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Flashcards in Exam 1 path Deck (48):
1

Premortum exam of pulmonary embolism

lines of Zahn

2

Pulmonary embolism on gross exam

lower lobe
triangle shaped pointing toward hilum

3

Microscopic exam of pulmonary embolism

plexiform lesions (adjacent to vessel)
concentric laminar intimal fibrosis
(above both are irreversible)

4

Goodpasture syndrome

type II cytotoxic hypersensitivity
triad of sx
1. diffuse pulmonary hemorrhage
2. glomerulonephritis
3. anti-GBM Abs
men b/t 15-30 y/o

5

Goodpastures dx tool

IgG Abs against alveoli and glomeruli in serum

6

Goodpastures microscopic exam

lungs: linear deposits of IgG, thickening of alveolar septa
kidney: focal proliferative to crescentic glomerulonephritis, linear deposits of IgG

7

Idiopathic pulmonary hemosiderosis

intermittant hemoptysis
refractory anemia
in children/teens
no serum Abs

8

Microscopic exam of idiopathic pulmonary hemosiderosis

hemosiderin laden macrophages
alveolar capillary congestion
no necrosis/vasculitis/granulomas
interstitial fibrosis

9

Wegener granulomatosis

necrotizing granuolmatous inflammation (kidney and lungs)
necrotizing vasculitis (sm/med vessels)
c-ANCA against neutrophil proteinase 3 (PR3)
neutrophils activated and damage endothelium

10

Pulmonary HTN presentation

exertional dyspnea
in women 20-40 y/o

11

Familial pulmonary HTN gene

BMPR2 mutation (when inactivated)

12

Most common cause of secondary pulmonary HTN

recurrent pulmonary embolism

13

Acute Respiratory Distress syndrome

hyaline membrane at capillary/alveolar interface,
neutrophil damage to type I and II pneumocytes,
inhibited recovery due to damage to type II pneumocytes

14

Causes of pulmonary hypoplasia

oligohydramnios
decreased intrathoracic space

15

Most common tracheoesophageal fistula type

blind esophagus with lower esophagus connected to trachea

16

Extralobar sequestration

mostly on L side
polyhydramnios and edema can cause
external to lung w/ separate pleural lining

17

Intralobar sequestration

assc with fibrosis/infections/bronchiectasis
usually lower lobe
aortic branch supplied
not in pleura

18

Atelectasis

incomplete expansion of the lungs
collapse of previously inflated lung

19

Resorption atelectasis

complete airway obstruction
mediastinal shift toward obstruction
excess secretions/asthma/foreign body
retraction of lung in airless state (cells filled with secretions)
most common type

20

Compression atelectasis

mediastinal shift away from affected lung
pleural cavity filled (with fluid/air)

21

Contraction atelectasis

fibrotic changes in lung/pleura
prevents full expansion
irreversible

22

Pulmonary edema histology

engorged capillaries
hemosiderin laden macrophages
granular pink precipitate

23

Acute respiratory distress syndrome (acute lung injury)

diffuse alveolar damage with hyaline deposition lining capillary/alveoli interface

24

Acute interstitial pneumonia

Hamman-Rich syndrome
rapidly progressive in young aduts
flu like illness w/ SOB
brisk interstitial fibroblastic proliferation

25

Impact of obstructive lung disease on airflow rate

decreases (FEV1/FEV)

26

Impact of restrictive lung disease on airflow rate

normal or increased (FEV1/FEV)

27

Cause of emphysema

imbalance of protease/antiproteases

28

Centriacinar emphysema

upper half of lungs
respiratory bronchioles
from long standing smoking

29

Panacinar emphysema

uniform destruction of entire alveolus
lower half of lungs
A1AT deficiency
assc with liver cirrhosis (PAS + stain)

30

Paraseptal emphysema

distal airway structures
apical/giant bullae with spontaneous pneumothorax
around septa or pleura

31

Symptoms/findings of emphysema

pursed lips/pink skin/Tx barrel chest
functional capacity loss
decreased FEV1/FEV

32

Dx for chronic bronchitis

persistent cough/copious sputum production for 3 months (2x) within 2 years

33

Symptoms/findings of chronic bronchitis

hypercapnea (cyanotic)
wt gain
aka blue bloaters
elevated Reid index (over 0.4) due to thickened mucus layer

34

Atopic asthma

in children
type 1 hypersensitivity (IgE mediated)

35

Occupational asthma

from repeated exposure to chemicals/irritants

36

Drug induced asthma

commonly aspirin (assc with nasal polyps)

37

Non-atopic asthma

respiratory infections with normal serum IgE

38

Status asthmaticus

unrelenting asthma attack
refractory to bronchodilators

39

Findings with asthmatic lungs

Curschmann spirals
Charcot-Leyden crystals (from eosinophils)
over distended lungs
goblet cell hyperplasia

40

What is bronchiectasis?

permanent dilation of the airways

41

Sx of bronchiectasis

SOB
cough
hemoptysis

42

Cause of congenital bronchiectasis

developmental arrest of bronchial tree

43

Acquired bronchiectasis

in adults
infectious insult/obstruction/drainage impairment can cause

44

Causes of bronchiectasis

bronchial obstruction
cystic fibrosis
Kartagener syndrome (immotile cilia/sinusitis/situs inversus)
allergic bronchopulmonary aspergillosis

45

Pts with allergic bronchopulmonary aspergillosis

asthmatics
cystic fibrosis

46

Who are pink puffers?

pts with emphysema
thin/barrel chest/pursed lips

47

Who are blue bloaters?

pts with chronic bronchitis
heavy/cyanotic

48

Kartagener's syndrome

dynein arms mutation (immotile cilia)
situs inversus
bronchiectasis
sinusitis