Pathology Flashcards
Most common site of nasal polyp
middle meatus
Most common nose bleed
anteroinferior nasal septum
Life threatening hemorrhage in nose
Artery involved?
posterior segment
sphenopalatine artery a branch of maxillary artery
Kiesselbach plexus formed by
LEGS: superior Labial artery, anterior and posterior Ethmoidal arteries, Greater palatine artery, Sphenopalatine artery.
Rapidly declining effect of topical nasal decongestant is due to
Tachyphylaxis
↓production of endogenous norepinephrine
lab test used clinically to rule out DVT:
Imaging test of choice is :
►D-dimer
►compression ultrasound with Doppler.
Most pulmonary emboli arise from
proximal deep veins of lower extremity.
______ is imaging test of choice for PE
CT pulmonary angiography
______ is imaging test of choice for PE in CKD
ventilation/perfusion scan
Changes in flow-volume curve in PE
normal, as there is no effect on ventilation. only effect on perfusion
_____ doesnot remain constant after 30 years even in non-smokers
FEV1
Hypercoagulable state: Pregnancy changes
Compression of IVC and iliac vein
↑ production of coagulation factors
↓ Protein S
Protein C resistance
Ruptured alveoli allow tracking of air into the mediastinum via
peribronchial and perivascular sheaths
Pneumomediastinum Clinical features:
Clinical features: chest pain, dyspnea, voice change, subcutaneous emphysema, ⊕ Hamman sign (crepitus on cardiac auscultation).
Chronic mediastinitis—also known as ____
Common cause
fibrosing mediastinitis; due to proliferation of connective tissue in mediastinum.
Histoplasma capsulatum is common cause
Posterior mediastinal masses—
►neurogenic tumor (eg, neurofibroma),
►multiple myeloma.
______ increase respiratory rate in response to pathologic alveolar process (eg. pulmonary edema, pneumonia)
Alveolar juxtacapillary receptors
_______ is the major cause of dyspnea and exercise limitation in COPD
Dynamic hyperinflation
Dynamic hyperinflation
Hyperinflation in COPD during exercise. patient requires extra time for exhalation → increasing trapped air during rapid breathing → ↓tidal volume
Depth and rate of respiration are controlled by _____ based on _______
medullary respiratory center
based on inputs from central and peripheral chemoreceptors
Damage in late phase of asthma is due to
Major basic protein released by eosinophils
Damage in early phase of asthma due to
PREFORMED Histamine
GENERATION of LT C4,D4,E4
Most common cause of COPD exacerbation is
- Viral (rhino, influenza, parainfluenza)
2. Bacterial
Current Jelly & Rusty coloured sputum is due to
Extravasation of RBCs and Hb in sputum
ABPA microscopy
Fungi donot invade mucosa and non-caseating granulomas would not be seen
Air enters pleural space but cannot exit.
tension pneumothorax
tension pneumothorax complication
May lead to increased intrathoracic pressure →mediastinal displacement →kinking of IVC →↓venous return →→cardiac output.
Obstructive hyperinflation occurs in
partial airway obstruction (dilated during inspiration but closed during expiration)
Atelectasis X-ray finding
Opacification
Partial obstruction of large airway physical finding
A focal, monophasic wheeze
Diffuse alveolar hemorrhage: Restrictive or Obstructive pattern?
dilutes surfactant → alveolar atelectasis → Restrictive flow-volume pattern
Atelectasis: Restrictive or Obstructive pattern?
Restrictive flow-volume pattern
Atelectasis etiologies:
Obstructive
Compressive
Contraction
Adhesive: due to lack of surfactant
Hepatic hydrothorax
ascites forced into right sided pleural cavity through fenestrations in diaphragm (transudative)
Mesothelioma Histology
Psammoma bodies seen on histology.
Calretinin and cytokeratin 5/6 ⊕, pancytokeratin
cuboidal/spindle shaped cells
BOOP 4 features
Foamy macrophages
Masson bodies
Interstitial collagen deposition
Uniform fibroblastic proliferation
PE physical exam
Diffuse crackles, ronchi, scattered wheeze
Progressive hypoxemia refractory to oxygen therapy
ARDS
ARDS symptoms
►Abnormal chest X-ray (bilateral lung opacities)
►Respiratory failure within 1 week of alveolar insult
►Decreased Pao2/Fio2 (ratio < 300, hypoxemia due to intrapulmonary shunting and diffusion abnormalities)
►Symptoms of respiratory failure are not due to HF/fluid overload
Non cardiogenic pulmonary edema seen in
ARDS
High altitude
OSA is primarily a problem of _____ not _____
pharynx, not larynx
Most common indicator of obesity hypoventilation syndrome is
↓ Expiratory reserve volume
↓ Functional residual capacity
Normal RV
Obesity hypoventilation syndrome is also known as
During waking hours
During sleep
►Also known as Pickwickian syndrome.
► ↑Paco2 during waking hours (retention); ↓Pao2 and ↑Paco2 during sleep.
Pulmonary hypertension: death from
decompensated cor pulmonale.
Pulmonary arterial hypertension: Heritable PAH can be due to
an inactivating mutation in BMPR2 gene (normally inhibits vascular smooth muscle proliferation)
Portal HTN causes pulmonary HTN, how?
Portopulmonary HTN
►Portal HTN → portosystemic shunt → unmetabolized substances into pulmonary circulation (serotonin) → smooth muscle hyperplasia of pulmonary capillaries → pulmonary HTN
► ↑hydrostatic pressure on portal vein releases endothelin →portosytemic shunt → pulmonary HTN
Silicosis histology:
Nodules composed of whorled collagen fibers and dust laden macrophages
