respiratory pathology Flashcards
Keisselbach plexus
anterior segment of nostril; often nose bleeds occur here
Sphenopalatine artery
life threatening nosebleeds occur here; branch of maxillary artery
Virchow triad
stasis, hypercoagulability, endothelial damage
Homan sign
indicative of DVT; dorsiflex the foot, leads to calf pain
DVT prophylaxis, acute management, and treatment
prophylaxis and acute management is unfractionated or LMWH (enoxaparin); treatment is oral anticoagulants like warfarin, rivaroxaban
Lines of Zahn
interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in thrombi formed before death; help distinguish pre- and postmortem thrombi
amniotic fluid emboli
can lead to DIC, esp postpartum
Hallmark on PFTs of obstructive lung disease
Decr FEV/FVC ratio
chronic bronchitis (blue bloater)
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
emphysema (pink puffer)
enlargemnet of air spaces, decreased recoil, increased compliance; decreaed diffusion capacity
two types of emphysema are centriacinar and panacinar
centriacinar is assoc with smoking; panacinar is assoc with alpha 1 antitrypsin def
pathophys of emphysema
increased elastase activity leading to loss of elastic fibers and therefore increased lung compliance; barrel shaped chest is characteristic of the pink puffer
Curschmann spirals
shed epithelium formd whorled mucus plugs; seen in asthma
Charcot-Leyden crystals
seen in asthma; these are eosinophilic hexagonal , double pointed needle-like crystals formed from breakdown of eosinophils in the sputum
Pulsus paradoxus
Decrease in systolic BP (CO) with inspiration
bronchiectasis
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
Interstitial lung diseases
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
FEV1/FVC ratio in normal, obstructive, and restrictive lung disease
normal is 80, obstructive is less than 70, and restrictive is greater than 80
hypersensitivity pneumonitis
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
what is a pneumoconiosis and what are the types?
restrictive lung disease caused by inhalation of dusts; types are coal worker’s pneumoconiosis, silicosis, asbestosis, beryliosis
all pneumoconioses increase the risk for what?
cor pulmonale and caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulm nodules)
asbestosis
“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
berylliosis
assoc with exposure to beryllium in aerospace and manufacturing industries; granulomatous histology and therefore occasionally responsive to steroids; affects the upper lobes
coal worker’s pneumoconiosis
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
silicosis
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
neonatal resp distress syndrome
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
therapeutic supplemental oxygen in NRDS babies can lead to what three bad outcomes?
retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia
risk factors for NRDS
prematurity, maternal diabetes (due to increased fetal insulin), C-section (decr release of fetal glucocorticoids)
complications of NRDS
metabolic acidosis, PDA, necrotizing enterocolitis
treatment for NRDS babies
maternal steroids before birth, artificial surfactant for the infant
ARDS
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
management of ARDS
mechanical ventilation with low tidal volumes, address underlying cause
what is normal mean pulmonary artery pressure?
10-14 mm Hg; pulm hypertension is when presure is over 25 mm Hg at rest
pulmonary hypertension
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
Idiopathic pulmonary arterial hypertension
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
pulm hypertensions due to lung diseases or hypoxia
destruction of lung parenchyma (COPD) , hypoxemic vasoconstriction (living at high altitude, OSA)
pleural effusion breath sounds, percussion, fremitus, tracheal deviation
breath sound decreased, dull to percussion, decreased fremitus, no tracheal dev
atelectasis (bronchial obstruction) breath sounds, percussion, fremitus, tracheal deviation
decreased BS, dull to percussion, decreased fremitus, deviation of trachea toward the lesion
simple pneumothorax
decr BS, hyperresonant to percussion, decreased fremitus, no deviation (or away from the lesion if tension pneumo)
consolidation
bronchial BS, late inspir crackles, dull to percussion, increased frem, no dev
causes of transudative pleural effusion
heart failure, nephrotic syndrome, hepatic cirrhosis
causes of exudative pleural effusion
malignancy, pneumonia, collagen vascular disease, trauma
what causes interstitial (atyical) pneumonia?
viruses (RSV, CMV, infleunza, adenovirus), mycoplasma, legionella, chlamydia; generally follows a more indolent course (walking pneumonia)
best treatment for lung abscess
clinda
lung abscess on CXR
air-fluid level; due to anaerobes (bacteroides, fusobacterium, peptostreptococcus) or staph aureus
histology assoc with mesothelioma
psammoma bodies
pancoast tumor (superior sulcus tumor)
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
SVC syndrome
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
Sites of metastasis from lung cancer
adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly)
what cancers met to the lung?
breast, colon, prostate, and bladder cancer
sqaumaous and Small cell carcinomas of the lung are located where?
sentral (central)
small cell carcinoma
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
what are the 4 types of nonsmall cell lung cancer?
adenocarcinoma, squamous cell, large cell, bronchial carcionoid tumor
adenocarcinoma of the lung
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
histology of lung adenocarcinma
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
squamous cell carcinoma
central location; hilar mass arising from bronchus; cavitation, cigarettes, hypercalcemia (produces PTHrP); keratin pearls and intercellular bridges on histology
large cell carcinoma
peripherally located; highly anaplastic undifferentiated tumor; poor prognosis; less responsive to chemo; removed surgically; pleomorphic giant cells on histology; can secrete beta-hcg
bronchial carcinoid tumor
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
