Pulmonary Pathology Flashcards
Bacterial pneumonia
Intra-alveolar bacterial infection
Gram +: pneumococcal pneumonia
Gram -: result in early tissue necrosis and access formation
Shaking chills Fever Chest pain if pleuritic involvement Cough becoming productive of purulent, blood-streaked or rusty sputum Decreased or bronchial breath sounds and/or crackles Tachypnea Increased WBC count Hypoxemia, hypocapnea initially Hypercapnia with increasing severity CXR confirmation of infiltrate
Viral pneumonia
Interstitial or intra-alveolar inflammatory process caused by viral agents
Recent history of URI Fever Chills Dry cough Headaches Decreased breath sounds and/or crackles Hypoxemia and hypercapnia Normal WBC count CXR confirmation of interstitial infiltrate
Aspiration pneumonia
Aspirated material causes acute inflammatory reaction within lungs
Usually found in patients with dysphagia, fixed neck extension, intoxication, impaired consciousness, neuromuscular disease or recent anesthesia
Sx begin shortly after aspiration (hours)
Cough may be dry at onset, progresses to produce putrid secretions
Dyspnea
Tachypnea
Cyanosis
Tachycardia
Wheezes and crackles with decreased breath sounds
Hypoxemia, hypercapnia in severe cases
Chest pain over involved area
Fever
WBC count shows varying degrees of leukocytosis
CXR initially shows pneumonitis
Chronic aspiration shows necrotizing pneumonia with cavitation
Tuberculosis (TB)
Mycobacterium tuberculosis infection spread by aerosolized droplets from an untreated infected host.
Incubation period: 2-10 weeks
Primary disease lasts 10 days-2 weeks
Post primary infection: reactivation of dormant infection, can occur years after
2 weeks on anti tuberculin drugs –> non infectious host
While infectious: isolation in negative-pressure room
Medication: 3-12 months
Mild sx: slight nonproductive cough, low-grade fever, possible CXR changes
Fever Weight loss Cough Hilar adenopathy: enlargement of lymph nodes surrounding hilum Night sweat Crackles Hemoptysis: blood-streaked sputum WBC shows increased lymphocytes CXR shows upper lobe involvement with air space densities, cavitation, pleural involvement, and parenchymal fibrosis
Pneumocystis pneumonia (PCP)
Caused by fungus in immunocompromised hosts (following transplantation, neonates or HIV patients)
Insidious progressive SOB Nonproductive cough Crackles Weakness Fever Chest X-ray shows interstitial infiltrates CBC shows no evidence of infection
SARS (Severe acute respiratory syndrome)
Atypical illness caused by a cornovirus.
Southern mainland China, Singapore, Toronto, Vietnam and Hong Kong
High temperature
Dry cough
Increased WBC, decreased platelets and lymphocytes
Increased liver function tests
Abnormal CXR with borderline breath sound changes
Chronic obstructive pulmonary disease (COPD)
Airflow limitation that is not fully reversible, limitation is progressive and associated with an abnormal inflammatory response of the lungs to noxious particles/gases
Cough/sputum production/hemoptysis
Dyspnea on exertion
Breath sounds decreased with adventitious sounds
Increased respiratory rate (RR)
Weight loss/anorexia
Increased A-P diameter of chest wall
Cyanosis
Clubbing
Postures to structurally elevate shoulder girdle
CXR showing hyperinflation, flattened diaphragms, hyper lucency
ABG changes of hypoxemia, hypercapnia
PFTs: decreased FEV1, FVC, FEV1/FVC ratio and increased FRC and RV
COPD Stage 1 (Mild)
FEV1/FVC 80% predicted
With or without chronic symptoms
COPD Stage 2 (Moderate)
FEV1/FVC
COPD Stage 3 (Severe)
FEV1/FVC
COPD Stage 4 (very severe)
FEV1/FVC
Asthma
Increased reactivity of trachea and bronchi to various stimuli leading to widespread narrowing of AW due to inflammation, smooth muscle constriction and secretions
Wheezing, possible crackles, decreased breath sounds Increased secretions of variable amounts Dyspnea Increased accessory muscle use Anxiety Tachycardia Tachypnea Hypoxemia Hypocapnia Cyanosis PFTs: impaired flow rates CXR: hyperlucency and flattened diaphragms during exacerbation
Cystic Fibrosis (CF)
Genetically inherited disease with thickening of secretions of all exocrine glands leading to obstruction
Clinical signs: meconium ileus, frequent respiratory infections,inability to gain weight
Diagnosis: blood test indicating trypsinogen or positive sweat electrolyte test
Onset of symptoms: early childhood
Dyspnea, esp. on exertion
Productive cough
Hypoxemia, hypercapnea
Cyanosis
Clubbing
Use of accessory muscles of ventilation
Tachypnea
Crackles, wheezes and/or decreased breath sounds
PFTs: obstructive or restrictive pattern, or both
CXR: increased marines, findings of bronchiectasis, and/or pneumonitis
Bronchiectasis
Chronic congenital or acquired disease with abnormal dilation of bronchi and excess sputum production
Cough and expectoration of large amounts of mucopurulent secretions Frequent secondary infections Hemoptysis Crackles, decreased breath sounds Cyanosis Clubbing Hypoxemia Dyspnea CXR shows increased bronchial markings with interstitial changes
Respiratory distress syndrome (RDS)
Alveolar collapse in premature infant due to lung immaturity and inadequate level of pulmonary surfactant
Respiratory distress Crackles Tachypnea Hypoxemia Cyanosis Accessory muscle use Expiratory grunting, flaring nares CXR: classic granular pattern (ground glass) due to distended terminal AW and alveolar collapse
PT: increased breathing effort caused by handling a premature infant must be weighed against benefits of PT
Bronchopulmonary dysplasia
Obstructive pulmonary disease; sequela of premature infants with RDS due to high pressures of mechanical ventilation, high fractions of inspired oxygen and/or infection
Lung areas show pulmonary immaturity and dysfunction due to hyperinflation
Hypoxemia, hypercapnea Crackles, wheezing, and/or decreased breath sounds Increased bronchial secretions Hyperinflation Frequent lower respiratory infections Delayed growth and development Cor pulmonale CXR: hyperinflation, low diaphragms, atelectasis and/or cystic changes
Restrictive disease due to alterations in lung parenchyma and pleura
Fibrotic changes within pulmonary parenchyma or pleura due to idiopathic pulmonary fibrosis, asbestosis, radiation pneumonitis, oxygen toxicity
Dyspnea Hypoxemia, hypocapnea Crackles Clubbing Cyanosis PFTs: reduction in VC, FRC and TLC CXR: reduced lung vol, diffuse interstitial infiltrates and/or pleural thickening
Restrictive disease due to alterations in chest wall
Restricted motion of bony thorax
Shallow, rapid breathing Dyspnea Hypoxemia, hypocapnea Cyanosis Clubbing Crackles Reduced cough effectiveness PFTs: reduced VC, FRC and TLC CXR: reduced lung vol, atelectasis
Restrictive disease due to alterations in the neuromuscular apparatus
Decreased muscular strength lead stop inability to expand rib cage
Dyspnea Hypoxemia, hypocapnia Decreased breath sounds, crackles Clubbing Cyanosis Reduced cough effectiveness PFTs: reduced VC, TLC CXR: reduced lung vol, atelectasis
Bronchogenic Carcinoma
Small cell carcinoma and non-small cell carcinoma leads to obstruction or compression of AW, blood vessel or nerve
Local mets: pleura, chest wall, mediastinal structures
Distal mets: lymph nodes, liver, bone, brain an adrenals
Unexplained weight loss
Hemoptysis
Dyspnea
Weakness
Fatigue
Wheezing
Pneumonia with productive cough due to AW compression
Hoarseness with compression of laryngeal nerve
Atelectasis or bacterial pneumonia with nonproductive cough due to AW obstruction
Chemo, radiation, surgery
Rib fracture
Flail chest
Fracture of ribs due to blunt trauma.
Flail chest: 2+ fractures in 2+ adjacent ribs
Shallow breathing
Splinting due to pain
Crepitation may be felt during ventilatory cycle over fracture site
Paradoxical movement of a flail section during ventilatory cycle
Confirmation by CXR
Pneumothorax
Air in pleural space, usually through a lacerated visceral pleura from a rib fracture or ruptured bull
Chest pain Dyspnea Tracheal and mediastinal shift away from injured side Absent or decreased breath sounds Increased tympani with mediate percussion Cyanosis Respiratory distress Confirmation by CXR
Hemothorax
Blood in pleural space, usually from a laceration of parietal pleura
Chest pain Dyspnea Tracheal and mediastinal shift away from injured side Absent or decreased breath sounds Cyanosis Respiratory distress Confirmation by CXR
Lung contusion
Blood and edema within alveoli and interstitial space due to blunt chest trauma with or without rib fractures
Cough with hemoptysis Dyspnea Decreased breath sounds and/or crackles Cyanosis Confirmation of CXR by ill-defined patchy densities
Pulmonary edema
Seepage of fluid from pulmonary vascular system into interstitial space; may cause alveolar edema
Cardiogenic: increased pressure in pulmonary capillaries assoc. with LV failure, aortic valvular disease or mitral valvular dis
Non-Cardiogenic: increased permeability of alveolar capillary membranes due to inhalation of toxic fumes, hypervolemia, narcotic overdose, or ARDS
Crackles Tachypnea Dyspnea Hypoxemia Peripheral edema (cardiogenic) Cough with pink, frothy secretions CXR: increased valvular markings, hazy opacities in gravity-dependent areas of lung in butterfly pattern Atelectasis possible
Pulmonary emboli
Thrombus from peripheral venous circulation becomes embolic and lodges in pulmonary circulation
History consistent with pulmonary emboli: DVT, oral contraceptives, recent abdominal or hip surgery, polycythemia, prolonged bed rest
Sudden onset of dyspnea
Tachycardia
Hypoxemia
Cyanosis
Auscultatory: normal or crackles and decreased breath sounds
V/Q scan: perfusion defects with concomitant normal ventilation
Chest pain
Hemoptysis
CXR: decreased vascular markings, high diaphragm, pulmonary infiltrate and/or pleural effusion
Pleural effusion
Excess fluid between visceral and parietal pleura caused by increased pleura permeability to proteins from inflammatory diseases within pleural space, decreased osmotic pressure, or interference of pleural reabsorption from tumor
Decreased breath sounds over effusion
Mediastinal shift AWAY from large effusion
Breathlessness with large effusions
CXR: fluid in pleural space in gravity-dependent areas of thorax if >300mL
Pain and fever only if pleural fluid is infected
Atelectasis
Collapsed or airless alveolar unit caused by hypoventilation due to pain during ventilatory cycle, internal bronchial obstruction, external bronchial compression, low TV, or neurologic insult
Decreased breath sounds Dyspnea Tachycardia Increased temperature CXR with platelike streaks
