Respiratory 2 (Use this LATEST edition!)

Question 1

what causes right heart failure?

Answer 1

pulmonary hypertension

Question 2

left heart failure causes

Answer 2

pulmonary edema

Question 3

restrictive pulmonary disease

Answer 3

restrics lung expansion, decreases lung volume, increases work of breathing, inadequate ventilation/oxygen

Question 4

restrictive pulmonary disease results in

Answer 4

hypoxia + diffusional defect when there’s edema + fibrosis of alveolar walls

Question 5

restrictive pulmonary disease has 3 phases to damage alveolar walls

Answer 5

hyaline membrane in alveolar sacs
edema + inflammation of interstitium
fibrosis

Question 6

Acute respiratory distress syndrome (ARDS)

Answer 6

produced by diffuse alveolar damage (DAD) leading to systemic metabolic derangements

Question 7

ARDS increases alveolar capillary permeability causing

Answer 7

leakage of fibrin rich edema fluid into alveoli

Question 8

Phase 1 of ARDS : Acute exude

Answer 8

forms hyaline membranes in alveolar spaces; exudation of fibrin rich edema fluid mixed with cytoplasmic + lipid remnants of necrotic epithelial cells

Question 9

Phase 2 of ARDS: Late organization

Answer 9

cell proliferation and fibrosis; congested, impaired ventilation; regeneration of type II alveolar lining cells and organization of hyaline membrane with pulmonary fibrosis

Question 10

When does interstitial fibrosis with thickening of alveolar walls or fibrous obliteration of alveolar spaces occur?

Answer 10

phase 2 of ARDS

Question 11

ARDS treatment

Answer 11

mortality reduced to 40%

Question 12

AdULT respiratory distress syndrome interstitial fibrosis leads to

Answer 12

honeycomb lung

Question 13

2 causes of chronic interstitial lung disease (inhaled)

Answer 13

1. extrinsic allergic alveolitis (immune rxn to inhaled organic dusts),
2. pneumoconiosis- inhaling industrial (mineral) dusts

Question 14

intrinsic diseases that cause chronic interstitial lung disease

Answer 14

1. idiopathic interstitial pneumonitis (inflammation of alveoli)
2. non-organ specific autoimmune CT diseases
3. sarcoidosis

Question 15

immune reaction in lung to inhaled antigens causes extrinsic allergic alveolitis (hypersensitivity pneuonitis)

Answer 15

1. proteins in bird droppings
2. contaminated vegetable derived material
3. actinomyces + fungi in rotting crops

Farmer’s lung- moldy hay
Bird Fancier’s lung- Pigeon feces
Bagassosis- moldy sugarcane

Question 16

4 types of pneumoconiosis

Answer 16

1. antracosis
2. coal worker’s pneumoconiosis
3. silicosis
4. asbestosis

Question 17

what causes coal worker’s pneumoconiosis?

Answer 17

inhalation of coal dust with carbon and silica

Question 18

progressive massive fibrosis (restrictive pulmonary disease) in Coal Worker’s is usually surrounded by

Answer 18

emphysema

Question 19

Silicosis

Answer 19

silica particles within nodules under polarized light; silica in macrophages cause TB

Question 20

Asbestosis long latent period often seen of up to

Answer 20

50 years b/w exposure and onset of clinical disease

Question 21

asbestosis

Answer 21

a lung disease resulting from the inhalation of asbestos particles, marked by severe fibrosis and a high risk of mesothelioma (cancer of the pleura)

Question 22

Ferruginous bodies

Answer 22

asbestosis bodies within macrophages; long thin fibers coated w/ hemosiderin and protein to form yellow brown filaments w/ a beaded or drumstick pattern

Question 23

sarcoidosis

Answer 23

granulomatous lung disease, non-caseating histiocytic granulomas in lung interstitum

Question 24

histiocytic and giant cell inflammation in

Answer 24

sarcoidosis

Question 25

other granulomatous lung diseases

Answer 25

``` (TGIF) TB Granulomatous Vasculitis Inhaled Foreign bodies (e.g. pneumoconiosis) Fungal infections (e.g. histoplasmosis) ```

Question 26

sarcoidosis prognosis

Answer 26

70% recover via steroid tx

Question 27

What affects interstitium of lungs, causing fibrosis

Answer 27

restrictive pulmonary disease

Question 28

restrictive pulmonary disease

Answer 28

diffuse alveolar damage (DAD) is initial response

Question 29

ARDS is an acute form of

Answer 29

diffuse alveolar damage caused by sepsis and shock

Question 30

progressive pulmonary interstitial fibrosis leads to

Answer 30

honey comb lung

Question 31

idiopathic interstitial pneumonitis leads to

Answer 31

idiopathic progressive fibrosis of lung interstitium

Question 32

Farmers Lung is an example of

Answer 32

an extrinsic allergic alveolitis due to hypersensitivity to inhaled allergens

Question 33

pneumoconiosis exhibits fibrosis caused by

Answer 33

reactions to inhaled mineral dusts

Question 34

coalworker's pneuoconiosis has what two forms

Answer 34

simple and progressive massive fibrosis

Question 35

asbestos predisposes

Answer 35

interstitial fibrosis, lung cancer, and mesothelioma

Question 36

sarcoidosis + autoimmune CT diseases cause

Answer 36

interstitial fibrosis

Question 37

lung cancer histopathological types

Answer 37

1. adenocarcinoma 38% 2. squamous cell carcinoma 20% 3. small cell anaplastic carcinoma 14% 4. large cell anaplastic carcinoma 3% 5. mixed 25%

Question 38

most common form of lung cancer in females

Answer 38

adenocarcinoma

Question 39

lung cancer spreads in 4 ways

Answer 39

local, lymphatic, transcoelomic, hematogenous

Question 40

main sites of hematogenous spread

Answer 40

brain, bone, liver, adrenal glands

Question 41

bone sites of hematogenous spread

Answer 41

rib, vertebrae, humeri + femora with pain or pathological fracture

Question 42

squamous cell carcinoma

Answer 42

usually in males; central and close to carina w/ features related to bronchial obstruction

Question 43

4 histopathological patterns of adenocarcinoma

Answer 43

``` (MAPS) mucinous acinar papillary solid ```

Question 44

most malignant lung cancer

Answer 44

small cell anaplastic carcinoma of the lung

Question 45

small cell anaplastic carcinoma of the lung

Answer 45

bronchial epithelium but differentiates into neuroendocrine cells

Question 46

Ectopic hormone like ACTH (from small cell anaplastic carcinoma of the lung) leads to

Answer 46

paraneoplastic syndrome

Question 47

lung cancer symptom

Answer 47

cough (80%) ; infection distal to airway is blocked

Question 48

lung cancer metastasis

Answer 48

frequent sign present in 70%;

Question 49

hematogenous spread of lung cancer

Answer 49

``` (LPCH) leukoerythroblastic anemia pathological fracture CNS symptoms Hepatomegaly and jaundice ```

Question 50

Pancoast tumor

Answer 50

superior sulcus tumor at apex of lung; w/ invasion of sympathetic chain

Question 51

What leads to Horner syndrome

Answer 51

pancoast tumor

Question 52

Horner Syndrome

Answer 52

ptosis, enopthalmos, small pupils (miosis), lack of sweat (anhydrosis)

Question 53

lung cancer

Answer 53

very sensitive to radiotherapy and chemotherapy but survival is poor complete local response in 30% median survival= 11 mos. one year survival= 45%

Question 54

coin lesions

Answer 54

rounded, solitary radiopaque lesion on chest radiograph; 1/3 of cases (>50 yrs) caused by lung carcinoma

Question 55

common causes of coin lesions

Answer 55

primary bronchiole or lung carcinoma metastatic tumor granulomatous inflammation like TB lung abscess

Question 56

uncommon causes of coin lesions

Answer 56

fungal mycetoma

Question 57

lung cancer survival

Answer 57

5 yrs; 5-30% depending on type and stage; median approximately 15%

Question 58

Pleural Fluid Types

Answer 58

Cool PB FEAT! Chylothorax (lymphatic fluid) - leak from lymphatic duct Pus-empyema due to infection Blood- hemothorax; due to trauma or surgery Fluid effusion Exudate-high protein Air- pneumothorax Transudate-low protein fluid due to movement of excess fluid through normal vessels

Question 59

Malignant Mesothelioma latent period of

Answer 59

25 to 45 years

Question 60

pediatric lung disease

Answer 60

- due to deficiency of surfactant in lungs | - hyaline membrane disease caused by a deficiency of surfactant as a result of immaturity + damaged type II pneumocytes

Question 61

50% mortality if

Question 62

Cystic Fibrosis

Answer 62

Defective fxn in a membrane cl channel of epithelial cells; decreased release of Na+ and H20 to liquify mucus; bronchi and bronchioles become obstructed

Question 63

Problem with cystic fibrosis

Answer 63

bronchiectasis and hemoptysis

Question 64

median survival age of people with cystic fibrosis

Answer 64

30 years old