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respiratory pathology Flashcards

1
Q

Keisselbach plexus

A

anterior segment of nostril; often nose bleeds occur here

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2
Q

Sphenopalatine artery

A

life threatening nosebleeds occur here; branch of maxillary artery

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3
Q

Virchow triad

A

stasis, hypercoagulability, endothelial damage

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4
Q

Homan sign

A

indicative of DVT; dorsiflex the foot, leads to calf pain

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5
Q

DVT prophylaxis, acute management, and treatment

A

prophylaxis and acute management is unfractionated or LMWH (enoxaparin); treatment is oral anticoagulants like warfarin, rivaroxaban

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6
Q

Lines of Zahn

A

interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in thrombi formed before death; help distinguish pre- and postmortem thrombi

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7
Q

amniotic fluid emboli

A

can lead to DIC, esp postpartum

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8
Q

Hallmark on PFTs of obstructive lung disease

A

Decr FEV/FVC ratio

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9
Q

chronic bronchitis (blue bloater)

A

hyperplasia of mucus-secreting glands in bronchi leads to Reid index (thickness of gland layer/total thickness of bronchial wall)>50%; productive cough for over 3 mos per year (not necessarily consec) for over 2 years

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10
Q

emphysema (pink puffer)

A

enlargemnet of air spaces, decreased recoil, increased compliance; decreaed diffusion capacity

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11
Q

two types of emphysema are centriacinar and panacinar

A

centriacinar is assoc with smoking; panacinar is assoc with alpha 1 antitrypsin def

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12
Q

pathophys of emphysema

A

increased elastase activity leading to loss of elastic fibers and therefore increased lung compliance; barrel shaped chest is characteristic of the pink puffer

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13
Q

Curschmann spirals

A

shed epithelium formd whorled mucus plugs; seen in asthma

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14
Q

Charcot-Leyden crystals

A

seen in asthma; these are eosinophilic hexagonal , double pointed needle-like crystals formed from breakdown of eosinophils in the sputum

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15
Q

Pulsus paradoxus

A

Decrease in systolic BP (CO) with inspiration

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16
Q

bronchiectasis

A

seen in CF, also smoking, Kartagener syndrome, allergic bronchopulmonary aspergillosis; chronic necrotizing infection of bronchi leading to permanently dilated airways, purulent sputum, recurrent infections, and hemoptysis

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17
Q

Interstitial lung diseases

A

ARDS, neonatal resp distress syndrome (NRDS, hylaine membrane disease), pneumoconioses (anthracosis, silicosis, asbestosis), sarcoidosis, IPF, goodpasture syndrome, granulomatosis with polyangiitis (Wegener), Langerhans cell histiocytosis (eosinophilc granuloma), hypersens pneumonitis

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18
Q

FEV1/FVC ratio in normal, obstructive, and restrictive lung disease

A

normal is 80, obstructive is less than 70, and restrictive is greater than 80

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19
Q

hypersensitivity pneumonitis

A

mixed type 3 and 4 hypersens reaction to an environmental antigen leads to dyspnea, cough, chest tightness, HA; often seen n farmers and those exposed to birds

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20
Q

what is a pneumoconiosis and what are the types?

A

restrictive lung disease caused by inhalation of dusts; types are coal worker’s pneumoconiosis, silicosis, asbestosis, beryliosis

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21
Q

all pneumoconioses increase the risk for what?

A

cor pulmonale and caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulm nodules)

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22
Q

asbestosis

A

“ivory white” calcified supradiaphragmatic and pleural plaques are pathognomonic; assoc with increased risk of lung cancer (bronchogenic>mesothelioma); affects the lower lobes; asbestos (ferruginous) bodes are golden brown fusiform rods resembling dumbbells, found in alveolar sputum

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23
Q

berylliosis

A

assoc with exposure to beryllium in aerospace and manufacturing industries; granulomatous histology and therefore occasionally responsive to steroids; affects the upper lobes

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24
Q

coal worker’s pneumoconiosis

A

prolonged coal dust exposure leads to macrophages laden with carbon, which leads to inflamm and firbosis; also known as black lung disease; affects the upper lobes; anthracosis is asymp condition found in urban dwellers exposed to sooty air

25
Q

silicosis

A

assoc with mines; macriphages respond to silica and release fibrogenic factors, leading to fibrosis; lead to increased risk of bronchogenic carcinoma; affects upper lobes; eggshell calcification of hilar lymph nodes

26
Q

neonatal resp distress syndrome

A

surfactant deficiency leads to increased surface tension which leads to alveolar collapse (ground glass opacities); lecithin:sphingomyelin ratio less than 1.5 in amniotic fluid is predictive of NRDS; persistently low o2 tension leads to risk of PDA

27
Q

therapeutic supplemental oxygen in NRDS babies can lead to what three bad outcomes?

A

retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia

28
Q

risk factors for NRDS

A

prematurity, maternal diabetes (due to increased fetal insulin), C-section (decr release of fetal glucocorticoids)

29
Q

complications of NRDS

A

metabolic acidosis, PDA, necrotizing enterocolitis

30
Q

treatment for NRDS babies

A

maternal steroids before birth, artificial surfactant for the infant

31
Q

ARDS

A

acute onset resp failure, bilateral lung opacities, decreased PaO2/FiO2; May be caused by trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, amniotic fluid embolism; pathogenesis is that there is diffuse damage to the alveoli, which leads to the capillaries leaking protein rich stuff into the alveoli and causing pulmonary edema; results in formation of intra-alveolar hyaline membranes

32
Q

management of ARDS

A

mechanical ventilation with low tidal volumes, address underlying cause

33
Q

what is normal mean pulmonary artery pressure?

A

10-14 mm Hg; pulm hypertension is when presure is over 25 mm Hg at rest

34
Q

pulmonary hypertension

A

over 25 mm hg; results in arteriosclerosis, medial hypertrophy, intimal fibrosis of pulmonary arteries; leads to RVH which can cause death from decompensated cor pulmonale

35
Q

Idiopathic pulmonary arterial hypertension

A

heritable; often due to inactivating mutation in BMPR2 gene (normally inhibits vascular smooth muscle proliferation); poor prognsosi; includes pulm venous occlusive disease and persistent PH of the newborn; other causes include drugs (amphetamines, cocaine), connective tissue disease, HIV infection, portal hypertension, congenital heart disease, schistosomiasis

36
Q

pulm hypertensions due to lung diseases or hypoxia

A

destruction of lung parenchyma (COPD) , hypoxemic vasoconstriction (living at high altitude, OSA)

37
Q

pleural effusion breath sounds, percussion, fremitus, tracheal deviation

A

breath sound decreased, dull to percussion, decreased fremitus, no tracheal dev

38
Q

atelectasis (bronchial obstruction) breath sounds, percussion, fremitus, tracheal deviation

A

decreased BS, dull to percussion, decreased fremitus, deviation of trachea toward the lesion

39
Q

simple pneumothorax

A

decr BS, hyperresonant to percussion, decreased fremitus, no deviation (or away from the lesion if tension pneumo)

40
Q

consolidation

A

bronchial BS, late inspir crackles, dull to percussion, increased frem, no dev

41
Q

causes of transudative pleural effusion

A

heart failure, nephrotic syndrome, hepatic cirrhosis

42
Q

causes of exudative pleural effusion

A

malignancy, pneumonia, collagen vascular disease, trauma

43
Q

what causes interstitial (atyical) pneumonia?

A

viruses (RSV, CMV, infleunza, adenovirus), mycoplasma, legionella, chlamydia; generally follows a more indolent course (walking pneumonia)

44
Q

best treatment for lung abscess

A

clinda

45
Q

lung abscess on CXR

A

air-fluid level; due to anaerobes (bacteroides, fusobacterium, peptostreptococcus) or staph aureus

46
Q

histology assoc with mesothelioma

A

psammoma bodies

47
Q

pancoast tumor (superior sulcus tumor)

A

carcinoma that occurs in the apex of the lung; may cause Pancoast syndrome by invading the cervical sympathetic chain, causing Horner syndrome, SVC syndrome, sensorimotor deficits, and hoarseness

48
Q

SVC syndrome

A

facial plethora; edema of the neck and upper extremities; often caused by malignancy and thrombosis from indwelling catheters; medical emergency because leads to incr ICP and increased risk of aneurysm/rupture of intracranial arteries

49
Q

Sites of metastasis from lung cancer

A

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

50
Q

what cancers met to the lung?

A

breast, colon, prostate, and bladder cancer

51
Q

sqaumaous and Small cell carcinomas of the lung are located where?

A

sentral (central)

52
Q

small cell carcinoma

A

central; very aggressive, may produce ACTH (cushing syndrome), SIADH, or lambert-eaton syndrome; amplification of myc oncogenes is common; inoperable, treat with chemo; on histology, this is a neoplasm of neuroendocrine kulchitsky cells (small dark blue cells); chromogranin A positive

53
Q

what are the 4 types of nonsmall cell lung cancer?

A

adenocarcinoma, squamous cell, large cell, bronchial carcionoid tumor

54
Q

adenocarcinoma of the lung

A

located peripherally; most common lung cancer in NON-smokers and overall; activating mutations include KRAS, EGFR, and ALK; assoc with hypertrophic osteoarthropathy (clubbing); the bronchioloalveolar subtypr (adenocarcinoma in situ) has cxr with hazy infiltrates similar to PNA, excellent prognosis

55
Q

histology of lung adenocarcinma

A

glandular pattern on histology, often stains mucin pos; the bronchoalveolar subtype grows along the alveolar septa which leads to apparent thickening of the alveolar walls

56
Q

squamous cell carcinoma

A

central location; hilar mass arising from bronchus; cavitation, cigarettes, hypercalcemia (produces PTHrP); keratin pearls and intercellular bridges on histology

57
Q

large cell carcinoma

A

peripherally located; highly anaplastic undifferentiated tumor; poor prognosis; less responsive to chemo; removed surgically; pleomorphic giant cells on histology; can secrete beta-hcg

58
Q

bronchial carcinoid tumor

A

excellent prognosis, mets are rare; sx due to mass effect; occasionally causes carcinoid syndrome (serotonin secretion leads to flushing, diarrhea, wheezing); on histology. Nests of neurendocrine cells; chromogranin A positive

Step 1 (18 decks)

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