Respiratory- Phatology (2)

Question 1

Sleep apnea

Answer 1

Repeated cessation of breathing > 10 seconds during sleep. confirmed by sleep study

Nocturnal hypoxia Ž systemic/pulmonary hypertension, arrhythmias, sudden death

Obstructive sleep apnea, Central sleep apnea, Obesity
hypoventilation syndrome (Pickwickian syndrome)

Question 2

Pulmonary hypertension

Answer 2

Normal mean pulmonary artery pressure = 10–14 mm Hg; pulmonary hypertension ≥ 25

Course: severe respiratory distress Ž cyanosis and RVH Ž death from decompensated cor pulmonale.

Question 3

Pulmonary hypertension types

Answer 3

Pulmonary arterial hypertension

Left heart disease

Lung diseases or hypoxia

Chronic thromboembolic

Multifactorial

Question 4

Lung—physical findings

Answer 4

Pag. 662

Question 5

Pleural effusions types

Answer 5

Transudate, Exudate, Lymphatic

Question 6

Pneumothorax clinical manifestations

Answer 6

Dyspnea, uneven chest expansion. Chest pain, decrease tactile fremitus, hyperresonance, and diminished breath sounds, all on the affected side

Question 7

Primary spontaneous pneumothorax

Answer 7

Due to rupture of apical subpleural bleb or cysts. Occurs most frequently in tall, thin, young males
and smokers

Question 8

Secondary spontaneous pneumothorax

Answer 8

Due to diseased lung (eg, bullae in emphysema, infections), mechanical ventilation with use of high pressures Ž barotrauma.

Question 9

Traumatic pneumothorax

Answer 9

Caused by blunt (eg, rib fracture), penetrating (eg, gunshot), or iatrogenic (eg, central line placement, lung biopsy, barotrauma due to mechanical ventilation) trauma.

Question 10

Tension pneumothorax

Answer 10

any of the Pneumothorax. Air enters pleural space but cannot exit. Increasing trapped air Ž tension pneumothorax.

Trachea deviates away from affected lung. May lead to high intrathoracic pressure Ž low venous return
Ž low cardiac function.

Question 11

Lobar pneumonia

Answer 11

S pneumoniae most frequently, also Legionella, Klebsiella

Intra-alveolar exudate Ž consolidation

Question 12

Bronchopneumonia

Answer 12

S pneumoniae, S aureus, H influenzae, Klebsiella

Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving ≥ 1 lobe

Question 13

Interstitial (atypical) pneumonia

Answer 13

Mycoplasma, Chlamydophila pneumoniae, Chlamydophila psittaci, Legionella, viruses (RSV, CMV, influenza, adenovirus)

Diffuse patchy inflammation localized to interstitial areas at alveolar walls; diffuse distribution involving ≥ 1 lobe

Indolent course (“walking” pneumonia)

Question 14

Cryptogenic organizing pneumonia

Answer 14

Etiology unknown. Secondary organizing pneumonia caused by chronic inflammatory diseases or medication side effects (eg, amiodarone).

Formerly known as bronchiolitis obliterans organizing pneumonia (BOOP).

Question 15

Natural history of lobar pneumonia

Answer 15

Pag. 664

Question 16

Lung cancer

Answer 16

pag. 665

Question 17

Superior vena cava syndrome

Answer 17

“facial plethora”, jugular venous distention, and upper
extremities edema.

Commonly caused by malignancy and thrombosis from indwelling catheters

Question 18

Pancoast tumor (superiro sulcus tumor)

Answer 18

ƒƒ Recurrent laryngeal nerve Ž hoarseness
ƒƒ Stellate ganglion Ž Horner syndrome ipsilateral
ƒƒ Superior vena cava Ž SVC syndrome
ƒƒ Brachiocephalic vein Ž brachiocephalic syndrome (unilateral symptoms)
ƒƒ Brachial plexus Ž sensorimotor deficits

Question 19

Lung abscess

Answer 19

Air-fluid levels often seen on CXR. Fluid levels common in cavities

Due to anaerobes (eg, Bacteroides, Fusobacterium, Peptostreptococcus) or S aureus.

2° to aspiration is most often found in right lung