Pulmonary pathology Flashcards
Rhinositus
Obstruction of sinus drainage into nasal cavity
Typically maxillary sinuses –> that drain into middle nasal meatus
Common causes: S. pneumo, H influenza
Epistaxis
Nose bleed
Generally occurs in anterior segment of nostril
Can be life threatening if in posterior segment (sphenopalatine a.- part of maxillary a)
Tx: cauterization (often of nasal septum) –> highly vascularized
Head and neck ca
Most often Squamous cell ca
Generally in oral cavity
Deep venous thrombosis
Virchow triad: SHE
Stasis
Hypercoagulability
Endothelial damage
S&S: Homan sign- pain with dorsiflexion of foot
Tx: unfractionated heparin or LMWH (enoxaparin) --> prophylaxis and acute management Oral anticoags (like warfarin or riveroxaban for long term tx)
Imaging: compression US
Pulmonary emboli
V/Q mismatch; causes increase A-a gradient –> hypoxemia –> respiratory alkalosis (because of hyperventilation)
Lines of Zahn: pink and red; tells you that emboli formed right before death
Can be caused by FAT BAT (fat, air (nitrogen bubbles in ascending divers), thrombus, bacteria, amniotic fluid (fetal squamous cells seen in pulmonary vasculature), and tumor)
Obstructive lung diseases
Main characteristics: increased TLC, but decreased FEV1/FVC (<0.8)
Causes: Chronic bronchitis, emphysema, asthma, bronchiectasis
Chronic bronchitis
Hyperplasia of mucus secreting glands
Productive cough (for > 2 years- not necessary consecutive)
Can cause pulmonary HTN and for pulmonale
Emphysema
Enlargement of air spaces, decreased diffusion capacity, increased compliance
Centriacinar- smoking
Panacinar- alpha-1 antitrypsin
Barrel shaped chest, exhale through pursed lips (to increase airway back pressure and prevent airway collapse
Asthma
Smooth muscle hypertrophy; Curschmann spirals (whorled mucus plugs); Charcot-Leyden crystals (eosinophilic, hexagonal crystals)
Dx: methacholine challenge –> muscarinic agonist –> increases bronchial tone
Bronchiectasis
Necrotizing infection of bronchi –> causes permanently dilated airways, digital clubbing
Can happen with allergic bronchopulmonary aspergillosis
Restrictive lung disease
Decreased FVC and TLC; increased FEV1/FVC; decreased DLCO
Types can be muscular or lung-related
Muscular/ mechanical causes
Weakened intercostal muscles: Polio, ALS, MG, Guillian-Barre
Poor structural apparatus: scoliosis, obesity
Intersitial lung disease
Sarcoidosis
Fibrosis (idiopathic): see honeycombing (on S-ray) and clubbing
ARDS/ NRDS
Goodpasture
Wegener- granulomatosis with polyangiitis
Drug toxicity (bleomycin, amiodarone, busulfan, methotrexate)
Flow volume loops
Right shift: Restrictive
Left shift: obstructive
Hypersensitivity pneumonitis
Mixed type III/IV HS reaction
Seen in farmer exposed to birds
Pneumoconiosis
Increased risk of cor pulmonate, cancer and Caplan syndrome (RA and pneumoconiosis w/ nodules)
Types: Asbestosis, beryllosis, coal workers, silicosis