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Flashcards in Pathology - respiratory Deck (36):
1

Bacterial rhinosinusitis superimposed on viral URI

S. pneumo
H. flu
Morazella catarrhalis

2

Keisselbach plexus vs. posterior segment of nostril

Benign vs. life-threatening hemorrhages (which come from sphenopalatine artery, a branch of the maxillary artery)

3

Origin of DVTs

proximal deep veins of lower extremitiy

dorsiflexion of foot = calf pain

use heparin for short term ppx and tx, then warfarin/rivaroxaban for long term tx

4

Pathophysiology of pulmonary emboli

V/Q mismatch --> hypoxemia --> respiratory alkalosis

Lines of Zahn - interdigitating lines of pink (platelets/fibrin) and red (RBCs) found only in thrombi formed BEFORE death (indicates a pre-mortem thrombus)

5

6 types of emboli in PE

Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor (FATBAT)

fat - long bone injury
amniotic fluid - seen w/ DIC
air - ascending divers

6

PFTs in obstructive lung disease

decr. FEV1/FVC ratio***

decr. FEV1 (airways close prematurely at high lung volumes)

7

Hyperplasia of mucus-secreting glands in bronchi

Chronic bronchitis (b = blue bloater)

Reid index = thickness of bronchial wall, >50%

cough: 3 mos/yr, for >2 yrs

8

Enlargement of air spaces, decr. recoil, decr. diffusion capacity for CO, destruction of alveolar walls

Emphysema (p = pink puffer)

incr. elastase activity = loss of elastic fibers

exhalation through pursed lips = incr. airway pressure, prevent airway collapse

9

Two main aspects of asthma

Bronchial hyperresponsiveness --> bronchoconstriction

Smooth muscle hypertrophy

Look for mucus plugging, pulsus paradoxus, decr. I:E ratio

10

Chronic necrotizing infection of bronchi

Bronchiectasis

Permanently dilated airways, purulent sputum, recurrent infections, hemoptysis

11

PFTs in restrictive lung disease

normal FEV1/FVC ratio

decr. FVC

12

Etiologies of restrictive lung disease

1.) poor breathing mechanics (normal A-a gradient)

2.) interstitial lung disease (decr. diffusion capacity, incr. A-a gradient)

13

Hypersensitvity pneumonitis

Type III/IV rxn

14

Cor pulmonale, Caplan syndrome (RA + intrapulmonary nodules)

signs of pneumoconioses

15

Supradiaphragmatic and pleural plaques

Asbestosis

incr. risk of cancer (bronchogenic carcinoma > mesothelioma)

absestos bodies = golden-brown rods that look like dumbbells, found in sputum

16

Macrophages laden with carbon, inflammation and fibrosis

Coal workers' pneumoconiosis

Upper lobes affected

anthracosis - similar, but found in urban people with pollution

17

Mechanism of silicosis

Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. Eggshell calcification of hilar lymph nodes

Affects upper lung lobes

Silica may disrupt phagolysosomes and impair macrophages, incr. susceptibility to TB! also, incr. risk of bronchogenic carcinoma

18

Therapeutic O2 in neonatal RDS complications

1.) retinopathy
2.) intraventricular hemorrhage
3.) bronchopulmonary dysplasia

19

Risk factors for neonatal RDS

Prematuriy, maternal diabetes, C-section delivery

Lecithin:sphingomyelin ratio <1.5

Persistently low O2 levels can lead to risk of PDA

20

Damage mediators in ARDS

1.) neutrophils
2.) activation of coagulation cascade
3.) oxygen-derived free radicals

lead to diffuse alveolar damage, leading to incr. alveolar capillary permeability, then protein-rich leakage into alveoli and pulmonary edema

21

Vascular changes in pulmonary hypertension

Arteriosclerosis
Medial hypertrophy
Intimal fibrosis of pulmonary arteries

22

Causes of pulmonary artery hypertension

***hereditary: BMPR2 gene, normally inhibits vascular smooth muscle proliferation

23

Increased fremitus

consolidation!

lobar pneumonia, pulmonary edema

24

Hyperresonant breath sounds

Pneumothorax

25

TGs in pleural fluid

Lymphatic pleural edema (chylothorax)

thoracic duct injury from trauma or malignancy

26

Atypical pneumonias

Viruses, mycoplasma, legionella, chlamydia

diffuse patchy inflammation localized to interstitial areas at alveolar walls

27

Two causes of lung abscess

Aspiration of oropharyngeal contents

Bronchial aspiration

28

Face/arm edema, JVD, swollen collateral veins on chest, shortness of breath, coughing

SVC syndrome, sometimes seen with Pancoast tumor

Medical emergency, can lead to headaches, dizziness, rupture of aneurysm/intracranial arteries (incr. ICP)

29

Lung cancer complications

SPHERE: SVC syndrome, Pancoast tumor, Horner, Endocrine, Recurrent laryngeal nerve compression, Effusions

30

Two centrally located lung cancers

Squamous cell

Small cell

31

Three main neoplastic syndromes with small cell lung cancer

ACTH - Cushing syndrome
SIADH
Abs against pre-synaptic Ca channels - Lambert-Eaton

Look for neuroendocrine cells - Kulchitsky cells

32

Lung cancer assoc. w/ clubbing, glandular pattern on histology

Adenocarcinoma

activating mutations: KRAS, EGFR, ALK

33

Lung cancer w/ cavitation, cigarettes, hypercalcemia (PTHrP)

squamous cell carcinoma

hilar mass arising from bronchus

look for keratin pearls and intercellular bridges

34

Highly anaplastic undifferentiated lung cancer

Large cell carcinoma

pleomorphic giant cells, can secrete b-hCG

35

Phases of lobar pneumonia

congestion --> red hepatization --> gray hepatization --> resolution

36

Progression of tuberculous infection

Granulomatous with caseous necrosis

Caseous: T-cell mediated delayed hypersensitivity (Th1 stimulation of macs and CD8 T cells)