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Pathology Block 11 > Respiratory System II > Flashcards

Respiratory System II Flashcards

1
Q

Epidemiology and pathogenisis of pulmonary thromboembolism

A

Third most common cardiovascular cause of death after acute MI and stroke

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2
Q

Source of Pulmonary thromboembolism

A

Majority (90%) originate from the deep veins of the lower extremities and pelvis

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3
Q

Risk factors for pulmonary thromboembolism

A

Stasis of blood flow (prolonged bed rest, plane rides)

hypercoagulable states

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4
Q

Size of embolus in pulmonary thromboembolism

A

Determines the pulmonary vessel that is occluded

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5
Q

Large embolis in pulmonary thromboembolism

A

Occlude the main pulmonary arteries (saddle embolus)

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6
Q

Small emboli in pulmonary thromboembolism

A

Occlude medium sized and small pulmonary arteries

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7
Q

Consequences of pulmonary thromboembolism

A
  • increase in pulmonary artery pressure
  • decreased blood flow to pulmonary parenchyma
  • may cause hemorrhagic infarction
  • red-blue raised, wedge-shaped area that extends to the pleural surface
  • hemorrhagic pleural effusion May also occur
  • majority in lower lobes
  • perfusion is greater than ventilation in the lower lobes
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8
Q

Clinical findings in pulmonary thromboembolism

A
  • saddle embolus
  • sudden onset of dyspnea and tachypenia
  • pleuritis chest pain, friction rub
  • fever
  • experitory wheezing
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9
Q

Saddle embolus in pulmonary thromboembolism

A

Sudden death

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10
Q

Formed elsewhere that detaches and travels throughout the vasculatiure

A

Thrombus

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11
Q

DX for pulmonary thromboembolism

A
  • CT scan
  • X ray
  • Abnormal perfusion radionuclide scan
  • Ventilation scan is normal, but the perfusion scan is abnormal
  • positive D-dimers-non-specific
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12
Q

Smokers and high dose contraceptives can cause

A

Pulmonary thromboembolism

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13
Q

Mean pulmonary artery pressure >25mmHg at rest and mean pulmonary artery pressure >30mmHg with exercise

A

Pulmonary HTN

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14
Q

Primary PH

A

More common in women, genetic predisposition

-vascular hyperreactivity with proliferation of smooth muscle

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15
Q

Secondary PH

A
  • endothelial cell dysfunction, loss of vasodilator (NO), increas in vasoconstrictors
  • hypoxemia and respiratory acidosis stimulate vasoconstriction of pulmonary arteries, causes smooth muscle hyperplasia and hypertrophy
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16
Q

Hypoxia and respiratory acidosis in PH

A

Stimulate vasoconstriction of pulmonary arteries

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17
Q

Mechanism secondary PH

A

Respiratory acidosis/hypoxemia, vasoconstriction

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18
Q

TX for PH

A

Cialis, lol

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19
Q

Combination of PH and RVH leading to right sided heart failure

A

Cor pulmonae

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20
Q

Causes of cor pulmonae

A

-chronic hypoxemia, chronic lung disease, living at high altitude
-chronic respiratory acidosis
—

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21
Q

Pathological findings of cor pulmonae

A

Enlarged right side of heart

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22
Q

Condition caused by excess fluid in the lungs, this fluid collects in the numerous air sacs in the lungs, making it difficult to breathe, in most cases, heart problems causes it

A

Pulmonary edema

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23
Q

Increases hydrostatic pressure in lung capillaries in PE

A

Left sided heart failure, volume overload, mitral stenosis

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24
Q

Decrease oncotic pressure in PE

A

Nephrotic syndrome and cirrhosis

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25
Q

PE due to microvascular or alveolar injury (exudate)

A
  • Infections-sepsis, pneumonia
  • aspiration-drowning and gastric contents
  • drugs (heroin)
  • high altitude
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26
Q

Fibrosis disorders, granulomatous disease

A

Chronic intestinal lung disease

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27
Q

Pathogenisis of interstitial fibrosis

A

Earliest manifestation is alveolitis

Leukocytes release cytokines, which stimulate fibrosis

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28
Q

Effects of interstitial fibrosis

A
  • decreases lung compliance (capacity to expand), decreased expansion of the lung parenchyma during inspiration, functional loss of alveolar capillary units
  • increases lung elasticity (stiffness)
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29
Q

Clinical findings of interstitial lung disease

A

Dry cough and exertion all dyspnea

Potential for cor pulmonae

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30
Q

Ability of lungs to expand

A

Compliance

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31
Q

Stiffness

A

Increased lung elasticity

32
Q

What is idiopathic pulmonary fibrosis more common in

A

Smoking males than in females

Occurs in individuals 40 to 70 years old

33
Q

Pathogenisis of idiopathic pulmonary fibrosis

A
  • repeated cycles of alveolitis are triggered by an unknown agent
  • release of cytokines produces interstitial fibrosis
  • alveolar fibrosis leds to proximal dilation of the small airways
  • lung has a honeycomb appearance
34
Q

Clinical findings of idiopathic pulmonary fibrosis

A
  • fever
  • progessing dyspnea and exertion
  • choleric, nonproductive cough
  • late inspiration crackles
35
Q

Honey comb lung

A

Idiopathic pulmonary fibrosis

36
Q

Inhalation of mineral dust unto the lungs leading to interstitial fibrosis, mineral dust includes coal dust, silica, asbestos

A

Pneumoconiosis

37
Q

Particles size in pneumoconiosis

A
  • > 5um are captured in the mucus of large bronchi and eliminated by coughing
  • <0.5um: reach the alveoli and are phagocytosed by alveolar macrophages
  • 1-5um: tend to get stuck at the bifurcation of respiratory bronchioles
38
Q

Anthracosis

A

Coal workers pneumoconiosis

  • usually benign
  • sources of coal dust
  • usually asymptomatic
39
Q

Coal workers pneuoconiosis: simple CWP

A

Fibrosis opacities are smaller than 1cm in the upper lobes and upper portions of lower lobes

40
Q

Coal workers pneumoconiosis: crippling CWP

A

Progressive massive fibrosis

  • fibrotic opacities larger than 1-2cm with or without necrotic centers
  • crippling lung disease (black lung)
41
Q

Multisystem noninfection granulomatous disease that produces chronic interstitial fibrosis

A

Sarcoidosis

42
Q

Who is more likely to get sarcoidosis

A

Common in black and non smokers, women, 20-39 years old

43
Q

Pathogenisis of sarcoidosis

A

Disorder in immune regulation

44
Q

Dx of sarcoidosis

A

Dx of exclusion, must rule out other granulomatous disease

45
Q

Pathology of sarcoidosis

A

Granuloma contain multinucleated giant cells

46
Q

Primary target of sarcoidosis

A

Lungs

  • granuloma located int he interstitial and mediastinal and hilarious nodes
  • dyspnea is the most common symptom
47
Q

Most common symptom of sarcoidosis

48
Q

Skin lesion of sarcoidosis

A

Modular lesions containg granuloma

49
Q

Eye lesions in sarcoidosis

A

Produces uveitis

50
Q

Lab findings in sarcoidosis

A

Increases ACE enzyme

51
Q

Tx in sarcoidosis

A
  • majority have spontaneous remission in 3 years and do not require treatment
  • steroids
52
Q

Most common fatal cancer in both men and women worldwide

A

Lung cancer

53
Q

Accounts for >30% of cancer deaths in men

A

Lung cancer

54
Q

> 25% of cancer deaths in women

A

Lung cancer

55
Q

Peak incidence of lung cancer

56
Q

Causes of lung cancer

A
  • smoking
  • risk increases with quantity and duration of smoking
  • men who smoke
  • asbestos
  • certain metals
  • secondhand smoke
57
Q

Primary lung cancer by specific type in decrease incidence

A
  • adenocarcinoma
  • squamous cell carcinoma
  • small cell lung carcinoma
  • large cell carcinoma
  • bronchial carcinoid
58
Q

Clinical classification of lung cancer

A

Non-small cell and small cell carcinoma (small cell there is nothing that can be done)

59
Q

Common sites for metastasis in lung cancer

A 
Hilarious lymph nodes 
Adrenal gland 
Liver 
Brain
Bone
60
Q

Scar tissue in lungs

A

Common sites of lung cancer development

61
Q

What most often underlies the development of lung cancer

A

Genetic mutations

  • oncogenes (HER2 and BCL-2)
  • suppressor genes (P53)
62
Q

What is inevitably connected with cancer development

A

mutations to P53

63
Q

Major gene to regulate cell damage

64
Q

Clinical findings of lung cancer

A 
Cough-most common
Weight loss 
Hemoptysis-most worrying 
Dyspnea 
Chest pain
65
Q

Adenocarcinoma lung cancer

A

Derived from Clara cells, mucin severeting bronchioar cells or type II pneumocystes

66
Q

Most common primary cancer in non smokers and women

A

Adenocarcinoma

67
Q

What is the best prognosis cancer type for lung cancer

A

Adenocarcinoma

68
Q

Central, more common in men, strong association with smoke, high frequency of P53 mutations

A

Squamous and small cell carcinaom

69
Q

Pancoast tumor

A

Lung carcinoma localized in the apex of the lungs, can cause horners syndrome

70
Q

Horner syndrome

A

Ptosis
Miosis
Anhydrosis
Caused by compression of the superior sympathetic ganglion most often by tumors originating from the apex of the lung

71
Q

Pneumothorax

A

Air in thoracic cavity

72
Q

Hemothorax

A

Blood in thoracic cavity

73
Q

Loss of lung volume caused by collapse of alveoli

A

Atelectasis

  • results in shunting to indeaquatly oxygenated blood from pulmonary arteries to the pulmonary veins
  • ventilation-perfusion imbalance
  • hypoxia
74
Q

Excessive snoring with intervals of breath cessation (apnea)

A

Obstructive sleep apnea

75
Q

Causes of obstructive sleep apnea

A

Obesity is the most common cause

-pharyngeal muscles collapse

76
Q

Clinical findings of obstructive sleep apnea

A

Excessive snoring with episodes of apnea, daytime somnolence and tiredness

Pathology Block 11 (8 decks)

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