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Respiratory - First Aid > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

1
Q

What is shown in this coronal CT?

A

Rhinosinusitis.

Yellow arrows: Bilateral maxillary sinusitis

Red arrow: Nasal septal deviation (unrelated to rhinosinusitis)

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2
Q

Rhinosinusitis pathology:

A

Obstruction of sinus drainage into nasal cavity –> inflammation and pain over affected area

Typically maxillary sinuses in adults

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3
Q

Rhinosinusitis - most common causes?

A

Most common acute cause: viral URI

May cause superimposed bacterial infection, most commonly: S. pneumoniae, H. influenzae, and M. catarrhalis

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4
Q

Epistaxis

A

Nose bleed

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5
Q

Epistaxis most common occurs in…

A

Anterior segment of nostril (Kiesselbach plexus)

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6
Q

Epistaxis in posterior segment of nostril can lead to…

A

Life threatening hemorrhage

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7
Q

Sphenopalatine artery is located in which segment of the nostril?

A

Posterior

(Sphenopalatine a. is branch of maxillary a.)

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8
Q

Deep Vein Thrombosis:

A

Blood clot within deep vein which leads to swelling, redness, warmth, pain

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9
Q

Virchow’s Triad:

A

SHE

Stasis

Hypercoagability (defect in coagulation cascade proteins, most commonly factor V Leiden)

Endothelial damage (exposed collagen triggers clotting cascade)

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10
Q

People with ____?____ are predisposed to DVT.

A

Virchow’s Triad (SHE)

Stasis

Hypercoaguability

Endothelial damage

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11
Q

95% of pulmonary emboli arise from where?

A

Deep leg veins

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12
Q

Homan Sign

A

Dorsiflex foot –> calf pain

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13
Q

Prevention and acute management of DVT?

A

Heparin

(unfractionated or low-molecular weight,

ex. enoxaparin)

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14
Q

Long term prevention of DVT recurrence?

A

Warfarin (oral anticoagulant)

Can also use Rivaroxaban, another oral anticoagulant

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15
Q

Name this study and disease it is test of choice for.

A

CT pulmonary angiography

Test of choice for PE

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16
Q

Pulmonary Emboli lead to what physiological defects?

A

V/Q mismatch –> hypoxemia –> respiratory alkalosis

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17
Q

Pulmonary Embolism causes what symptoms?

A

Sudden-onset dyspnea, chest pain, tachypnea.

May present as sudden death.

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18
Q

Types of Pulmonary Emboli:

A

An embolus moves like a FAT BAT

Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor

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19
Q

Fat Emboli are associated with…

A

Long bone fractures and liposuction

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20
Q

Was this pathology formed pre or post mortem?

A

Formed before death!

Lines of Zahn are interdigitating areas of pink (platelets, fibrin) and red(RBCs) found only in thrmobi formed before death.

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21
Q

What is this an image of?

A

Pulmonary thromboembolus

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22
Q

Classic triad of hypoxemia, neurologic abnormalities, and petechial rash is associated with what?

A

Fat emboli (PE)

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23
Q

Amniotic fluid emboli can lead to…

A

DIC, especially postpartum

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24
Q

Air (Gas) Emboli are caused by…

A

Nitrogen bubbles that precipitate in ascending divers

Treat with hyperbaric O2

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25
Q

Patient likely presents with what symptoms?

A

Sudden-onset dyspnea, chest pain, tachpnea.

May present with sudden death.

pic: Pulmonary Embolism

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26
Q

Obstructive lung disease:

A

Obstruction of air flow resulting in air trapping in the lungs.

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27
Q

Hallmark Pulmonary Function Test in Obstructive Lung Disease:

A

FEV1 (Forced Expiratory Volume in 1 sec) decreased a LOT

FVC (Forced Vital Capacity) decreased some

Leads to DECREASED FEV1/FVC ratio

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28
Q

FEV1/FVC ratio in healthy adults

A

75-80%

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29
Q

Chronic Bronchitis pathology:

A

Bronchitis = Blue Bloater

Hyperplasia of mucus-secreting glands in the bronchi

Reid index >50%

Disease of small airways

A form of COPD along with Emphysema

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30
Q

What is the Reid Index?

A

Thickness of gland layer/total thickness of bronchial wall

Bronchitis: >50%

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31
Q

Chronic Bronichitis: Diagnostic criteria

A

Productive cough for > 3 months per year (not necessarily consecutive) for >2 years.

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32
Q

Chronic Bronchitis: Findings

A

Wheezing, crackles, cyanosis (early-onset hypoxemia due to shunting), late-onset dyspnea, CO2 retention

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33
Q

Emphysema pathology:

A

Enlargement of air spaces, decreased recoil, increased compliance, decreased DLCO

Increased elastase activity –> loss of elastic fibers –> increased lung compliance

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34
Q

What is DLCO?

A

Diffusion capacity of the Lung for CO

Measures the partial pressure difference between COinspired<strong> </strong>and COexpired

Determines the extent to which O2 passes from air sacs to blood.

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35
Q

What are the two types of Emphysema and what causes them?

A

Centriacinar - associated with smoking

Panacinar - associated with α1-antitrypsin deficiency

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36
Q

Emphysema signs and symptoms:

A

Emphysema “ Pink Puffer”

Exhalation through pursed lips (to increase airway pressure and prevent airway collapse during respiration)

Barrel-shaped chest

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37
Q

Pathological microscopy shown on left shows what pathological feature of what disease?

(Microscopy is relatively normal on right)

A

Destruction of alveolar walls (arrow)

Emphysema

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38
Q

Name specific type of disease shown in gross specimen

A

Centriacinar Emphysema

(Associated with smoking)

Specimen shows multiple air-space cavities lined by heavy black carbon deposits

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39
Q

This disease is associated with what?

A

Smoking

(Centriacinar Emphysema)

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40
Q

X-Ray of what disease?

A

Emphysema

barrel-shaped chest (Increased A-P Diameter)

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41
Q

Asthma

A

Bronchial hyperresponsiveness causes reversible bronchoconstriction.

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42
Q

Asthma pathology:

A

Smooth muscle hypertrophy, Curschmann sprials (shed epithelium forms mucus plugs), and Charcot-Leyden crystals (formed from breakdown of eosinophils in sputum)

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43
Q

Curschmann spirals:

A

shed epithelium which forms mucus plugs

seen in Asthma on microscopy!

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44
Q

Charcot-Leyden Crystals:

A

Formed from breakdown of eosinophils in sputum

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45
Q

Name the feature and disease

A

Curschmann spirals

Asthma

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46
Q

Common triggers for asthma:

A

Viral URIs, allergens, stress

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47
Q

How do you test for asthma?

A

Methacholine challenge

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48
Q

Methacholine challenge test:

A

Methacholine is a non-selective muscarinic receptor agonist (M3)

Pt inhales aerosolized methacholine, leading to bronchoconstriction

Degree of narrowing can be quantified by spirometry.

Pt with asthma will react to lower doses of drug.

Contraindicated: in ppl with severe airway obstruction

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49
Q

Asthma Findings:

A

Cough, wheezing, tachypnea, dyspnea, hypoxemia, decreased I/E ratio, pulsus paradoxis, mucus plugging

I/E ratio: time of inspiration/expiration

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50
Q

Pulsus Paradoxus:

A

Abnormally large decrease in systolic pressure during INSPIRATION (>10mmHg)

Sign that is indicative of several conditions: obstructive lung disease, cardiac tamponade, pericarditis, etc.

Normally: decrease in BP (<10mmHg) on inhalation and increase in BP on exhalation

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51
Q

This image is indicative of what finding in what disease process?

A

Mucus plugging

Asthma

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52
Q

Bronchiectasis pathology:

A

Chronic necrotizing infection of bronchi which leads to PERMANENTLY dilated airways, PURULENT (foul smelling) sputum, recurrent infections, and hemoptysis.

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53
Q

Bronchial obstruction, poor ciliary motility (smoking), Kartagener syndrome, cystic fibrosis, allergic bronchopulmonary aspergillosis is associated with what disease?

A

Bronchiectasis

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54
Q

What disease process is shown in this patient with Cystic Fibrosis?

A

Bronchiectasis

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55
Q

Restrictive Lung Disease

A

Restricted lung expansion causes DECREASED lung volumes (FVC and TLC).

FEV1/FVC ration INCREASED >80%

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56
Q

Restrictive Lung Diseases with Poor breathing mechanics:

A

Poor muscular effort - Polio, Myasthenia Gravis

Poor structural apparatus - Scoliosis, Morbid Obesity

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57
Q

Interstitial Lung Disease is ….. and causes what physiologic changes ?

A

a group of lung diseases that affect the interstitium (tissue and space around the air sacs of the lungs)

Causes DECREASED diffusing capacity, INCREASED A-a gradient

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58
Q

This image shows what characteristic finding in what interstitial lung disease?

A

“Honeycomb Lung”

Idiopathic pulmonary fibrosis (repeated cycles of lung injury and wound healing with increased collagen deposition)

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59
Q

Another name for Neonatal Respiratory Distress Syndrome, and type of lung disease

A

Hyaline Membrane Disease

Interstitial Lung Disease

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60
Q

Examples of Pneumoconioses, and type of lung disease.

A

Anthracosis, Silicosis, Asbestosis

Interstitial Lung Disease

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61
Q

Drug toxicities that can cause Interstitial Lung Disease:

A

Bleomycin, Busulfan, Amiodarone, Methotrexate

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62
Q

Hypersensitivity Pneumonitis: pathology, symptoms, and epidemiology

A

Mixed type III/IV hypersensitivity rxn to environmental antigen

Causes dyspnea, cough, chest tightness, headache.

Often seen in farmers and those exposed to birds.

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63
Q

Pneumoconioses: examples, what they lead to, type of lung disease

A

Coal workers’ pnumoconiosis (anthracosis), silicosis, and asbestosis

Lead to increased risk of cor pulmonale and Caplan Syndrome

Interstitial Lung Disease (Restrictive)

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64
Q

Caplan Syndrome

A

Rheumatoid Arthritis and Pneumoconiosis with intrapulmonary nodules

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65
Q

Name feature and disease

A

Asbestos (ferruginous) bodies - golden-brown fusiform rods resembling dumbbells.

Asbestosis (Pneumoconiosis, Interstitial Lung Disease)

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66
Q

This image is pathognomonic for what disease?

A

Asbestosis

See “Ivory white” calcified pleural plaques (arrows)

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67
Q

Asbestosis is associated with what professions?

A

Shipbuilding, roofing, and plumbing.

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68
Q

Asbestosis is associated with an increased risk for what?

A

Increase incidence of bronchogenic carcinoma and mesothelioma.

BUT Bronchogenic carcinoma >> mesothelioma

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69
Q

Which lobes are affected in Asbestosis?

A

Lower lobes

Asbestos is from the roof, but affects the base (lower lobes)

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70
Q

This image is pathognomonic for what disease?

A

Asbestosis

Shown is a diaphragm specimen with “ivory white” calcified supradiaphragmatic plaques

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71
Q

Coal Workers’ Pneumoconiosis

A

“Black Lung Disease”

Prolonged coal exposure –> macrophages laden with carbon –> inflammation and fibrosis

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72
Q

What lobes are affected in Coal Workers’ Pneumoconiosis?

A

Upper lobes

Silica and coal are from the base (earth), but affect the roof (upper lobes)

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73
Q

Anthracosis

A

asymptomatic condition found in many urban dwellers exposed to pollution

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74
Q

Silicosis is associated with what occupations?

A

Foundries (factories producing metal castings), sandblasting, and mining.

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75
Q

Silicosis pathology:

A

Macrophages respond to silica and release fibrogenic factors, leading to fibrosis.

May disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB.

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76
Q

Silicosis patients are at increased risk for….

A

bronchogenic carcinoma, and possibly TB

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77
Q

What lobes are affected in Silicosis?

A

Upper lobes

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78
Q

White arrows point to what feature of what disease?

A

“Eggshell” calcification of hilar lymph nodes

Silicosis

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79
Q

Neonatal respiratory distress syndrome: Cause

A

Prematurity - get surfactant deficiency which leads to INCREASED surface tension and alveolar collapse.

80
Q

Lecithin:sphyngomyelin ratio predictive of neonatal respiratory distress syndrome:

A

<1.5 in amniotic fluid

<2 is abnormal

81
Q

Persistently low O2 tension in Neonatal respiratory distress syndrome leads to risk of….

A

Patent ductus arteriosus

82
Q

Therapeutic supplemental O2 in Neonatal Respiratory Distress Syndrome can result in

A

Retinopathy of Prematurity (ROP) and bronchopulmonary dysplasia

83
Q

Risk factors for Neonatal Respiratory Distress Syndrome:

A

Prematurity

Maternal Diabetes (due to increased fetal insulin)

C-section delivery (decreased release of fetal glucocorticoids)

84
Q

Treatment for Neonatal Respiratory Distress Syndrome

A

Maternal steroids (glucocorticoids) before birth: (speeds up production of surfactant)

Artificial surfactant (synthetic or derived from cow) through endotracheal tube

85
Q

Acute Respiratory Distress Syndrome (ARDS) cause

A

trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, or amniotic fluid embolism

86
Q

ARDS pathology:

A

Diffuse alveolar damage leads to increased alveolar capillary permeability –> protein-rich leakage into alveoli and noncardiogenic pulmonary edema

Formation of intra-alveolar hyaline membrane

87
Q

This “ground-glass” appearance of lung fields is seen in what disease?

A

Neonatal Respiratory Distress Syndrome

88
Q

ARDS is characterized by:

A

Acute onset respiratory failure, bilateral lung opacities, decreased PaO2/FiO2 (normal 300-500 mmHg), and no HF.

89
Q

ARDS Management:

A

Mechanical ventilation with low tidal volumes

Address underlying cause

90
Q

Near-complete opacification of the lungs with obscured cardiomediastinal silhouette is seen in what disease?

A

ARDS

91
Q

Name the pathology and disease.

A

Thickened hyaline membranes (pink), and alveolar fluid (clear frothy)

ARDS

92
Q

The initial damage in ARDS is due to ?

A

Release of neutrophilic substances toxic to alveolar wall, activation of coagulation cascade, and oxygen-derived free radicals.

93
Q
A

Normal FEV1/FVC Ratio = 80%

94
Q
A

Obstructive Lung Disease

FEV1/FVC <80%

In both obstructive and restrictive, FEV1 and FVC are reduced. In obstructive, however, FEV1 is more dramatically reduced compared to FVC, resulting in a decreased ratio.

95
Q
A

Restrictive Lung Disease

FEV1/FVC >/= 80%

In both obstructive and restrictive, FEV1 and FVC are reduced.

96
Q

Pulmonary Hypertension =

A

>/= 25mmHg at rest

97
Q

Normal pulmonary artery pressure =

A

10-14 mmHg

98
Q

Pulmonary Hypertension results in…

A

arteriosclerosis, medial hypertrophy, and intimal fibrosis of pulmonary arteries

99
Q

Primary (Idiopathic) Pulmonary Hypertension is caused by what?

A

Inactivating mutation in BMPR2 gene, which normally functions to inhibit proliferation of vascular smooth muscle.

Heritable

Poor Prognosis

100
Q

Secondary Pulmonary Hypertension can be due to…

A

COPD, mitral stenosis, recurrent thromboemboli, autoimmune disease, left-to-right shunt, sleep apnea, certain drugs, HIV infection, Congenital Heart Disease, Schistosomiasis, or living at high altitude

101
Q

Why would a left-to-right shunt cause PAH?

A

Increases shear stress which leads to endothelial injury

102
Q

Why would living at high altitude cause Pulmonary HTN?

A

Causes hypoxic vasoconstriction

103
Q

What drugs can cause Pulmonary HTN?

A

Cocaine, Amphetamines

104
Q

Sleep apnea is defined by

A

Repeated cessation of breating > 10 seconds during sleep.

Leads to disrupted sleep, and daytime somnolence.

105
Q

How is PaO2 affected during the day in someone who suffers from sleep apnea?

A

Normal

106
Q

How is PaO2 affected at night in someone with sleep apnea?

A

Nocturnal hypoxia, which leads to systemic/pulmonary hypertension, arrhythmias (A-Fib/A-flutter), and sudden death.

107
Q

Central sleep apnea is due to? Outcome?

A

CNS injury / toxicity

no respiratory effort

108
Q

Obstructive sleep apnea is due to? Result?

A

Airway obstruction caused by excess parapharyngeal tissue in adults, adenotonsillar hypertrophy in children.

Respiratory effort against airway obstruction

109
Q

Obstructive sleep apnea is associated with

A

obesity, lound snoring

110
Q

Sleep apnea treatment:

A

weight loss, CPAP, surgery

111
Q

Sleep apnea can cause polycethmia becauase…

A

hypoxia leads to increase EPO release which leads to erythropoiesis

112
Q

Obesity hypoventilation syndrome:

A

BMI >/= 30 which leads to hypoventilation during sleep, decreased PaO2 and Increased PaCO2 during waking hours

113
Q

Breath sounds, percussion, and fremitus in pleural effusion:

A

Breath sounds: decreased

Percussion: Dull

Fremitus: decreased

No tracheal deviation

114
Q

Breath sounds, percussion, fremitus, and tracheal deviation in atelectasis

A

Breath sounds: decreased

Percussion: dull

Fremitus: decreased

Deviation: toward side of lesion

115
Q

Breath sounds, percussion, fremitus, and tracheal deviation in spontaneous pneumothorax:

A

breath sounds: decreased

Percussion: hyperresonant

Fremitus: decreased

No tracheal deviation

116
Q

Breath sounds, percussion, fremitus, and tracheal deviation in tension pneumothorax

A

breath sounds: decreased

percussion: hyperresonant

fremitus; decreased

tracheal deviation: AWAY from side of lesion

117
Q

Percussion to normal lung:

A

resonance

118
Q

Breath sounds, percussion, fremitus, and tracheal deviation in lung consolidation (lobar pnumonia, pulmonary edema)

A

breath sounds: bronchial breath sounds; late inspiratory crackles

Percussion: dull

Fremitus: INCREASED

tracheal deviation: none

119
Q

Leading cause of cancer death

A

Lung cancer

120
Q

Lung cancer often presents with:

A

cough, hemoptysis, bronchial obtruction, wheezing, pneumonic “coin” lesion on xray or noncalcified nodule on CT

121
Q

Most common type of lung cancer

A

Secondary (metastases) from other areas

122
Q

Lung metastases are more common than primary neoplasms. Most often from:

A

breast, colon, prostate, and bladder

123
Q

Lung cancer often metastasizes to these areas:

A

adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly)

124
Q

Lung cancer complications:

A

SPHERE

Superior vena cava syndrome

Pancoast tumor

Horner syndrome

Endocrine (paraneoplastic)

Recurrent laryngeal symptoms (hoarseness)

Effusions (pleural or pericardial)

125
Q

Risk factors of lung cancer:

A

smoking, second hand smoke, radon, asbestos, family history

126
Q

Adenocarcinoma location

A

peripheral

127
Q

Most common lung cancer in nonsmokers

A

Adenocarcinoma

128
Q

Most common lung cancer overall (except for metastases)

A

Adenocarcinoma

129
Q

k-ras, EGFR, and ALK are activating mutations in what cancer?

A

Adenocarcinoma

130
Q

Clubbing is associated with what lung cancer?

A

Adenocarcinoma

Clubbing = hypertrophic osteoarthropathy

131
Q

Lung cancer in which chest x-ray shows hazy infiltrates similar to pneumonia:

A

Bronchioalveolar subtype of Adenocarcinoma

132
Q

What lung cancer grows along alveolar septa and leads to apparent “thickening” of alveolar walls?

A

Bronchioloalveolar subtype of Adenocarcinoma

133
Q

What lung cancer has a glandular pattern on histology, and often stains mucin + ?

A

Adenocarcinoma

134
Q

This is an image of what type of lung pathology?

A

Adenocarcinoma: Glandular pattern on histology, often stains mucin +

135
Q

Squamous cell carcinoma is located where?

A

Centrally

(Squamous and Small cell carcinomas are Sentral (central))

136
Q

Hilar mass arising from bronchus is indicative of what lung cancer?

A

Squamous cell carcinoma

137
Q

Cavitation, Cigarettes, hyperCalcemia (produces PTHrP) are characeteristics of what lung cancer?

A

Squamous cell carcinoma

138
Q

Keratin pearls and intercellular bridges are indicative of what lung pathology?

A

Squamous cell carcinoma

139
Q

Name lung pathology and histological charactersitics:

A

Squamous cell carcinoma

Keratin pearls and intracellular bridges

Note sheets of large, dysplastic squamous cells (arrows) surrounding dark pink keratin pearls (lower right)

140
Q

Small cell (oat cell) carcinoma is located where?

A

Centrally

141
Q

Undifferentiated and very aggressive form of lung cancer:

A

small cell (oat cell) carcinoma

142
Q

ACTH, ADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome) are often produced in this lung cancer:

A

small cell (oat cell) carcinoma

143
Q

Amplification of myc oncogenes is common in this type of lung cancer

A

small cell (oat cell) carcinoma

144
Q

How is small cell (oat cell) carcinoma treated?

A

Chemotherapy. Inoperable

145
Q

This image is characteristic finding in what lung pathology?

A

small cell (oat cell) carcinoma

Neoplasm of neuroendocrine or Kulchitsky cells -> small cark blue cells

Sheets of dark purple tumor cells with nuclear molding, high mitotic rate, necrosis, and “salt and pepper” neuroendocrine-type chrmatin

146
Q

Large cell carcinoma is located where?

A

Periphery

147
Q

This lung cancer characteristically has anaplastic undifferentiated tumors

A

Large cell carcinoma

148
Q

How do you treat large cell carcinoma?

A

Surgical removal. Less responsive to chemotherapy

149
Q

Histologically, this lung cancer has pleomorphic giant cells and can secrete beta-hCG

A

large cell carcinoma

150
Q

This lung cancer has an excellent prognosis

A

Bronchial carcinoid tumor (metastasis is rare)

151
Q

Symptoms in bronchial carcinoid tumor are usually due to

A

mass effect; occasionally carcinoid syndrome (5-HT secretion, flushing, diarrhea, wheezing)

152
Q

What is carcinoid syndrome?

A

Seen in bronchial carcinoid tumor

5-HT secretion –> flushing, diarrhea, wheezing

153
Q

What is shown in this xray?

A

Hilar mass arising from bronchus (squamous cell carcinoma)

154
Q

Nests of neuroendocrine cells are indicative of what type of lung pathology?

A

Bronchial carcinoid tumor

155
Q

These lung cancers are chromogranin A +:

A

bronchial carcinoid tumor

small cell (oat cell) carcinoma

Why? Both consist of neuroendocrine cells, and chromogranin A is located in the secretory granules of neurons and endocrine cells

156
Q

Malignancy of the pleura associated with asbestosis:

A

Mesothelioma

157
Q

Mesothelioma results in …

A

hemorrhagic pleural effusions and pleural thickening

158
Q

What characteristic finding is seen on histology of mesothelioma?

A

Psammoma bodies

159
Q

Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus

A

Pancoast Tumor

160
Q

Pancoast tumor that impinges on cervical sympathetic plexus may result in:

A

Horner syndrome (ispilateral ptosis, miosis, and anhidrosis)

SVC syndrome

Sensorimotor deficits

Hoarseness

161
Q

Superior Vena Cava Syndrome

A

An obstruction of the SVC that impairs blood drainage from the head (“facial plethora”), neck (jugular venous distention), and upper extremities (edema).

162
Q

What causes SVC syndrome?

A

Commonly caused by malignancy (Pancoast Tumor) and thrombosis from indwelling catheters.

163
Q

Is SVC syndrome a serious problem?

A

It is a medical emergency. Can raise intracranial pressure (severe obstruction) which can lead to headaches, dizziness, and increased risk of aneurysm/rupture of intracranial arteries

164
Q

This MRI shows what lung pathology?

A

Pancoast tumor. See mass at Right lung apex.

165
Q

What are these characteristic structures, and in what lung pathology are they found in?

A

Psammoma bodies

Mesothelioma

166
Q

Most common organism to cause lobar pneumonia?

A

S. pneumoniae

Legionella and Klebsiella are also common

167
Q

Characteristics of lobar pneumonia:

A

intra-alveolar exudate –> consolidation; may involve entire lung

168
Q

Typical organisms in bronchopneumonia:

A

S. pneumoniae, S. aureus, H. influenzae, Klebsiella

169
Q

Characteristics of Bronchopneumonia:

A

Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving >/= 1 lobe

170
Q

This Xray shows what?

A

Lobar pneumonia. Dense right upper lobe consolidation with branching air-bronchograms; sharp inferior margin represents the horizontal fissure.

171
Q

This gross specimen shows what lung pathology?

A

Lobar pneumonia

172
Q

What cells are whinin the alveolar spaces, and what lung pathology is this indicative of?

A

Neutrophilic infiltrate

Bronchopneumonia

173
Q

Name consolidation pattern and lung pathology:

A

Patchy distribution involving >1 lobe

Bronchopneumonia

174
Q

Interstitial (atypical) pneumonia is most commonly caused by what organisms?

A

Viruses (influenza, RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia

175
Q

Interstitial pneumonia is characterized by:

A

diffuse patchy inflammation localized to interstitial areas at alveolar walls

Distribution >/= 1 lobe

Follows more indolent course

176
Q

This xray shows what characteristics and what lung pathology?

A

Course bilateral reticular opacities, worse on right

Interstitial pneumonia (diffuse, patchy interstitial inflammation)

177
Q

Localized collection of pus within parenchyma:

A

lung abscess

178
Q

Lung absesses are caused by:

A

bronchial obstruction (cancer) or aspiration of oropharyngeal contents (especially in pts predisposed to loss of consciousness [alcoholics or epileptics])

179
Q

This specimen shows what lung pathology?

A

lung abscess

180
Q

This xray shows what characteristics and what lung pathology?

A

Air fluid levels and cavitation.

Lung abscess

181
Q

Lung abscesses are often caused by what organisms?

A

Anaerobes (Bacteroides, Fusobacterium, Peptostreptococcus) or S. aureus

182
Q

Treatment for Lung Abscess

A

Clindamycin

183
Q

Pleural Effusion:

A

Excess accumulation of fluid between the two pleural layers –> restricted lung expansion during inspiration

184
Q

Transudate:

A

Decreased protein content.

Due to CHF (increased hydrostatic pressure), nephrotic syndrome (proteinuria -> decreased colloid oncotic pressure), or hepatic cirrhosis (decreased colloid oncotic pressure)

185
Q

Exudate:

A

Increased protein content, cloudy.

Due to malignancy, pneumonia, collagen vascular disease, trauma

Occurs in states of Increased vascular permeability

186
Q

Must be drained in light of risk of infection:

A

Exudate

187
Q

Lymphatic/Chylothorax:

A

Due to thoracic injury from trauma, malignancy.

Milky-white appearing fluid; Increased triglycerides

188
Q

Xray shows what pathology?

A

Pleural effusion (excess accumulation of fluid between the 2 pleural layers)

189
Q

CT shows what pathology?

A

Pleural Effusion

190
Q

What is seen on Xray and CT after treatment of pleural effusion?

A

Almost complete resolution after therapy.

191
Q

Pneumothorax:

A

Accumulation of air in the pleural space

192
Q

Pneumothorax signs and symptoms:

A

Unilateral chest pain and dyspnea, unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminished breath sounds, all on the affected side.

193
Q

Spontaneous pneumothorax:

A

Accumulation of air in the pleural space.

Occurs most frequently in tall, thin, young males because of rupture of apical blebs.

194
Q

Tension pneumothorax:

A

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.

195
Q

What is shown on this CT?

A

Pneumothorax (collapsed lung)

196
Q

What is shown on the xray?

A

Tension pneumothorax.

Deviation of trachea away from hyperlucent left lung. Low left hemidiaphragm.

Respiratory - First Aid (8 decks)

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