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Respiratory (Zoe) > Pathology (Pleuritic disease) > Flashcards

Pathology (Pleuritic disease) Flashcards

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1
Q

What is the dual blood supply to the lungs?

A

Pulmonary arteries and bronchial arteries

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2
Q

Is the pulmonary system low or high pressure compared to the systemic circulation?

A

Low

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3
Q

Where does fluid accumulate in the lungs and what is this called?

A

In the interstitum and in the alveolar spaces.

Pulmonary odema

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4
Q

Will pulmonary oedema show a restrictive or obstructive pattern on spirometry?

A

Restrictive

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5
Q

Give two generalised causes of pulmonary oedema?

A

Haemodynamic (increased hydrostatic pressure due to left sided heart failure)
Cellular injury: In the alveolar lining cells or in the alveolar endothelium

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6
Q

What is ARDS?

A

Acute respiratory distress syndrome: a severe, life-threatening medical condition characterized by widespread inflammation in the lungs.

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7
Q

Give some reasons that ARDS would occur?

A

Sepsis, trauma, diffuse infection, lack of oxygen

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8
Q

What is the pathogenesis of ARDS?

A 
Injury (for example a bacterial endotoxin)
Infiltration of inflammatory cells
Cytokines
Oxygen free radicals
Injury to cell membranes
Fibrous exudate lining alveolar walls
Cellular regeneration
Inflammation
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9
Q

Give three possible outcomes for ARDS?

A
  1. Death
  2. Resolution
  3. Fibrosis
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10
Q

What is respiratory distress syndrome of the newborn?

A

When babies are born prematurely their type 2 alveolar cells are not yet mature enough to produce high enough levels of surfactant. Surfactant reduced alveolar surface tension and so without this neonates have to put a massive effort into expanding the lungs. They therefore struggle to breath.

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11
Q

What is an embolus?

A

A detached intravascular mass carried by the blood so a site of infection distant from the site of origin.

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12
Q

What are most emboli? Give some rarer examples also.

A

Thrombi (from blood)

Can also be gas, fat, tumour clumps

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13
Q

What is the source of most pulmonary emboli?

A

DVT

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14
Q

What are the three prongs of virchows triad? What do these put you at risk for?

A

Hypercoaguability of the blood
Stasis of the blood/abnormal flow
Endothelial damage
Put you at risk for a DVT or a PE.

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15
Q

What are the symptoms of a PE?

A

Severed pleuritic chest pain
Dysponea
Haemoptysis
Sudden death or collapse

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16
Q

What two factors are required for a pulmonary infarct?

A

Embolus

Compromised bronchial artery supply

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17
Q

What are the mechanisms by which you get pulmonary hypertension?

A
  1. Hypoxia due to vascular constriction (most pressure on the lungs)
  2. Increased blood flow through the pulmonary circulation.
  3. Blockage due to a PE
  4. emphysema which causes a loss of the pulmonary vascular bed.
  5. Back pressure from left sided heart failure.
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18
Q

Describe the morphology of pulmonary hypertension

A
  1. Arteries become hypertrophied
  2. Fibrosis of these arteries
  3. Atheroma
  4. Right ventricular hypertrophy (due to increased back flow into the right side of the heart
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19
Q

What is cor pulmonale?

A

Enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lungs (pulmonary hypertension)

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20
Q

What are some symptoms of cor pulmonale?

A

Dysponea, Fatigue, syncope,

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21
Q

What are some signs you would see in for pulmonale?

A

Ankle/sacral oedema, hepatomegaly, raised JVP, tricuspid regurgitation ( pan systolic murmur)

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22
Q

What is the pleura made of?

A

Mesothelial cells designed for fluid reabsorption, which make up a surface lining for the lungs and the mediatstinum.

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23
Q

What is a transudate effusion and what does it show?

A

Pleural effusion containing less 30g of protein, shows that their is organ failure (e.g. cardiac)

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24
Q

What is an exudate effusion and what does it show?

A

Pleural effusion showing more than 30g of protein. This shows that there is pneumonia, connective tissue disease, malignancy, TB (NOT ORGAN FAILURE)

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25
What is a pneumothorax?
Air in the pleural space
26
What is a primary pneumothorax?
A pneumothorax that occurs with no known cause.
27
What is a secondary pneumothorax?
One that occurs in the context of existing lung pathology.
28
What is a tension pneumothorax?
When the pleura rips a one way valve is formed meaning that, with each inspiration, more air is drawn into the thoracic cavity and cannot renter the lung. It is a medical emergency!
29
What are bullae?
Air pockets within the lungs that can burst and cause a pneumothorax.
30
Give an example of primary pleural neoplasia?
Benign | Malignant mesothelioma
31
Give an example of a secondary pleural neoplasia and sites of its likely origin:
Adenocarcinomas | Lung, ovary
32
What is a mesothelioma?
An asbestos related tumour found in the pleural cavity. | It has mixed epithelial and mesenchymal differentiation.
33
What would you expect the pleural fluid to be like in malignant mesothelioma?
Bloody
34
How would you make a definitive diagnosis of mesothelioma?
Histology following a pleural biopsy. (Abrams needle thorascopy)
35
How many ml of serous fluid are secreted into the pleural cavity?
4mls
36
What are the two layers of pleura, where are they, and what do they sense?
Visceral: Covers the lung and senses stretch. Parietal: Covers the inner surface of the thoraces wall and senses pain.
37
What is the function of the pleural fluid?
Allows the pleura to slide smooth during respiration. Surface tension allows a lung surface to stay touching the thoracic wall and therefore creates a seal between the 2 surfaces.
38
What happens to the two pleural surfaces at the lung root?
The two layers combine around the root of lthe lung so the root of the lung itself actually has no pleural coverage. They ;ayers combine to form the pulmonary ligament.
39
What does the pulmonary ligament do?
Runs inferiorly and attaches the root of the lung to the diaphragm.
40
What is the nervous supply of the visceral pleura?
Sensory ending of Vagus nerve. Vasomotor fibres
41
What is the nervous supply of the parietal pleura?
Intercostal nerves and phrenic nerve
42
What colour would a pleural effusion be on a chest x ray?
White
43
What finding on examination most clearly suggests a pleural effusion?
Stony dull to percussion.
44
What tests could you do if you suspected a pleural effusion?
``` CXR Pleural aspirate CT Cytology Pleural biopsy Thoracoscopy Biopsy if you were concerned about malignancy. ```
45
What colour should the pleural fluid be?
Straw coloured
46
What would you suspect if the pleural fluid was bloody?
Trauma, malignancy, infection, infarction
47
What would you suspect t if the pleural fluid was turbid or milky?
Empyema, chylothorax
48
What is a chylothorax?
A kind of pleural effusion consisting of lymphatic fluid.
49
What would you suspect if the pleural fluid was foul smelling?
Anaerobic empyema
50
If there had been an oesophageal rupture what would there most likely be in the pleural fluid?
Food
51
What pathology would give you a very viscous pleural aspirate?
Mesothelioma
52
If your aspirate had a very high neutrophil count what would you suspect had happened?
Parapnemonia(pneumonia that has travelled into the pleural space) or a PE
53
What would the cell cytology look like in someone who suffered from chronic effusions?
Mononucleur cells
54
What would you strongly suspect if the pleural aspirate was rich in lymphocytes?
TB | also could be sarcoid, lymphoma or rheumatoid
55
What could be causing an exudate (low protein) pleural aspirate?
1. Cardiac failure 2. Liver cirrhosis 3. Nephrotic syndrome 4. Ateclectasis 5. Hyperthyroidism 6. Meig's syndrome 7. Urinothorax 8. Pericarditis
56
What could be causing a transudate (high protein) pleural aspirate?
1. Parapneumonia 2. Pulmonary emboli 3. Malignant effusion 4. Rheumoatoid 5. Mesothelioma 6. TB 7. Oesophageal rupture 8. Chylothorax 9. Benign asbestos effusion 10. Drugs
57
What is the normal pH of pleural fluid?
7.4
58
At what pH would drainage be required?
Below 7.2 as this suggests parapneumonia or empyema.
59
Would glucose levels be low or high in the pleural fluid at times of infection?
Low. Would also be low in TB, rheumatoid, malignancy, oesophageal rupture.
60
What is pleurodesis? When would this be indicated?
When the visceral and parietal pleura are stuck together with talc or surgery. This would only ever be done in malignancy.
61
What is a negative implication of pleruodesis?
Reduces exercise tolerance.
62
You see fluid on a chest x - ray which is sticking to the wall rather than being seen at the bottom of the lungs, what is it most likely to be?
Empyema.
63
What would be indications that you needed a chest drain?
``` Tension pneumothorax Symptomatic pneumothroax Complicated parapneumonia Malignant pleural effusion Traumatic haemopneumothorax. ```
64
Give some complications of chest drains
Pain, inadequate placement, surgical emphysema, infection, haemorrhage, organ damage, re expansion pulmonary oedema,large effusions that drain to quickly, vasovagal reaction (patient may faint) Sudden death as a result of extreme vagal reaction.
65
List some asbestos related pathologies
``` Benign pleural plaques Asbestos related pleural effusions Asbestosis Mesothelioma Diffuse pleural thickening Rounded ateletasis ```
66
When looking at a x ray what would benign pleural plaques look like?
Calcified regions.
67
What is the usual treatment for benign pleural plaques?
No treatment required and these are usually asymptomatic.
68
Give some features of asbestos related pleural effusions
Small and unilateral, resolve spontaneously, bloodstained. They require symptomatic treatment.
69
What is diffuse pleural thickening?
Extensive fibrosis of the viscera pleura which then forma adhesion to parietal pleura. The patient will suffer from SOB and chest pain and you will see a restrictive spirometry. It is difficult to treat but very important to diagnose as the patient is entitled to compensation
70
What investigations would you carry out if you suspected mesothelioma and what would results would you expect to find?
Aspiration of pleural aspiration (Low cytological yield) CXR and CT (effusion, pleural nodularity, local invasion) Biopsy under Ct or US guidance.
71
What treatments are available for mesothelioma?
``` Pleurodesis Radiotherapy Chemotherapy Surgery Mostly palliative Family will be entitled to compensation so all deaths must be reported ```
72
What MRI findings would you expect to see with mesothelioma?
Pleura will be clearly enlarged and visible (should not be able to see the pleura at all under normal circumstances)
73
What is classified as a small pneumothorax?
Less that 2cm rim of air
74
What is classified as a large pneumothorax?
More that 2cm rim of air
75
What does 2cm of air represent in a pneumothorax
50% of the thoracic cavity.
76
How would you treat a pneumothorax that was asymptomatic and small?
No treatment would be required.
77
What treatments may be given for a larger pneumothorax?
Aspiration Chest drain Suction Surgery
78
What would be indications for surgical intervention is the case of a pneumothorax?
Your second pneumothorax on the same lung (ipsilateral). Your first pneumothorax but on the opposite lung(contralateral). Bilateral pneumothorax A persistant air leak after 5 days of drainage. A spontaneous heamothorax High risk professions such as pilots and drivers.
79
What follow up treatment is required after a pneumothorax?
Follow up chest x ray | Stop smoking
80
Can you fly again after a pneumothorax?
After 6 weeks you should be fine to drive | If you have had surgery this should be confirmed by a chest x ray
81
Should you dive again after a pneumothorax?
No
82
What happens in a tension pneumothorax?
A one way valve is created so whit each inspiration more air floes into the thoraces cavity. This is a medical emergency Chest contents move away
83
What signs and symptoms would you see in a patient with a tension pneumothorax?
Trachea deviates away from the side where there is a pneumothorax Raised JVP Hypotension Reduced ir entry Patients would be in respiratory distress
84
How do you treat a tension pneumothorax?
Needle decompression with a large bore venflon. | This is inserted in the second intercostal space anteriorly, mid clavicular line.

Respiratory (Zoe) (7 decks)

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