Pathoma 7, 8, 9 Flashcards
(138 cards)
1
Q
What are the 3 layers of arterial walls and what are they made of?
A
- Intima – endothelium
- Media – smooth muscle
- Adventitia – connective tissue
2
Q
50+ Female w/: headaches, visual disturbances, jaw claudication. Labs: elevated ESR. Biopsy: inflamed vessel walls.
What disease?
A
Giant Cell Arteritis (aka. GCA, Temporal arteritis) – Large-vessel
3
Q
Presents: Giant Cell Arteritis symptoms + flu-like symptoms w/ joint and muscle pain
What disease that is often associated with GCA?
A
Polymyalgia Rheumatica
4
Q
Biopsy of a branch of external carotid: inflamed vessel wall w/ giant cells and intimal fibrosis
What disease?
A
Giant Cell Arteritis (aka. GCA, Temporal arteritis) – Large-vessel vasculitis
5
Q
Under 50 y/o Asian female w/: visual and neurologic symptoms, weak/absent pulse in upper extremities. Labs: elevated ESR.
What disease?
A
Takayasu Arteritis – Large-vessel vasculitis
6
Q
Young adult w/: HTN, abdominal pain w/ melena (black tarry feces), neurologic disturbances, and skin lesions. Blood vessel histo: transmural inflammation w/ fibrinoid necrosis, ‘string-of-pearls’ appearance
What disease?
A
Polyarteritis Nodosa – Medium-vessel vasculitis
HTN= renal artery involvment
Abdn pain w/ melena= mesenteric artery involvement
- -Necrotizing vasculitis of multiple organs; SPARES LUNGS
- -Fatal if not treated
7
Q
Which vasculitis’ treatment includes cyclophosphamide?
A
Polyarteritis Nodosa Wegener Granulomatosis (Granulomatosis w/ Polyangiitis) Microscopic Polyangiitis
8
Q
2 y/o Asian child w/: fever, conjunctivitis, erythematous rash of palms and soles, enlarged cervical lymph nodes.
What disease?
Treatment?
A
Kawasaki Disease – Medium-vessel vasculitis
–Treat w/ Aspirin, IVIG; self limited
9
Q
Patient is a heavy smoker w/: Raynaud phenomenon, ulceration, gangrene and autoamputation of fingers and toes.
What disease?
Treatment?
A
Beurger Disease – Medium-vessel vasculitis
–Treatment: smoking cessation
10
Q
Middle aged male w/: sinusitis, nasopharyngeal ulceration, saddle-nose, hemoptysis, hematuria. CXR: bilateral nodular lung infiltrates. Lab: c-ANCA. Biopsy: necrotizing granulomas, adjacent necrotizing vasculitis.
What disease?
A
Granulomatosis w/ Polyangiitis (Wegener) – Small-vessel vasculitis
11
Q
Middle aged male w/: hemoptysis, hematuria. CXR: bilateral nodular lung infiltrates. Labs: p-ANCA. Biopsy: no granulomas.
What disease?
A
Microscopic Polyangiitis – Small-vessel vasculitis
12
Q
Asthmatic patient w/: necrotizing granulomas in lungs. Labs: eosinophilia, p-ANCA.
What disease?
A
Churg-Strauss Syndrome – Small-vessel vasculitis
13
Q
Pediatric patient w/: recent Hx of URI, GI pain and bleeding, hematuria, palpable purpura on buttocks and legs. Previous episode of symptoms resolved by itself.
What disease?
A
Henoch-Schönlein Purpura – Small-vessel vasculitis
14
Q
What is the developmental defect of blood vessel wall that causes 2ndary HTN in young females?
What mechanism?
Where does it affect?
A
- Fibromuscular dysplasia
- Irregular thickening of large- and medium-sized arteries
- Renal artery
15
Q
Systemic HTN: over ___mm/Hg
Malignant HTN: over ___mm/Hg
A
- 140/90
- - 180/120
16
Q
It consists of a lipid core (mostly cholesterol) w/ a fibromuscular cap, and undergoes dystrophic calcification.
What is it?
A
Intimal plaque – Atherosclerosis
17
Q
What are some common large- and medium-sized arteries affected by Atherosclerosis?
A
- Abdominal aorta
- Coronary artery
- Popliteal artery
- Internal carotid artery
18
Q
Lipid oxidation and subsequent consumption by macrophages via scavenger receptors results in formation of ___
A
Foam cells
19
Q
Which type of arteriolosclerosis is a consequence of:
- -malignant HTN?
- -Diabetes?
- -benign HTN?
A
– Hyaline arteriolosclerosis – long-standing benign HTN, Diabetes
– Hyperplastic arteriolosclerosis – malignant HTN
20
Q
Which type of arteriolosclerosis results in:
- -Acute renal failure?
- -Glomerular scarring (arteriolonephrosclerosis)?
- -Chronic renal failure?
- -End-organ ischemia?
A
- -Acute renal failure – Hyperplastic
- -Arteriolonephrosclerosis – Hyaline
- -Chronic renal failure – Hyaline
- -End-organ ischemia – Both
21
Q
In Microscopy, which type of arteriolosclerosis has:
- “flea-bitten appearance”
- Pink proteins
- “onion-skin appearance”
A
- “flea-bitten appearance” – Hyperplastic
- Pink proteins – Hyaline (pink hyaline proteins)
- “onion-skin appearance” – Hyperplastic
22
Q
What is calcification of the media of muscular (medium-sized) arteries?
A
Mönckeberg Medial Calcific Sclerosis
- Not clinically significant
- Incidental finding on x-ray or mammography
23
Q
What 2 diseases commonly cause weakness of connective tissue in the media (called ___) in younger individuals that leads to Aortic Dissection?
A
– Marfan syndrome, Ehlers-Danlos syndrome
– Cystic medial necrosis = weakness of connective tissue in the media
24
Q
Old patient w/ HTN has acute sharp, tearing chest pain radiating to the back.
What is it?
A
Aortic Dissection
25
What are the 3 most common complications of Aortic Dissection?
1. Pericardial Tamponade (most common cause of death)
2. Rupture w/ fatal hemorrhage
3. Obstruction of branching arteries (coronary, renal) --> end-organ ischemia
26
Patient w/: Aortic valve insufficiency, and difficulty swallowing. Microscopy: 'tree-bark' appearance of aorta. Dark field microscopy: spirochetes.
What is it?
Thoracic Aortic Aneurysm
- -Classically seen in Tertiary Syphilis
- -Endarteritis of vasa vasorum --> luminal narrowing, decreased flow, atrophy of vessel wall
27
60+ y/o male smoker w/: HTN, enlarging midline pulsatile abdominal mass.
What is it?
Abdominal Aortic Aneurysm
28
60+ y/o male w/ 6cm dilation in abdominal aorta 1 hour ago now has triad of: Hypotension, Pulsatile abdominal mass, and flank pain.
What is it?
Ruptured Abdominal Aortic Aneurysm
- - Triad: Hypotension, Pulsatile abdominal mass, Flank pain
- - Major complication of aneurysm, esp. after 5+cm diameter
29
What is associated w/ exposure to polyvinyl chloride, arsenic, and Throtrast?
Liver angiosarcoma
30
Between what 2 locations does Abdominal Aortic Aneurysm usually arise?
- - Below renal arteries
| - - Above aortic bifurcation
31
What vascular tumor is commonly present at birth, and regresses during childhood?
What does it usually involve?
- - Hemangioma = benign tumor of blood vessels
| - - Skin and liver
32
What is highly aggressive malignant proliferation of blood vessel endothelia cells?
Common sites?
- - Angiosarcoma
| - - Skin, breast, liver
33
A former Eastern European soldier w/ AIDS recently had a liver transplant and now presents w/ purple patches, plaques, and nodules on the skin. Labs: anti-HHV8 antibody.
What is it?
Kaposi Sarcoma
34
What's more common? [Primary/Secondary] HTN.
Primary HTN = 95% of cases; unknown etiology
| Secondary HTN = 5% of cases; identifiable etiology
35
What are 2 ways Angiotensin II raises BP?
1. Contract arteriolar smooth muscle
| 2. Promote adrenal release of Aldosterone
36
EKG finding in Subendocardial vs. Transmural ischemia:
- - Subendocardial = ST-depression
| - - Transmural = ST-elevation
37
EKG finding in:
1. Stable Angina
2. Unstable Angina
3. Prinzmetal Angina
1. Stable Angina = ST-depression (subendocardial)
2. Unstable Angina = ST-depression (subendocardial)
3. Prinzmetal Angina = ST-elevation (transmural)
38
Myocardial Infarction most common:
- -Chamber involved?
- -Vessel involved?
- -2nd most common vessel?
- -Left Ventricle
- -Left Anterior Descending (LAD)
- -Right Coronary Artery (RCA)
39
MI involving this vessel --> anterior wall, anterior septum of LV infarction
LAD
40
MI involving this vessel --> posterior wall, posterior septum, LV papillary muscle infarction
RCA
41
MI involving this vessel --> lateral wall of LV
Left Circumflex Artery
42
Troponin I vs. CK-MB
1. Which rises earlier?
2. Which peaks faster?
3. Which normalizes faster?
1. Troponin (2-4hrs) faster than CK-MB (4-6hrs)
2. Same (24h) for both
3. CK-MB (72h) faster than Troponin (7-10days)
43
Initial phase of MI has what EKG finding? Why?
ST-depression b/c subendocardial necrosis
44
Reperfusion of irreversibly-damaged cells resulting in calcium influx leads to what?
Hypercontraction of myofibrils --> contraction band necrosis
45
What is reperfusion injury?
Return of oxygen and inflammatory cells --> free radical generation --> further myocyte damage
46
What is the usual immediate cause of sudden cardiac death?
Fatal ventricular arrhythmia
47
Definition of Sudden Cardiac Death
- -Unexpected death due to cardiac disease
- -Occurs w/o symptoms
- -Or less than 1hr after symptoms arise
48
What is Cor Pulmonale?
--Right ventricle enlargment and failure
--Due to increase pulm. vascular resistance or pulm. HTN
49
Microscopic finding of 'Heart-failure' cells:
Hemosiderin-laden macrophages
50
What is the most common cause of Right Heart Failure?
Left heart failure
51
What is it called when a left-to-right shunt increases right heart pressure to cause a reversal of flow creating a right-to-left shunt?
Eisenmenger Syndrome
52
What 4 common symptoms do you see in Eisenmenger syndrome?
1. Late cyanosis (not as a baby)
2. Right ventricular hypertrophy
3. Polycythemia
4. Nail clubbing
53
What direction of shunting presents as cyanosis shortly after birth?
Right-to-left shunt
54
What is the most common congenital heart defect that is also associated w/ fetal alcohol syndrome?
Ventricular Septal Defect (VSD)
--left-to-right shunt
55
What kind of congenital heart defect is associated w/ Down Syndrome?
Ostium primum type of Atrial Septal Defect (ASD)
56
What kind of congenital heart defect is associated w/ congenital Rubella?
Patent Ductus Arteriosus (PDA)
57
What congenital heart defect has a split S2 on auscultation (increased blood in right heart that delays closure of pulmonary valve)
Atrial Septal Defect (ASD)
58
What congenital heart defect has a 'machine-like' murmur?
Patent Ductus Arteriosus (PDA)
59
How does Indomethacin treat Patent Ductus Ateriorsus (PDA)?
- -Decreases Prostaglandin E1
| - -Prostaglandin E1 maintains patency of ductus arteriosus
60
What is Tetralogy of Fallot?
1. Stenosis of right ventricular outflow tract
2. Right ventricular hypertrophy
3. Ventricular Septal Defect (VSD)
4. Aorta that overrides VSD
61
What congenital heart defect is associated with maternal diabetes?
Transposition of the Great Vessels
62
What congenital heart defect has a 'boot-shaped' heart on X-ray?
Tetralogy of Fallot
63
Infant patient w/ Turner syndrome has lower extremity cyanosis.
What congenital heart defect?
What is it associated with?
Coarctation of the Aortal (Infantile form)
- -Associated w/ PDA
- -Occurs distal to arch, but proximal to PDA
64
What is it called when the tricuspid valve fails to develop and the right ventricle is hypoplastic?
What is often associated?
--Tricuspid atresia
--ASD --> right-to-left shunt --> early cyanosis
65
Adult patient presents w/ upper extremity HTN, lower extremity Hypotension, and weak pulses. CXR: 'notching' of ribs due to engorged arteries.
What congenital heart defect?
What is it associated with?
- -Coarctation of the Aorta (Adult form)
| - -Associated w/ Bicuspid aortic valve
66
What is bacterial M protein resembling human tissue protein called?
Molecular mimicry
67
What are the 5 Major Jones criteria of Acute Rheumatic Fever?
1. Migratory polyarthritis
2. Pancarditis (endocarditis, myocarditis, pericarditis)
3. Subcutaneous nodules
4. Erythema marginatum
5. Sydenham chorea
68
What are reactive histiocytes w/ slender, wavy nuclei called?
When and where are they seen?
--Anitschkow cells
--In Aschoff bodies in myocardium in rheumatic heart disease
69
This thing, found in the myocardium, is characterized by foci of chronic inflammation, reactive histiocytes w/ slender, wavy nuclei, giant cells, and fibrinoid material.
What is it?
Aschoff bodies found in myocardium of rheumatic heart disease
70
Patient develops an annular, nonpruritic rash with erythematous borders involving the trunk and limbs after a recent URI.
What is it, specifically?
What condition is is a part of?
- -Erythema marginatum
| - -Acute Rheumatic Fever
71
What prior infection causes Acute Rheumatic Fever?
- -Pharyngitis
- -Group A B-hemolytic streptococci (Strep. pyogenes)
- -2-3wks after
- -
72
Patient develops swelling and pain that moves between wrists, knees, and ankles that resolves by itself after a recent URI.
What is it, specifically?
What condition is is a part of?
- -Migratory polyarthritis
| - -Acute Rheumatic Fever
73
Patient develops infectious endocarditis and dies. Biopsy shows 'fish-mouth' appearance of mitral valve w/ thickening of chordae tendineae and valve cusps. Aortic valve commissures are fused.
What is it?
Chronic Rheumatic Heart Disease
- -Almost always mitral valve
- -Occasional aortic valve --> commissure fusion
74
60+ y/o patient w/ bicuspid aortic valve has a systolic ejection click followed by a crescendo-decrescendo murmur on auscultation.
What is it?
Aortic Stenosis
75
What are 3 complications of Aortic Stenosis?
1. Concentric LVH
2. Microangiopathic hemolytic anemia -- calcified valve damages RBCs
3. Angina and syncope w/ exercise -- insufficient perfusion of myocardium and brain
76
Patient has a bounding (water-hammer) pulse and head bobbing. Exam: pulsating nail bed (Quincke pulse), early, blowing diastolic murmur, BP 140/65. Echo: LV dilation, and eccentric cardiac hypertrophy.
What is it?
Aortic Regurgitation
| --Characteristic: Increased pulse pressure, eccentric hypertrophy
77
What is cardiac muscle mass in concentric vs. eccentric hypertrophy?
- -Concentric = high muscle mass, normal volume
| - -Eccentric = normal muscle mass, high volume
78
Water-hammer pulse and Quincke pulse are seen in what disease?
Aortic regurgitation
- -water-hammer = bounding pulse
- -Quincke = pulsating nail bed
79
What causes high Pulse Pressure in Aortic Regurgitation?
- -Systolic pressure increase = increased stroke volume
| - -Diastolic pressure decrease = regurgitation
80
Patient with either Marfan or Ehlers-Danlos syndrome (who knows) has a mid-systolic click and a late systolic murmur. Click and murmur become softer when squatting. Somehow he dies and biopsy shows myxoid degeneration (accumulation of ground substance).
What is it?
Mitral Valve Prolapse
--Prolapse (click) --> regurgitation (murmur from mid systole)
81
Patient has a holosystolic "blowing" murmur that gets louder w/ squatting and expiration.
What is it?
Mitral Regurgitation
- -Squatting --> higher TPR --> more regurgitation
- -Expiration --> more return to LA -->
82
Patient with chronic rheumatic valve disease is found to have volume overload leading to dilation of LA. Exam: opening snap followed by diastolic rumble.
What is it?
Mitral Stenosis
- -Mitral valve open after S2 --> diastolic opening snap (split S2)
- -Turbulent flow from LA to LV --> low pitch diastolic rumble
83
Endocarditis:
- -Most common overall cause?
- -Most common cause in IV drug users?
- -Most common cause in colorectal carcinoma patients?
- -Most common cause w/ negative blood cultures?
- -Overall = Strep. viridians
- -IV = Staph. aureus
- -Cancer = Strep. bovis
- - (-) Cultures = HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)
84
Patient presents w/ anemia, fever, murmur, erythematous nontender lesions on palms and soles, tender lesions on fingers and toes, splinter hemorrhages in nail bed and retinal hemorrhages w/ pale centers
What is it?
Bacterial Endocarditis
- -Janeway lesions = erythematous nontender lesion on palms and soles
- -Osler nodes = tender lesions on fingres and toes
- -Splinter hemorrhages = vertically running blood clots
- -Roth spots = retinal hemorrhages w/ pale centers
85
Afebrile patient w/ Hx of SLE and a holosystolic "blowing" murmur has an Echocardiogram showing a vegetation on the mitral valve
What is it?
Libman-Sacks endocarditis -- sterile vegetations
--Holosystolic "blowing" murmur = mitral regurgitation
86
```
In Anemia of chronic disease:
Hb = ___
MCV = ___
Ferritin = ___
TIBC = ___
Serum iron = ___
% Saturation = ___
```
```
Hb = low
MCV = low
Ferritin = high
TIBC = low
Serum iron = low
% Saturation = high
```
87
What is it called when you get sterile vegetations that arise in association w/ SLE?
Where do the vegetations occur?
- -Libman-Sacks endocarditis
| - -surface and undersurface of mitral valve-->regurgitation
88
What is the most common form of cardiomyopathy?
Dilated cardiomyopathy
89
Most common cause of this heart disease is an autosomal dominant mutation in sarcomere proteins
Hypertrophic cardiomyopathy -- massive hypertrophy of left ventricle
90
A young athlete with known diastolic dysfunction (ventricle cannot fill) and has occasional syncope with exercise suddenly dies due to a ventricular arrhythmia. On biopsy, his heart shows myofiber disarray.
What does he have?
--Hypertrophic cardiomyopathy
91
This syndrome is characterized by endomyocardial fibrosis with an eosinophilic infiltrate and eosinophilia.
What does it cause?
Loeffler Syndrome --> Restrictive cardiomyopathy
92
Patient presents w/ CHF due to restrictive cardiomyopathy.
| What are expected classic EKG findings?
- -Low-voltage
| - -diminished QRS amplitude
93
Patient presents with an episode of syncope. Echo shows a pedunculated mass in the left atrium near the mitral valve.. Biopsy shows mesenchymal tumor with a gelatinous appearance and abundant ground substance in histology.
What is it?
--Myxoma -- most common adult primary cardiac tumor
--Syncope b/c mitral valve obstruction
94
A young child with tuberous sclerosis has a mass in his left ventricle.
What is it?
Rhabdomyoma -- benign hamartoma of cardiac MUSCLE
--most common primary cardiac tumor in children
95
Breast and lung carcinoma, melanoma and lymphoma commonly metastasize to the heart. Where do they usually affect and what does it result in?
Pericardium --> pericardial effusion
96
Patient presents w/ fever, chills, productive cough w/ yellow-green, sometimes rusty, sputum. Exam: resp. rate 25, pleuritic chest pain, decreased breath sounds, dullness to percussion. Labs: elevated WBCs
What is it?
What 3 tests can make the diagnosis?
Pneumonia
- -CXR
- -Sputum gram stain and culture
- -Blood cultures
97
Aspiration pneumonia:
- -What organisms usually cause it?
- -In what patient population?
- -What classical finding?
- -Anaerobic bacterial in oropharynx
- -Patients w/ risk of aspiration = alcoholics, comatose
- -Right lower lobe abscess (b/c right main stem bronches branches at a less acute angle than left)
98
What type of pneumonia is often multifocal and bilateral?
Bronchopneumonia
99
Differentiate causes of Red vs. Gray hepatization in pneumonia
Red--due to exudate, neutrophils and hemorrhage filling alveolar spaces --> spongy lung into solid consistency
Gray--due to degradation of red cells within exudate
100
What is another name for 'atypical' pneumonia?
| What symptomatic differences make it 'atypical'?
- -Interstitial Pneumonia
| - -Presents w/ relatively mild upper respiratory symptoms (minimal sputum, low fever)
101
What 2 things make TB reactivation occur at apex of the lung?
- -Relatively poor lymphatic drainage
| - -High oxygen tension
102
What is it called when TB spreads to affect the lumbar vertebrae?
Pott disease
103
TB causes focal, caseating necrosis in the lower lobe and hilar lymph nodes that undergoes fibrosis and calcification.
What is this thing called?
Ghon complex
104
4 Clinical features of TB:
- -Fever
- -Night sweats
- -Cough w/ hemoptysis
- -Weight loss
105
How do the following change in in COPD:
- -FVC? (forced vital capacity)
- -FEV1?
- -TLC? (total lung capacity)
- -FVC decreases
- -FEV1 decreases more than FVC
- ---so FEV1/FVC ratio decreases
- -TLC increases
106
Patient is a smoker presents with 3 months of productive cough (lots of mucus) for the past 2 years. Exam: high PaCO2, low PaO2 that causes cyanosis. He's pissed another doctor called him a "blue bloater".
What is it?
What pathophysiologic change?
--Chronic bronchitis
--Hypertrophy of bronchial mucinous glands ( over 50% Reid index)
107
What causes:
- -Panacinar emphysema that is most severe in lower lobes?
- -Centriacinar emphysema that is most severe in upper lobes?
What causes:
Smoking-->Centriacinar emphysema that is most severe in upper lobes?
A1AT (a1-antidrypsin) deficiency -->Panacinar emphysema that is most severe in lower lobes?
108
A1AT (a1-antitrypsin) deficiency is due to misfolding of the mutated protein. It can accumulate in the endoplasmic reticulum of what cell and lead to what condition (other than emphysema)?
Hepatocytes --> Liver damage --> Liver cirrhosis
109
Patient has dyspnea, wheezing, a productive cough, spiral-shaped mucus plugs, and eosinophil-derived crystals
What is it?
Asthma
| --classic Curschmann spirals and Charcot-Leyden crystals
110
Is Asthma TH1 or TH2 mediated?
TH2! = antibody-mediated
111
In asthma, TH2 cells secrete IL4, IL5, and IL10. What do they do?
- -IL4 = mediate calss switch to IgE
- -IL5 = attracts eosinophils
- -IL10 = stimulate TH2, inhibit TH1
112
A man with sinusitis, infertility, situs inversus, and Cystic Fibrosis presents with cough, dyspnea, and foul-smelling sputum. He might also have a type of aspergillosis, a tumor, or a necrotizing infection. It results in permanent dilation of brinchioles and bronchi b/c loss of airway tone results in air trapping.
What is it?
Bronchiectasis
--sinusitis + infertility + situs inversus = Kartagener syndrome = dynein arm defect affecting ciliary movement
113
How do the following change in in Restrictive Respiratory Diseases:
- -FVC? (forced vital capacity)
- -FEV1?
- -TLC? (total lung capacity)
- -FVC decreases more than FEV1
- -FEV1 decreases
- ---so FEV1/FVC ratio increases
- -TLC decreases
114
Patient w/ history of radiation therapy and taking bleomycin and amiodarone presents w/ progressive dyspnea and cough. CT: diffuse fibrosis described as 'honeycomb' lung
What is it?
What is the role of TGF-B here?
--Idiopathic Pulmonary Fibrosis
--TGF-B from injured pneumocytes induces fibrosis
115
In Pneumoconiosis, chronic exposure to fibrogenic particles (carbon dust, silica, beryllium, or asbestos) leads to interestitial fibrosis.
What pathogenic process causes this?
Alveolar macrophages engulf foreign particles --> induces fibrosis
116
Young African American female patient presents w/ dyspnea and cough. Labs: elevated serum ACE, hypercalcemia. Biopsy: noncaseating granulomas in hilar lymph nodes and lungs w/ stellate inclusions ('asteroid bodies') in giant cells.
What is it?
--Sarcoidosis -- characteristic noncaseating granulomas in multiple organs
117
Patient that is a pigeon breeder has fever, cough, and dyspnea a couple hours after he gets some new pigeons that resolves when he decides he doesn't want to breed pigeons anymore.
Wha is it?
Hypersensitivity Pneumonitis --granulomatous reaction to inhaled organic antigens (Pigeon breeder's lung)
118
Criterion for pulmonary HTN:
Mean pulmonary arterial pressure greater than 25mmHg
119
A young adult female has an inactivating mutation of BMPR2 leading to proliferation of vascular smooth muscle.
She has a familial form of what?
Primary pulmonary HTN
120
Hypoxemia (COPD or interstitial lung disease), increased volume in pulmonary circuit (congenital heart disease), or recurrent embolism are all potential causes of this:
Secondary pulmonary HTN
121
Patient with some kind of disease process develops hypoxemia and cyanosis w/ respiratory distress. CXR: 'white out'. Microscopy: hyaline membranes in alveoli.
What is it?
Acute Respiratory Distress Syndrome (ARDS)
122
A premature neonate delivered by c-section by a mother w/ diabetes develops tachypnea w/ use of accessory muscles, grunting, increasing respiratory effort after birth, and hypoxemia w/ cyanosis. CXR: diffuse granularity of lung, "ground-glass" appearance.
What is it?
Neonatal Respiratory Distress Syndrome
123
Do Type 1 or 2 pneumocytes produce surfactant?
Type 2
124
What are the 3 key risk factors for Lung Cancer?
1. Cigarette smoke
2. Radon
3. Asbestos
125
CXR reveals a solitary nodule ('coin-lesion') that suggests lung cancer. BUT
- -What benign lesions could it be?
- -What do you need to diagnose cancer?
--Could be: granuloma (TB or fungus like Histoplasma) or Bronchial hamartoma
--Biopsy necessary for cancer diagnosis
126
Small cell carcinoma arises from what cells?
Neuroendocrine (Kulchitsky) cells
127
What lung cancer has characteristic keratin pearls or intercellular bridges in histology?
Squamous Cell Carcinoma
128
What is the most common lung tumor in nonsmokers and female smokers?
Adenocarcinoma
129
What kind of lung cancer is likely if you see multiple 'cannon-ball' nodules on imaging?
2ndary Lung Cancer -- metastasis to lung
130
What category of lung cancer does not respond well to chemotherapy?
Non-small cell carcinoma -- treated upfront w/ surgical resection
131
Pleural involvement is classically seen with what kind of lung cancer?
Adenocarcinoma
132
Lung cancer can cause distended head and neck veins w/ edema and blue discoloration of arms and face. What is it called when this happens?
Superior vena cava syndrome -- obstruction of SVC
133
Lung cancer can cause hoarsness and diaphragmatic paralysis when it involves what anatomic structures?
- -Recurrent laryngeal nerve --> hoarsness
| - -Phrenic nerve --> diaphragmatic paralysis
134
What is a unique site of metastasis for lung cancer?
Adrenal gland
135
What kind of lung cancer can cause Horner syndrome
Apical (Pancoast) tumor --> sympathetic chain compression
136
A retired shipyard worker presents w/ recurrent pleural effusions, dyspnea, and chest pain.
What is it?
Mesothelioma
137
A young adult has a rupture of an emphysematous bleb.
| What is it?
Spontaneous pneumothorax -- collapse of a portion of the lung
138
Trachea displacement in spontaneous vs. tension pneumothorax:
```
Spontaneous = shift to side of collapse
Tension = pushed opposite to side of injury
```
