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MHD/Pharm Block 6 > Pulm Flashcards > Flashcards

Pulm Flashcards

1
Q

Acute Interstitial Pneumonia: Pathogenesis and presentation

A

.Similar presentation to ARDS. Influenza like illness followed by shortenss of breath.

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2
Q

Diagnosis of Bronchiectasis

A

Histology/pathology shows Large airways are visible all the way to the lung periphery. CXR shows “Signet ring sign”, “Tram tracking” , PFT shows decreased FEV1/FVC

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3
Q

Management and prognosis of Neonatal Respiratory Distress Syndrome (NRDS)

A

Treatment options: CPAP, Exogenous surfactant

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4
Q

Management and prognosis of Squamous cell carcinoma

A

5 year survival is 5-7.5%

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5
Q

Pathology of Asthma

A

Histology/pathology shows Bronchial smooth muscle proliferation, eosinophils in the submucosa, thickened basement membrane. Can see Curschmann spirals, Charcot-Leyden crystals. PFT shows FEV1/FVC

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6
Q

Management and prognosis of Pleural effusion - exudative

A

Uncomplicated exudative: treat the cause. Complicated exudative: serial taps to drain fluid

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7
Q

Diagnosis of Adenocarcinoma

A

Histology/pathology shows Peripheral tumors. Well demarcated spiculated mass with central scarring. Gland forming or mucin containing cells. . Mutated genes: EGFR, ALK fusions, KRAS

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8
Q

Diagnosis of Acute Interstitial Pneumonia

A

Histology/pathology shows DAD with brisk interstitial fibroblastic proliferation.

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9
Q

Management and prognosis of Central sleep apnea

A

CPAP

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10
Q

Management and prognosis of Pleural effusion - transudative

A

Treat the cause

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11
Q

Diagnosis of Pleural effusion - exudative

A

Lights criteria for exudates: looks at protein, LDH and cholesterol levels. CXR shows blunting of the costophrenic angle, meniscus sign with white out of one lung, mediastinum shifted away

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12
Q

Pneumonia: Pathogenesis and presentation

A

Increased risk in elderly, smokers, pulmonary disease, recent viral illness, diabetes, chronic renal disease, immunodeficiency.Cough, sputum, fever, shortness of breath.

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13
Q

Diagnosis of Pneumothorax

A

Hyperresonant lungs, unilateral hyperinflation. CXR shows trachea and mediastinal shift toward affected lung

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14
Q

Diagnosis of Chronic Bronchitis

A

Histology/pathology shows Mucus glands hypertrophy, inflammation, fibrosis. Reid index (gland to wall ratio) elevated.. Clinical dx: Persistent productive cough for at least three consecutive months in at least two consecutive years. PFT shows FEV1/FVC

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15
Q

Diagnosis of Neonatal Respiratory Distress Syndrome (NRDS)

A

Histology/pathology shows Diffuse alveolar damage: pneumocyte and endothelial cell necrosis, edema, hyaline membrane formation.

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16
Q

Diagnosis of Idiopathic Pulmonary Fibrosis

A

Histology: Usual interstitial pneumonia, Morphology: cobblestoned pleural surface with non-uniform fibrosis. Honecomb fibrosis is seen. CXR or CT shows honeycombing of subpleural regions. Trichrome stain can be used to confirm collagen deposition. PFT shows decreased TLC

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17
Q

Diagnosis of Pneumoconioses

A

Histology/pathology shows inhaled particles anthracosis = coal deposits, whorls= silica. CXR showing fibrotic lung. PFT shows decreased TLC

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18
Q

Management and prognosis of Adenocarcinoma

A

Metastasizes early. 5 year survival is 10-12%

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19
Q

Diagnosis of Mesothelioma

A

Histology/pathology shows Tumor spreads widely in pleural space, invades by contiguous spread or diffuse seeding. . Chromosome deletions (1p, 3p, 6q, 9p, 22q) and somatic mutations of TSGs (p16/CDKN2A, NF2)

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20
Q

Management and prognosis of Tuberculosis

A

Long term therapy. “RIPE”

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21
Q

Tuberculosis: Pathogenesis and presentation

A

Droplets inhaled, macrophages take up and granuloma forms. Primary infection usually causes latent TB. Secondary disease (10% of infection) is reactivated infection in upper lung and/or extrapulmonary sites.Usually in foreign born individuals, AIDS patients. Infection progresses to disase 10% of the time. Restrictive lung disease

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22
Q

Diagnosis of Obesity-hypoventilation syndrome

A

Polysomnography, Apnea hypopnea index > 5 (episodes per hour)

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23
Q

Diagnosis of Central sleep apnea

A

Polysomnography, Apnea hypopnea index > 5 (episodes per hour)

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24
Q

Diagnosis of Large cell carcinoma

A

Histology/pathology shows Undifferentiated cells. No squamous or glandular differentiation is seen..

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25
Q

Diagnosis of Kartagener Syndrome

A

Histology/pathology shows Cilia and flagella lose their dynein arms, are thus unable to move.

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26
Q

Bronchiectasis: Pathogenesis and presentation

A

Obstruction, infection, or congenital defects can cause permanent dilatation of the bronchi and bronchioles caused by destruction of muscle and elastic tissue.Cough, purulent sputum, persistent or severe infections

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27
Q

Management and prognosis of Pulmonary embolism

A

Depends on degree of occlusion. Treated with anticoagulation. Could be fatal, could lead to recurrent PE.

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28
Q

Diagnosis of Carcinoid tumor

A

Split into typical (low mitotic rate, no necrosis) and atypical (more frequent mitosis, focal necrosis).

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29
Q

Diagnosis of Pulmonary Edema/ High pressure pulmonary edema

A

Pathology shows distended lungs, frothy fluid oozes out. Histology shows congested capillaries and acellular fluid filled air spaces. CXR shows cardiomegaly, pleural effusions, alveolar opacities

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30
Q

Management and prognosis of Asthma

A

Treated with “relievers” (beta agonists), used as needed, and “controllers”(corticosteroids), used regularly.

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31
Q

Diagnosis of Small cell carcinoma

A

Histology/pathology shows centrally arising tumors. Densely packed tumor with small blue cells with round/ovoid nuclei, scant cytoplasm, “salt and pepper” chromatin. Inactivation of p53 and RB in all cases. Also show loss of 3p, 4q, 5q, 13q and 15q

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32
Q

Management and prognosis of Sepsis

A

Goal directed fluid resuscitation, control source of infection with ABX, vasopressors, support failing organs. High mortality

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33
Q

Obstructive sleep apnea: Pathogenesis and presentation

A

Increased risk in obese, large neck circumference, hypertension, elderly men, smokers.Upper airway obstruction causes periods of apnea, chest/abdominal effort remains

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34
Q

Diagnosis of Emphysema

A

Histology/pathology shows Hyperinflated lungs with formation of bullae. Histology shows hugely distended alveoli with no fibrosis or thickened septa. 4 classes based on location: centriacinar, panacinar, distal acinar, irregular. PFT shows decreased FEV1/FVC

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35
Q

Small cell carcinoma: Pathogenesis and presentation

A

Rapidly growing high grade neuroendocrine tumor.Smokers. Lung cancer presenting with cough, weight loss, chest pain, dyspnea.

36
Q

Alpha 1 Antitrypsin Deficiency: Pathogenesis and presentation

A

Genetic deficiency of alpha 1 antitrypsin predisposes individuals to emphysema.

37
Q

Large cell carcinoma: Pathogenesis and presentation

A

.Non-small cell lung cancer. Lung cancer presenting with cough, weight loss, chest pain, dyspnea.

38
Q

Idiopathic Pulmonary Fibrosis: Pathogenesis and presentation

A

Repeated cycles of epithelial activation/injury by an unidentified agent leads to abnormal epithelial repair, firboblastic proliferation, collagen deposition.Men>Women, 40-70yo present with dyspnea on exertion, dry cough, velcro crackles. Restrictive lung disease

39
Q

Diagnosis of Pulmonary embolism

A

Histology can determine type of substance causing obstruction, decreased lumenal diameter. PE causes red infarct of lung.

40
Q

Neonatal Respiratory Distress Syndrome (NRDS): Pathogenesis and presentation

A

Deficiency of surfactant prevents lungs from inflating after birth. Increased surface tension causes collapse, damage to alveolar walls.Higher risk in premies, maternal diabetes and C-section

41
Q

Sarcoidosis: Pathogenesis and presentation

A

Unknown etiology. Involves an increases T helper CD4 immune response .Multisystem disease affecting young adults (more common in African Americans, Danish and Swedish). Usually in upper lobes. No association with smoking. Restrictive lung disease.

42
Q

Diagnosis of Tuberculosis

A

Histology/pathology shows Ghon focus is primary site of lung infection. Ranke complex is calcified Ghon complex. Sputum smears will be AFB+. Positive PPD indicates previous exposure to TB. Quantiferon assay is blood test that confirms infection. CXR showing upper lung field infiltrates, cavities.

43
Q

Diagnosis of Pneumonia

A

Histology/pathology shows Infection can cause tissue destruction, necrosis, suppuration, cavitation. Exam shows consolidation (seen on CXR), elevated WBC. Causative agent can be determined by micro lab.

44
Q

Diagnosis of Squamous cell carcinoma

A

Histology/pathology shows Tumors arise centrally. Intercellular bridges and keratinization will be seen. Highest frequency of p53 mutations

45
Q

Diagnosis of Acute Respiratory Distress Syndrome (ARDS)

A

Histology/pathology shows Diffuse alveolar damage: pneumocyte and endothelial cell necrosis, edema, hyaline membrane formation. CXR shows bilateral infiltrates

46
Q

Management and prognosis of Acute Respiratory Distress Syndrome (ARDS)

A

High mortality. Underlying condition must be identified and treated. Of those who recover, 50% restore to normal lung architecture, 50% progress to honeycomb fibrosis

47
Q

Pulmonary Edema/ High pressure pulmonary edema: Pathogenesis and presentation

A

Main cause is left heart failure or volume overload. Could also becaused by microvascular injury..

48
Q

Pleural effusion - transudative: Pathogenesis and presentation

A

Caused by increased pressure gradients: LV failure, nephrotic syndrome, cirrhosis, malnutrition, atelectasis.Present asymptomatic, or can have pain, dyspnea, respiratory failure

49
Q

Adenocarcinoma: Pathogenesis and presentation

A

Progress through atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive adenocarcinoma.More frequent in women, not associated with smoking. Non-small cell lung cancer

50
Q

Upper respiratory tract infections: Pathogenesis and presentation

A

Most common infection in US. Present with rhinitis, sinusitis, otitis, pharyngitis, laryngotracheitis, epiglotitis, bronchitis

51
Q

Pleural effusion - exudative: Pathogenesis and presentation

A

Caused by leaky pleura: infection, inflammation, cancer or direct entry of ascitic fluid, blood, lymph or GI secretions.Present asymptomatic, or can have pain, dyspnea, respiratory failure

52
Q

Management and prognosis of Large cell carcinoma

A

Poor prognosis. Metastasize to liver, adrenals, brain. 5 year survival is 2-3%

53
Q

Management and prognosis of Mesothelioma

A

Poor prognosis. Rare to survive more than a year

54
Q

Diagnosis of Sarcoidosis

A

Histology/pathology shows Non-caseating granulomas. Can see calcification (Schaumann bodies) and asteroid bodies within the giant cells. Diagnosis of exclusion (rule out TB, fungi). CXR shows bilateral hilar LAD and nodules in the lung parenchyma. PFT shows decreased TLC

55
Q

Diagnosis of Obstructive sleep apnea

A

Polysomnography, Apnea hypopnea index > 5 (episodes per hour)

56
Q

Management and prognosis of Obesity-hypoventilation syndrome

A

Weight loss, CPAP

57
Q

Kartagener Syndrome: Pathogenesis and presentation

A

Autosomal recessive disorder of the cilia.Sinusitis, bronchiectasis, situs inversus (flipped organs), infertility

58
Q

Management and prognosis of Emphysema

A

Treatment: stop smoking!, short or long acting bronchodilators

59
Q

Management and prognosis of Idiopathic Pulmonary Fibrosis

A

Poor prognosis. Mean survival less than 3 years. Lung transplant is only definitive treatment. Experimental treatment: pirfenidone, nintedanib

60
Q

Management and prognosis of Alpha 1 Antitrypsin Deficiency

A

Recombinant antitrypsin can be administered

61
Q

Carcinoid tumor: Pathogenesis and presentation

A

Low grade malignant neuroendocrine tumor, locally invasive but rarely metastasizes.Presents early (40yo). Lung cancer presenting with cough, weight loss, chest pain, dyspnea.

62
Q

Diagnosis of Atelectasis

A

Histology/pathology shows Loss of alveolar space, septa all pushed together. CXR shows mediastinal shift (toward resorptive lung, or away from compressed lung)

63
Q

Diagnosis of Pleural effusion - transudative

A

CXR shows blunting of the costophrenic angle, meniscus sign with white out of one lung, mediastinum shifted away

64
Q

Mesothelioma: Pathogenesis and presentation

A

Tumor encases entire lung, acts like a very severe restrictive lung disease..Pleural tumor related to asbestos exposure. Presents with chest pain, dyspnea, recurrent pleural effusion.

65
Q

Pneumothorax: Pathogenesis and presentation

A

Air in the pleura causes lung to collapse. Air either from alveoli or enters from hole in the chest wall.Often asymptomatic, but could present with chest pain, dyspnea, cough, shock (if tension)

66
Q

Management and prognosis of Atelectasis

A

Resorptive and compression atelectasis are reversible, contraction atelectasis is not

67
Q

Management and prognosis of Obstructive sleep apnea

A

Weight loss, CPAP

68
Q

Management and prognosis of Pneumothorax

A

Tension pneumothorax is problematic due to air trapping, decreased venous return and hypotension. Treat: observation +/- supplemental O2. Chest tube may be needed to remove air.

69
Q

Emphysema: Pathogenesis and presentation

A

Destruction of septae leading to enlarged alveolar sacs. Mild chronic inflammation leads to imbalance between proteases and antiproteases.”COPD”, “Pink puffer” presents with dyspnea, hyperinflated chest, often appear cachectic

70
Q

Management and prognosis of Bronchiectasis

A

Permanent damage. Can cause respiratory insufficiency, cor pulmonale, brain abscesses and amyloidosis. Therapy focused on airway clearance, anti-inflammation, and ABX

71
Q

Sepsis: Pathogenesis and presentation

A

Massive inflammatory response triggered by TNFalpha and IL1. Triggers DIC, vasodilation, cellular injury, .Fever, tachycardia, tachypnea, elevated white count with a positive culture. Septic shock also includes organ dysfunction, hypoperfusion

72
Q

Pneumoconioses: Pathogenesis and presentation

A

Accumulation of small dust particles terminal small airways and air sacs. Macrophages take up particles causing inflammatory response, fibrogenesis and collagen deposition. .Respiratory insufficiency in patients that have exposure to coal, silica, or asbestos. Restrictive lung disease

73
Q

Management and prognosis of Pneumonia

A

Treated with macrolide or doxycycline for outpatient. FQ or beta lactam+macrolide for inpatient Mortality 5% for outpatients, 15-20% for inpatients

74
Q

Management and prognosis of Chronic Bronchitis

A

Can cause cor pulmonale, promote infections, trigger bronchogenic carcinoma (via metaplasia). Treatment: stop smoking!, short or long acting bronchodilators

75
Q

Central sleep apnea: Pathogenesis and presentation

A

CHF and CNS disease increase risk.Failure of brain to initiate respiration, no rib or abdominal effort

76
Q

Management and prognosis of Carcinoid tumor

A

Good prognosis: 50-95% 5 year survival rate

77
Q

Management and prognosis of Sarcoidosis

A

Most recover with minimal manifestations. 20% have permanent loss of lung or eye function. Cardiac, CNS complications may cause death.

78
Q

Atelectasis: Pathogenesis and presentation

A

Incomplete expansion of the lungs, collapsed lungs due to resporption, compression or contraction.Resorption is when obstruction leads to collapse of lung distally. Compression is when something pushes lung to collapse. Contraction is due to scarring of lung tissue that causes collapse

79
Q

Management and prognosis of Small cell carcinoma

A

Rarely resectable. Treated with radiotherapy, chemotherapy. 5 year survival is 5-8%

80
Q

Chronic Bronchitis: Pathogenesis and presentation

A

“COPD” Often in smokers, urban dwellers, middle aged men. “Blue bloater” presents with productive cough, infection, mild dyspnea

81
Q

Squamous cell carcinoma: Pathogenesis and presentation

A

Precursor lesions: squamous metaplasia, dysplasia, carcinoma in-situ.Men with smoking history. May be hypercalcemic from paraneoplastic PTH secretion. Non-small cell lung cancer. Lung cancer presenting with cough, weight loss, chest pain, dyspnea.

82
Q

Asthma: Pathogenesis and presentation

A

Intermittent and reversible airway obstruction with eosinophilic bronchial inflammation, bronchial smooth muscle hypertrophy, and increased mucus production. .Wheezing, breathlessness, chest tightness, cough. Triggered by infections, irritants, cold air, stress or exercise. Symptoms come and go, are reversible

83
Q

Pulmonary embolism: Pathogenesis and presentation

A

Intravascular substance (thrombi, atherosclerotic plaque, amniotic fluid, air, fat) carried by blood into the lung. Often DVT dislodging to form embolus.

84
Q

Management and prognosis of Pneumoconioses

A

Progressive fibrosis. Asbestosis associated with malignant mesothelioma and lung cancer, especially in smokers

85
Q

Acute Respiratory Distress Syndrome (ARDS): Pathogenesis and presentation

A

Main causes: sepsis, diffuse pulmonary infections, gastric aspiration, mechanical trauma/head injuries. 3 Phases: early exudative phase, subacute proliferative phase, fibrotic phase. Imbalance of pro-inflammatory and anti-inflammatory mediators.Rapid onset, tachypnea, dyspnea, cyanosis with severe arterial hypoxemia, may progress to multisystem organ failure

86
Q

Diagnosis of Sepsis

A

SIRS criteria. Labs will show elevated WBCs, CRP, glucose, creatinine, liver enzymes, lactate

MHD/Pharm Block 6 (4 decks)

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