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6 Respiratory > Lung Pathology > Flashcards

Lung Pathology Flashcards

1
Q

Three patterns of pneumonia

A
  1. Lobar: invasion of alveoli
  2. Bronchopneumonia (patchy multiple lobes and interstitium)
  3. Interstitial (atypical): inflammation of alveolar walls only
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2
Q

Which microbes are typically responsible for these types of pneumonia?

  1. Lobar
  2. Bronchopneumonia
  3. Interstitial
A
  1. Lobar: S. pneumonia
  2. Bronchopneumonia: S. aureus
  3. Interstitial: viruses & atypical bacterial

(they are called “atypical” because they are not S. pneumonia)

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3
Q

3 “atypical” bacteria (bacteria other than S. pneumoniae) that cause “atypical pneumonia” aka interstitial pneumonia

A
  1. Legionella pneumophila
  2. Mycoplasma pneumoniae
  3. Chlamydophila pneumoniae
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4
Q

which type of pneumonia?

A

Bronchopneumonia: patchy, multiple lobes. alveoli and interstitium affected

(MC microbe: S. aureus)

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5
Q

Which type of pneumonia is this?

A

interstitial: interstitial infiltrates on CXR. only affects alveolar walls

(viral or atypical pneumonia microbes: legionella pneumophila, micoplasma pneumonia, chlamydophilla pneumoniae)

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6
Q

microbes that cause pneumonia in children

A
  1. Viruses (RSV)
  2. Mycoplasma
  3. Chlamydia Pneumoniae
  4. Streptococcus Pneumoniae
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7
Q

3 Gram-negative rods that can cause pneumonia in adults

A
  1. Klebsiella
  2. E. Coli
  3. Pseudomonas
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8
Q

4 Signs/Symptoms of pneumonia

A
  1. High Fever
  2. Productive cough
  3. Elevated WBC
  4. Pleuritic chest pain
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9
Q

Community acquired pneumonia is usually caused by which microbes (3)?

A
  1. S. Pneumoniae
  2. H. Influenza
  3. S. Aureus
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10
Q

Nosocomial pneumonia is typically acquired from which microbes?

A

Gram negatives: seudomonas, Klebsiella, E. Coli

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11
Q

Legionella pneumonia 2 non-respiratory signs/symptoms

A
  1. GI symptoms: Watery diarrhea, N/V
  2. Hyponatremia (Na<130 meq/L): confusion
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12
Q

legionella pneumonia is diagnosed via…

A

urinary antigen test

(tx: fluoroquinolone or azythromycin)

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13
Q

pontiac fever

A

milder legionella

(happened first at a convension in Pontiac Michigan)

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14
Q

pontiac fever signs/symptoms

A

Fever, malaise, chills, fatigue, and headache

(no respiratory symptoms)

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15
Q

which virus can cause pneumonia in transplant or immunocompromised patients?

A

CMV

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16
Q

RSV starts with a fever and runny nose and progresses to…

A

cough and wheezing: Bronchiolitis, pneumonia or acute respiratory failure

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17
Q

“Air fluid level” on CXR indicates…

A

Lung absess

(MC d/t aspiration/anaerobes)

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18
Q

Pneumocystis jirovecii is diagnosed via…

A

microscopy w/silver stain: visualize the cysts

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19
Q
  • tension pneumothorax cause tracheal deviation (toward/away) from it.
  • spontaneous?
A
  • away
  • toward
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20
Q

Three general etiologies of pleural effusion:

A
  1. Transudative (oncotic/hydrostatic forces)
  2. Exudative (leakage/increased vascular permeability)
  3. Lymphatic (chylothorax)
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21
Q

Transudative Effusion of the lung is d/t …

A

Something driving fluid into pleural space (MC: CHF (High pressure))

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22
Q

3 causes of transudative pleural effusion

A
  1. CHF (high pressure)
  2. Nephrotic syndrome (low protein)
  3. Cirrhosis (low albumin)

(the fluid in the effusion itself has little protein, don’t drain. Tx underlying cause)

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23
Q

2 causes of exudative pleural effusions

A
  1. Malignancy
  2. Pneumonia

(Protein in pleural fluid vs. transudative which has little protein in fluid. Usually requires drainage)

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24
Q

How to distinguish if pleural effusion is transudative or exudative?

A

Light’s Criteria – Exudate if:
1. Pleural protein/serum protein greater than 0.5
1. Pleural LDH/serum LDH greater than 0.6
1. Pleural LDH greater than 2/3 upper limits normal LDH

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25
Q

Lymphatic fluid effusion is d/t …

A

From thoracic duct obstruction/injury:
1. Malignancy (MCC)
1. Trauma (usually surgical)

(Milky-appearing fluid)

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26
Q

Mesothelioma is a…

A

Pleural tumor

(Asbestos is only known risk factor. Decades after exposure: Pleural thickening and pleural effusion)

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27
Q

Patient presents with low onset of dyspnea, cough, chest pain. CXR shows pleural thickening and pleural effusion. Diagnosis?

A

mesothelioma

(rare complication of asbestos. Bronchogenic carcinoma is the more common complication)

28
Q

Central Sleep Apnea: patients with marginal ventilation when

A

awake. They hypoventilate when awake and fall asleep → apnea periods

29
Q

4 Causes of central sleep apnea

A
  1. CNS disease (encephalitis)
  2. NM diseases (polio, ALS)
  3. Severe kyphoscoliosis
  4. Narcotics
30
Q

Central Sleep Apnea has … breathing

A

Cheyne-Stokes: Cyclic breathing with delayed detection/response to changes in PaCO2

(Common in heart failure and stroke patients)

31
Q

Pulmonary nodule on CXR: “Coin lesion” indicate

A

lung cancer

(if it changes over time = malignant. if not = benign; harmatoma or granuloma)

32
Q

3 causes of lung granulomas

A
  1. Fungi: Histoplasmosis (patient from Midwest, Miss/Ohio river valley) or Coccidioidomycosis (southwest, California)
  2. Mycobacteria
  3. Tuberculosis (MC)
33
Q

MC lung cancer

A

non-small cell (good prognosis)

34
Q

Small cell lung cancer is a/w…

A
  1. Classic in male smokers
  2. Neuroendocrine tumor
  3. Central tumor
35
Q

3 Paraneoplastic syndromes a/w small cell cancer

A
  1. ACTH: cushings, hyperglycemia
  2. ADH: hyponatremia/confusion
  3. Antibodies: lamber-eaton
36
Q

5 subtypes of non-small cell lung cancer

A
  1. Squamous Cell Carcinoma
  2. Adenocarcinoma
  3. Large cell carcinoma
  4. Bronchioloalveolar Carcinoma
  5. Carcinoid tumor
37
Q

Key lung pathology: Keratin production (“pearls”) by tumor cells
* Intercellular desmosomes (“intercellular bridges”)

A

Squamous Cell Carcinoma
* Hilar mass arising from bronchus

38
Q

Squamous cell carcinoma presentation (3)

A
  1. Male smokers
  2. Hypercalcemia d/t tumor releasing PTHrP
  3. “Stones, bones, groans, psychiatric overtones”: one and abdominal pain, confusion
39
Q

Adenocarcinoma of the lung is a … tumor and located…

A
  • glandular
  • peripherally

(Most common lung cancer: nonsmokers/females)

40
Q

Large Cell Carcinoma is differentiated from the other lung cancers by

A

non-specific location, not glandular (like adenocarcinoma or squamous)

(poor prognosis)

41
Q

types of bronchiolalveolar carcinoma

A
  1. mucinous: goblet cells
  2. non-mucinous: clara cells or type II pneumocytes
42
Q

which lung cancer looks like pneumonia on CXR?

A

bronchioalveolar

(excellent prognosis)

43
Q

3 Complications of lung cancer

A
  1. Pleural effusions
  2. Phrenic nerve compression (dx: “sniff test”)
  3. Recurrent laryngeal nerve compression: hoarseness
  4. SVC syndrome (compression, medical emergency)
44
Q

SVC syndrome

A

Obstruction of blood flow through SVC. causes facial swelling or head fullness and arm swelling (blood can’t drain)

(can cause cranial artery rupture, medical emergency)

45
Q

Presentation of SVC syndrome

A

Headaches, confusion, coma

(Can cause increased ICP and or cranial artery rupture)

46
Q

Lung cancers can metastasize to… (4)

A
  1. Adrenals
  2. Brain: HA, seizures
  3. Bone: Pathologic fractures Liver: Hepatomegaly, jaundice
47
Q

Lung cancers are most frequently caused by metastasis rather than metastasizing to other organs. Which two cancers metastasize to the lungs?

A
  1. Breast
  2. Colon

(evident by multiple lesions on CXR)

48
Q

cystic fibrosis genetic inheritence

A

AR

49
Q

CFTR protein function

A

ATP ion transporter
in epithelial cells: allows Cl out–> hydration
sweat glands: removes NaCl from sweat

50
Q

MC CFTR gene mutation

A

delta F508: deletion of 3 DNA bases

(causes a misfolding of protein)

51
Q

Non-lung complication of CF?

A
  1. pancreatitis leading to CF-diabetes and vitamin deficiency (fat-soluble)
  2. muconeum ileus (stool too thick)
  3. biliary obstruction
  4. males are infertile (no vas deferens)

(may also have clubbing and nasal polyps)

52
Q

what is the sweat chloride test?

A

pilocarpine iontophoresis

(driven into skin to cause profuse sweating)

53
Q

hallmark pathology of sarcoidosis

A

non-caseating granuloma

(no necrosis = non-caseating)

54
Q

sarcoidosis begins with an accumulation of … cells

A

TH1 CD4

(high CD4:CD8 ratio)

55
Q

which 2 cytokines are involved in sarcoidosis?

A
  1. IL-2
  2. IFN- γ
56
Q

sarcoidosis effect on the heart

A
  1. cardiomyopathy
  2. heart block
57
Q

diagnosis?

A

massive pulmonary embolism

to the right: V1 shows a pseudo RBBB

58
Q

Wells score is used to…

A

determine probability of pulmonary embolism

(often used in ER to determine if a CT angiogram needs to be done)

59
Q

how does V/Q scan work?

(only used if CT angio not possible d/t kidney disease)

A
  • radioactive die inhaled then injected
  • left: you can see the entire lung is ventilated
  • right: circled area is NOT perfused
60
Q

Fat Embolism often occurs after a long bone facture. Fat may cross lungs → small artery infarctions. What are the symptoms of fat embolism syndrome:

A
  1. pulmonary: dyspnea, ARDS
  2. neuro: confusion
  3. skin: petechiae
61
Q

Phases of amniotic fluid embolism

A

Phase 1: Pulmonary artery vasospasm → pulmonary hypertension
* Right heart failure →Hypoxia → myocardial capillary damage → left heart failure →Pulmonary capillary damage → ARDS
Phase 2: (hemorrhagic phase) Massive hemorrhage and DIC

62
Q

pulmonary edema on CXR will show… (3)

A
  1. enlarged heart
  2. fluffy infiltraes
  3. kerley B lines
63
Q

pleural effusions on CXR

A

blunting of costophrenic angle

64
Q

interstitial fibrosis on CXR

A

honeycombing: spacing between the “white fluffy stuff”

65
Q

MC etiology of bi-basilar crackles in post-op surgical patients?

A

atalectasis d/t poor chest wall motion post-op

6 Respiratory (4 decks)

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