Pulmonary: Restrictive + Vascular + HTN + Miscellaneous Flashcards
1
Q
Restrictive lung disease are due to what?
A
Reduced lung compliance (Hard to fill lungs)
2
Q
Restrictive
FVC?
FEV1?
FEV1/FVC
A
FVC: reduced
FEV1: Reduced
FEV1/FVC: Normal
3
Q
Acute restrictive is defined by what symptoms (4)
A
- Acute dyspena
- Hypoxia
- Bilateral pulmonary infiltrates
- Absence of left heart failure
4
Q
How are ALI and ARDS related?
A
ALI is like early stage ARDS
5
Q
What are ALI/ARDS the most comon cause of?
A
Non-cardiogenic pulmonary edema
6
Q
ALI/ARDS is due to what (2)
A
- Direct injury to lungs
2. Indirect injury due to systemic disease
7
Q
Injury to lungs for ALI/ARDS is due to what? (3)
A
- Infections
- Toxins (Sepsis)
- Trauma
8
Q
ALI/ARDS path?
A
- Endothelial injury
- Alveolar edema
- Type II pneumocytes injured
9
Q
Cause of ALI/ARDS damage?
A
Imbalance of pro-inflammatory and anti-inflammatory cytokines
10
Q
3 major morphologic changes in ARDS/ALI?
A
- Hyaline membrane formation2
- Hepatization of lungs
- Vascular congestion
11
Q
End stage of ARDS/ALI?
A
Fibrosis and honey-combing
12
Q
What do pathologists call ARDS/ALI?
A
DAD = Diffuse alveolar destruction
13
Q
When do ARDS/ALI symptoms appear?
A
Within 72 hours of insult
14
Q
What % die in ARDS/ALI?
A
30-40% (pretty high)
15
Q
How well do ARDS/ALI survivors recover?
A
Complete regain of function within a year
16
Q
Chronic restrictive lung disease end-stage? (2)
A
- Diffuse interstitial fibrosis
2. with or without Honeycombing
17
Q
What data is important for chronic restrictive diagnosis? (2)
A
- Social
2. Occupational
18
Q
Causes of chronic restrictive lung diseases? 7
A
- Asbestos
- Silicosis
- Coal
- Drugs
- Radiation
- High O2
- Immunologic
19
Q
Definition of idiopathic pulmonary fibrosis?
A
Progressive interstitial fibrosis
20
Q
IPF/UIP sex?
Age?
How is this diagnosed
A
Males
Elderly
Diagnosis of exclusion
21
Q
How is the process of IPF/UIP in terms of morphology and age of fibrosis?
A
Heterogeneous
22
Q
Main symptom of IPF/UIP?
A
Slow, continuous dyspnea
23
Q
Sarcoidosis present how? 5
A
Lung problem in 90%
Noncaseating granulomas
Bilateral hilar and paratracheal lymphadenopathy (potato nodes)
Interstitial fibrosis
24
Q
How do you diagnose sarcoidosis?
A
Diagnosis of exclusion of any other granuloma formers (Myco, Fungi)
25
Common complications of sarcoidosis besides lung? 2
Eye
| Skin
26
Popuation of Sarcoidosis
Age
Ethnicies
Smoking
Younger than 40
Danes, Swedes, US Blacks >>>> Whites and Asians
Nonsmokers more common
27
The presumed cause of sarcoidosis?
Abnormal immune regulation in genetically predisposed people that are exposed to some enviromental stimuli
28
Genetic factors of sarcoidosis (2)
1. Familial and racial clustering
| 2. Putative antigens like viruses, myco, pollen
29
Constitutional signs
Fever
Fatigue
Myalgias
30
What if sarcoidosis has uveoparotid involvement
Mikulicz syndrome
31
What test is elevated in granulomatous disorders and hence sarcoidosis? 2
```
ACE elevated (granulomas)
Increased urine calcium (granulomas)
```
32
Hypersensitivity pneumonitis is defined how?
Immune mediated inflammatory disease of distal lung and alveoli due to sensitivity to inhaled antigens like mold, dust, chemicals
33
How does hypersensitivity pneumonitis affect the lung? (3)
1. Decreased diffusion capacity
2. Decreased lung compliance
3. Decreased lung total volume
34
acute form hypersensitivity pneumonitis presents how?
Fever, cough, dyspena 4 to 8 hours after exposure
| Go on vacation, goes away, gets back to work
35
Chronic form of hypersensitivity pneumonitis presents how?
Insidiously and not easy to diagnosis
36
Evidence that suggests hypersensitivity pneumonitis is immune mediated?
BAL fluids with increased pro-inflammatory chemokines
2. Increased CD4/CD8 ratio
3. Serum Ab's suggesting Type III
4. Noncaseating granulomas suggesting Type IV
37
Diffuse alveolar hemorrhage syndromes present how (3)
1. Hemoptysis
2. Anemia
3. Diffuse pulmonary infiltrates
38
Diffuse alveolar hemorrhage syndrome members
Goodpasture and Idiopathic Pulmonary Hemosiderosis
39
Goodpastures syndrome definition (2)
Hemorrhagic interstitial pneumonitis and crescentis glomerulonephritis
40
Goodpastures syndrome has what Ab's?
IgG against BM and glomerulis suggesting Type II hypersenstivity
41
Lungs in Goodpastures syndrome show what?
Focal necrosis of alveolar walls
Hemorrhage in alveoli
Hemosiderin laden macrophages
42
Goodpastures syndrome treatment (2)
1. Plasmapharesis
| 2. Immunosuppression
43
```
Idiopathic pulmonary hemosiderosis is similar to what?
Except for (2)
```
Presents the exact same as Goodpastures
1. No Anti-Basement membrane Ab's
2. No renal disease
44
Wegener Granulomatosis definition
Vasculitis
45
Triad of wegener granulomatosis?
1. URT crusting
2. Lower respiratory disease
3. Renal disease
46
What is the mediator of Wegener granulomatosis?
Auto Ab's against Type IV collagen in renal glomeruli and lung alveoli
47
Two necrotizing features of Wegener granulomatosis?
1. Necrotizing capillaritis
| 2. Necrotizing granulomas
48
Radiographic changes in Wegener's
Granulomas that cavitate and coalesce
49
What is Wegener granulomatosis
C-ANCA
50
Collagen vascular disease can cause pulmonary disease, which members?
SLE
RA
Scleroderma
Dermatomyositis
51
What do collagen vascular diseases most often cause?
Interstitial pneumonitis
52
What is the worst ending for collagen vascular disease?
Progressive pulmonary fibrosis leading to end-stage honeycomb lung
53
Accelerated pulmonary fibrosis in RA patients?
| Exposure to what? (3)
Caplan syndrome
Coal, silica, asbestos
54
Transplantation pulmonary
Acute rejection involves (3)
Fevers, Leukocytosis, Mimicking infections
55
Pulmonary embolism that occludes pulmonary arteries at bifurcation?
Result?
Saddle embolus
Sudden death
56
Most pulmonary emboli are what form?
DVT
57
Studies for pulmonary emboli? (3)
1. Doppler studies
2. Radiography
3. D-Dimer test (positive)
58
Predisposing conditions for PE's 7
1. Prolonged bed rest
2. Surgery to legs or knees
3. Bone fractures in the leg
4. CHF
5. Pregnancy and oral birth control
6. Inherited disease
7. Mucinous adenocarcinomas
59
What tests can you do in acute PE situations 2
1. DNA analysis
| 2. Factor V test
60
Why don't we see infarctions often in PE?
| Where will you normally see a PE infarct?
Dual blood supply
| Distal, wedge-shaped, and involves the pleural
61
How is the pain of a PE infarct described?
| What will you hear?
Positional
| Friction rub
62
Most PE's have what effect?
None, asymptomatic
63
How does HTN occur with PE's
Enough small PE's block off enough arteries to raise resistance
64
Patients with one PE have what risk for a second?
30% risk
65
Most often Pulmonary HTN is secondary to what two things?
1. Decreased pulmonary vascular cross-sectional area
| 2. Increased pulmonary vascular blood flow
66
Pulmonary HTN situations (3)
1. COPD/Interstitial lung disease
2. Recurrent PE's
3. Heart disease with left to right shunt
67
Types of secondary pulmonary hypertension? (3)
1. Plexiform pulmonary arteriopathy (most) convoluted tortuous path
2. Thrombotic pulmonary arteriopathy
3. Pulmonary venoocclusive disease
68
If you see atheromas in pulmonary vessels you have to think what?
Pulmonary hypertension
69
Morphology of PHTN? 2
1. Atheromas
| 2. Intimal and medial thickening
70
Patients with P-HTN the most?
Young females
71
Only hope for pulmonary HTN patients?
Lung transplant
72
Cancer types in lungs
1. Small cell
2. Squamous cell
3. Adenocarcinoma
73
Which cancer type in central in lungs?
Squamous
74
Adeno cancers tend to be where?
| Two populations
Peripheral
Females and smokers
75
Which cancer cavitates the most?
Squamous cell
76
most common cancer with perineoplastic syndrome?
Small cell
77
Hypercalcemia with lung cancer?
Squamous cell
78
Asbestosis is what?
Fibrosis you get from asbestos exposure
79
What is most common thing we see with asbestos?
Pleural plaques THEN fibrosis
80
Most common malignancy with asbestosis?
Bronchogenic carcinoma
81
Which cancer is most associated with asbestsos?
Mesothelioma
82
Silicosis appears how? (3)
Concentric fibrosis with nodules
Refractory material
TB infection
