Path - Lecture 4 (pulomary Vascular Diseases )

Question 1

Pulmonary Thromboembolism

Answer 1

-DVT related

Question 2

The pathophysiologic consequences of pulmonary thromboembolism depend largely on:

Answer 2

1. The size of the embolus
   2.the cardiopulmonary status of the patient

Question 3

two important consequences of pulmonary arterial occlusion:

Answer 3

1.an increase in pulmonary artery pressure from blockage of flow and
2.Ischemia of the downstream pulmonary parenchyma

Question 4

Pathogenesis of pulmonary thromboembolism

Answer 4

1.Perfusion of atelectatic lung zones

2.The decrease in cardiac output causes a widening of the difference in arterial-venous oxygen saturation.

3.Right-to-left shunting of blood may occur through a patent foramen ovale

Question 5

Morphology of pulmonary embolism - large embolus

Answer 5

-large embolus may embed in the pulmonary artery
-it may also lodge in the major branches or lodge astride the bifurcation as a saddle embolus
-increase in pulmonary artery pressure
-right sided heart failure

Question 6

Morphology of pulmonary thromboembolism In small vessels

Answer 6

-impact medium sized and small sized pulmonary arteries
-hemorrhage may occur as a result of ischemic damage to the endothelial cells (leading to capillary rupture).
-With compromised cardiovascular status (congestive heart failure or underlying lung disease) infarction results.

Question 7

Pulmonary embolism clinical features

Answer 7

-dyspnea
-tachypnea
-tachycardia
-pleuritic chest pain
-chronic cor pulmonale

Question 8

Pulmonary Hypertension

Answer 8

Pulmonary artery pressure greater than or equal to 25 mm Hg at rest

Question 9

What are the classifications of pulmonary HTN

Answer 9

-LVF and mitral stenosis
-recurrent tiny thromboembolism
-COPD ,Brochiectasis ,ILD
-idiopathic

Question 10

Pathogenesis of idiopathic pulmonary htn

Answer 10

-inactivating germ line mutations in
the gene encoding bone morphogenetic
protein receptor 2 (BMPR2)
-Defects in BMPR2 signaling leads to dysfunction of endothelium and proliferation of vascular smooth muscle cells in the pulmonary vasculature

Question 11

Morphology of pulmonary htn

Answer 11

-medium sized arteries walls thicken
-Small arteries/arterioles = Thickening, medial hypertrophy, reduplication of
the internal and external elastic lamina
-RV hypertrophy
-plexiform lesions

Question 12

Clinical features of primary pulmonary htn

Answer 12

• Young women
• Fatigue, syncope, dyspnea on exertion, chest pain
• Severe respiratory insufficiency, cyanosis, death from right heart failure 2-5 years from diagnosis

Question 13

Clinical features of secondary pulmonary htn

Answer 13

• Any age onset
• Reflects underlying disease (pulmonary or cardiovascular)
• Symptoms of respiratory insufficiency and right heart strain

Question 14

Diffuse Alveolar Haemorrhage Syndromes

Answer 14

Immune mediated diseases which manifest as :
Hemoptyisis , anemia ,diffuse pulmonary infiltrates
-good pasture syndrome
-Wegners granulomatosis
-idiopathic hemosiderosis

Question 15

GOODPASTURE SYNDROME - epidemiology

Answer 15

-Pulmonary-renal syndrome: proliferative and rapidly progressive
glomerulonephritis and hemorrhagic interstitial pneumonitis
- teens and 20s
-males
-

Question 16

Pathogenesis of good pastures syndrome

Answer 16

• Kidney and lung injury are caused by circulating autoantibodies against the non-collagenous domain of the α3 chain of collagen IV.
• The antibodies initiate inflammatory destruction of the basement membrane in renal glomeruli and pulmonary alveoli
• Linear deposition of IgG along basement membranes – glomerular basement membranes (kidney) or alveolar septa (lung)

Question 17

Morphology of good pasture

Answer 17

-gross : heavy lungs , red consolidation
-micro :
-Intra-alveolar hemorrhage
• Patchy necrosis of alveolar walls
• Intra-alveolar hemosiderin
• Septal thickening and reactive hypertrophy of type II cells

Question 18

Clinical findings in good pastures

Answer 18

-Hemoptysis,anemia,pulmonaryinfiltrates
• Featuresofglomerulonephritis–hematuria,edema,uremia
-focal consolidations
-linear deposits of Ig along the basement membrane

Question 19

Idiopathic pulmonary hemosiderosis

Answer 19

-children >adults
-histo similar to good pastures
-no association with renal disease
-no anti BM antibody

Question 20

Acquired atelectasis

Answer 20

-Refers either to incomplete expansion of the lungs (neonatal atelectasis) or to the collapse of previously inflated lungs
-decreased oxygenation
-ventilation perfusion imbalance

Question 21

RESORPTION ATELECTASIS

Answer 21

-stems from obstruction of an airway
-excessive secretions in the smaller bronchi
-Aspiration of foreign bodies
-Intrabronchial tumors

Question 22

Clinical features of resorption atelectasis

Answer 22

• Ipsilateral deviation of trachea and mediastinum
• Ipsilateral diaphragmatic elevation
• Absent breath sounds and absent
vocal vibratory sensation (tactile
fremitus)
• Collapsed lung does not expand on
inspiration

Question 23

Compression Atelectasis

Answer 23

-compressed by air ,fluid or tumor
-accumulate in the pleural cavity and increases pressure
-Trachea and mediastinum shift away from the affected lung

Question 24

Contraction atelectasis

Answer 24

-Occurs when focal or generalized pulmonary or pleural fibrosis prevents full lung expansion

Question 25

Course and complications of atelectasis

Answer 25

-is usually reversible
-treat promptly