Pulmonary vascular disease and pleural disease

Question 1

What is the pressure system of pulmonary circuation?

Answer 1

Low pressure

Question 2

Due to the pulmonary circulation being a low pressure system, with thin walled vessels, what is there low incidence of at normal pressure?

Answer 2

Atherosclerosis

Question 3

What is pulmonary oedema?

Answer 3

Accumulation of fluid in the lung - interstitium and alveolar spaces

Question 4

What type of pattern of disease does pulmonary oedema cause?

Answer 4

Restrictive pattern

Question 5

What are the 2 main pathological causes of pulmonary oedema?

Answer 5

1. Haemodynamic (increase in hydrostatic pressure)

2. Due to cellular injury (alveolar lining cells/alveolar endothelium)

Question 6

What condition causes localised pulmonary oedema?

Answer 6

Pneumonia

Question 7

What condition causes generalised pulmonary oedema?

Answer 7

Adult respiratory distress syndrome (ARDS)

Question 8

What is DADS?

Answer 8

Diffuse alveolar damage syndrome

Question 9

What are 4 causes of shock lung?

Answer 9

1. Sepsis
2. Diffuse infection (virus, mycoplasma)
3. Severe trauma
4. Oxygen

Question 10

What 4 things are involved in the pathogenesis of ARDS after injury (e.g. bacterial endotoxin)

Answer 10

Infliltration of inflamamtory cells
Cytokines
Oxygen free radicals
Injury to cell membranes

Question 11

Name 3 things involved with the pathology of ARDS

Answer 11

Fibrinous exudate lining alveolar walls (hyaline membranes)
Cellular regeneration
Inflammation

Question 12

What can be the outcome of ARDS?

Answer 12

Fibrosis (chronic restrictive lung disease)

Question 13

Who does neonatal RDS occur in?

Answer 13

Premature infants

Question 14

What causes neonatal RDS?

Answer 14

Deficiency in surfactant (type 2 alveolar lining cells)

Question 15

How does neonatal RDS cause physical damage to cells?

Answer 15

Increased effort in expanding lungs

Question 16

What is a detached intravascular mass carried by the blood to a site in the body distant from its point of origin?

Answer 16

Embolus

Question 17

What is an important cause of sudden death and pulmonary hypertension?

Answer 17

PE

Question 18

What are 95% of emboli?

Answer 18

Thromboemboli

Question 19

Where is the source for most pulmonary emboli?

Answer 19

DVT of lower limbs

Question 20

What are these the effects of - sudden death, severe chest pain/dyspnoea/haemoptysis, pulmonary infarction and pulmonary hypertension?

Answer 20

PE

Question 21

What do the effects of PE depend on?

Answer 21

Size of embolus
Cardiac function
Respiratory function

Question 22

What do recurrent small emboli lead to?

Answer 22

Pulmonary hypertension

Question 23

In a pulmonary infarct (ischaemic necrosis), what artery supply is compromised?

Answer 23

Bronchial artery supply

Question 24

What are the two classes of pulmonary hypertension?

Answer 24

Primary (rare, young women)

Secondary

Question 25

What are 4 mechanisms of pulmonary hypertension?

Answer 25

1. Hypoxia (vascular constriction) 2. Increased flow through pulmonary circulation (congenital heart disease) 3. Blockage (PE) or loss (emphysema) of pulmonary vascular bed 4. Back pressure from left sided heart failure

Question 26

Give the steps in the morphology of pulmonary hypertension

Answer 26

1. Medial hypertrophy of arteries 2. Intimal thickening (fibrosis) 3. Atheroma 4. Right ventricular hypertrophy 5. Extreme cases (congenital heart disease, primary pulmonary hypertension) - plexogenic change/necrosis

Question 27

What is a pulmonary hypertension complicating lung disease?

Answer 27

Cor Pulmonale

Question 28

What are three physiological features of Cor Pulmonale?

Answer 28

Right ventricular hypertrophy Right ventircular dilatation Right heart failure (swollen legs, congested liver)

Question 29

What might be seen on a CXR due to right ventricular dilatation?

Answer 29

Cardiomegaly

Question 30

What is the name for a mesothelial surface lining the lungs and medastinum?

Answer 30

Pleura

Question 31

What type of cells does the pleura have, that are designed for fluid absorption?

Answer 31

Mesothelial cells

Question 32

What two types of fluid can you get in a pleural effusion?

Answer 32

Transudate | Exudate

Question 33

What protein levels are transudate and exudate pleural effusions?

Answer 33

Transudate - low protein | Exudate - High protein

Question 34

What two conditions can lead to pleural effusion transudate?

Answer 34

Cardiac failure | Hypoproteinaemia

Question 35

What four conditions can lead to pleural effusion exudate?

Answer 35

Pneumonia TB Connective tissue disease Maliganancy (primary or metastatic)

Question 36

What two factors can cause pneumothorax?

Answer 36

Trauma | Rupture of bulla

Question 37

What is a primary pleural neoplasia - malignant - called?

Answer 37

Maligannt mesothelioma

Question 38

What disease is closely related to mesothelioma?

Answer 38

Asbestosis

Question 39

What investigation can you do for malignant effusions?

Answer 39

Cytology, biopsy

Question 40

Where does the dual blood supply for the pulmonary circulation come from?

Answer 40

Pulmonary veins | Bronchial arteries