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Lung - Path Flashcards

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1
Q

Pt ingests nitrates. Develops dusky skin color.

A

Fe oxidized to Fe3+. Stops binding O2, binds CN instead.

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2
Q

Treatment of CN? Mech?

A

1) Nitrates. Make Fe in heme oxidized to Fe3+. Hb will preferentially bind CN, clearing it from tissues
2) Thiosulfate. Takes cyanide from oxidized Hb to from thiocyanide, which can be renally excreted

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3
Q

Pulmonary HTN defined at pressures over? Leads to?

A

Over 25 mmHg. Leads to arteriosclerosis, medial hypertrophyy, and intimal fibrosis of pulmonary arteries

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4
Q

Primary pulmonary HTN. gene? Lesion?

A

inactivating mutation in BMPR2. Plexiform lesion.

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5
Q

Mechanisms for these causes of 2ndary pulmonary HTN?

COPD, mitral stenosis, thromboemboli, autoimmune dz, left-to-right shunt, high altitude

A

destruction of lung
backup of pressure
down surface area of vessel lumen
inflammation leads to fibrosis and medial hypertrophy
increased stress leads to endothelial damage
hypoxic vasoconstriction

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6
Q

Pt with chocolate colored blood?

A

Methemoglobin

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7
Q

Pt in a house fire?

A

up CO and CN in blood

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8
Q

CO - cyanosis?

A

No. masked by cherry red pigment of CO.

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9
Q

Pt with AIDS, increased methemoglobin. why?

A

increased PCP infections. Take sulfa drugs - cause methemoglobin

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10
Q

Give pt 100% O2. No improvement. Cause in child? adult?

A

Hyaline membrane Dz

ARDs

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11
Q

How pulmonary edema affects deep breathing?

A

fluid increases size of lung - J-receptors activated sooner, can’t take deep breath

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12
Q

Pt with Male infertitlity, situs inversus, sinusitis also likely to get?

A

Kartagner’s bronchiectasis

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13
Q

Fat embolus - triad? Usually caused by?

A

Pt with hypoxemia, neurologic abnormalities and petechial rash. Complication of. Caused by fracture of long bone and liposuction

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14
Q

Emboli that can lead to DIC?

A

Amniotic fluid emboli

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15
Q

How to distinguish pre vs post-mortem thrombi?

A

Lines of zahn in between layers of blood and fibrin

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16
Q

Causes of ARDS?

A

AP GU(ARDS)

Uremia, Pancreatitis, Amniotic fluid embolism, gastric aspiration

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17
Q

ARDs - initial damage due to?

A

1) release of neutrophilic substances toxic to alveolar wall
2) coagulation cascade
3) O2 derived free radicals

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18
Q

FEV1/FVC<80?

A

COPD

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19
Q

lung volumes COPD vs restrictive?

A

greater than normal vs less than normal

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20
Q

Obstructive sleep apnea - effects on lungs? heart? kidneys?

A

pul HTN; arrythmias; increased EPO release

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21
Q

Decreased breath sounds, dullness to percussion, decreased frenitus?

A

PE

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22
Q

Decreased breath sounds, dullness to percussion, decreased frenitus + trachial deviation toward side of lesion?

A

Atelecatsis

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23
Q

Decreased breath sounds, hyperresonant to percussion, decreased frenitus, + trachial deviation toward side of lesion

A

Spontaneous pneumothorax

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24
Q

Decreased breath sounds, hyperresonant to percussion, decreased frenitus, + trachial away from side of lesion

A

Tension pneumothorax

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25
Late inspiratory crackles, dullness to percussion, increased fremitus?
Consolidation
26
Pt with cough, hemoptysis, noncalcified nodule on CT or coin lesion? Most common type?
Lung cancer. Mets most common - from breast, colon, prostate, bladder.
27
Cancers not related to smoking?
Bronchioloalveolar (adenoCA from clara cells) and bronchial carcinod (central neuroendocrine tumor)
28
Lung cancer - K-ras?
adenoCA
29
Lung Cancer - Pt with clubbing r?
adenoCA
30
Lung Cancer - peripheral location?
AdenoCA and Large cell CA
31
Hazy infiltrates similar to pneumonia on CXR?
bronchioloalveolar cancer (subtype of adenoCA)
32
Squamous cell CA - signs?
Cavitation Cigarettes hyperCalcemia (PTHrP)
33
Small cell (oat) CA - Signs?
ACTH ADH Antibodies against Ca channels (Lambert-Eaton) Amplification of myc oncogenes
34
Lung Cancer - pleomorphic giant cells?
Large cell CA
35
Lung Cancer - flushing, wheezing, diarrhea?
Bronchial carcinoid tumor
36
Lung Cancer - chromogranin positive?
Bronchial carcinoid tumor
37
Lung Cancer - inoperable?
Small Cell
38
Lung Cancer - looks like thickened septal walls?
bronchioloalveolar (subtype of adenoCA). grows along alveolar septa -
39
Lung Cancer - Complications?
``` SPHERE SVC syndrome (obstruction of SVC) Pancoast Tumor Horner's syndrome Endocrine (paraneoplastic) Recurrent laryngeal symptoms (horseness) Effusions (pleural or pericardial) ```
40
Lung Cancer - pleural?
Mesothelioma
41
Lung Cancer - psammoma bodies?
Mesothelioma
42
Lung Cancer - hemorrhagic pleural effusions
Mesothelioma
43
Pt with JVD, upper extremity swelling, headaches, dizziness?
SVC syndrome.
44
Intra-alveolar exudate and consolidation? Causes?
Lobar Pneumonia. S. pneumoniae and klebsiella
45
Acute inflammatory infiltrates from bronchioles in adjacent alveoli. Patchy distribution involving 1+ lobes? causes?
Bronchopneumonia. Pneumococus, S aureus, H flu, klebsiella
46
Diffuse patchy inflammation localized to interstitial areas at alveolar walls? Causes?
Interstitial (atypical) pneumonia. Viruses (influenza, RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia
47
Pt susceptible to lung abcess?
Alcoholics/epileptics
48
microorganisms that cause lung abcess?
S aureus or anaerobes: (Bacteroides, fusobacterium, peptostreptococcus)
49
Farmers or pt exposed to birds. Type of reaction? Presents with?
Hypersensitivity pneumonitis. HSR III/IV. Dyspnea, cough, chest tightness, headache.
50
Type of pleural effusion - decreased protein content? Causes?
Transudate. CHF, nephrotic, hepatic cirrhosis
51
Type of pleural effusion - increased protein content. Causes?
exudate. Malignancy, pneumonia, CVD, trauma
52
Type of pleural effusion - increased TGs. Causes?
Lymphatic. Thoracic duct injury/malignancy
53
Tall thin male with rupture of apical bleb?
Spontaneous pneumothorax
54
Airway Biopsy shows increased thickness of gland layer?
COPD
55
Types of emphysema?
Centriacinar - smoking | Panacinar - a1-antitrypsin
56
Mucus plugs and smooth muscle hypertrophy?
Asthma
57
Dz where Crystals form by the breakdown of eosinophils in sputum?
Asthma
58
Hemoptysis and purulent sputum. Chronic necrotizing infection of bronchi?
Bronchiectasis
59
Restrictive lung disease by normal Aa gradient?
Poor muscular effort (Polio, myasthenia gravis) | Poor structural apparatus (scoliosis, morbid obesity)
60
Restrictive lung dz and Eosinophilc granuloma ?
Langerhan's cell histiocytosis
61
Drugs that cause Restrictive lung dz?
Bleomycin, busulfan amiodarone methotrexate
62
Anthracosis? affects?
Coal miners lung (affects upper lobes)
63
Mech of silicosis? increases risk for? Affects what part of lung?
Macrophages release fibrogenic factors - fibrosis. TB and bronchogenic CA. Upper lobes and egg-shell hilar findings.
64
Foundries and Sandblasting increases risk for?
Silicosis
65
Calcified pleural plaques found in?
Asbestosis
66
yellowish fusiform rods resembing dumbbells? Increased risk for?
Asbestosis. Bronchogenic CA andb mesothelioma.
67
Baby born C-section. Not enough surfactant compared to baby born vaginally. Why?
less release of fetal glucocorticoids during birth.

Repiratory (2 decks)

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