Pulm Flashcards
cavity (with thick wall)
emphysema
25 y/o with bronchiectasis must be worked up for what disease?
CF
most cases present early childhood/neonatal, but some can present later in life
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?
Pneumothorax (iatrogenic)
ABPA
allergic bronchopulmonary aspergillosis
Acute phase of DAD is marked by what steps?
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
Aerosilized dornase-alpha (recomibinant human DNase) is used to treat what?
Cystic fibrosis
alpha 1- antitrypsin deficiency
panacinar emphysema
bronchiectasis
very high serum IgE levels
eosinophilia in blood
= ?
ABPA
Bronchopulmonary dysplasia
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
Cause of ARDS
infections resulting in sepsis
trauma, surgery, drugs, etc.
Causes of exudative effusion
abnormality/injury to pleura increased hydraulic conductance or decreased osmotic pressure connective tissue diseases pulmonary embolism tuberculosis malignancy parapneumonic effusion or empyema
causes of pulmonary edema
hemodynamic- CHF
alveolar injury
idiopathic- high altitude sickness
Causes of transudative effusion
CHF cirrhosis renal failure increased mean hydrostatic pressure or decreased plasma protein osmotic pressure
Charcot Leyden Crystal
marker for?
Asthma
Common infectious pathogens causing Acute Bronchiolitis
mycoplasma
RSV
influenza
COPD- physical findings
barrel chest
increased tympany to percussion
retraction of chest wall at base (hoober’s sign)
pursed-lipped breathing
cyanosis
prolonged expiratory phase
rhonchi
COPD- Clubbing or no?
No
CT- diagnosis?
Normal
DAD caused by what?
radiation
huge pneumocytes
hyaline membranes
Definition of Chronic Bronchitis
presence of cough and sputum production for at least 3 months of 2 consecutive years
Diagnosis of CF
clinical symptoms, sibling with CF, abnormal newborn screen AND evidence of CFTR dysfunction
requires 2 abnormal sweat tests (>60) to make diagnosis
Diagnosis?
bronchiectasis
– inflammatory destruction of wall
Diagnosis?
paraseptal emphysema
blebs under the pleura and around septae
diagnosis?
traction bronchioectasis
abnormalities are secondary to parenchymal fibrosis
Difference between DAD and ARDS
DAD (diffuse alveolar damage) is a pathologic term and ARDS is a clinical term
disease?
pulmonary edema
Emphysema seen in smokers
centriacinar (centrilobular) emphysema
fiindings? diagnosis?
hyperinflation
flattened diaphragm
== COPD
focus on patient’s left lung
emphysema
lots of open air space
focus on white blob
mucoid impaction
+ dilated airways
= bronchiectasis
Hyaline membrane formation occurs in what phase?
acute phase
LAMA
long acting muscarinic antagonist (i.e. anticholinergic)
ex: tiotropium, aclidinium bromide, umeclidinium bromide
LDH (pleural fluid/serum ratio) = 0.6
exudative effusion (
lesion
cysts
likely taken from a patient with what disease?
asthma
location of hyaline membrane
alveolar space
Metastatic disease to pleura- treatment
systemic chemo chest drainage (w/ tube) pleurodesis via chemicals or mechanical long term indweilling pleural catheter
Most common pathogens for CF patients
staph aureus– kids
pseudomonas– adults
Mucus sample
what cells do you see? what can cause this?
eosinophils
asthma attack
mutation in F508
Cystic fibrosis
most common mutation
name of opacity
cause?
tree in bud
acute bronchiolitis
name of cells? disease causing them?
hemosiderin laden macrophages–> CHF
RBCs leak out of capillaries slowly and macrophages digest them
can cause hemodynamic pulmonary edema
Parapneumonic effusion
pleural effusion that occurs along with infectious pneumonia effusion can be sterile (due to irritation) or infected with bacteria (empyema)
Pathogenesis of bronchiectasis
permenant dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue of the bronchus
typically results from chronic inflammation
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?
bronchiectasis
Patient’s lung removed prior to transplant
history of smoking and dyspnea
Diagnosis?
Emphysema
pattern seen here?
diagnosis?
“finger in glove” mucoid impaction–> severe bronchiectasis secondary to ABPA
Physical findings of Pleural Effusion
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
Physiology of Tension Pneumothorax
and Causes
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
Pleurodesis
fusion of the visceral and parietal pleura
sign seen here?
diagnosis?
signet ring sign
bronchiectasis
signet ring sign
bronchiectasis
situs inversus
bronchiectasis
sinusitis
Primary ciliary dyskinesia
(cilia is poorly functioning)
Subpleural blebs lined focally by mesothelial cells
paraseptal emphysema
Clinical manifestations of tension pneumothorax
Respiratory distress, chest pain, tachycardia , ipsilateral air entry , deviation of mediastinal structures to contralateral side, compromised cardiopulmonary function, hypotension, death
Therapy that reduces mortality in COPD
oxygen
smoking cessation
thick basement membrane; smooth muscle hypertrophy = diagnosis?
Asthma
This was removed from a patient’s lung on autopsy. Possible cause of death?
asthma attack
Total protein (pleural fluid/serum ratio) =
transudate effusion
Treatment for A
SAMA
or SABA
Treatment for ABPA
steroids (anti-inflammatory)
and anti-fungals
Treatment for B
LABA or LAMA
Treatment for C
ICS + LABA
or
LAMA
Treatment for D
ICS + LABA
and/or LAMA
Treatment for exudative effusion caused by connective tissue disease
steroids (oral)
Treatment for mesothelioma
systemic chemo possibly surgical removal of pleura
Treatment of Acute COPD
beta 2 agonist
anti-cholinergics
systemic corticosteroids
antibiotics
Treatment for A
SAMA or SABA
Treatment of infected parapneumonic effusion
= empyema treat with chest tube drainage or surgical intervention
Treatment of sterile parapneumonic effusion
treat pneumonia with antibiotics
what does this show?
scarring
what is this pattern called?
OP
=organizing pneumonia
near airway
what is this showing?
hyaline membrane
what is this showing?
stage 2 organizing phase
hyaline membranes
and type II pneumocytes (regeneration)
what is this showing? note the widening of the interstitium by fibrosis and fibroblasts with chronic inflammation
end stage DAD
what is this showing?
pink stuff
hyaline membranes
regenerating pneumocytes
stage 2 DAD
What is this?
normal bronchiole
what type of cells are the blue ones?
what pathology is this increase in cells showing?
mucus cells
chronic bronchitis
