Pulmonary: Restrictive + Vascular + HTN + Miscellaneous Flashcards Preview

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Flashcards in Pulmonary: Restrictive + Vascular + HTN + Miscellaneous Deck (82):
1

Restrictive lung disease are due to what?

Reduced lung compliance (Hard to fill lungs)

2

Restrictive
FVC?
FEV1?
FEV1/FVC

FVC: reduced
FEV1: Reduced
FEV1/FVC: Normal

3

Acute restrictive is defined by what symptoms (4)

1. Acute dyspena
2. Hypoxia
3. Bilateral pulmonary infiltrates
4. Absence of left heart failure

4

How are ALI and ARDS related?

ALI is like early stage ARDS

5

What are ALI/ARDS the most comon cause of?

Non-cardiogenic pulmonary edema

6

ALI/ARDS is due to what (2)

1. Direct injury to lungs
2. Indirect injury due to systemic disease

7

Injury to lungs for ALI/ARDS is due to what? (3)

1. Infections
2. Toxins (Sepsis)
3. Trauma

8

ALI/ARDS path?

1. Endothelial injury
2. Alveolar edema
3. Type II pneumocytes injured

9

Cause of ALI/ARDS damage?

Imbalance of pro-inflammatory and anti-inflammatory cytokines

10

3 major morphologic changes in ARDS/ALI?

1. Hyaline membrane formation2
2. Hepatization of lungs
3. Vascular congestion

11

End stage of ARDS/ALI?

Fibrosis and honey-combing

12

What do pathologists call ARDS/ALI?

DAD = Diffuse alveolar destruction

13

When do ARDS/ALI symptoms appear?

Within 72 hours of insult

14

What % die in ARDS/ALI?

30-40% (pretty high)

15

How well do ARDS/ALI survivors recover?

Complete regain of function within a year

16

Chronic restrictive lung disease end-stage? (2)

1. Diffuse interstitial fibrosis
2. with or without Honeycombing

17

What data is important for chronic restrictive diagnosis? (2)

1. Social
2. Occupational

18

Causes of chronic restrictive lung diseases? 7

1. Asbestos
2. Silicosis
3. Coal
4. Drugs
5. Radiation
6. High O2
7. Immunologic

19

Definition of idiopathic pulmonary fibrosis?

Progressive interstitial fibrosis

20

IPF/UIP sex?
Age?
How is this diagnosed

Males
Elderly
Diagnosis of exclusion

21

How is the process of IPF/UIP in terms of morphology and age of fibrosis?

Heterogeneous

22

Main symptom of IPF/UIP?

Slow, continuous dyspnea

23

Sarcoidosis present how? 5

Lung problem in 90%
Noncaseating granulomas
Bilateral hilar and paratracheal lymphadenopathy (potato nodes)
Interstitial fibrosis

24

How do you diagnose sarcoidosis?

Diagnosis of exclusion of any other granuloma formers (Myco, Fungi)

25

Common complications of sarcoidosis besides lung? 2

Eye
Skin

26

Popuation of Sarcoidosis
Age
Ethnicies
Smoking

Younger than 40

Danes, Swedes, US Blacks >>>> Whites and Asians

Nonsmokers more common

27

The presumed cause of sarcoidosis?

Abnormal immune regulation in genetically predisposed people that are exposed to some enviromental stimuli

28

Genetic factors of sarcoidosis (2)

1. Familial and racial clustering
2. Putative antigens like viruses, myco, pollen

29

Constitutional signs

Fever
Fatigue
Myalgias

30

What if sarcoidosis has uveoparotid involvement

Mikulicz syndrome

31

What test is elevated in granulomatous disorders and hence sarcoidosis? 2

ACE elevated (granulomas)
Increased urine calcium (granulomas)

32

Hypersensitivity pneumonitis is defined how?

Immune mediated inflammatory disease of distal lung and alveoli due to sensitivity to inhaled antigens like mold, dust, chemicals

33

How does hypersensitivity pneumonitis affect the lung? (3)

1. Decreased diffusion capacity
2. Decreased lung compliance
3. Decreased lung total volume

34

acute form hypersensitivity pneumonitis presents how?

Fever, cough, dyspena 4 to 8 hours after exposure

(Go on vacation, goes away, gets back to work)

35

Chronic form of hypersensitivity pneumonitis presents how?

Insidiously and not easy to diagnosis

36

Evidence that suggests hypersensitivity pneumonitis is immune mediated?

BAL fluids with increased pro-inflammatory chemokines
2. Increased CD4/CD8 ratio
3. Serum Ab's suggesting Type III
4. Noncaseating granulomas suggesting Type IV

37

Diffuse alveolar hemorrhage syndromes present how (3)

1. Hemoptysis
2. Anemia
3. Diffuse pulmonary infiltrates

38

Diffuse alveolar hemorrhage syndrome members

Goodpasture and Idiopathic Pulmonary Hemosiderosis

39

Goodpastures syndrome definition (2)

Hemorrhagic interstitial pneumonitis and crescentis glomerulonephritis

40

Goodpastures syndrome has what Ab's?

IgG against BM and glomerulis suggesting Type II hypersenstivity

41

Lungs in Goodpastures syndrome show what?

Focal necrosis of alveolar walls
Hemorrhage in alveoli
Hemosiderin laden macrophages

42

Goodpastures syndrome treatment (2)

1. Plasmapharesis
2. Immunosuppression

43

Idiopathic pulmonary hemosiderosis is similar to what?
Except for (2)

Presents the exact same as Goodpastures

1. No Anti-Basement membrane Ab's
2. No renal disease

44

Wegener Granulomatosis definition

Vasculitis

45

Triad of wegener granulomatosis?

1. URT crusting
2. Lower respiratory disease
3. Renal disease

46

What is the mediator of Wegener granulomatosis?

Auto Ab's against Type IV collagen in renal glomeruli and lung alveoli

47

Two necrotizing features of Wegener granulomatosis?

1. Necrotizing capillaritis
2. Necrotizing granulomas

48

Radiographic changes in Wegener's

Granulomas that cavitate and coalesce

49

What is Wegener granulomatosis

C-ANCA

50

Collagen vascular disease can cause pulmonary disease, which members?

SLE
RA
Scleroderma
Dermatomyositis

51

What do collagen vascular diseases most often cause?

Interstitial pneumonitis

52

What is the worst ending for collagen vascular disease?

Progressive pulmonary fibrosis leading to end-stage honeycomb lung

53

Accelerated pulmonary fibrosis in RA patients?
Exposure to what? (3)

Caplan syndrome

Coal, silica, asbestos

54

Transplantation pulmonary

Acute rejection involves (3)

Fevers, Leukocytosis, Mimicking infections

55

Pulmonary embolism that occludes pulmonary arteries at bifurcation?
Result?

Saddle embolus

Sudden death

56

Most pulmonary emboli are what form?

DVT

57

Studies for pulmonary emboli? (3)

1. Doppler studies
2. Radiography
3. D-Dimer test (positive)

58

Predisposing conditions for PE's 7

1. Prolonged bed rest
2. Surgery to legs or knees
3. Bone fractures in the leg
4. CHF
5. Pregnancy and oral birth control
6. Inherited disease
7. Mucinous adenocarcinomas

59

What tests can you do in acute PE situations 2

1. DNA analysis
2. Factor V test

60

Why don't we see infarctions often in PE?
Where will you normally see a PE infarct?

Dual blood supply
Distal, wedge-shaped, and involves the pleural

61

How is the pain of a PE infarct described?
What will you hear?

Positional
Friction rub

62

Most PE's have what effect?

None, asymptomatic

63

How does HTN occur with PE's

Enough small PE's block off enough arteries to raise resistance

64

Patients with one PE have what risk for a second?

30% risk

65

Most often Pulmonary HTN is secondary to what two things?

1. Decreased pulmonary vascular cross-sectional area
2. Increased pulmonary vascular blood flow

66

Pulmonary HTN situations (3)

1. COPD/Interstitial lung disease
2. Recurrent PE's
3. Heart disease with left to right shunt

67

Types of secondary pulmonary hypertension? (3)

1. Plexiform pulmonary arteriopathy (most) convoluted tortuous path
2. Thrombotic pulmonary arteriopathy
3. Pulmonary venoocclusive disease

68

If you see atheromas in pulmonary vessels you have to think what?

Pulmonary hypertension

69

Morphology of PHTN? 2

1. Atheromas
2. Intimal and medial thickening

70

Patients with P-HTN the most?

Young females

71

Only hope for pulmonary HTN patients?

Lung transplant

72

Cancer types in lungs

1. Small cell
2. Squamous cell
3. Adenocarcinoma

73

Which cancer type in central in lungs?

Squamous

74

Adeno cancers tend to be where?
Two populations

Peripheral

Females and smokers

75

Which cancer cavitates the most?

Squamous cell

76

most common cancer with perineoplastic syndrome?

Small cell

77

Hypercalcemia with lung cancer?

Squamous cell

78

Asbestosis is what?

Fibrosis you get from asbestos exposure

79

What is most common thing we see with asbestos?

Pleural plaques THEN fibrosis

80

Most common malignancy with asbestosis?

Bronchogenic carcinoma

81

Which cancer is most associated with asbestsos?

Mesothelioma

82

Silicosis appears how? (3)

Concentric fibrosis with nodules
Refractory material
TB infection