Pulmonary System Pathology Flashcards
What happens in an obstructive lugng disorder? What are the major examples of obstructive diseases?
expiratory airflow limitation:
asthma COPD chronic bronchitis bronchiectasis bronchiolitis
What happens in a restrictive lung disorder? What are the major examples of restrictive diseases
reduced total lung capcity/reduced ventilatory elasticity
diffuse parenchymal or interstitial lung disease like idiopathic pulmonary fibrosis and occupational lung diseases
chest wall/pleural diseases, massive obesity, neuromuscular diseases
What volumes/capacities will be low in obstructive and what will be low in restrictive?
obstructive = forced expiratory volume low
restrictive - total lung capacity low
What should you think of with sudden respiratory distress and unlateral leg swelling?
DVT/PE
What is a normal pulse ox?
equal or over 95%
WHen you do chest imaging, what can CXR tell you?
Use to look for pulmonary or pleural disease, cardiac enlargement and mediastinal pathology
note - larger airway disease and pulmonary vascular disease are usually NORMAL on CSR
When you do chest imaging, what can CT scan do for you?
It gives much better detail for chest contents like mass lesions, larger airways, lymph nodes, aorta pathology, esophagus issues and mediastinal masses/cysts
What is atelectasis?
collapse or loss of lung volume
What are the general classifications of secondary atelectasis?
- obstructive - resorption of alveolar gas distal to bronchial obstruction by mucus
- resorptive - alveolar collapse due to pneumonia or poor lung ventilation and POST GENERAL ANESTHESIA!
- Compression - pulmonary collapse due to mass effect
- conntraction - pulmonary shrinkage due to pleural fibrosis
What are the symptoms of asthma?
episodic wheezing, dyspnea, cough with or without tenadious mucus/sputum
kids may have cough-predominant symptoms
What does a diagnosis of pneumonia require?
pulmonary infiltrate on CXR or CT - lobar or whole lung ingiltrates or cavitation with or without effusion
What’s the basis for pulmonary edema?
In general, what’s the most common cause?
it’s movement of fluid into the alveolar spaces due to hemodynamically increased alveolar capillary pressure (cardiogenic) or alveolar microvascular injury (non-cardiogenic)
CHF is the most common cause
What’s the most common cause of cardiogenic pulmonary edema
left ventricular failure due to coronary disease (MI)
but also chronic HTN, cardiomyuopathy, aortic valve disease, new-onset arrhythmias and mitral stenosis
What lab findings will tell you if a pulmonary edema is from heart failure?
serum-B-natriuretic peptide
What imaging is best for assessing LV systolic/diastolic function, cardiac pressures, valvular disease or pericardial effusion/tamponade?
echocardiography
What is the major non-cardiogenic cause of acute pulmonary edema/
acute respiratory distress syndrome
or acute lung injury
slide 248 - How do the hypersensitivity pneumonidites present clinically?
acute attacks 4-6 hours post exposure to the inhaled antigen with fever, dyspnea, cough and leukocytosis
chronically with signs of restrictive lung disease
slide 275 - WHat are three highly important causes of acquired hypercoaculability resulting in predisposition to PE?
immobilization
post-surgery
cancer
276 - True or false: patients with DVT/PE will typically have either an inherited or an acquired hypercoagulability.
false - they can have both
302 - What are the 5 most commn causes of pulmonary hemorrhage (hemoptysis) and which can cause massive hemoptysis?
bronchogenic carcinoma bronchiectasis tuberculosis bronchitis bacterial pneumoniae (the top three can cause massive)
358 - What is the commonest site of metastatic neoplasms?
the lungs
Will mets to the lung typically be multiple or single? unilateral or bilateral?
multiple and bilateral
366 - WHat is a pleural effusion?
usually there’s no more than 15 ml of clear serous fluid in each pleural cavity. In pleural effusion, you get an increase of that fluid.
What are the symptoms of pleural effusion?
atelectasis (comrpession) chest pain from pleuritis dyspnea cough fever
What is the msot common efflusion cause (in general terms)?
increased fluid production
can be from increased hydrostatic pressure (CHF)
decreased osmotic pressure 9nephrotic syndrome0
cirrhosis wih ascites (diaphragmatic transit)
peritoneal dialysis
urninothorax
What are the three clinical factors for ARDS?
inciting event
bilateral pulmonary infiltrates
hypoxemia
What are two most common causes of ARDS?
sepsis and general trauma (shock lung)
but also pulmonary infection, aspiration, inhaled irritants, drug overdose, drowning, transufsion
For chronic pulmonary ilfiltrates of unknown type, what should you do first?
Get a pulmonary medicine consult!!!!!
they’ll rule out infection, check for cancer, look for interstitial lung disease causes and then determine whether it’s idiopathic or not.
202 - ILD with a known cause is usually due to what? Aka, what’s the cause?
an inhalational exposure to an occupational/environmental particle (usually based on their employment - miners, farmers, etc.)
203 - What are the 3 smoking-related causes of interstitial lung disease?
- pulmonary langerhans cell hstiocytosis
- desquamative interstitial pneumonia/respiratory bronchiolitis interstitial lung disease
- idiopathic pulmonary fibrosis
What percentage of IPF cases are in smokers?
70%
slide 204 - What are the two most common cause of interstitial lung disease in which we don’t really understand the pathogenesis
sarcoidosis
idiopathic interstitial lung disease
Why is diagnosis for idiopathic interstitial lung disease so hard to make?
because there are tons of different entities that cause the same clinical picture.
What is the most lethal cuase of ILD?
idiopathic pulmonary fibrosis - 70-80% mortlity at 5 years post diagnosis.
Describe sarcoidosis
it’s idiopathic SYSTEMIC granulomatous disease with lung involvement in 90% of cases
What is the main cause of pulmonary hypertension?
chronic hypoxemic vasoconstriction from chronic lung disease
What is the most lethal cancer in the world? As in, what cancer kills the most people?
primary lung cancer
99% of primary lung neoplasia are what type?
carcinoma (most common visceral cancer in the world)
What are some risk factors for pimary lung cancer
smoking obviously
radiation exposure
asbestosis
pulmonary fibrosis
What are the general two types of lung cancer?
non-small cell carcinoma
small-cell carcinoma
What’s the most common non-small cell carcinoma (and most ccmmon primary lung cancer)? Who gets it?
adenocarcinoma
female dominant - can not be related to smoking
What are the other two non-small cell carcinomas?
squamous cell carcinoma
large cell carcinoma (undifferentiated
then a few miscellanceous
What lung cancer is the most likely to cause a paraneoplastic syndrome?
small cell carcinoma - neuroendocrine cells are factories for it
If you have lung cancer, what type do you want?
carcinoid tumor - usually treatable with surgery alone.
What is carcinoid tumor a tumor of?
well-differentiated neuroendocrine carcinoma
Most common lung tumors?
metastases
