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Pulmonary > Pulmonary pathology > Flashcards

Pulmonary pathology Flashcards

1
Q

Rhinositus

A

Obstruction of sinus drainage into nasal cavity

Typically maxillary sinuses –> that drain into middle nasal meatus

Common causes: S. pneumo, H influenza

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2
Q

Epistaxis

A

Nose bleed

Generally occurs in anterior segment of nostril

Can be life threatening if in posterior segment (sphenopalatine a.- part of maxillary a)

Tx: cauterization (often of nasal septum) –> highly vascularized

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3
Q

Head and neck ca

A

Most often Squamous cell ca

Generally in oral cavity

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4
Q

Deep venous thrombosis

A

Virchow triad: SHE
Stasis
Hypercoagulability
Endothelial damage

S&S: Homan sign- pain with dorsiflexion of foot

Tx: unfractionated heparin or LMWH (enoxaparin) --> prophylaxis and acute management
Oral anticoags (like warfarin or riveroxaban for long term tx)

Imaging: compression US

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5
Q

Pulmonary emboli

A

V/Q mismatch; causes increase A-a gradient –> hypoxemia –> respiratory alkalosis (because of hyperventilation)

Lines of Zahn: pink and red; tells you that emboli formed right before death

Can be caused by FAT BAT (fat, air (nitrogen bubbles in ascending divers), thrombus, bacteria, amniotic fluid (fetal squamous cells seen in pulmonary vasculature), and tumor)

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6
Q

Obstructive lung diseases

A

Main characteristics: increased TLC, but decreased FEV1/FVC (<0.8)

Causes: Chronic bronchitis, emphysema, asthma, bronchiectasis

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7
Q

Chronic bronchitis

A

Hyperplasia of mucus secreting glands

Productive cough (for > 2 years- not necessary consecutive)

Can cause pulmonary HTN and for pulmonale

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8
Q

Emphysema

A

Enlargement of air spaces, decreased diffusion capacity, increased compliance

Centriacinar- smoking
Panacinar- alpha-1 antitrypsin

Barrel shaped chest, exhale through pursed lips (to increase airway back pressure and prevent airway collapse

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9
Q

Asthma

A

Smooth muscle hypertrophy; Curschmann spirals (whorled mucus plugs); Charcot-Leyden crystals (eosinophilic, hexagonal crystals)

Dx: methacholine challenge –> muscarinic agonist –> increases bronchial tone

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10
Q

Bronchiectasis

A

Necrotizing infection of bronchi –> causes permanently dilated airways, digital clubbing

Can happen with allergic bronchopulmonary aspergillosis

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11
Q

Restrictive lung disease

A

Decreased FVC and TLC; increased FEV1/FVC; decreased DLCO

Types can be muscular or lung-related

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12
Q

Muscular/ mechanical causes

A

Weakened intercostal muscles: Polio, ALS, MG, Guillian-Barre

Poor structural apparatus: scoliosis, obesity

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13
Q

Intersitial lung disease

A

Sarcoidosis
Fibrosis (idiopathic): see honeycombing (on S-ray) and clubbing
ARDS/ NRDS
Goodpasture
Wegener- granulomatosis with polyangiitis
Drug toxicity (bleomycin, amiodarone, busulfan, methotrexate)

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14
Q

Flow volume loops

A

Right shift: Restrictive

Left shift: obstructive

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15
Q

Hypersensitivity pneumonitis

A

Mixed type III/IV HS reaction

Seen in farmer exposed to birds

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16
Q

Pneumoconiosis

A

Increased risk of cor pulmonate, cancer and Caplan syndrome (RA and pneumoconiosis w/ nodules)

Types: Asbestosis, beryllosis, coal workers, silicosis

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17
Q

Asbestosis

A

Ferruginous bodies (via Prussian blue stain)- brown rods resembling dumbbells

Shipbuilding, roofing, plumbing

White plaques in pleura

Bronchogenic carcinoma (esp. if smoker) > Mesothelioma

Lower lobes

18
Q

Berylliosis

A

Aerospace and manufacturing industries

Granulomatous; steroids may help

Upper lobes

19
Q

Coal workers

A

Black lung disease

Macrophages with carbon –> Cause inflammation and fibrosis

Upper lobes

Anthracosis: asymptomatic; found in urban dwellars

20
Q

Silicosis

A

Foundries (metal factory), sandblasting, mines (not to be confused with coal workers)

Macrophages respond to silica –> causes fibrosis; may also increase susceptibility to TB

Upper lobes

Eggshell calcifications of hilar lymph nodes

21
Q

General trends of pneumoconiosis

A

Asbestos is from the roof (insulation/ ceiling), but affects the base (lower lung)

All the others affect the upper lungs (and are metals/ coal that are found in the ground)

22
Q

ARDS

A

Endothelial damage (neutrophils release toxic factors) –> causes increased alveolar capillary permeability –> protein leaks into alveoli –> diffuse alveolar damage

Causes formation of intra-alvelolar hyaline membrane

Characterized by bilateral lung opacities without evidence of fluid overload or HF

Can be due to SPARTAS: sepsis, pancreatitis, aspiration, uRemia, trauma, amniotic fluid embolism, shock

Tx: mechanical ventilation with low tidal volumes

23
Q

Sleep apnea

A

Cessation of breathing for > 10 seconds during sleep; normal Pa_O2 during the day

Can cause pulm HTN

24
Q

Obstructive sleep apnea

A

Assoc with obesity, excess tissue/ tonsils in airway

Tx: weight loss, CPAP, and surgery

25
Q

Central sleep apnea

A

CNS injury/ toxicity causes lack of respiratory effort (opioids, HF)

26
Q

Obesity hypoventilation volume

A

Obesity causes hypoventilation–> causes decreased PaO2 and increased PaCO2 at NIGHT AND increased PaCO2 during the DAY

27
Q

Lobar

A

S.pneumo, Legionella, Klebs

28
Q

Bronchopneumonia (patchy- acute inflammatory infiltrate)

A

S.pneumo, S. aureus, H. influenzae, Klebsiella

29
Q

Interstitial (atypical)

A

Mucoplasma, Chlamydia, Legionella, virus (RSV, CMV< influenza, adenovirus)

Slower course, diffuse, patchy infiltrate

30
Q

Lung abscess

A

Collection of pus within parenchyma

Causes: aspiration, bronchial obstruction (cancer)

S&S: air-fluid levels

Tx: Clindamycin (because infection generally caused by anaerobes- e.g. B. fragilis)

31
Q

Mesothelioma

A

Malignancy of the pleura

Associated with asbestosis; psammoma bodies on histology

CYTOKERATIN and CALRETININ +

Smoking not a RF

32
Q

Pancoast tumor

A

Carcinoma of the apex of the lung

Hoarseness –> recurrent laryngeal nerve
Horner (ptsosis, anhidrosis, miosis) –> sympathetic chain
Superior vena cava –> SVC syndrome
Sensorimotor deficit

33
Q

SVC syndrome

A

JVD and upper extremity edema caused by tumor pressing on SVC or thrombosis from indwelling catheters

Obstruction of right brachiocephalic vein will present similarly BUT only right side will be affected

34
Q

Lung cancer

A

LEADING CAUSE OF DEATH

S&S: cough, hemoptysis, brochial obstruction, wheexing, coin lesion on CXR

Can met to adrenals, brain, bone, liver

Mets are more common to the lung than primary lung tumors (often from breast, colon, bladder, prostate)

35
Q

Central

A

Squamous and Small cell are CENTRAL and caused by SMOKING

36
Q

Small cell lung ca

A

May secrete ACTH, SIADH, or Antibodies (against presynaptic Ca2+ channel or neurons)

Associated with myc oncogenes

Histology: neoplasm of neuroendocrine cells (Kulchitsky) –> small dark blue cells

Chromogranin A +
Enolase +

37
Q

Squamous cell carcinoma

A

Also central

Cavitation, hyperCalcemia (produces PTHrP), and Cigarettes

Keratin pearls

38
Q

Adenocarcinoma

A

Peripheral; most common lung ca in nonsmokers

Associated with mutations in KRAS, EGFR, and ALK

Can see clubbing

Generally mucin +

Bronchioloalveloar subtype –> looks thickening of alveolar walls (better prognosis) –> looks like hazy infiltrates in CXR

39
Q

Large cell

A

Anaplastic, undifferentiated; poor prognosis

Pleomorphic giant cells; can secrete beta-hCG

40
Q

Bronchial carcinoid tumor

A

Good prognosis, mets rare

carcinoid syndrome symptoms (flushing, diarrhea, wheezing)

Chromogranin A +

Pulmonary (2 decks)

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