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First Aid > pulmonary 3 > Flashcards

pulmonary 3 Flashcards

1
Q

What drugs can cause restrictive lung disease?

A

bleomycin, busulfan, amiodarone, methotrexate

Always check drug history!

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2
Q

Describe Sarcoidosis.

A

“A GRUELING DISEASE”

A= ACE & ca2+ increase; G= granulomas (non-caseating); R= Rheumatoid Arthritis; U= uveitis; E= erythema nodosum; L= lymphadenopathy; I= idiopathic; N= non-caseating granuloma; G= gammaglobulinemia; V= Vitamin D increase.

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3
Q

What is idiopathic pulmonary fibrosis?ADD PICTURE OF HONEYCOMB

A

Repeated cycles of lung injury & wound healing with increased collagen deposition, “honey-comb” lung appearance & digital clubbing.

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4
Q

Antibody for Goodpasture Syndrome? What organ does this condition affect?

A

Anti Glomerular-BM antibodies

Affects the lung & kidney (glomerulonephritis).

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5
Q

What is found on histology for Pulmonary Langerhans cell histiocytosis? Risk factor for this disease?

A

Langerhan’s-like cells on histology with Birbeck granules inside (tennis racket shaped granules)

Smoking.

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6
Q

What direction does the Flow-Volume Loop go for Obstructive diseases?

A

Left.

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7
Q

What direction does the Flow-Volume Loop go for Restrictive diseases?

A

Right.

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8
Q

Describe FEV1 & FVC for obstructive & restrictive diseases.

A

FEV1 & FVC are decreased for both. However, FEV1 is more dramatically reduced compared to FVC, resulting in a decreased FEV1/FVC ratio.

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9
Q

What is the pathogenesis for Hypersensitivity pneumonitis?

A

Mixed type III/IV hypersensitivity reaction to environmental antigen leading to dyspnea, cough, chest tightness, headache.

Often seen in farmers & those exposed to birds.

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10
Q

What is the overall title for pneumoconioses?

A

“Environmental lung disease”

Chronic, fibrotic lung disease due to inhalation of environmental dust.

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11
Q

What do coal worker’s pneumoconiosis, silicosis & asbestosis increase the risk for?

A

Cor pulmonale, cancer & Caplan syndrome (rheumatoid arthritis & pneumoconioses with intrapulmonary nodules).

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12
Q

How is asbestosis transmitted?

A

Shipbuilding, roofing, plumbing.

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13
Q

What lobes does Asbestosis affect?

A

Lower lobes.

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14
Q

What does having Asbestosis increase the risk of getting?

A

1) Bronchogenic carcinoma > risk of mesothelioma; 2) pleural effusions.

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15
Q

How is Beryllioses transmitted?

A

Exposure to beryllium in aerospace & manufacturing industries.

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16
Q

What is seen on histology in Beryllioses?

A

Granulomatous (non-caseating granulomas via cell-mediated immunity induction)

Looks like Sarcoidosis.

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17
Q

What lobes are affected in Beryllioses?

A

Upper.

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18
Q

What will be seen on chest X-ray in silicosis and anthracosis?

A

“Eggshell” calcification of hilar lymph nodes.

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19
Q

How is Coal worker’s pneumoconiosis transmitted?

A

Prolonged coal dust exposure leading to macrophages laden with carbon, inflammation & fibrosis.

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20
Q

What is Coal worker’s pneumoconiosis also known as?

A

Black lung disease.

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21
Q

What lobes are affected in Coal worker’s pneumoconiosis?

A

Upper.

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22
Q

What is Anthracosis?

A

Asymptomatic condition found in many urban dwellers exposed to sooty air.

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23
Q

How is Silicosis transmitted?

A

Foundries, sandblasting, mines.

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24
Q

Pathogenesis of Silicosis?

A

Macrophages respond to silica & release fibrogenic factors, leading to fibrosis.

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25
Q

What is thought that Silica disrupts & what does this potentially cause?

A

Disrupt phagolysosomes & impair macrophages, increasing susceptibility to TB.

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26
Q

What lobes are affected in Silicosis?

A

Upper.

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27
Q

What is the only pneumoconioses that affects the lower lobes?

A

Asbestosis.

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28
Q

What is the only pneumoconioses that does not increase the risk for getting cancer?

A

Coal worker’s pneumoconiosis.

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29
Q

What will be seen histologically in asbestosis?

A

Hemosiderin-laden asbestos (ferruginous) bodies are golden-brown rods resembling dumbbells, found in alveolar septum sputum sample, visualized using Prussian Blue stain.

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30
Q

Aside from noncaseating granulomas, what will be seen histologically in sarcoidosis?

A

“Asteroid bodies:” stellate inclusions within giant cells of the granulomas.

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31
Q

What will be seen on CXR in asbestosis?

A

“Ivory white” calcified, supradiaphragmatic & pleural plaques but NOT precancerous.

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32
Q

What is ARDS?

A

Clinical syndrome characterized by acute onset respiratory failure, bilateral lung opacities, decreased PaO2/FIO2, no evidence of HF/fluid overload.

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33
Q

What are the causes of ARDS?

A

“SPARTAS”

S= sepsis; P= pancreatitis; pneumonia; A= aspiration; R= uRemia; T= trauma; A= amniotic fluid embolism; S= shock.

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34
Q

What is the main risk factor for ARDS?

A

Alcoholism.

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35
Q

What is the pathogenesis of ARDS?

A

Endothelial damage leads to increased alveolar capillary permeability, protein-rich leakage into alveoli, diffuse alveolar damage & noncardiogenic pulmonary edema.

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36
Q

What does ARDS result in the formation of?

A

Intra-alveolar hyaline membranes.

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37
Q

What is the damage in ARDS due to?

A

Initial damage due to release of neutrophilic substances toxic to alveolar wall, activation of coagulation cascade & O2-derived free radicals.

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38
Q

Management of ARDS?

A

Mechanical ventilation with low tidal volumes, address underlying cause.

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39
Q

What is sleep apnea?

A

Repeated cessation of breathing lasting 10 seconds or longer during sleep leading to disrupted sleep and daytime somnolence.

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40
Q

What happens to the PaO2 during the day to a patient with sleep apnea?

A

Normal.

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41
Q

Complications of sleep apnea?

A

Nocturnal hypoxia leading to systemic/pulmonary hypertension, arrhythmias, sudden death.

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42
Q

What is obstructive sleep apnea?

A

Respiratory effort against airway obstruction.

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43
Q

What is associated with obstructive sleep apnea?

A

Obesity & loud snoring.

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44
Q

What is obstructive sleep apnea caused by?

A

Excess pharyngeal tissue in adults, adenotonsillar hypertrophy in kids.

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45
Q

Tx for obstructive sleep apnea?

A

Weight loss, CPAP, surgery, stimulation of CN XII.

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46
Q

Complications of obstructive sleep apnea?

A

Lungs become hypoxic leading to vasoconstriction of lung vessels & pulmonary HTN, which may turn to cor pulmonale, arrhythmias & sudden cardiac death.

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47
Q

What is Central Sleep apnea?

A

No respiratory effort due to CNS injury/toxicity, HF, opioids.

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48
Q

Who is central sleep apnea common in?

A

Pre-mature infants (tx with caffeine).

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49
Q

What is obesity hypoventilation syndrome?

A

Obesity (BMI greater than or equal to 30) leading to hypoventilation, decreased PaO2 & increased PaCO2 during sleep.

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50
Q

What is the normal pressure of the pulmonary artery?

A

10-14 mmHg.

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51
Q

What levels of pressure indicate pulmonary HTN, both at rest and during exercise?

A

Rest: >25 mmHg; Exercise: >35 mmHg.

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52
Q

What is the characterization of pulmonary HTN?

A

Arteriolosclerosis, medial hypertrophy, & intimal fibrosis of the pulmonary arteries.

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53
Q

What is the course of disease for pulmonary HTN?

A

Severe respiratory distress leading to cyanosis and RVH, eventually death from decompensated COR PULMONALE.

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54
Q

What causes primary pulmonary HTN?

A

Inactivating mutation in the BMPR2 gene, classically seen in young females.

55
Q

What is the normal function of the BMPR2 gene?

A

Inhibition of vascular smooth muscle proliferation.

56
Q

What does this BMPR2 mutation lead to?

A

Decreased vessel radius, increased resistance, & increased pulmonary arterial pressure.

57
Q

What are other causes of primary Pulmonary HTN?

A

Drugs (i.e. amphetamines, cocaine), connective tissue diseases, HIV, portal HTN, congenital heart disease, schistosomiasis.

58
Q

What are the causes of secondary pulmonary HTN?

A

1) Left heart disease; 2) Lung disease or hypoxia; 3) Chronic thromboemboli; 4) Multifactorial.

59
Q

What happens to the breath sounds, percussion, fremitus & tracheal deviation for a pleural effusion?

A

Breath sounds= decreased; percussion= dull; fremitus= decrease; tracheal deviation= none OR away from side of lesion.

60
Q

What happens to the breath sounds, percussion, fremitus & tracheal deviation for atelectasis?

A

Breath sounds= decreased; percussion= dull; fremitus= decrease; tracheal deviation= toward side of lesion.

61
Q

What happens to the breath sounds, percussion, fremitus & tracheal deviation for a simple pneumothorax?

A

Breath sounds= decreased; percussion= hyperresonant; fremitus= decrease; tracheal deviation= none.

62
Q

What happens to the breath sounds, percussion, fremitus & tracheal deviation for a tension pneumothorax?

A

Breath sounds= decreased; percussion= hyperresonant; fremitus= decrease; tracheal deviation= away from side of lesion.

63
Q

What happens to the breath sounds, percussion, fremitus & tracheal deviation for consolidation?

A

Breath sounds= bronchial breath sounds; percussion= dull; fremitus= increase; tracheal deviation= none.

64
Q

What is a pleural effusion?

A

Excess accumulation of fluid between pleural layers leading to restricted lung expansion during inspiration.

65
Q

How to treat a pleural effusion?

A

Thoracentesis to remove fluid.

66
Q

What is a transudate pleural effusion?

A

Decreased protein content due to increased hydrostatic pressure or decreased oncotic pressure.

67
Q

What is an exudate pleural effusion?

A

Increased protein content, cloudy due to malignancy, pneumonia, collagen vascular disease, trauma.

68
Q

What is a lymphatic pleural effusion?

A

AKA chylothorax, due to thoracic duct injury from trauma or malignancy.

69
Q

What is a pneumothorax?

A

Accumulation of air in the pleural space.

70
Q

Effects of a pneumothorax?

A

Unilateral chest pain & dyspnea, unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminished breath sounds, all on the affected side.

71
Q

What is a primary spontaneous pneumothorax?

A

Due to rupture of atypical sub-pleural bleb or cysts, occurs in tall, thin young males.

72
Q

What is a primary secondary pneumothorax?

A

Due to diseased lung or mechanical ventilation with use of high pressures.

73
Q

What is a traumatic pneumothorax?

A

Caused by blunt or penetrating trauma.

74
Q

What is a tension pneumothorax?

A

Air enters the pleural space but cannot exit, leading to trachea deviating away from affected lung.

75
Q

Tx for tension pneumothorax?

A

Immediate needle decompression & chest tube placement.

76
Q

Symptoms for a tension pneumothorax?

A

SOB, chest pain, tachypnea, tachycardia.

77
Q

What is pneumonia?

A

Inflammation of alveoli.

78
Q

What is lobar pneumonia caused by?

A

S. pneumoniae most commonly, also Legionella, Klebsiella.

79
Q

What are the characteristics of lobar pneumonia?

A

Intra-alveolar exudate leading to consolidation.

80
Q

What is bronchopneumonia pneumonia caused by?

A

S. pneumoniae, S. aureus, H. influenzae, Klebsiella.

81
Q

What are the characteristics of bronchopneumonia pneumonia?

A

Acute inflammatory infiltrates from bronchioles into adjacent alveoli.

82
Q

Another name for interstitial (atypical) pneumonia?

A

Walking pneumonia.

83
Q

What is interstitial (atypical) pneumonia caused by?

A

Mycoplasma, Chlamydia, Legionella, viruses.

84
Q

What are the characteristics of interstitial (atypical) pneumonia?

A

Diffuse patchy inflammation localized to interstitial areas at alveolar walls.

85
Q

What is a lung abscess?

A

Localized collection of pus within parenchyma.

86
Q

What is a lung abscess caused by?

A

Aspiration of oropharyngeal contents or bronchial obstruction.

87
Q

Tx for lung abscess?

A

Clindamycin.

88
Q

What is seen on CXR of a lung abscess?

A

Air-fluid levels.

89
Q

What is the cavitation due to?

A

Anaerobes (i.e. Bacteroides, Fusobacterium, Peptostreptococcus).

90
Q

What is a mesothelioma?

A

Malignancy of the pleura associated with asbestosis.

91
Q

What is the treatment for lung abscess?

A

Clindamycin

92
Q

What is seen on CXR of a lung abscess?

A

Air-fluid levels

Fluid levels are common in cavities (presence suggests cavitation).

93
Q

What is the cavitation in a lung abscess due to?

A

Anaerobes (i.e. Bacteroides, Fusobacterium, Peptostreptococcus)

94
Q

What is a mesothelioma?

A

Malignancy of the pleura (outer linings of the lungs) associated with asbestosis.

95
Q

What is seen on histology for a mesothelioma?

A

Psammoma bodies (round collection of Ca2+)

96
Q

What is positive in most mesotheliomas and negative in most carcinomas?

A

Cytokeratin & calretinin

97
Q

Is smoking a risk factor for mesothelioma?

A

No

98
Q

Where else can a mesothelioma arise?

A

Peritoneum, pericardium, tunica vaginalis (testes sac)

99
Q

What is another name for a Pancoast tumor?

A

Superior Sulcus Tumor

100
Q

Where is the location of a Pancoast tumor?

A

Apex of lung

101
Q

What can a Pancoast tumor cause by compression of various structures?

A

Recurrent laryngeal nerve -> hoarseness

Superior cervical ganglion -> Horner Syndrome (ipsilateral ptosis, miosis, anhydrosis)

SVC -> SVC syndrome

Sensorimotor deficit

Shoulder pain radiating toward axilla & scapula

Upper extremity edema d/t subclavian vessel compression

Spinal cord compression/paraplegia

102
Q

What causes SVC syndrome?

A

Compression of the SVC

103
Q

What are the effects of SVC syndrome?

A

Impaired blood drainage from head (facial plethora = blanching after fingertip pressure), neck (JVD), & upper extremities (edema)

104
Q

What are the most common causes of SVC syndrome?

A

Pancoast tumor & thrombosis from indwelling catheter

105
Q

Is SVC syndrome a medical emergency?

A

Yes -> can raise ICP -> headaches, dizziness, increase risk of aneurysm/rupture of intracranial arteries

106
Q

What does CXR show for pulmonary edema?

A

Bilateral, fluffy infiltrate

107
Q

What does CXR show for interstitial lung disease?

A

Bilateral reticular markings

108
Q

What does CXR show for pneumothorax?

A

Increased lucency

109
Q

What does CXR show for pleural effusion?

A

Complete hemithorax opacification

110
Q

What does CXR show for pulmonary embolism?

A

Normal

111
Q

Describe what happens to your body when you have a pneumothorax?

A

Air accumulates in the pleural space causing it to expand & compress the underlying lung which may collapse.

112
Q

What are the details of a spontaneous pneumothorax?

A

Passage of air into the pleural sac from an abnormal connection between pleura & the bronchial system as a result of bullous emphysema or some other lung disease.

113
Q

What are the symptoms of a spontaneous pneumothorax?

A

Sharp pain on one side of chest & SOB. Trachea deviates toward affected lung.

114
Q

What are the details of a tension pneumothorax?

A

Can result from trauma, lung infection or medical procedures. Air becomes trapped in the pleural space & cannot escape -> air & pressure accumulating within the chest each time the patient inhales. The lung on the affected side collapses & the mediastinum is pushed towards the contralateral side compressing the other lung -> impaired venous return, decreased CO, decreased BP, LOC -> shock & death.

115
Q

What are the symptoms for typical pneumonia?

A

Fever, cough, malaise, purulent sputum, chest pain, SOB. CXR shows a lobar infiltrate that ‘whites out’ the image.

116
Q

What is lobar infiltrate?

A

Well-defined lung consolidation

117
Q

What is a lung consolidation?

A

Region of lung tissue filled with liquid.

118
Q

What are the symptoms for atypical pneumonia?

A

Less severe symptoms, non-productive cough, headache, fatigue. CXR shows diffuse, patchy infiltrate.

119
Q

What does a CXR for a main stem bronchus lesion look like?

A

Completely opacified (‘white-out’ d/t decrease of radiolucent air) hemithorax on affected side.

120
Q

What does hemithorax mean?

A

1/2 of the chest.

121
Q

What symptoms does a patient with a main stem bronchus lesion exhibit?

A

Decreased breath sounds & deviation of trachea to the affected side suggestive of lung collapse (atelectasis).

122
Q

What is a main stem bronchus lesion caused by?

A

Lung tumor that obstructs the main stem bronchus.

123
Q

Why does the lung collapse in a main stem bronchus lesion?

A

No new air is getting in.

124
Q

What is the leading cause of cancer death?

A

Lung cancer.

125
Q

What are the symptoms of lung cancer?

A

Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic ‘coin’ lesion on CXR or noncalcified nodule on CT, weight loss, night sweats.

126
Q

What are the risk factors for lung cancer?

A

Smoking, second-hand smoke, radon, asbestos, family history.

127
Q

What is radon?

A

Heavy gas that settles down into coal mines. Grows along alveolar septa -> apparent ‘thickening’ of alveolar walls.

128
Q

What are the characteristics of a large cell carcinoma?

A

Prognosis & metastasis for a bronchial carcinoid tumor are good & rare.

129
Q

What are the symptoms of a bronchial carcinoid tumor?

A

Due to mass effect or carcinoid syndrome (flushing, wheezing & diarrhea).

‘B-FDR’
B = bronchospasm & wheezing
F = flushing
D = diarrhea
R = right sided heart lesions (i.e. valve, murmur)

130
Q

What is the histology for a bronchial carcinoid tumor?

A

Nests of neuroendocrine cells. Chromogranin A positive.

131
Q

Which lung carcinomas have some relationship with smoking?

A

Small cell, adenocarcinoma, squamous cell, large cell.

132
Q

What are the 2 lung carcinomas most likely seen in non-smokers?

A

Adenocarcinoma & bronchial carcinoid tumor.

133
Q

When will you see an increased CEA marker?

A

‘P-CLUBS’ cancer

P = pancreas
C = colon
LU = lungs
B = breast
S = stomach.

First Aid (18 decks)

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