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Pulmonary - step > Pathology > Flashcards

Pathology Flashcards

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1
Q

most common site of rhinosinusitis in adults

A

maxillary sinues

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2
Q

most common site of rhinosinusitis in children

A

ethmoid sinuses

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3
Q

most common acute cause of rhinosinusitis

A

viral URI

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4
Q

most common superimposed bacterial infections in rhinosinusitis

A

S pneumonia
H influenza
M catarrhalis

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5
Q 
fever
nasal congestion +/- purulent discharge
pain over sinuses
painful teeth
cough
periorbital ceullitis
A

rhinosinusitis
painful teeth - maxially sinus
cough - post nasal drip
periorbital cellulitis - ethmoid sinus

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6
Q

where is most common site of epistaxis

A

kiesselbach plexus

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7
Q

describe vessels that make up kiesselbach plexus

A 
maxillary --> sphenopalatine
maxillary --> greater palatine
ophthalmic --> anterior ethmoidal
facial - superior labile
at anterioinferior region
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8
Q

when can life threatening hemorrhages/epistaxis occur

A

when occur in posterior segment at the sphenopalatine artery, branch of maxillary

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9
Q

what is the most common sign of platelet disorders

A

epistaxis

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10
Q

hemorrhagic /orange discolouration, unilateral calf
ischemic ulcers near medial malleolus of ankle
superficial varicosies
warm, red, pain, swelling

A

DVT

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11
Q

predisposition to DVT plsease

A

stasis: > 3 days of immobility, post op
hypercoagulbility: OCP, antithrombin III deficieincy, prote C and S deficiency, factov V leiden deficieicy
endotheliali dmaange
VIIRCHHOOOWW

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12
Q

physical signs of DVT

A

homan - pain on dorsiflexion

pratt - pain on palpation of calf

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13
Q

prophylaxis and acute management of DVT

A

unfrac heparin

LMW heparin/enoxaparin

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14
Q

treatement and long term prevention of DVT

A

warfarin, rivaroxaban

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15
Q

dx of dvt please

A

u/s

d dimer assay

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16
Q

sudden onset dyspnea
chest pain
tachypnea
tachycardia

A

pulmonary embolism

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17
Q

what is a line of zahn

A

interdigitating areas of pink - platelet and fibinr and red - red blood cells that can only occur in a thrombus formed pre mortem

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18
Q

what protects infarcts in the lungs

A

bronchial circulation DUAL

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19
Q

where si the most common location of PE

A

lower lobes

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20
Q

what is most common symptom/CXPX of PE?

A

sudden onset of dyspnea/tachypnea

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21
Q

describe the labs you’d see with pE

A

respiratory alkalosis
PaO2 < 80
increased A-a gradient
increased D-dimer

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22
Q

describe the CXR of PE

A

elevation fo ipsilateral diaphragm
pleural effusion
cut off sign: hypovascularity after embolus and Hampton bump: wedge shaped consolidation

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23
Q

dx of PE

A

spiral CT
V/Q - v normal, q abnormal
d dimers

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24
Q

dyspnea
tachycardia
petechiae on chest and extremities
24-72 hours after bone fracture

A

fat embolus

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25
labs in fat embolus
increasd A-a gradient thrombocytopenia fat globules in urin, pulm blood, BAL
26
feal squamous cells, lanugo hair in maternal pulmonary vessel
amniotic fluid embolus
27
``` immediately post partum dyspnea cyanosis hypotension bleeding - DIC ```
amniotic fluid embolus
28
what causes dyspnea in amniotic fluid embolus
ARDS and pulmonary oedema
29
prognosis fo AF emboli
50% die within 1 hour | 80% have permanent neurological deficits
30
labs in AF embolus
hypoxemia respiratory alkalosis increased PTT (DIC is present)
31
complications of decompression syndrome
pneumothorax | PE
32
what is caisson disease
chronic persistant gas emboli in bones | aseptic necrosis in femur, tibia, humurus
33
what is imaging test of choice for PE
CT pulmonary angiography and filling defects
34
how does sudden death result form PE
saddle embolus tha tblocks both pulmonary arteryes | acute cor pulmonale
35
PFT in restrictive lung diseases
decreased lung columes. FEV1/FVC > 80% or normal
36
``` decreased lung volumes increased FEV1/FVC decreased FEV1 decreased FVC bilateral hilar lymphadenopathy noncaseating granulmonas increased ACE increased Ca++ ```
sarcoidosis
37
describe the pathogenesis of idiopathic pulmonary fibrosis
repeated cycles fo lung injuery and wound healing with increased collagen deposition
38
describe cxpx of granulomatosis with polyangiitis/wegeners
small vessel vasculitis URT: perforation fo nasal septum, chronic sinusitis, otitis media, mastoiditis LRT: hemoptysis, cough, dyspnea renal: hematuria, red cell casts focal neecrotozing vasculitis, necrotizing granulomas in the lung and upper airway, necrotozign glomeruloneh=htiris PR3-ANCA/cANCA/antiproteinase 3
39
drugs that can cause restrictive lung disease
busulfan bleomycin amiodarone methotrexate
40
does restrictive disease lead to resp alk or resp acid
alkalosis | like emphysema and early asthma, not like chronic bronchitis
41
what causes bilateral upper lobe pulmonary fibrosis
pneumoconiosis, silicosis, tb, histoplasmosis, sarcoidosis, allergic pulmonary; aspergillosis, ankylosing spondylitis = predispose to sudden death
42
shipbuilding, roofing, plubing, demolition of old buildings, autoshopts
asbestosis
43
foundries, sandblasting, mines
silicosis
44
upperlobe pneumoconioses
boerylliosis coal workers silicosis
45
lower lobe pneumoconioses
asbestosis
46
pneumoconiosis associated with cor pulmonale
asbestosis, berylliosis, silicosis
47
pneumoconiosis associated with vaplan syndrome
asbestosis, silicosis
48
pneumoconiosis assiociated with lung cancer
asbestosis - bronchogenic and mesothelioma berylliosis silicosi
49
pneumoconiosis associated with increasd TB risk
silicosis
50
supradiaphragmatic and pleural plaques calcified ivory white
asbestosis
51
what are ferruginous bodies
asbestos boddies - golden brown fusiform rods resembling dumbbesls found in alveolar sputum in asbestosis, formed by macroahges after phagocytosis of asbestos molecule
52
least fibrogenic cause of pneumoconiosis
coal workers > silica, beryllium, asbestos
53
nuclear, aerospace, manufacturing industrie
berylliosis pneumoconioses
54
sheumatoid arthritis | pneumoconiosis with intrapulmonary nodules
caplan syndrome associated with pneuomnocionses
55
what type of hypersensitivity are pneumoconioses
mixed type III and IV reaction to environmental antigens
56
``` dyspnea cough chest tightness headache farmer/birds ```
hypersentivity pneumonitis
57
black lung disaese
MO with coal dust/carbon that cans inflammation and fibrosis via PDGF and IFG
58
anthraocosis
asymptomatic condition in urban dwellers exposed to sooty air. dusc cells
59
how does silicosis increased TB risk?
silica phagocytosed into MO (promot fibrogeneiss) and may disrupt the phagolysosomes and impair MO -- increases susceptibility
60
pneumoconises with increasd risk of bronchogenic carcinoma
asbestosis | silicosis
61
eggshell hilar lymph nodes
silicosis
62
what causes fainting in a panic attack
hyperventiatilin - decreasd PzCO2 - decresad vasodilation in cerebral vessels - les bldo flow - fainting.
63
ground glass appearance on CXr
collapse of alveoli | NRDS
64
why is there an increased risk of PDA in NRDS?
persistently low O2 tension.
65
what are potential consequnces of therapeutic O2 in NRDS?
retinopathy of prematurity intraventricualr hemorrhage bronchopulmonary dysplasia RIB
66
what are complications of neonatal respiratory distress syndrome?
metabolic acidosis PDA necrotizing enterocolitis
67
acute onset of respiratory failure bilateral lung opacities decrease PaO2/FiO2 no heart failure
acute respiratory distress syndrome
68
what can causes ARDS
``` gram negative sepsis 40% shock 20% gastric aspiration 30% uremia acute pancreatitis amniotic fluid emboism ```
69
describe the pathogenesis of ARDS
diffuse alveolar damage - increased alveolar capillary permeatbility - exudate/protein rich leakage into alveoli and NON CARDIOGENCI OEDEMA (differentiate with PCWP) leadin to formation of intraalveolar hyaline membranes. initial damage d;ue to PMN, coag cascade, ROS
70
management of ARDS
low tidal volume mechanical ventiatilon | address underlying cause
71
severe hypoxemia not responsive to 100% O2 | PCWP < 18 mmHg
ARDS
72
clear frothy alveolar fluid
ARDS
73
what does nocturnal hypoxia cause in sleep apnea
systemic/pulmonary hypertension, arrhtyhmias, a fib abd flutter, sudden death
74
what causes obstructive sleep apnea
``` obesity tonsillar hypertrophy nasal septum deviation hypothyroidism acromegaly ```
75
describe obesity hypoventilation syndrome
obesity > 30 kg/m^2 hypoventilation/decreased RR decreased PaO2 and increased PaCO2 in sleep increased PaCO2 in waking hours - retention effects~*~
76
what defines pulmonary hypetension
pulmonary artery pressure at rest of > 25 | pulmonary artery pressure at exercise of > 35
77
pathogenesis fo pulmonary hypertension
increased pulmonary arery pressure - arteriosclerosis - medial hhypertrophy - intimal fibrosis of arteirs -- severe respiratory distress - cyanosis sand righ ventricular failure - decompensate cor pulmnoale - fatal
78
BMPR2 gene mutations
normally inhibits vascular smooth muscle proliferation -- leads to vascular hyperreactivitn and proliferation of smc = pulmonary arterial hypertension heritable, more common in women.
79
list the raindrops for the umbrella term of pulmonary arterial hypertension
``` pulmonary venous occlusive disease persistent pulmonary hypertension of newborn drugs - amphetamines, cocaine connective tissue disease HIV infection portal hypertension congenital heart disease schistosomiasis haemotopium ```
80
what causes Ph due to left hear tdisease
systolic and diastolic dusfunction and valvular disease - mitral stenosis
81
what can lead to pulmonary hypertension due to lung disease or hypoxia
desrruction of lung parenchyma (COPS) or hypoxemic vasoconstriction at obstructive sleep apnea, living in high altitude
82
how can pulmonary hypertension result from chronic thromboemboli
recurrent microthrombi decreas the corss sectional area of the pulmonary vascular bed - increased resistance
83
describe the physical findings of plueral effusion
dull percussion decreased breath sounds absent fremitus none or tracheal deviation away from affected side
84
describe the physical findings of atelectasis/bronchial obstruction
decreased breath sounds dull percussion absent fremitus tracheal deviation towards affected side
85
simple pneumothorax phys findings plz
decrease breath sounds hyperresonant percussion absent fremitus tracheal deviation towards same side if total collapse of lung
86
tension pneumotoroax phys findings please
decreased breath sounds hyperresonant percussion absent fremitus tracheal deviation away from affected side
87
consolidation @ lobar pneumonia and pulmonary oedema
bronchial breath sounds / late inspiratory crackles dull percussion increased freitus/present fremitus no deviation of trachea
88
what is a pleural effusion
excess fluid inbetween pleural layers - causes decreased lung expamsion
89
what causes a transudate/pleura effusion style
messed up starling forces like CHF - hydrostatic increased like nephrotic syndrome - oncotic decrease hepatic cirrhosis - oncotic decrease and probly increasd hydrostatic too
90
what causes a exudate/plueral effusion
``` leaky vasculature - high protein content, cloudy malignany MOST COMMON pneumonia collagen vascular disease truam have to drain - risk of infection ```
91
what causes a lymphatic pleural effusion
aka chylothorax thoracic durct injuery from trauma or malignancy milkey icnread CM/TAGS
92
define pneumothorax
accumulation of air in the pleural space
93
unilateral chest pain dyspnea unilateral chest expansion
pneumothorax: decreased tactile fremitus, hyperresonance, diminised breath sounds on aaffected side
94
tall young thin males | apical belb or cyst rupture
primary spontaneous pneumothorax
95
disease lungs with bullae like emphysema of with infections OR high pressure ventilation/barotruama
secondary spontaneous pneumothorax
96
blunt or penetrating trauma to pleura
traumatic pnemothorax
97
describe tension pneumothorax
can result from primar or secondary spontaneous or traumatic pneumos --> air enters pleraul space but can t exit - increasd trapped air - tension pneumothorax - trachea moves AWAY from trapped air.
98
causes of lobar pneumonia
s pneumonia ** most common legionella blebseilla
99
sudden onste of high fever productive cough tachycardia
presentation of typical pneumonia
100
``` suddent onset of high fever productive cough tachycardia dull puersuccion late inspiratory crackles bronchial breath sounds bronchophony, egophony increased vocal fremitus ```
loba pneumonia
101
causes of beonchopneumonia
s pneumonia s aureus h influenzes klebsiella
102
causes of atypical/interstitial pneumonia
mycoplasma ** most common legionella chlamydia @ neonates viruss - influenza, CMV, RSV, adeno
103
describe lobar pneumonia
intra=alveolar exudate -- consolidation | may involve entire lobe or lung
104
describe bronchopneumonia
acute inflammatory infiltrates from bronchioles into adjacent alveoli patchy distribution involving > 1 lobe
105
describe interstitial/atypical pneumonia
diffuse pathy inflammation localized to interstitial areas at alveolar walsl diffuse distribution involving > 1 lobe more indolent generally
106
causes of nosocomial pneumonia
respirators, severe underlying disease, antibitoics, immunosuppression
107
bugs in nosocomial pneunomia
pseudomonas @ respirator, e coli, staph aureus
108
pneumonia in AIDs
PCP, CMV, asperigillosis
109
spking fever | productive cough with fould smelling sputum
lung abscess
110
what is a lung abscess?
localized collection fo pus in the parenchyma
111
who gets lung abcesses?
those predisposed to aspiration of oropharyngeal contents ie those presposed to loss of consciousness - OH , epileptics or recent dental work or bronchial obstruction - cancers
112
CXR with air fluid levels
lung abscess
113
bugs in lung abscesses
anaerobes - fusobacterium, peptostreptococcus, s aureus
114
what is a mesothelioma
maligi of pleura associated with asbestosis (also bronchogenic carcinoma - clara cells)
115
consequences of mesothelioma
hemorrhagic pleura effusion | pleura thickening
116
is smoking a risk factor for mesothelioma?
nooppeers
117
where do you see psmomma bodies
``` from dystrophic calcification papillary carcinoma of thyroid serous papillary cystadenocarcinoma of ovary meningioma malignant mesotheliuma ``` = laminated concentric spherules
118
``` ipsilateral ptosis miosis anhidrosis purple/blue discolouration of chest, neck, arms, facial pleothora, JVD sensorimotor deficits hoarseness ```
pancoast tumor/superior culcus tuor
119
what causes a pancoast tumour
carcinoma in the apex of the lunds | invades cervical sympathetic chain
120
blanching after fingertip pressure JVD upper rextremities edema
superior vena cava syndrome
121
what causes superior vena cava syndrome
obstruction fo the SVC that iapires blood draninag from the head and upper extremities mailignancy - pan coast thrombosis from indwelling catheters
122
what are consequences of superior vena cava syndreome
EMERGENCY!! | can raise intracranial pressure - h/a and dizziness, increased risk of aneurysm and rupture of itnracrainal arteries
123
cough weight loss hemoptysis dyspnea
lung cancer
124
other presentations of lung cancer
clubbing (bronchiectasis too) SVC syndrome pancoast tumor endocrine deltas - ectopic secretion
125
CXR and CT of lung cancer
pneumonic ''coin'' lesion | noncalcified on CT
126
where does lung cancer metastasize to?
adrenals > liver > brain > bone
127
what cancer mets to the lungs?
breast > colon, prostate, bladder
128
what are risk factors for lung cancer
``` smoking secondhand smoke radon asbestos famility history ```
129
which types of lung cancer are central
small cell squamous large - or peripheral
130
which types of lung cancer are peripheral
adenocarcinoma | large - or central
131
most common lung cancer?
adenocarcinoma
132
lung cancers more common in women
adenocarcinoma
133
lung cancers more commin in men
squamous cell large cell just a little ebit small cell
134
ACTH, ADH, anti-vg Ca lung cancer?
small cell
135
PTHrp lung cancer?
squamous
136
p53 and RB1 lung cancer?
small cell
137
KRAS, egfr, alk
adenocarinoma
138
p53 lung cancer?
squamous
139
more responsive to surgery than chemo lung cancer
large cell
140
more responsive to chemo than surgery lung cancer
small cell
141
undifferentiated from neuroendorince kulchitsky cels
small cell | dark small blue cells
142
associated with hypertrophic osteoarthropathy
ie clubbing | adenocarcinoma
143
describe the broncoalveolar subtype fo adenocarcinoma
adenocarcinoma in situ | CXR shows hazy infilatrates silimiarl to pneumona - excellent progontosis
144
which lung cancer grows rapidly and mets early
small cell - chemo not surgery to treat
145
which lung cancer grows slowly and mets early
adeoncarcinoma
146
apparent thicekening of alveolar walls lung cancer
bronchioloalveolar subtype of adenocarcinoma
147
glandular patter on histiology
adenocarcinoma
148
chromagranin A + lung cancer
small cell | bronchial carcinoid tumour
149
poor prognosis lung cnacers
small cell | large cell
150
secretes betahCG lung cnacer
large cell
151
excellent prognosis lung cancer
bronchial carcinoid tumor | bronchioloalveolar subtype of adenocarcinoma
152
mass effect syptoms + flushing, wheezing, diarrhoea lung cancer
bronchial carcinoid tumour
153
most common lung cnacer in children
bronchial carcinoid tumour
154
nests of neuroendocrine cells
bronchial coarcinoid tumour.
155
low grade lung cancer
bronchial carcinoid tumour

Pulmonary - step (4 decks)

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