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First Aid > Respiratory - Pathology > Flashcards

Respiratory - Pathology Flashcards

1
Q

Rhinosinusitis

  • Definition
  • Due to…
  • Findings
A
  • Definition
    • Obstruction of sinus drainage into nasal cavity Ž
    • –> 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.
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2
Q

Deep venous thrombosis

  • Predisposed by…
  • Most arise from…
  • Homan sign
  • Treatment
A
  • Predisposed by Virchow triad:
    • Stasis
    • ƒƒHypercoagulability (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 Ž–> calf pain.
  • Treatment
    • Use heparin for prevention and acute management
    • Use warfarin for long-term prevention of DVT recurrence.
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3
Q

Pulmonary emboli (603)

  • Due to…
  • Findings
  • Types
  • Diagnosis
A
  • Due to…
    • V/Q mismatch –> hypoxemia Ž–> 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.
  • Diagnosis
    • CT pulmonary angiography is the imaging test of choice for a PE (look for filling defects) [A] [B] [C].
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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 Ž–> increased RV and decreased FVC.
    • Chronic, hypoxic pulmonary vasoconstriction can lead to cor pulmonale
  • PFTs
    • Really decreased FEV1
    • Decreased FVC Ž–> decreased FEV1/FVC ratio (hallmark)
    • V/Q mismatch.
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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 Ž
      • –> 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.
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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 –>Ž loss of elastic fibers Ž–>Ž increased lung compliance.
    • Exhalation through pursed lips to increases airway pressure and prevent airway collapse during respiration.
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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.
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8
Q

Bronchiectasis

  • Type of disease
  • Pathology
  • Associations
A
  • Type of disease
    • Obstructive lung disease
  • Pathology
    • Chronic necrotizing infection of bronchi Ž–> permanently dilated airways, purulent sputum, recurrent infections, hemoptysis.
  • Associations
    • Associated with bronchial obstruction, poor ciliary motility (smoking), Kartagener syndrome, cystic fibrosis, allergic bronchopulmonary aspergillosis.
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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)
      • ƒƒGoodpasture syndrome
      • ƒƒGranulomatosis with polyangiitis (Wegener)
      • Langerhans cell histiocytosis (eosinophilic granuloma)
      • ƒƒHypersensitivity pneumonitis
      • ƒƒDrug toxicity (bleomycin, busulfan, amiodarone, methotrexate)
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10
Q

Pneumo-

  • Hypersensitivity pneumonitis
  • Pneumoconioses
A
  • Hypersensitivity pneumonitis
    • Mixed type III/IV hypersensitivity reaction to environmental antigen
      • –>Ž dyspnea, cough, chest tightness, headache.
    • Often seen in farmers and those exposed to birds.
  • Pneumoconioses
    • Coal workers’ pneumoconiosis, silicosis, and asbestosis
    • Ž–> increased risk of cor pulmonale and Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules).
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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].
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12
Q

Coal workers’ pneumoconiosis

  • Type of disease
  • Definition
  • Findings
  • Anthracosis
A
  • Type of disease
    • Pneumoconiosis
  • Definition
    • Prolonged coal dust exposure –>Ž macrophages laden with carbon –>Ž 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.
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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.
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14
Q

Neonatal respiratory distress syndrome

  • Definition
  • Associations
  • Risk factors
  • Treatment
A
  • Definition
    • Surfactant deficiency Ž–> increased surface tension Ž–> alveolar collapse.
    • A lecithin : sphingomyelin ratio < 1.5 in amniotic fluid is predictive of neonatal respiratory distress syndrome.
  • Associations
    • Persistently low O2 tension –>Ž 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.
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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 Ž–> increased alveolar capillary permeability –>Ž 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].
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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
17
Q

Pulmonary hypertension

  • vs. normal pulmonary artery pressure
  • Results in…
  • Primary
  • Secondary
  • Course
A
  • vs. normal pulmonary artery pressure
    • Normal pulmonary artery pressure = 10–14 mmHg
    • Pulmonary hypertension ≥ 25 mmHg at rest.
  • Results in arteriosclerosis, medial hypertrophy, and intimal fibrosis of pulmonary arteries.
  • Primary
    • Due to an inactivating mutation in the BMPR2 gene (normally functions to inhibit vascular smooth muscle proliferation)
    • Poor prognosis.
  • Secondary due to…
    • COPD (destruction of lung parenchyma)
    • Mitral stenosis (increased resistance –>Ž increased pressure)
    • Recurrent thromboemboli (decreased cross-sectional area of pulmonary vascular bed)
    • Autoimmune disease (e.g., systemic sclerosis; inflammation –>Ž intimal fibrosis –>Ž medial hypertrophy)
    • Left-to-right shunt (increased shear stress –>Ž endothelial injury)
    • Sleep apnea or living at high altitude (hypoxic vasoconstriction).
  • Course
    • Severe respiratory distress Ž–> cyanosis and RVH Ž–> death from decompensated cor pulmonale.
18
Q

Sleep apnea

  • Definition
  • Hypoxia Ž–>
  • Nocturnal hypoxia Ž–>
  • Central sleep apnea
  • Obstructive sleep apnea
  • Obesity hypoventilation syndrome
  • Treatment
A
  • Definition
    • Repeated cessation of breathing > 10 seconds during sleep –>Ž disrupted sleep –>Ž daytime somnolence.
    • Normal Pao2 during the day.
  • Hypoxia Ž–>
    • Increased EPO release Ž–> increased erythropoiesis
  • Nocturnal hypoxia Ž–>
    • Systemic/pulmonary hypertension, arrhythmias (atrial fibrillation/ flutter), and sudden death.
  • Central sleep apnea
    • No respiratory effort.
  • Obstructive sleep apnea
    • Respiratory effort against airway obstruction.
    • Associated with obesity, loud snoring.
  • Obesity hypoventilation syndrome
    • Obesity (BMI ≥ 30 kg/m2) –>Ž hypoventilation Ž–> decreased Pao2 and –> decreased Paco2 during waking hours
  • Treatment
    • Weight loss, CPAP, surgery.
19
Q

Lung—physical findings

  • For each abnormality
    • Breath sounds (increased/decreased/other)
    • Percussion (dull/hyperresonant)
    • Fremitus (increased/decreased)
    • Tracheal deviation (toward/away/none)
  • Pleural effusion
  • Atelectasis (bronchial obstruction)
  • Spontaneous pneumothorax
  • Tension pneumothorax
  • Consolidation (lobar pneumonia, pulmonary edema)
A
  • Pleural effusion
    • Breath sounds: Decreased
    • Percussion: Dull
    • Fremitus: Decreased
    • Tracheal deviation: None
  • Atelectasis (bronchial obstruction)
    • Breath sounds: Decreased
    • Percussion: Dull
    • Fremitus: Decreased
    • Tracheal deviation: Toward side of lesion
  • Spontaneous pneumothorax
    • Breath sounds: Decreased
    • Percussion: Hyperresonant
    • Fremitus: Decreased
    • Tracheal deviation: None
  • Tension pneumothorax
    • Breath sounds: Decreased
    • Percussion: Hyperresonant
    • Fremitus: Decreased
    • Tracheal deviation: Away from side of lesion
  • Consolidation (lobar pneumonia, pulmonary edema)
    • Breath sounds: Bronchial breath sounds; late inspiratory crackles
    • Percussion: Dull
    • Fremitus: Increased
    • Tracheal deviation: None
20
Q

Lung cancer

  • Epidemiology
  • Findings
  • Locations
  • Complications
  • Associations
A
  • Epidemiology
    • Lung cancer is the leading cause of cancer death.
  • Findings
    • Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic “coin” lesion on x-ray film or noncalcified nodule on CT.
  • Locations
    • In the lung, metastases (usually multiple lesions) are more common than 1° neoplasms.
    • Most often from breast, colon, prostate, and bladder cancer.
    • Sites of metastases from lung cancer—adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly).
  • SPHERE of complications:
    • Superior vena cava syndrome
    • Pancoast tumor
    • Horner syndrome
    • Endocrine (paraneoplastic)
    • Recurrent laryngeal symptoms (hoarseness)
    • Effusions (pleural or pericardial)
  • Associations
    • All lung cancer types except bronchial carcinoid are associated with smoking.
    • Squamous and Small cell carcinomas are Sentral (central).
21
Q

Lung cancer:
Adenocarcinoma

  • Location (central/peripheral)
  • Characteristics
  • Histology
A
  • Location
    • Peripheral
  • Characteristics
    • Most common lung cancer in nonsmokers and overall (except for metastases).
    • Activating mutations include k-ras, EGFR, and ALK.
    • Associated with hypertrophic osteoarthropathy (clubbing).
    • Bronchioloalveolar subtype (adenocarcinoma in situ): CXR often shows hazy infiltrates similar to pneumonia
    • Excellent prognosis.
  • Histology
    • Bronchioloalveolar subtype: grows along alveolar septa Ž–> apparent “thickening” of alveolar walls.
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 Ž–> 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 –>Ž small dark blue cells [B].
24
Q

Lung cancer:
Large cell carcinoma

  • Location (central/peripheral)
  • Characteristics
  • Histology
A
  • Location
    • Peripheral
  • Characteristics
    • Highly anaplastic undifferentiated tumor
    • Poor prognosis.
    • Less responsive to chemotherapy
    • Removed surgically.
  • Histology
    • Pleomorphic giant cells.
25
Q

Lung cancer:
Bronchial carcinoid tumor

  • Characteristics
  • Histology
A
  • Characteristics
    • Excellent prognosis
    • Metastasis rare.
    • Symptoms usually due to mass effect
    • Occasionally carcinoid syndrome (5-HT secretion –>Ž flushing, diarrhea, wheezing).
  • Histology
    • Nests of neuroendocrine cells
    • Chromogranin A (+).
26
Q

Mesothelioma

  • Definition
  • Findings
A
  • Definition
    • Malignancy of the pleura associated with asbestosis.
  • Findings
    • Results in hemorrhagic pleural effusions and pleural thickening.
    • Psammoma bodies seen on histology.
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].
28
Q

Superior vena cava syndrome

  • Definition
  • Due to…
  • Findings
A
  • Definition
    • An obstruction of the SVC that impairs blood drainage from the head (“facial plethora”), neck (jugular venous distention), and upper extremities (edema).
    • Medical emergency
  • Due to…
    • Commonly caused by malignancy and thrombosis from indwelling catheters.
  • Findings
    • Can raise intracranial pressure (if obstruction severe) –>Ž headaches, dizziness, and increased risk of aneurysm/rupture of intracranial arteries.
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 Ž–> consolidation
      • May involve entire lung [A] [B].
  • 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].
  • 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.
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] Ž–> restricted lung expansion during inspiration.
  • Transudate 
    • Definition
      • Decreased protein content.
    • Due to CHF, nephrotic syndrome, or hepatic cirrhosis.
  • 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
  • Lymphatic
    • Definition
      • Also known as chylothorax.
      • Milky-appearing fluid
      • Increased triglycerides
    • Due to thoracic duct injury from trauma, malignancy.
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].

First Aid (92 decks)

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