Respiratory - Pathology Flashcards
1
Q
Rhinosinusitis
- Definition
- Due to…
- Findings
A
- Definition
- Obstruction of sinus drainage into nasal cavity
- –> inflammation and pain over affected area (typically maxillary sinuses in adults [A]).
- Due to…
- Most common acute cause is viral URI
- Findings
- May cause superimposed bacterial infection, most commonly S. pneumoniae, H. influenzae, and M. catarrhalis.
2
Q
Deep venous thrombosis
- Predisposed by…
- Most arise from…
- Homan sign
- Treatment
A
- Predisposed by Virchow triad:
- Stasis
- Hypercoagulability (e.g., defect in coagulation cascade proteins, most commonly factor V Leiden)
- Endothelial damage (exposed collagen triggers clotting cascade)
- Approximately 95% of pulmonary emboli arise from deep leg veins.
- Homan sign
- Dorsiflexion of foot –> calf pain.
- Treatment
- Use heparin for prevention and acute management
- Use warfarin for long-term prevention of DVT recurrence.
3
Q
Pulmonary emboli (603)
- Due to…
- Findings
- Types
- Diagnosis
A
- Due to…
- V/Q mismatch –> hypoxemia –> respiratory alkalosis.
- Findings
- Sudden-onset dyspnea, chest pain, tachypnea.
- May present as sudden death.
- Types
-
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor.
- An embolus moves like a FAT BAT
- Fat emboli
- Associated with long bone fractures and liposuction
- Classic triad of hypoxemia, neurologic abnormalities, and petechial rash.
- Amniotic fluid emboli
- Can lead to DIC, especially postpartum.
- Gas emboli
- Nitrogen bubbles precipitate in ascending divers
- Treat with hyperbaric oxygen.
-
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor.
- Diagnosis
- CT pulmonary angiography is the imaging test of choice for a PE (look for filling defects) [A] [B] [C].
4
Q
Obstructive lung diseases
- Definition
- Findings
- PFTs
A
- Definition
- Obstruction of air flow resulting in air trapping in the lungs.
- Findings
- Airways close prematurely at high lung volumes –> increased RV and decreased FVC.
- Chronic, hypoxic pulmonary vasoconstriction can lead to cor pulmonale
- PFTs
- Really decreased FEV1
- Decreased FVC –> decreased FEV1/FVC ratio (hallmark)
- V/Q mismatch.
5
Q
Chronic bronchitis
- Type of disease
- Pathology
- Definition
- Findings
A
- Type of disease
- Obstructive lung disease
- Pathology
- A form of COPD along with emphysema.
- Hyperplasia of mucus-secreting glands in the bronchi
- –> Reid index (thickness of gland layer/total thickness of bronchial wall) > 50%.
- Definition
- AKA “blue bloater”
- Productive cough for > 3 months per year (not necessarily consecutive) for > 2 years.
- Disease of small airways.
- Findings
- Wheezing, crackles, cyanosis (early-onset hypoxemia due to shunting), late-onset dyspnea, CO2 retention.
6
Q
Emphysema
- Type of disease
- Pathology
- Two types
- Definition
- Findings
A
- Type of disease
- Obstructive lung disease
- Pathology
- Enlargement of air spaces, decreased recoil, increased compliance, decreased DLCO resulting from destruction of alveolar walls [A].
- Two types
- Centriacinar—associated with smoking [B].
- Panacinar—associated with a1-antitrypsin deficiency.
- Definition
- AKA “pink puffer,” barrelshaped chest
- Findings
- Increased elastase activity –> loss of elastic fibers –> increased lung compliance.
- Exhalation through pursed lips to increases airway pressure and prevent airway collapse during respiration.
7
Q
Asthma
- Type of disease
- Pathology
- Due to…
- Diagnosis
- Findings
A
- Type of disease
- Obstructive lung disease
- Pathology
- Bronchial hyperresponsiveness causes reversible bronchoconstriction.
- Smooth muscle hypertrophy, Curschmann spirals (shed epithelium forms mucus plugs), and Charcot-Leyden crystals (formed from breakdown of eosinophils in sputum).
- Due to…
- Can be triggered by viral URIs, allergens, and stress.
- Diagnosis
- Test with methacholine challenge.
- Findings
- Cough, wheezing, tachypnea, dyspnea, hypoxemia, decreased I/E ratio, pulsus paradoxus, mucus plugging.
8
Q
Bronchiectasis
- Type of disease
- Pathology
- Associations
A
- Type of disease
- Obstructive lung disease
- Pathology
- Chronic necrotizing infection of bronchi –> permanently dilated airways, purulent sputum, recurrent infections, hemoptysis.
- Associations
- Associated with bronchial obstruction, poor ciliary motility (smoking), Kartagener syndrome, cystic fibrosis, allergic bronchopulmonary aspergillosis.
9
Q
Restrictive lung disease
- Definition
- PFTs
- Types
- Poor breathing mechanics
- Interstitial lung diseases
A
- Definition
- Restricted lung expansion causes decreased lung volumes (decreased FVC and TLC).
- PFTs
- FEV1/FVC ratio ≥ 80%.
- Types
- Poor breathing mechanics (extrapulmonary, peripheral hypoventilation, normal A-a gradient):
- Poor muscular effort—polio, myasthenia gravis
- Poor structural apparatus—scoliosis, morbid obesity
- Interstitial lung diseases (pulmonary decreased diffusing capacity, increased A-a gradient):
- Acute respiratory distress syndrome (ARDS)
- Neonatal respiratory distress syndrome (hyaline membrane disease)
- Pneumoconioses (anthracosis, silicosis, asbestosis)
- Sarcoidosis (bilateral hilar lymphadenopathy, noncaseating granuloma; increased ACE and Ca2+)
- Idiopathic pulmonary fibrosis (repeated cycles of lung injury and wound healing with increased collagen deposition)
- Goodpasture syndrome
- Granulomatosis with polyangiitis (Wegener)
- Langerhans cell histiocytosis (eosinophilic granuloma)
- Hypersensitivity pneumonitis
- Drug toxicity (bleomycin, busulfan, amiodarone, methotrexate)
- Poor breathing mechanics (extrapulmonary, peripheral hypoventilation, normal A-a gradient):
10
Q
Pneumo-
- Hypersensitivity pneumonitis
- Pneumoconioses
A
- Hypersensitivity pneumonitis
- Mixed type III/IV hypersensitivity reaction to environmental antigen
- –> dyspnea, cough, chest tightness, headache.
- Often seen in farmers and those exposed to birds.
- Mixed type III/IV hypersensitivity reaction to environmental antigen
- Pneumoconioses
- Coal workers’ pneumoconiosis, silicosis, and asbestosis
- –> increased risk of cor pulmonale and Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules).
11
Q
Asbestosis
- Type of disease
- Associations
- Findings
A
- Type of disease
- Pneumoconiosis
- Associations
- Associated with shipbuilding, roofing, and plumbing.
- Associated with an increased incidence of bronchogenic carcinoma and mesothelioma
- Findings
- “Ivory white,” calcified pleural plaques [A] are pathognomonic of asbestos exposure, but are not precancerous.
- Affects lower lobes.
- Asbestos is from the roof (was common in insulation), but affects the base (lower lobes).
- Silica and coal are from the base (earth), but affect the roof (upper lobes).
- Asbestos (ferruginous) bodies are golden-brown fusiform rods resembling dumbbells [B].
12
Q
Coal workers’ pneumoconiosis
- Type of disease
- Definition
- Findings
- Anthracosis
A
- Type of disease
- Pneumoconiosis
- Definition
- Prolonged coal dust exposure –> macrophages laden with carbon –> inflammation and fibrosis.
- Also known as black lung disease.
- Findings
- Affects upper lobes.
- Asbestos is from the roof (was common in insulation), but affects the base (lower lobes).
- Silica and coal are from the base (earth), but affect the roof (upper lobes).
-
Anthracosis
- Asymptomatic condition found in many urban dwellers exposed to sooty air.
13
Q
Silicosis
- Type of disease
- Associations
- Due to…
- Findings
A
- Type of disease
- Pneumoconiosis
- Associations
- Associated with foundries, sandblasting, and mines.
- Also increases risk of bronchogenic carcinoma.
- Due to…
- Macrophages respond to silica and release fibrogenic factors, leading to fibrosis.
- It is thought that silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB.
- Findings
- Affects upper lobes.
- **Asbestos is from the roof (was common in insulation), but affects the base (lower lobes). **
- Silica and coal are from the base (earth), but affect the roof (upper lobes).
- “Eggshell” calcification of hilar lymph nodes.
- Affects upper lobes.
14
Q
Neonatal respiratory distress syndrome
- Definition
- Associations
- Risk factors
- Treatment
A
- Definition
- Surfactant deficiency –> increased surface tension –> alveolar collapse.
- A lecithin : sphingomyelin ratio < 1.5 in amniotic fluid is predictive of neonatal respiratory distress syndrome.
- Associations
- Persistently low O2 tension –> risk of PDA.
- Therapeutic supplemental O2 can result in retinopathy of prematurity and bronchopulmonary dysplasia.
- Risk factors
- Prematurity, maternal diabetes (due to increased fetal insulin), C-section delivery (decreased release of fetal glucocorticoids).
- Treatment
- Maternal steroids before birth
- Artificial surfactant for infant.
15
Q
Acute respiratory distress syndrome
- Due to…
- Definition
- Findings
A
- Due to…
- May be caused by trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, or amniotic fluid embolism.
- Definition
- Diffuse alveolar damage –> increased alveolar capillary permeability –> protein-rich leakage into alveoli and noncardiogenic pulmonary edema (normal PCWP) [A].
- Initial damage due to release of neutrophilic substances toxic to alveolar wall, activation of coagulation cascade, and oxygen-derived free radicals.
- Findings
- Results in formation of intra-alveolar hyaline membrane [B].
16
Q
Obstructive vs. restrictive lung disease
- FEV1 / FVC
- Normal
- Obstructive
- Restrictive
- Lung volumes
- Obstructive
- Restrictive
A
- FEV1 / FVC
- Normal = 80%
- Obstructive < 80%
- FEV1 and FVC are reduced
- FEV1 is more dramatically reduced compared to FVC
- Results in a decreased FEV1/FVC ratio
- Restrictive >/= 80%
- FEV1 and FVC are reduced
- Lung volumes
- Obstructive > normal (increased TLC, increased FRC, increased RV)
- Restrictive < normal
22
Q
Lung cancer:
Squamous cell carcinoma
- Location (central/peripheral)
- Characteristics
- Histology
A
- Location
- Central
- Characteristics
- Hilar mass arising from bronchus
- Cavitation
- Cigarettes
- HyperCalcemia (produces PTHrP).
- Histology
- Keratin pearls and intercellular bridges [A].
23
Q
Lung cancer: Small cell (oat cell) carcinoma
- Location (central/peripheral)
- Characteristics
- Histology
A
- Location
- Central
- Characteristics
- Undifferentiated –> very aggressive.
- May produce ACTH, ADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome).
- Amplification of myc oncogenes common.
- Inoperable; treat with chemotherapy.
- Histology
- Neoplasm of neuroendocrine Kulchitsky cells –> small dark blue cells [B].
27
Q
Pancoast tumor
A
- Carcinoma that occurs in apex of lung may affect cervical sympathetic plexus
- Causes Horner syndrome (ipsilateral ptosis, miosis, and anhidrosis), SVC syndrome, sensorimotor deficits, and hoarseness [A].
29
Q
Pneumonia (611)
- For each
- Typical organisms
- Characteristics
- Lobar
- Bronchopneumonia
- Interstitial (atypical) pneumonia
A
- Lobar
-
Typical organisms:
- S. pneumoniae most frequently
- Also Legionella, Klebsiella
-
Characteristics:
- Intra-alveolar exudate –> consolidation
- May involve entire lung [A] [B].
-
Typical organisms:
- Bronchopneumonia
-
Typical organisms:
- S. pneumoniae, S. aureus, H. influenzae, Klebsiella
-
Characteristics:
- Acute inflammatory infiltrates from bronchioles into adjacent alveoli
- Patchy distribution involving ≥ 1 lobe [C].
-
Typical organisms:
- Interstitial (atypical) pneumonia
-
Typical organisms:
- Viruses (influenza, RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia
-
Characteristics:
- Diffuse patchy inflammation localized to interstitial areas at alveolar walls
- Distribution involving ≥ 1 lobe [D].
- Generally follows a more indolent course.
-
Typical organisms:
30
Q
Lung abscess
- Definition
- Due to…
- Findings
A
- Definition
- Localized collection of pus within parenchyma.
- Due to…
- Bronchial obstruction (e.g., cancer) or aspiration of oropharyngeal contents (especially in patients predisposed to loss of consciousness [e.g., alcoholics or epileptics]).
- Often due to S. aureus or anaerobes (Bacteroides, Fusobacterium, Peptostreptococcus).
- Findings
- Air-fluid levels [A] often seen on CXR.
31
Q
Pleural effusions
- Definition
- For each
- Definition
- Due to…
- Transudate
- Exudate
- Lymphatic
A
- Definition
- Excess accumulation of fluid between the two pleural layers [A] –> restricted lung expansion during inspiration.
- Transudate
- Definition
- Decreased protein content.
- Due to CHF, nephrotic syndrome, or hepatic cirrhosis.
- Definition
- Exudate
- Definition
- Increased protein content, cloudy.
- Occurs in states of increased vascular permeability
- Must be drained in light of risk of infection
- Due to malignancy, pneumonia, collagen vascular disease, trauma
- Definition
- Lymphatic
- Definition
- Also known as chylothorax.
- Milky-appearing fluid
- Increased triglycerides
- Due to thoracic duct injury from trauma, malignancy.
- Definition
32
Q
Pneumothorax
- Definition
- Findings
- Spontaneous pneumothorax
- Tension pneumothorax
A
- Definition
- Accumulation of air in the pleural space [A].
- Findings
- Unilateral chest pain and dyspnea, unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminished breath sounds, all on the affected side.
- Spontaneous pneumothorax
- Accumulation of air in the pleural space [A].
- Occurs most frequently in tall, thin, young males because of rupture of apical blebs.
- Tension pneumothorax
- Usually occurs in setting of trauma or lung infection.
- Air is capable of entering pleural space but not exiting.
- Trachea deviates away from affected lung [B].
