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P&T Block 2 > Pulm > Flashcards

Pulm Flashcards

1
Q
A

cavity (with thick wall)

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2
Q
A

emphysema

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3
Q

25 y/o with bronchiectasis must be worked up for what disease?

A

CF

most cases present early childhood/neonatal, but some can present later in life

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4
Q

55 y/o F presents w/ pleuritic chest pain which she describes as sharp, intermittent, and positional. Shortness of breath with exertion

bronchoscopy 3 days ago

faint wheeze in left lung; distant sounds in left apex

likely diagnosis?

A

Pneumothorax (iatrogenic)

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5
Q

ABPA

A

allergic bronchopulmonary aspergillosis

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6
Q

Acute phase of DAD is marked by what steps?

A

death of type I cells, no protection –> influx of neutrophils, cytokines, fluid –> inflammation and edema

formation of hyaline membrane from necrotic cells and fibrin

cell death

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7
Q

Aerosilized dornase-alpha (recomibinant human DNase) is used to treat what?

A

Cystic fibrosis

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8
Q

alpha 1- antitrypsin deficiency

A

panacinar emphysema

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9
Q

bronchiectasis

very high serum IgE levels

eosinophilia in blood

= ?

A

ABPA

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10
Q

Bronchopulmonary dysplasia

A

aka: neonatal chronic lung disease

results from effects of oxygen and mechanical ventilation in newborns with RDS

infants with birth weight <1250 grams = 97% of cases

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11
Q

Cause of ARDS

A

infections resulting in sepsis

trauma, surgery, drugs, etc.

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12
Q

Causes of exudative effusion

A

abnormality/injury to pleura increased hydraulic conductance or decreased osmotic pressure connective tissue diseases pulmonary embolism tuberculosis malignancy parapneumonic effusion or empyema

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13
Q

causes of pulmonary edema

A

hemodynamic- CHF

alveolar injury

idiopathic- high altitude sickness

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14
Q

Causes of transudative effusion

A

CHF cirrhosis renal failure increased mean hydrostatic pressure or decreased plasma protein osmotic pressure

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15
Q

Charcot Leyden Crystal

marker for?

A

Asthma

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16
Q

Common infectious pathogens causing Acute Bronchiolitis

A

mycoplasma

RSV

influenza

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17
Q

COPD- physical findings

A

barrel chest

increased tympany to percussion

retraction of chest wall at base (hoober’s sign)

pursed-lipped breathing

cyanosis

prolonged expiratory phase

rhonchi

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18
Q

COPD- Clubbing or no?

A

No

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19
Q

CT- diagnosis?

A

Normal

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20
Q

DAD caused by what?

A

radiation

huge pneumocytes

hyaline membranes

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21
Q

Definition of Chronic Bronchitis

A

presence of cough and sputum production for at least 3 months of 2 consecutive years

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22
Q

Diagnosis of CF

A

clinical symptoms, sibling with CF, abnormal newborn screen AND evidence of CFTR dysfunction

requires 2 abnormal sweat tests (>60) to make diagnosis

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23
Q

Diagnosis?

A

bronchiectasis

– inflammatory destruction of wall

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24
Q

Diagnosis?

A

paraseptal emphysema

blebs under the pleura and around septae

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25
Q

diagnosis?

A

traction bronchioectasis

abnormalities are secondary to parenchymal fibrosis

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26
Q

Difference between DAD and ARDS

A

DAD (diffuse alveolar damage) is a pathologic term and ARDS is a clinical term

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27
Q

disease?

A

pulmonary edema

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28
Q

Emphysema seen in smokers

A

centriacinar (centrilobular) emphysema

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29
Q

fiindings? diagnosis?

A

hyperinflation

flattened diaphragm

== COPD

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30
Q

focus on patient’s left lung

A

emphysema

lots of open air space

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31
Q

focus on white blob

A

mucoid impaction

+ dilated airways

= bronchiectasis

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32
Q

Hyaline membrane formation occurs in what phase?

A

acute phase

33
Q

LAMA

A

long acting muscarinic antagonist (i.e. anticholinergic)

ex: tiotropium, aclidinium bromide, umeclidinium bromide

34
Q

LDH (pleural fluid/serum ratio) = 0.6

A

exudative effusion (

35
Q

lesion

A

cysts

36
Q

likely taken from a patient with what disease?

A

asthma

37
Q

location of hyaline membrane

A

alveolar space

38
Q

Metastatic disease to pleura- treatment

A

systemic chemo chest drainage (w/ tube) pleurodesis via chemicals or mechanical long term indweilling pleural catheter

39
Q

Most common pathogens for CF patients

A

staph aureus– kids

pseudomonas– adults

40
Q

Mucus sample

what cells do you see? what can cause this?

A

eosinophils

asthma attack

41
Q

mutation in F508

A

Cystic fibrosis

most common mutation

42
Q

name of opacity

cause?

A

tree in bud

acute bronchiolitis

43
Q

name of cells? disease causing them?

A

hemosiderin laden macrophages–> CHF

RBCs leak out of capillaries slowly and macrophages digest them

can cause hemodynamic pulmonary edema

44
Q

Parapneumonic effusion

A

pleural effusion that occurs along with infectious pneumonia effusion can be sterile (due to irritation) or infected with bacteria (empyema)

45
Q

Pathogenesis of bronchiectasis

A

permenant dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue of the bronchus

typically results from chronic inflammation

46
Q

patient presenting with productive cough (about 1 cup of sputum per day)

PMH of pulmonary infections in childhood

ronchi, wheezing, and bronchial breath sounds are heard on exam

possible diagnosis?

A

bronchiectasis

47
Q

Patient’s lung removed prior to transplant

history of smoking and dyspnea

Diagnosis?

A

Emphysema

48
Q

pattern seen here?

diagnosis?

A

“finger in glove” mucoid impaction–> severe bronchiectasis secondary to ABPA

49
Q

Physical findings of Pleural Effusion

A

decreased expansion of ipsilateral hemithorax decreased or absent fremitus on ipsilateral side dull or flat percussion decreased breath sounds pleural rub (occasional) contralateral tracheal or mediastinal shift

50
Q

Physiology of Tension Pneumothorax

and Causes

A

air under pressure within the pleural space displaces mediastinal structures and compromises cardiopulmonary function.

results from any lung parenchymal or bronchial injury that acts as a one-way valve and allows free air to move into an intact pleural space but prevents the free exit of that air

51
Q

Pleurodesis

A

fusion of the visceral and parietal pleura

52
Q

sign seen here?

diagnosis?

A

signet ring sign

bronchiectasis

53
Q

signet ring sign

A

bronchiectasis

54
Q

situs inversus

bronchiectasis

sinusitis

A

Primary ciliary dyskinesia

(cilia is poorly functioning)

55
Q

Subpleural blebs lined focally by mesothelial cells

A

paraseptal emphysema

56
Q

Clinical manifestations of tension pneumothorax

A

Respiratory distress, chest pain, tachycardia , ipsilateral air entry , deviation of mediastinal structures to contralateral side, compromised cardiopulmonary function, hypotension, death

57
Q

Therapy that reduces mortality in COPD

A

oxygen

smoking cessation

58
Q

thick basement membrane; smooth muscle hypertrophy = diagnosis?

A

Asthma

59
Q

This was removed from a patient’s lung on autopsy. Possible cause of death?

A

asthma attack

60
Q

Total protein (pleural fluid/serum ratio) =

A

transudate effusion

61
Q

Treatment for A

A

SAMA

or SABA

62
Q

Treatment for ABPA

A

steroids (anti-inflammatory)

and anti-fungals

63
Q

Treatment for B

A

LABA or LAMA

64
Q

Treatment for C

A

ICS + LABA

or

LAMA

65
Q

Treatment for D

A

ICS + LABA

and/or LAMA

66
Q

Treatment for exudative effusion caused by connective tissue disease

A

steroids (oral)

67
Q

Treatment for mesothelioma

A

systemic chemo possibly surgical removal of pleura

68
Q

Treatment of Acute COPD

A

beta 2 agonist

anti-cholinergics

systemic corticosteroids

antibiotics

69
Q

Treatment for A

A

SAMA or SABA

70
Q

Treatment of infected parapneumonic effusion

A

= empyema treat with chest tube drainage or surgical intervention

71
Q

Treatment of sterile parapneumonic effusion

A

treat pneumonia with antibiotics

72
Q

what does this show?

A

scarring

73
Q

what is this pattern called?

A

OP

=organizing pneumonia

near airway

74
Q

what is this showing?

A

hyaline membrane

75
Q

what is this showing?

A

stage 2 organizing phase

hyaline membranes

and type II pneumocytes (regeneration)

76
Q

what is this showing? note the widening of the interstitium by fibrosis and fibroblasts with chronic inflammation

A

end stage DAD

77
Q

what is this showing?

pink stuff

A

hyaline membranes

regenerating pneumocytes

stage 2 DAD

78
Q

What is this?

A

normal bronchiole

79
Q

what type of cells are the blue ones?

what pathology is this increase in cells showing?

A

mucus cells

chronic bronchitis

P&T Block 2 (4 decks)

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