RESP Flashcards
Causes of ↓AIR FLOW
Reversible (3), Irreversible (3)?
REVERSIBLE CAUSES:
- Dynamic hyperinflation during exercise
- Contraction of smooth muscles surrounding airways
- Accumulation in bronchi of:
- Exudate
- Mucus
- Infl cells
IRREVERSIBLE CAUSES:
- Fibrosis -> narrowing of airways
- Destruction of alveoli (due to their loss of elasticity)
- Destruction of structures supporting alveoli
“Child with nasal polyp + resp defects”
Cystic Fibrosis
General Pres of LOWER Resp Path (9)?
PRES:
- Dysnea
- Cyanosis
- Diaphoresis
- Weight loss
- Fever
- Cough
- Excretions
- Chest pain
- Hemoptysis
Pleural Transudate
Def’n, Seen In (3)?
Extravascular fluid with↓protein content.
SEEN IN:
- CHF
- Hepatic Cirrhosis
- Nephrotic Sx
Pleural Exudate
Def’n, Appearance, Seen In (General + 4)?
Extravascular fluid with↑protein content.
Cloudy.
SEEN IN: states of↑vascular permeability
- Trauma
- Malignancy
- Collagen Vascular Disease
- Pneumonia
** Must be drained to avoid infection **
Pleural Lymphatic Effusion (Chylothorax)
Def’n, Appearance, Seen In (General + 2)?
Presence of lymphatic fluid in pleural space. Due to leakage from thoracic duct or one of its main tributaries.
Milky fluid.
SEEN IN: Thoracic Duct injury
- Trauma
- Malignancy
Pneumothorax
Def’n, Pres (6)?
Accumulation of air in pleural space.
PRES: (all UNILATERAL + on AFFECTED side)
- Chest expansion
- Chest pain
- Dyspnea
- ↓breath sounds
- ↓tactile fremitus
- Hyperresonance
Spontaneous Pneumothorax
Mech, Pres (2 Epi + 2)?
THINK: Trachea + Diaphragm occupy empty space
RUPTURE of subpleural bleb -> HOLE in pleura ->
Collapse of portion of lung.
PRES: MC in young, tall + thin males. Also Scuba-Divers.
- Trachea deviates TOWARDS collapsed lung
- Diaphragm UP
Tension Pneumothorax
Mech, Seen In (2), Pres (2), RX?
THINK: ↑P / Compression pushing everything over to OPPOSITE side
SEEN IN:
- Trauma (penetrating chest wall injury)
- Lung infection
PRES:
- Trachea deviates AWAY from affected lung
- Diaphragm DOWN
RX:
- Chest Tube
Pulmonary Embolus (PE)
Etiology, Pres, Appearance on Pulm CTA, Course, DX (2)?
ET: 95% arise from deep leg veins / DVT
PRES: Chest pain, dyspnea, tachypnea
PULM CTA: Filling defects
COURSE: Small PEs produce infarcts ONLY if there is underlying lung dz.
DX:
- Screening: V/P Scan
- Confirmatory: Pulm CTA
Fat Emboli
Assoc (2), Pres (Triad)?
ASSOC:
- Liposuction
- Long bone fractures
PRES:
1. Hypoxemia 2. Petechial rash 3. Neuro abnormalities
Amniotic Fluid Emboli
Def’n, Pres (3), Micro Findings?
Emboli that enters maternal circ during labor/delivery.
PRES:
- DIC (due to thrombogenic nature of amniotic fluid)
- Shortness of breath
- Neuro symptoms
FINDING = Squamous cells + Keratin debri (from fetal skin) in embolus
Gas Emboli
Def’n, RX?
Nitrogen bubbles precipitate in ascending divers.
RX = Hyperbaric Oxygen
CO Poisoning (Carboxyhemoglobinemia)
Mech (3), Causes (3), Pres (2), RX?
MECH:
- CO very diffusable + has higher affinity for Hb than O2 does
- > ↓O2 Sat = Cyanosis
- Left shift of O2-Hb Dissociation Curve
- Blocking Cytochrome Oxidase (O2 unable to accept e-)
CAUSES:
- Closed space with room heater
- House Fire
- Car exhaust
PRES:
- Headache
- Red skin tinting (** masks signs of cyanosis **)
RX = 100% O2
Cyanide Poisoning
Mech, Cause, RX?
Cyanide (exactly like CO) blocks Cytochrome Oxidase.
CAUSE:
- House Fire (household products made of polyurethane)
RX:
- Nitrites (Thiosulfate):
(Oxidize Hb to MetHb (MetHb has higher affinity for cyanide) ->
MetHb binds cyanide ->
Cyanide no longer blocking cytochrome oxidase)
House Fire
2 things that produce Hypoxia?
- CO Poisoning
- Cyanide Poisoning (household products made of polyurethane)
Uncoupling
Explanation, Uncoupling Agents (3), Assoc?
Inner mitochondrial memb synthesizes ATP.
Although this memb is permeable to protons, you only want protons to go through a certain hole / pore in the memb because at the base of this hole / pore is where ATP Synthase is.
Uncoupling is when protons permeate the memb at ALL locations.
- > Protons draining right through memb -> Rxs producing these protons in the first place (rxs producing FADH + NADH) go into OVERDRIVE!
- > ↑Rx Rate = ↑Temp (Hyperthermia)
- > Very low ATP yield
UNCOUPLING AGENTS:
- Alcohol
- Dinitrophenol
- Salicylates
ASSOC:
- Hyperthermia
Methemoglobinemia
Def’n, Mech, Pres / Epi (2), Blood (CLUE), RX (2)?
Methemoglobin = Fe3+ (oxidized).
O2 can’t bind to heme groups containing Fe3+ ->↓O2 Sat = Cyanosis.
PRES:
- Cyanotic person coming from Rocky Mountains -> give O2 ->
REMAINS cyanotic
- People on Nitro or Sulfa drugs
BL: CHOCOLATE-COLORED
RX:
- IV Methylene Blue
- 2nd line = Vitamin C (reducing agent)
Obstructive Lung Diseases
Mech (4 steps), Comp (3)?
Obstruction of air flow -> AIR TRAPPING in lungs ->
Enlargement of air spaces ->
Airways close prematurely at high lung volumes.
COMP:
- Hypoxemia (due to destruction of alveolar capillaries)
- Cor Pulmonale (due to chronic hypoxic pulm vasoconstriction)
- ↑infection risk
Chronic Bronchitis
Chars (4)?
CHARS:
- Thickened bronchial walls
- Mucous gland enlargement
- Patchy squamous metaplasia of bronchial mucosa
- Lymphocytic infiltrate
COPD
Mech (2), Players (3), RF (4), DX?
Pulm INFL -> Small Airway dz (due to infl + remodeling)
-> Parenchymal destruction
(due to loss of alveolar connections +↓elasticity)
**↓AIR FLOW **
- CD8 T cells
- Macrophages
- Neutrophils
RF:
- a1-antitrypsin deficiency
- Hyper-reactive airways
- Infections
- Exposure to tobacco and/or occupational toxins (oxidative stress)
DX:
- Spirometry (gold standard): FEV1/FVC = 25-75% (normal = 80%)
Bronchoconstriction
Mech (2)?
MECH:
- Inflammatory processes
- ↑Parasympathetic tone (Ach + Adenosine)
Emphysema (“Pink Puffer”)
Mech (2 steps), Etiology, Pres (4)?
Destruction of alveolar air sacs / walls (w loss of elastic recoil)
-> Permanent alveolar DILATION + COLLAPSE during EXP.
ET: Protease / Antiprotease imbalance
PRES:
- “Barrel-shaped chest”
- Dyspnea + Tachypnea
- Exhalation thr pursed lips (to↑airway pressure + prevent collapse)
- Weight loss
Centracinar Emphysema
Etiology, Mech (3 steps)?
ET: Smoking (oxidative injury to bronchioles)
Ox injury -> Alv Macrophages + Neutrophils release Proteases
-> Protease-Antiprotease imbalance
Asthma
Def’n, Mech / H-S Type,
Players (2), Path (Early vs Late-phase rx), Assoc,
Micro Findings (3), Pres (6), DX?
Reversible bronchoconstriction -> **↓AIR FLOW **.
Bronchial HYPERRESPONSIVENESS most often due to allergic stim = Type 1 H-S.
- CD4 T cells
- Eosinophils
Early-Phase = IgE-mediated. Late-Phase = Infl-mediated.
ASSOC:
- Churg-Strauss Sx (Small-Vessel Vasculitis)
FINDINGS:
- Smooth muscle hypertrophy
- Curschmann’s spirals
- Charcot-Leyden crystals
PRES: ** Episodic clinical features **
- Coughing + Wheezing
- Dyspnea + Tachypnea
- Hypoxemia
- ↓I/E ratio
- Mucus plugging
- Pulsus Paradoxus
DX: Methacholine Challenge
“Triad” Asthma
Mech (2 steps), Seen In (3)?
S1. Aspirin or NSAIDs block COX ->
Arachidonic acid CAN’T form PGs.
(Lipoxygenase pathway left open).
S2. … in people who are sensitive to above …
C4, D4, E4 + LT = potent bronchoconstrictors formed.
PRES:
- Patient on Aspirin or NSAID (chronic pain sx)
- Nasal Polyps
- Occasional bouts of Asthma
Bronchiectasis
Mech (3 steps), Causes (5), Pres (3)?
Chronic NECROTIZING INFECTION of bronchi ->
Damage to bronchial walls ->
Permanent DILATION of bronchi / bronchioles.
CAUSES:
- Bronchial obstructions
- Problems with ciliary motility
- Smoking
- Kartagener’s Sx
- Cystic Fibrosis
- Allergic Bronchopulmonary Aspergillosis
- Common Variable Immunodef
PRES:
- Recurrent infections
- Foul-smelling purulent sputum
- Hemoptysis
Interstitial Pulmonary Fibrosis
Def’n, Appearance on Imaging, RX?
Repeated cycles of lung injury / healing with↑collagen.
“Honeycomb” Lung
RX = Lung Transplantation
Restrictive Lung Diseases
Def’n?
Restricted FILLING of lungs -> Restricted lung EXPANSION ->
↓Lung Volumes.
Pneumoconioses
Def’n, Mech?
Interstitial fibrosis due to chronic exposure to small fibrogenic particles.
MECH: Alveolar Macrophages engulf these particles -> Fibrosis.
Asbestos- 3 Dz Categories
- Asbestosis
- Benign Asbestos-Related PLEURAL Diseases:
- Pleural Effusion
- Pleural Thickening
- Pleural Plaques
- Atelectasis
- Malignant Asbestos-Related Diseases:
- Mesothelioma
- Asbestos-Related Lung Cancer
Asbestosis
Location, Assoc (3), Micro Finding, Comp (2)?
Affects LOWER lobes.
ASSOC:
- Roofing
- Plumbing
- Shipbuilding
FINDING = Asbestos bodies
COMP: advancement to fibrosis w alteration of pulm architecture
- ↑incidence of Bronchogenic Carcinoma
- ↑incidence of Mesothelioma
Silicosis
Location, Mech, Assoc (3), Micro Finding, Comp?
Affects UPPER lobes.
MACROPHAGES respond to silica and release fibrogenic factors ->
Fibrosis.
ASSOC:
- Foundries
- Mines
- Sandblasting
FINDING:
- “Eggshell” calcification of hilar lymph nodes
COMP:
- ↑susceptibility to TB
(silica disrupts phagolysosomes and impairs macrophages)
Sarcoidosis
Def’n, Pres (Epi + 4), Micro Finding, Labs (2), Comp (2), RX?
Systemic disease. Noncaseating granulomas in multiple organs, however MC in lungs + Hilar lymph nodes.
PRES: African American Women
- Bilateral Hilar lymphadenopathy
- Cough
- Dysnea
- Uveitis
FINDINGS:
- Asteroid bodies / Stellate inclusions
(often seen in Giant cells of granuloma)
LABS
- ACE ↑
- Ca ↑(epithelioid histiocytes convert Vit D to its active form)
COMP:
- Facial Nerve Palsy
- Restrictive / Obliterative Cardiomyopathy
RX: ** Often resolves spontaneously without treatment **
- Steroids
Hypersensitivity Pneumonitis
Def’n, H-S Type, Pres (2 Epi + CLUE)?
Granulomatous rx to inhaled organic antigens.
Mixed Type 3 / Type 4 H-S.
PRES: Farmers + Ppl exposed to Birds
- ** Pres hrs after exposure and resolves with removal of exposure ***
- Cough
- Chest tightness
- Dysnea
- Fever
- Headache
NRDS
Def’n, Mech (2), Assoc (3), Pres (3), Appearance on CXR?
RDS due to inadequate SURFACTANT levels.
↑Surface Tension -> Collapse of air sacs (Atelectasis)
-> Hyaline memb formation
ASSOC:
- Prematurity
- C-section delivery
- Maternal Diabetes
PRES:
- “Grunting”
- Resp distress with cyanosis + hyopoxemia + tachypnea +↑resp effort after birth
- PDA -> “Machine-like murmur” (PDA due to hypoxemia)
CXR: “Ground glass” appearance of lung (due to diffuse granularity)
ARDS
Mech (5 steps), Causes (2), Pres, Appearance on CXR, Comp?
Activation of NEUTROPHILS -> Damage to Pneumocytes
(—>↑ST + Atelectasis) ->
Damage to ALVEOLAR-CAPILLARY interface
(—> thickened diffusion barrier) ->
↑Permeability -> Leakage of protein-rich fluid into alveoli ->
Edema + Intraalveolar Hyaline memb ->
Intrapulmonary Shunting.
CAUSES:
- Septic Shock
- Acute Pancreatitis
PRES: “Cyanosis + Hypoxemia with resp distress”
CXR: “White out”
COMP: Interstitial Fibrosis (damage to Type II Pneumocytes ->
fibrosis + scarring)
Alveolar Hyaline Memb
Mech of Formation (7 steps), RX?
** Hyaline = Pink! **
Lack of SURFACTANT -> Collapse of air sacs ->
Massive Ventilation defect -> Massive Interpulm Shunt.
Degeneration of Type II Pneumocytes -> Leakage of Fibrinogen ->
Congealing of Fibrinogen = formation of hyaline memb.
RX:
- PEEP (Positive End Exp Pressure) Therapy
Lobar Pneumonia
Mech (2 steps), Micro Findings (3)?
INTRA-alveolar EXUDATE ->
CONSOLIDATION of 1 entire lobe of lung.
FINDINGS:
- Congestion (due to congested vessels + edema)
- Red Hepatization: exudate, hem and Neutrophils filling
alveolar air spaces -> gives lung solid consistency
- Gray Hepatization: degradation of red cells within exudate
Bronchopneumonia
Def’n, Appearance (3), Micro Finding?
ACUTE INFL (Neutrophilic) infiltrate from bronchioles -> adjacent alveoli.
- Often bilateral + multifocal
- Patchy distribution
- Areas of consolidation centered around bronchioles
FINDING = Neutrophils in alveolar spaces
Atypical / Interstitial / “Walking” Pneumonia
Appearance on CXR?
CXR: Bilateral, however worse on R.
- Coarse reticular opacities
Lung Abscess
Def’n, Causes (2), Pres, Appearance on XR?
Localized collection of pus within lung parenchyma.
Aspirate consists of aerobes + anaerobes.
CAUSES:
- Aspiration of oropharyngeal contents (street people)
- Bronchial obstruction
XR: Air-fluid levels / Fluid cavities
Pain from Diaphragm Irritation
Cause, Pres (where referred to)?
CAUSE = Air or Blood in peritoneal cavity
PRES = Pain referred to shoulder / trapezius ridge
Cor Pulmonale
Def’n, Causes (2), Pres, Comp?
RHF due to a pulm cause.
CAUSES:
- Pulmonary Htn
- Chronic lung conditions that cause prolonged low blood O2
PRES = Light-headedness or shortness of breath during activity
COMP:
- RHF
TB
Cause, Comp (3)?
CAUSE = Inhalation of aerosolized Mycobacterium Tb
COMP:
- Constrictive Pericarditis
- Erythema Nodosum
- Infectious Arthritis (due to mycobacterial dissemination)
Primary TB
Def’n, Locations (2), Pres (3), Micro Finding?
Arises with initial exposure.
LOWER Lobe + Hilar lymph nodes.
PRES:
- Generally asymptomatic
- Hilar lymphadenopathy
- PPD +
FINDING = Ghon Complex
Secondary / Reactivation TB
Def’n, Location, Causes (3),
Pres (3), Micro Finding, Course,
Comp (2), DX?
Arises with reactivation of Mycobacterium Tb.
APEX of Lung.
CAUSES:
- Aging
- Immune compromise
- TNF-a Inhibitor use
PRES:
- Weight loss
- Fever + night sweats
- Cough with hemoptysis
FINDING = CAVITARY FOCI of caseating necrosis
COURSE = Systemic spread
COMP:
- Tuberculous Bronchopneumonia
- Hiliary Pulmonary TB
DX = Biopsy of caseating granulomas
Vertebral TB (Pott Disease)
Pres?
PRES: 2ry TB + back pain
Lung Cancer #1
Metastasis TO Lung from (4)?
** Usually multiple lesions **
- Breast Cancer
- Colon Cancer
- Bladder Cancer
- Prostate Cancer
Lung Cancer #2
Metastasis FROM Lung to (4)?
- Brain
- Adrenals
- Liver
- Bone
Lung Cancer #3
Assoc,
Pres (3), Appearance on Imaging (CXR vs CT),
DX, Comp (6: “SPHERE”)?
ASSOC = Smoking! (All EXCEPT Bronchial Carcinoid Tumor)
PRES:
- Bronchial obstruction + Wheezing
- Cough
- Hemoptysis
Appearance on CXR = “Coin lesion”
Appearance on CT = Noncalcified nodule
DX requires Biopsy.
COMP: “SPHERE”
- SVC Sx
- Pancoast tumor
- Horner Sx
- Endocrine (paraneoplastic)
- Recurrent Laryngeal symptoms (eg hoarseness)
- Effusions (pleural or pericardial)
Bronchial or Bronchioloalveolar Adenocarcinoma
Location, Genetics (3 activating mutations), Pres?
Devel in site of PRIOR pulm injury / infl.
Grows along alveolar septa -> apparent “thickening” of alveolar walls.
GENETICS: Activating mutations:
- ALK
- EGFR
- K-ras
PRES = like Pneumonia, incl on Imaging!
Squamous Cell Carcinoma
Char, Pres, Micro Findings (2)?
“Cavitation”.
PRES:
- (parathyroid-like activity) Produces PTH -> Hypercalcemia
FINDINGS:
- Keratin pearls
- Intercellular bridges
Small Cell / Oat Cell Carcinoma of Lung
Def’n, Genetics, Assoc, Pres (2), Micro Finding, Comp (2)?
Neoplasm of neuroendocrine Kulchitsky cells (small dark blue cells).
GENETICS: myc oncogene amplification common.
ASSOC:
- Lambert-Eaton Myasthenic Sx
PRES: * Undifferentiated = very aggressive *
- Ectopic production of ACTH + ADH -> “SIADH”
- Production of antibodies against Ca channels -> Lambert-Eaton Sx
FINDING = “Salt + Pepper neuroendocrine-type chromatin”
COMP:
- SIADH (due to ectopic ADH)
- Cushing’s Sx
Large Cell Carcinoma
Micro Finding, RX, Prognosis?
FINDING:
- Giant cells (pleomorphic and with leukocyte fragments) in cytoplasm
RX: Less responsive to Chemotherapy
- Surgical removal
PROG: Undifferentiated + Anaplastic => poor prognosis
Bronchial Carcinoid Tumor
Def’n, Pres, Micro Findings (2), Comp, Prognosis?
Neoplasm of neuroendocrine cells.
PRES: Well differentiated
- Carcinoid Sx (flushing, wheezing, diarrhea)
FINDINGS:
- “Nests” of neuroendocrine cells
- Chromogranin +
COMP:
- Cushing’s Sx
PROG: Mets rare => excellent prognosis
Mesothelioma
Def’n, Mech (2), Assoc, Pres (3), Micro Finding?
Malignancy of pleura (mesothelial cells).
Malignancy of pleura -> pleural thickening
-> hem pleural effusions
ASSOC:
- Asbestosis
PRES:
- Dyspnea
- Chest pain
- Hem pleural effusions
FINDING = Psammoma Bodies
Pancoast Tumor
Location, Comp?
APEX.
COMP:
- Horner Sx (by tumor’s compression of sym ganglia / plexus)
Laryngeal Carcinoma (a squamous cell carcinoma)
MCC (2), Pres?
MCC: ** Synergistic effect **
- Smoking
- Alcohol
PRES = “hoarseness of throat”
Superior Vena Cava Sx
Def’n, Locations + Consequent Pres (3), Causes (2), Comp (2)?
OBSTRUCTION of SVC -> Impaired bl drainage from head, neck + upper extremities.
LOCATIONS: Impaired bl drainage from…
- Head -> “Facial plethora”
- Neck -> JVD
- Upper extremities -> Edema
CAUSES:
- Thromboses
- Neoplasms (ie Lung Cancer)
COMP:
- ↑ICP (if obstruction severe) -> Headaches + Dizziness
- Risk of aneurysm / rupture of cranial arteries
