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BHP Exam 3 > Respiratory 2 > Flashcards

Respiratory 2 Flashcards

1
Q

What results in hypoxia secondary to a diffusional defect?

A

restrictive pulmonary disease

-develops in edema and fibrosis of alveolar walls

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2
Q

Restrictive pulmonary disease is characterized by damage to alveolar walls with three main phases of reaction in the lung

A

1 hyaline membranes in alveolar sacs-exudation of fibrin-rich edema fluid mixed with the cytoplasmic and lipid remnants of necrotic epithelial cells

2 edema and inflammation of the interstitium

3 fibrosis in the interstitium

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3
Q

What produces acute respiratory distress syndrome (ARDS)?

A

Diffuse Alveolar damage (DAD) to lung alveolar walls leading to widespread systemic metabolic derrangements

(increase in alveolar capillary permeability causing leakage of fibrin-rich edema fluid into alveoli)

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4
Q

ARDS Phase 1: Acute Exude

A

Exudation of fibrin-rich edema fluid mixed with the cytoplasmic and lipid remnants of necrotic epithelial cells, forms hyaline membranes within alveolar spaces

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5
Q

ARDS Phase 2: Late Organization

A

Cell proliferation and fibrosis

1 congested, impaired ventilation
2 Regeneration of type II alveolar lining cells and organization of hyaline membranes with pulmonary fibrosis
3 Interstitial fibrosis with thickening of alveolar walls or fibrous obliteration of alveolar spaces

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6
Q

ARDS treatment

A
  • mortality reduced to 40% with treatment

- continous positive airway pressure ventilation and intensive support of cardiac, circulatory, and renal function

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7
Q

What causes chronic interstitial lung disease? (inhaled)

A

inhaled

1 extrinsic allergic alveolitis immune reaction to inhaled organic dusts
2 pneumoconiosis: inhaling industrial (mineral) dustsq

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8
Q

What causes chronic interstitial lung disease? (intrinsic disease)

A

intrinsic disease

1 idiopathic interstitial pneumonitis

2 non-organ specific autoimmune CT diseases
(atypical pneumonias»Chlamydia, Mycoplasma

3 Sarcoidosis

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9
Q

What causes extrinsic allergic alveolitis (hypersensitivity pneumonitis)

[Restrictive Pulmonary Disease]

A

immune reaction in the lung to inhaled antigens

1 animal : proteins in bird droppings

2 microbial: contaminated vegetable-derived material

or actinomyces and fungi that colonize rotting crops

(e.g.: hay, compost, sugar cane, maple bark)

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10
Q

What causes Coal Worker’s Pneumoconiosis?

A

inhalation of coal dust which contains both carbon and silica

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11
Q

What the two types of coal worker’s pneumonoconiosis?

A
  1. simple coalworker’s pneumoconiosis

2. progressive massive fibrosis

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12
Q

What is progressive massive fibrosis (PMF) surrounded by

A

irregular emphysema

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13
Q

What is the histopathology of silicosis like?

A

silica particles with nodules under polarized light

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14
Q

What complication is associated with silicosis?

A

development of TB due to impaired local defenses consequence of silica in macrophages (silicotuberculosis)

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15
Q

What is Asbestosis?

A

Insidious feature is the long latent period often seen of up to 50 years between exposure and onset of clinical disease

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16
Q

What occurs when Asbestosis progresses with a restrictive defect in the late stages?

A

pulmonary HTN and cor pulmonale

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17
Q

Asbestos bodies within macrophages= Ferruginous Bodies

A

long, thin fibers coated with hemosiderin and protein to form yellow brown filaments with a beaded or drumstick pattern

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18
Q

What can result in amrked predisposition to bronchogenic carcinoma and to malignant mesotheloma of the pleura or peritoneum?

A

Asbestosis

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19
Q

Cigarette smoking and what…….. further increases the risk of bronchogenic carcinoma

A

Asbestosis

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20
Q

Sarcoidosis

A

1 Progressive Granulomatous lung disease

2 Histiocytic and giant cell inflammation

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21
Q

What are other granulomatous lung diseases besides sarcoidosis?

A

1 Tuberculosis
2 Granulomatous Vasculitis
3 Fungal infection s(e.g. histoplasmosis)
4 Inhaled foreign bodies (e.g. pneumoconioses)

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22
Q

Clinical features of Sarcoidosis

A

1 shadowing on chest radiograph with enlargement of hilar lymph nodes
2 eye, associated glands, and salivary glands involved in up to 50%

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23
Q

Prognosis of sarcoidosis

A

approximately 70% recover via steroid treatment

  • 20% have permanent loss of some lung or eye movement
  • 10-15 % fatality (pulmonary fibrosis and cor pulmonale)
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24
Q

What affects interstitium of lungs, causing fibrosis?

A

restrictive pulmonary disease

25
Q

Extrinsic allergic alveolitis is due to hypersensitivity to

A

inhaled allergens (e.g. farmer’s lung)

26
Q

What is the MOST COMMON CAUSE OF DEATH from neoplasia in industrialized nation?

A

Carcinoma of the lung (lung cancer)

27
Q

Hematogenous Lung cancer spread

A

Main sites are brain, bone liver, and adrenal glands

*Bone sites esp. are ribs, vertebrae, humeri, and femora with pain or pathological fracture

28
Q

Squamous cell carcinoma of the lung

A

1 most common in males

2 usually central and close to the carina with feature related to bronchial obstruction

29
Q

What is the most highly malignant of lung cancers?

A

Small cell anaplastic carcinoma of lung
1 bronchial epithelium but differentiates into neuroendocrine cells
2 ectopic hormone (e.g. ACTH) production leads to paraneoplastic syndrome

30
Q

What are local symptoms of lung cancer?

A

Cough (80% infection distal to airway blocked by tumor)

31
Q

Lung cancer metastasis

A

1 frequent presenting sign present in about 70%
2 hematogenous spread
-pathological fracture (bone metastasis)
-leuko-erythroblastic anemia (extensive bone marrow replacement)
-CNS symptoms (brain mets)
-Hepatomegaly and jaundice (liver metastasis)

32
Q

What are ways of local spread during lung cancer metastasis?

A

intra-thoracic nodes

33
Q

Intrathoracic nodes of lung cancer metastasis

A

pancoast tumor- superior sulcus tumor at apex of the lung; often with invasion of cervical sympathetic chain leading to Horner’s syndrome

34
Q

Horner’s syndrome

A

Ptosis, enopthalmos, small pupil (miosis), lack of sweating [anhydrosis] on ipsilateral face

35
Q

Lung cancer staging and histopathological type

A

1 determine outcome and likely response to treatment
(e.g. squamous cell carcinoma detected at early stage (slow growth and operable) vs. small cell tumors (metastasis and poorest prognosis)
2 survival is better for early stage disease except for small cell carcinoma

36
Q

Lung cancer prognosis

A

very senstive to radiotherapy and chemotherapy but survival poor
1 complete local response in 30% of cases
2 median survival = 11 mos.
3 one year survival =45%

37
Q

coin lesions

A

1 rounded solitary radiopaque lesion on a chest radiograph

2 1/3 cases (in persons over age 50) caused by carcinoma of the lung

38
Q

Common causes of coin lesions

A 
1 primary bronchial or lung carcinoma
2 metastatic tumor (esp. kidney)
-bronchial hamartoma
-carcinoid tumor
3 granulomatous inflammation (e.g. TB)
4 Lung Abscess
39
Q

Uncommon causes of coin lesions

A

1 pulmonary cysts
2 pulmonary cysts
3 fungal mycetoma
4 vascular malformations

40
Q

Lung cancer summary

A

Overall 5-year survival= 5-30%, dependent on type and stage, median approximately 15%

41
Q

Pleural fluid types

A

1 pus-empyema; due to infection
2 blood-hemothorax; due to trauma or surgery
3 chylo-thorax (lymphatic fluid) - leakage from the thoracic duct of chyle (lymph fluid)
4 transudate= low protein fluid due to movement of excess fluid through normal vessel walls (e.g. high hydrostatic pressure in cardiac failure)

42
Q

pleural fluid types

A

1 exudate: high protein fluid (fibrin) due to movement of fluid through damaged vessel walls (e.g. tumor, infection, infarction)
2 air-pneumothorax
3 fluid effusion= transudate or exudate; caused by several diseases

43
Q

What pathology of the pleura may have a latent period of 25 to 45 years?

A

malignant mesothelioma

44
Q

How do we diagnose a malignant mesothelioma?

A

pleural biopsy

45
Q

What causes hyaline membrane disease (neonatal respiratory distress syndrome)?

A

deficiency of surfactant in the lungs as a result of immaturity

46
Q

What is the histopathology of pediatric lung disease?

A

hyaline membranes

47
Q

Pediatric lund disease has 50% mortality if weight is…

A
48
Q

Cystic Fibrosis

A

Molecular Pathogenesis
1 defective function in a membrane chloride channel epithelial cells
2 decreased release of sodium and water to liquify mucus
3 bronchi and bronchioles become obstructed

49
Q

4 primary problems of cystic fibrosis

A

1 repeated infections
2 bronchiectasis and hemoptysis
3 hyperinflation of lungs due to air trapping and pneumothorax
4 hypoxia, scarring, and destruction of the pulmonary vascular bed leads to pulmonary hypertension and cor pulmonale

50
Q

What is the median survival for patients with cystic fibrosis?

A

30 years

51
Q

What is an acute form of diffuse alveolar damage casued by severe sepsis and shock

A

ARDS

52
Q

What is the prototype pattern of initial response in the lung

A

diffuse alveolar damage response in the lung

53
Q

What leads to honeycomb lung?

A

progressive pulmonary interstitial fibrosis

54
Q

What leads to idiopathic progressive fibrosis of lung interstitium ?

A

Idiopathic interstitial pneumonitis leads

55
Q

what exhibits fibrosis caused by reactions to inhaled mineral dusts?

A

pneumoconioses

56
Q

What has simple and progressive massive fibrosis forms?

A

coalworker’s pneumoconiosis

57
Q

What predisposes to interstitial fibrosis, lung cancer, and mesothelioma?

A

asbestos

58
Q

What causes interstitial fibrosis

A

Sarcoidosis and autoimmune CT diseases

BHP Exam 3 (7 decks)

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