer 16

fibrinous

Question 17

๏ Histologically, appears as an eosinophilic meshwork of threads or as an amorphous coagulum.

Answer 17

fibrin

Question 18

๏ Purulent inflammation is characterized by the production of , an exudate of neutrophils, the liquefied debris of necrotic cells, and edema fluid.

Answer 18

pus

Question 19

The most frequent cause of purulent (also called suppurative ) inflammation is infection with bacteria that cause liquefactive tissue necrosis, such as ; these are referred to as pyogenic (pus-producing) bacteria.

Answer 19

staphylococci

Question 20

• Accumulation of pleural fluid may occur in the following settings:
• Increased hydrostatic pressure, eg, CHF.
• Decreased osmotic pressure, eg, nephrotic syndrome

. • Decreased lymphatic drainage, eg, mediastinal carcinomatosis.

• Increased vascular, eg, pneumonia.

Answer 20

permeability

Question 21

Noninflammatory collections of serous fluid within the pleural cavities are called

clear and straw colored.

The most common cause is cardiac failure, and so it is usually accompanied by pulmonary congestion/edema.

• Transudates may also collect in any systemic disease associated with generalized edema, and so are found in renal failure and cirrhosis of the liver

Answer 21

hydrothorax .

Question 22

The escape of blood into the pleural cavity is known as

• It is almost always a fatal complication of a ruptured aortic aneurysm or vascular trauma, or it may occur postoperatively

Answer 22

hemothorax.

Question 23

is an accumulation of milky fluid, usually of lymphatic origin, in the pleural cavity.

• Chyle is milky white because it contains finely emulsified fats.

Chylothorax is most often caused by duct trauma or obstruction, that secondarily causes rupture of major lymphatic ducts.

• It is typically caused by malignancies that the major lymphatic ducts.*

Answer 23

Chylothorax; thoracic; obstruct

Question 24

The most common causes of pleuritis are disorders associated with of the underlying lung, eg, tuberculosis, pneumonia, lung infarcts, lung abscess, and bronchiectasis.

exudates

Answer 24

inflammation

Question 25

Systemic disorders, including Rheumatoid arthritis, systemic lupus erythematosus, uremia, diffuse systemic infections, and involvement of the pleura can also cause serous or serofibrinous pleuritis

Answer 25

metastatic

note: slide shows malignant cells in pleural fluid

Question 26

Answer 26

A= metastatic mammary carcinoma in pleural fluid

B= Many proliferation spheres (arrows) are present due to continued division of carcinoma cells in nutrient rich effusions.

Question 27

A purulent pleural exudate () usually results from bacterial or mycotic seeding of the pleural space.

• Most commonly, seeding occurs by contiguous spread of organisms from infection.

Answer 27

empyema; intrapulmonary

Question 28

Empyema may resolve, but more often the exudate organizes into dense, tough fibrous that frequently obliterate the pleural space or envelop the lungs; either can seriously restrict pulmonary expansion.

Answer 28

adhesions

Question 29

Hemorrhagic pleuritis manifested by sanguineous inflammatory exudates is infrequent and is found in hemorrhagic diatheses, diseases, and neoplastic involvement of the pleural cavity.*

Answer 29

rickettsial

Question 30

When hemorrhagic pleuritis is seen, a careful search should be made for the presence of exfoliated cells.

Answer 30

tumor

note: tumor cells with hemorrhagic exudate (breast cancer metastasis)

Question 31

Answer 31

Light’s criteria

Question 32

Answer 32

Breast cancer, Romanaski stain

Question 33

Answer 33

small cell carcinoma, not a lot of cytoplasm, nuclear molding (puzzle pieces)