Possible questions? Flashcards
Name the six most common causes of emboli to the lungs.
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor (remember: An embolus moves like a FAT BAT)
Which three factors that promote blood coagulation are known as Virchow’s triad?
Stasis, hypercoagulability, endothelial damage
Describe Homan’s sign.
In Homan’s sign, dorsiflexion of the foot causes a tender calf muscle because of the presence of deep venous thromboses
What medication is used to prevent deep venous thrombosis?
Heparin (or modified heparin molecules such as enoxaparin)
What is the hallmark pulmonary function test finding in patients with obstructive lung disease?
Decreased forced expiratory volume1/forced vital capacity ratio
List four types of obstructive lung disease.
Chronic bronchitis, emphysema, asthma, and bronchiectasis
What 3 events increase risk of pneumonia
impaired cough reflex, damaged mucocilary elevator, mucus plug
Three types of pneumonia
Lobar, broncho, interstitial (atypical)
Which cells are responsible for resolution after pneumonia?
Type 2 pneumocytes
Which pathogen is the most common cause of community-acquired pneumonia in adults and elderly?
Strep pneumo
Which pathogen is the second most common cause of acquired pneumonia in adults?
S. aureus
In obstructive lung disease, there is a(n) _____ (decrease/increase) in residual volume and a(n) ____ (decrease/increase) in functional vital capacity.
Increase; decrease
What criteria must a patient meet to be considered to have chronic bronchitis?
A chronic productive cough at least three consecutive months in at least two years
What histologic changes would be seen on lung biopsy in a patient with chronic bronchitis?
Hypertrophy of the mucus-secreting glands in the bronchioles
The mucus gland hypertrophy seen in chronic bronchitis can be quantified using the _____ _____, which tends to be greater than what value in symptomatic patients?
Reid index; 50%
What is the reid index?
The Reid Index is a mathematical relationship that exists in a human bronchus section observed under the microscope. It is defined as ratio between the thickness of the submucosal mucus secreting glands and the thickness between the epithelium and cartilage that covers the bronchi.
How is the Reid index calculated?
Reid index = gland depth / total thickness of bronchial walls
What clinical findings are auscultated in the lungs of patients with chronic bronchitis?
Usually wheezing and crackles
What visible skin finding may be noted in patients with chronic bronchitis?
cyanosis
What pathologic changes are seen in the lungs of a patient with emphysema?
Enlargement of the air spaces; decrease in recoil resulting from the destruction of alveolar walls
Smoking is associated with _____ (centriacinar/panacinar) -type emphysema, whereas α1-antitrypsin deficiency is associated with _____ (centriacinar/panacinar) -type emphysema.
Centriacinar; panacinar
What exam finding is often auscultated in the lungs of patients with emphysema?
Breath sounds are usually diminished with a decreased inspiratory/expiratory ratio
List the agents used to treat Mycobacterium Avium Complex (MAC) infection.
Mneumonic: “AIDS”
Azithromycin
Claritromycine
Ethambutol
(+/-) Rifabutin
How long do you giveFirst-Line Agents for TB?
You giveall 4 for first 2 months then just Rifampin (RA) and Isoniazide (INH) for 4 more months after that.
In emphysemic lungs, there is a(n) (decrease/increase) _____ in recoil and, subsequently, a(n) _____ (decrease/increase) in compliance.
Decrease; increase. As a result, the residual volume of the lungs increases as the disease progresses
In emphysema, the decrease in lung recoil is a result of destruction of alveolar walls by increased activity of which enzyme?
elastase
Paraseptal emphysema is associated with bullae that can rupture and lead to _____ _____ in otherwise young healthy males.
Spontaneous pneumothorax
Individuals with emphysema tend to exhale through pursed lips to increase _____ _____ and prevent _____ _____ during expiration.
Airway pressure; airway collapse
The definitive feature of the bronchoconstriction of asthma is that it is fully _____.
Reversible
In patients with asthma, there is hyperresponsiveness of what lung segment?
The bronchi
While chronic bronchitis is a disease of the _____ (bronchi/bronchioles), asthma is a disease of _____ (bronchi/bronchioles).
Bronchioles; bronchi
Kartagener’s syndrome is associated with what types of lung disease?
Bronchiectasis and obstructive lung disease due to the failure of cilia to clear mucus from the lungs
Cough and wheezing are noted in patients with what two types of obstructive lung disease?
Asthma and chronic bronchitis
Tachypnea and pulsus paradoxus are noted in patients with what type of obstructive lung disease?
Asthma
Pulsus paradoxus- cardiac tamponade?
A child presents with cough, wheezing, dyspnea, tachypnea, hypoxemia, and mucus plugging. On exam, the patient also has a pulsus paradoxus. From what disease is this patient likely suffering?
Asthma
What finding is commonly noted on pulmonary function testing of patients with asthma as well as those with emphysema?
Decreased inspiratory/expiratory ratio; generally, obstructive diseases lengthen the expiratory phase
What blood pressure/pulse finding is often observed in patients with asthma?
Pulsus paradoxus
Blood pressure drop on inspiration?
What are Curschmann’s spirals?
Shed epithelium from mucous plugs associated with asthma
What two pathologic findings are associated with asthma?
Smooth muscle hypertrophy and mucous plugging
_____ is a chronic necrotizing infection of bronchi.
Bronchiectasis
In bronchiectasis, chronic necrotizing infection of the bronchi leads to what?
Permanent dilation of the airways
Patients with bronchiectasis often have a cough productive of what?
Blood and purulent sputum
Which two genetic diseases are associated with bronchiectasis?
Cystic fibrosis and Kartagener’s syndrome
Individuals with bronchiectasis are prone to develop which fungal pulmonary infection?
Aspergillosis
What are three common triggers of asthma attacks?
Viral upper respiratory infections, allergens, and stress
Compare the onset of dyspnea and hypoxia in emphysema vs chronic bronchitis.
In emphysema, there is early-onset dyspnea and late-onset hypoxemia; in chronic bronchitis, there is early-onset hypoxemia and late-onset dyspnea
What causes late-onset hypoxemia in emphysema?
The eventual loss of capillary beds, which occurs with the loss of alveolar walls
What causes early-onset hypoxemia in chronic bronchitis?
Shunting
What two lung volumes are typically decreased in patients with restrictive lung disease?
Functional vital capacity and total lung capacity
Patients with restrictive lung disease typically have an forced expiratory volume1/forced vital capacity ratio within what range?
> 80%; this differentiates restrictive from obstructive lung disease
What are the two general types of restrictive lung disease?
Poor breathing mechanics (caused by musculoskeletal or connective tissue disease) and interstitial lung diseases
Extrapulmonary causes of restrictive lung disease are generally the result of what?
Poor breathing mechanics, usually as a result of muscular dysfunction (eg, polio) or structural difficulty (eg, scoliosis, morbid obesity)
Pulmonary causes of restrictive lung disease are generally the result of what category of diseases?
Interstitial lung diseases
What infectious disease can cause poor muscular effort and thereby lead to extrapulmonary restrictive lung disease?
Polio
What disease of the neuromuscular junction can cause poor muscular effort and thereby lead to extrapulmonary restrictive lung disease?
Myasthenia gravis
What is the mechanism of extrapulmonary restrictive lung disease in scoliosis?
The curvature of the spine distorts the breathing mechanics of the rib cage
Other than scoliosis and muscle diseases, what condition can lead to extrapulmonary restrictive lung disease?
Morbid obesity
What category of interstitial lung diseases has a clear association with an environmental exposure?
Pneumoconioses
What disease is associated with repeated cycles of lung injury and wound healing with increased collagen deposition?
Idiopathic pulmonary fibrosis
Name three pneumoconioses that can cause restrictive lung disease.
Coal miner’s disease, silicosis, asbestosis
What nongranulomatous disease that commonly affects the renal and pulmonary systems can cause interstitial lung disease?
Goodpasture’s syndrome
What disease can cause restrictive lung disease due to eosinophilic granulomas in the lungs?
Histiocytosis X
Name three drugs that can cause interstitial lung disease.
Bleomycin, busulfan, and amiodarone
What processes cause restrictive lung disease due to poor muscular effort?
Polio and myasthenia gravis
What processes cause restrictive lung disease due to poor structural breathing mechanics?
scoliosis and morbid obesity
What processes cause restrictive lung disease due to interstitial lung pathology?
Acute respiratory distress syndrome, neonatal respiratory distress syndrome, pneumoconioses, sarcoidosis, idiopathic pulmonary fibrosis, Goodpasture’s syndrome, Wegener’s granulomatosis, histiocytosis X, and certain drug toxicities
Which lobe of the lung is most affected in coal miner’s disease?
Upper lobes
Coal miner’s disease can be associated with what two additional pathologic conditions?
Cor pulmonale or Caplan’s syndrome (the combination of pneumoconiosis and rheumatoid arthritis)
What cell type is responsible for the fibrosis induced by silica inhalation?
Macrophages (alverolar macrophages or dust cells)
Silicosis increases the risk of what infectious disease?
Tuberculosis
The finding of eggshell calcification on chest x-ray would increase suspicion of what disease?
Silicosis
What substance, used for such things as shipbuilding and insulation, can result in a diffuse pulmonary interstitial fibrosis?
Asbestos
Patients with asbestosis are at increased risk of what two cancers?
Mesothelioma and bronchogenic carcinoma
In neonatal respiratory distress syndrome, there is a deficiency of what chemical?
surfactant
How does the lack of surfactant in neonatal respiratory distress syndrome impair gas exchange in the lungs?
Surfactant deficiency leads to an increase in surface tension, resulting in collapse of the alveoli
Surfactant is made most abundantly during which period of neonatal gestation?
After the 35th week
What ratio is used as a measure of lung maturity in neonates? How is it tested?
The lecithin/sphingomyelin ratio in the amniotic fluid
In neonatal respiratory distress syndrome, the lecithin-to-sphingomyelin ratio is usually within what range?
<1.5
Medical treatment for neonatal respiratory distress syndrome includes what treatment for the mother before birth?
Maternal steroids
What vascular pathology is associated with persistently low oxygen tension due to neonatal respiratory distress syndrome?
Patent ductus arteriosus; patent ductus arteriosus can cause pulmonary hypertension if not corrected medically or surgically
What are three risk factors for neonatal respiratory distress syndrome?
Prematurity, maternal diabetes (due to elevated insulin), and cesarean delivery (due to decreased release of fetal glucocorticoids)
How can neonates be treated for respiratory distress syndrome after birth?
With artificial surfactant
Use of supplemental oxygen in neonates can lead to what ocular pathology?
Retinopathy of prematurity
In acute respiratory distress syndrome, acute alveolar damage leads to a(n) _____ (decrease/increase) in alveolar capillary permeability.
Increase
Despite many etiologies, what pathophysiology is seen in all cases of acute respiratory distress syndrome?
Fluid leakage into alveoli causing hyaline membrane formation on the inside of the alveolus thus impeding gas exchange
Name seven conditions known to cause acute respiratory distress syndrome.
Trauma, sepsis, shock, gastric aspiration, acute pancreatitis, amniotic fluid embolism, uremia
What obstetric complication can result in adult respiratory distress syndrome?
Amniotic fluid embolism
A chronic alcoholic suffering from acute pancreatitis is experiencing difficulty breathing and oxygen desaturation. From what pulmonary complication of acute pancreatitis may she be suffering?
Acute respiratory distress syndrome
Name three molecular mechanisms that contribute to the initial damage to the alveoli in acute respiratory distress syndrome.
Neutrophilic toxins, activation of the coagulation cascade, and oxygen-derived free radicals
The forced expiratory volume1:forced vital capacity is what percent in normal lungs; in obstructive lung disease; in and restrictive lung disease?
Approximately 80%; <80%; >80%
Forced expiratory volume1 and forced vital capacity are reduced in both obstructive and restrictive pulmonary diseases; however, forced expiratory volume1 is more dramatically reduced in ____ (obstructive/restrictive) pulmonary disease.
obstructive
In ____ (obstructive/restrictive) pulmonary disease, forced expiratory volume1/forced vital capacity <80% and lung volumes are increased.
Obstructive
In _____ (obstructive/restrictive) pulmonary disease, forced expiratory volume1/forced vital capacity >80% and lung volumes are decreased.
restrictive
How do total lung volumes in obstructive lung disease compare with normal lung volumes?
Lung volumes in chronic obstructive pulmonary disease are greater than normal lung volumes
Is residual volume decreased, increased, or normal in obstructive lung disease?
increased
How do total lung volumes in restrictive lung disease compare with normal lung volumes?
Lung volumes are less than normal in restrictive lung disease
In which type of lung disease, obstructive or restrictive, is the forced expiratory volume1/forced vital capacity ratio more dramatically reduced?
obstructive
Define sleep apnea.
The condition that occurs when a person repeatedly stops breathing for at least 10 seconds during sleep
Define central sleep apnea.
**
Define obstructive sleep apnea.
Sleep apnea with which there is a drive to breathe but mechanical airway obstruction (usually obesity) prevents respiration
An obese man complains of chronic fatigue. His wife says he is an especially loud snorer. What condition may be contributing to this patient’s fatigue?
sleep apnea
Name three treatments of sleep apnea.
Weight loss, continuous positive airway pressure, surgery
Name five conditions potentially associated with sleep apnea.
Obesity, loud snoring, pulmonary hypertension, arrhythmias, and possible sudden death
In the case of bronchial obstruction, what happens to the breath sounds over the affected area?
They are decreased or absent
What are the physical exam findings in a patient with bronchial obstruction?
Hyporesonance to percussion, decreased fremitus, and if there is tracheal deviation, it is towards the side of the lesion
What are the physical exam findings in a patient with pleural effusion?
Decreased breath sounds, dullness to percussion, decreased fremitus
What are the physical exam findings in a patient with lobar pneumonia?
Bronchial breath sounds, dullness to percussion, increased fremitus, no tracheal deviation
What are the physical exam findings in a patient with pneumothorax?
Decreased breath sounds, hyperresonance, absent fremitus, and tracheal deviation away from the lesion
Pleural effusions cause a(n) _____ (decrease/increase) in fremitus, whereas pneumonia causes a(n) _____ (decrease/increase) in fremitus.
Decrease; increase
Bronchial obstructions may cause tracheal deviation _____ (away from/toward) the lesion, whereas pneumothoraces result in deviation _____ (away from/toward) the lesion.
Toward; away from
In what area of the lungs does squamous cell carcinomas typically arise?
Central
