Respiratory Pathology Flashcards
(196 cards)
1
Q
What is shown in this coronal CT?
A
Rhinosinusitis.
Yellow arrows: Bilateral maxillary sinusitis
Red arrow: Nasal septal deviation (unrelated to rhinosinusitis)
2
Q
Rhinosinusitis pathology:
A
Obstruction of sinus drainage into nasal cavity –> inflammation and pain over affected area
Typically maxillary sinuses in adults
3
Q
Rhinosinusitis - most common causes?
A
Most common acute cause: viral URI
May cause superimposed bacterial infection, most commonly: S. pneumoniae, H. influenzae, and M. catarrhalis
4
Q
Epistaxis
A
Nose bleed
5
Q
Epistaxis most common occurs in…
A
Anterior segment of nostril (Kiesselbach plexus)
6
Q
Epistaxis in posterior segment of nostril can lead to…
A
Life threatening hemorrhage
7
Q
Sphenopalatine artery is located in which segment of the nostril?
A
Posterior
(Sphenopalatine a. is branch of maxillary a.)
8
Q
Deep Vein Thrombosis:
A
Blood clot within deep vein which leads to swelling, redness, warmth, pain
9
Q
Virchow’s Triad:
A
SHE
Stasis
Hypercoagability (defect in coagulation cascade proteins, most commonly factor V Leiden)
Endothelial damage (exposed collagen triggers clotting cascade)
10
Q
People with ____?____ are predisposed to DVT.
A
Virchow’s Triad (SHE)
Stasis
Hypercoaguability
Endothelial damage
11
Q
95% of pulmonary emboli arise from where?
A
Deep leg veins
12
Q
Homan Sign
A
Dorsiflex foot –> calf pain
13
Q
Prevention and acute management of DVT?
A
Heparin
(unfractionated or low-molecular weight,
ex. enoxaparin)
14
Q
Long term prevention of DVT recurrence?
A
Warfarin (oral anticoagulant)
Can also use Rivaroxaban, another oral anticoagulant
15
Q
Name this study and disease it is test of choice for.
A
CT pulmonary angiography
Test of choice for PE
16
Q
Pulmonary Emboli lead to what physiological defects?
A
V/Q mismatch –> hypoxemia –> respiratory alkalosis
17
Q
Pulmonary Embolism causes what symptoms?
A
Sudden-onset dyspnea, chest pain, tachypnea.
May present as sudden death.
18
Q
Types of Pulmonary Emboli:
A
An embolus moves like a FAT BAT
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor
19
Q
Fat Emboli are associated with…
A
Long bone fractures and liposuction
20
Q
Was this pathology formed pre or post mortem?
A
Formed before death!
Lines of Zahn are interdigitating areas of pink (platelets, fibrin) and red(RBCs) found only in thrmobi formed before death.
21
Q
What is this an image of?
A
Pulmonary thromboembolus
22
Q
Classic triad of hypoxemia, neurologic abnormalities, and petechial rash is associated with what?
A
Fat emboli (PE)
23
Q
Amniotic fluid emboli can lead to…
A
DIC, especially postpartum
24
Q
Air (Gas) Emboli are caused by…
A
Nitrogen bubbles that precipitate in ascending divers
Treat with hyperbaric O2
25
Patient likely presents with what symptoms?
Sudden-onset dyspnea, chest pain, tachpnea.
May present with sudden death.
pic: Pulmonary Embolism
26
Obstructive lung disease:
Obstruction of air flow resulting in air trapping in the lungs.
27
Hallmark Pulmonary Function Test in Obstructive Lung Disease:
FEV1 (Forced Expiratory Volume in 1 sec) decreased a LOT
FVC (Forced Vital Capacity) decreased some
Leads to **DECREASED FEV1/FVC ratio**
28
FEV1/FVC ratio in healthy adults
75-80%
29
Chronic Bronchitis pathology:
**B**ronchitis = **B**lue **B**loater
Hyperplasia of mucus-secreting glands in the bronchi
Reid index \>50%
Disease of small airways
A form of COPD along with Emphysema
30
What is the Reid Index?
Thickness of gland layer/total thickness of bronchial wall
Bronchitis: \>50%
31
Chronic Bronichitis: Diagnostic criteria
Productive cough for \> 3 months per year (not necessarily consecutive) for \>2 years.
32
Chronic Bronchitis: Findings
Wheezing, crackles, cyanosis (early-onset hypoxemia due to shunting), late-onset dyspnea, CO2 retention
33
Emphysema pathology:
Enlargement of air spaces, decreased recoil, increased compliance, decreased DLCO
Increased elastase activity --\> loss of elastic fibers --\> increased lung compliance
34
What is DLCO?
**D**iffusion capacity of the **L**ung for **CO**
## Footnote
Measures the partial pressure difference between COinspired and COexpired
Determines the extent to which O2 passes from air sacs to blood.
35
What are the two types of Emphysema and what causes them?
**Centriacinar** - associated with smoking
**Panacinar** - associated with α1-antitrypsin deficiency
36
Emphysema signs and symptoms:
Em**p**hysema " **P**ink **P**uffer"
## Footnote
Exhalation through pursed lips (to increase airway pressure and prevent airway collapse during respiration)
Barrel-shaped chest
37
Pathological microscopy shown on left shows what pathological feature of what disease?
(Microscopy is relatively normal on right)
Destruction of alveolar walls (arrow)
Emphysema
38
Name specific type of disease shown in gross specimen
Centriacinar Emphysema
(Associated with smoking)
Specimen shows multiple air-space cavities lined by heavy black carbon deposits
39
This disease is associated with what?
Smoking
(Centriacinar Emphysema)
40
X-Ray of what disease?
Emphysema
barrel-shaped chest (Increased A-P Diameter)
41
Asthma
Bronchial hyperresponsiveness causes reversible bronchoconstriction.
42
Asthma pathology:
Smooth muscle hypertrophy, Curschmann sprials (shed epithelium forms mucus plugs), and Charcot-Leyden crystals (formed from breakdown of eosinophils in sputum)
43
Curschmann spirals:
shed epithelium which forms mucus plugs
seen in Asthma on microscopy!
44
Charcot-Leyden Crystals:
Formed from breakdown of eosinophils in sputum
45
Name the feature and disease
Curschmann spirals
Asthma
46
Common triggers for asthma:
Viral URIs, allergens, stress
47
How do you test for asthma?
Methacholine challenge
48
Methacholine challenge test:
Methacholine is a non-selective muscarinic receptor agonist (M3)
Pt inhales aerosolized methacholine, leading to bronchoconstriction
Degree of narrowing can be quantified by spirometry.
Pt with asthma will react to lower doses of drug.
Contraindicated: in ppl with severe airway obstruction
49
Asthma Findings:
Cough, wheezing, tachypnea, dyspnea, hypoxemia, decreased I/E ratio, pulsus paradoxis, mucus plugging
## Footnote
I/E ratio: time of inspiration/expiration
50
Pulsus Paradoxus:
**Abnormally large decrease in systolic pressure during INSPIRATION (\>10mmHg)**
## Footnote
Sign that is indicative of several conditions: obstructive lung disease, cardiac tamponade, pericarditis, etc.
Normally: decrease in BP (\<10mmHg) on inhalation and increase in BP on exhalation
51
This image is indicative of what finding in what disease process?
Mucus plugging
Asthma
52
Bronchiectasis pathology:
Chronic necrotizing infection of bronchi which leads to PERMANENTLY dilated airways, PURULENT (foul smelling) sputum, recurrent infections, and hemoptysis.
53
Bronchial obstruction, poor ciliary motility (smoking), Kartagener syndrome, cystic fibrosis, allergic bronchopulmonary aspergillosis is associated with what disease?
Bronchiectasis
54
What disease process is shown in this patient with Cystic Fibrosis?
Bronchiectasis
55
Restrictive Lung Disease
Restricted lung expansion causes DECREASED lung volumes (FVC and TLC).
FEV1/FVC ration INCREASED \>80%
56
Restrictive Lung Diseases with Poor breathing mechanics:
Poor muscular effort - **Polio, Myasthenia Gravis**
Poor structural apparatus - **Scoliosis, Morbid Obesity**
57
Interstitial Lung Disease is ..... and causes what physiologic changes ?
a group of lung diseases that affect the interstitium (tissue and space around the air sacs of the lungs)
Causes DECREASED diffusing capacity, INCREASED A-a gradient
58
This image shows what characteristic finding in what interstitial lung disease?
"Honeycomb Lung"
Idiopathic pulmonary fibrosis (repeated cycles of lung injury and wound healing with increased collagen deposition)
59
Another name for Neonatal Respiratory Distress Syndrome, and type of lung disease
Hyaline Membrane Disease
Interstitial Lung Disease
60
Examples of Pneumoconioses, and type of lung disease.
Anthracosis, Silicosis, Asbestosis
Interstitial Lung Disease
61
Drug toxicities that can cause Interstitial Lung Disease:
Bleomycin, Busulfan, Amiodarone, Methotrexate
62
Hypersensitivity Pneumonitis: pathology, symptoms, and epidemiology
Mixed type III/IV hypersensitivity rxn to environmental antigen
Causes dyspnea, cough, chest tightness, headache.
Often seen in farmers and those exposed to birds.
63
Pneumoconioses: examples, what they lead to, type of lung disease
Coal workers' pnumoconiosis (anthracosis), silicosis, and asbestosis
Lead to increased risk of **cor pulmonale** and **Caplan Syndrome**
Interstitial Lung Disease (Restrictive)
64
Caplan Syndrome
Rheumatoid Arthritis and Pneumoconiosis with intrapulmonary nodules
65
Name feature and disease
Asbestos (ferruginous) bodies - golden-brown fusiform rods resembling dumbbells.
Asbestosis (Pneumoconiosis, Interstitial Lung Disease)
66
This image is pathognomonic for what disease?
Asbestosis
See "Ivory white" calcified pleural plaques (arrows)
67
Asbestosis is associated with what professions?
Shipbuilding, roofing, and plumbing.
68
Asbestosis is associated with an increased risk for what?
Increase incidence of bronchogenic carcinoma and mesothelioma.
BUT Bronchogenic carcinoma \>\> mesothelioma
69
Which lobes are affected in Asbestosis?
Lower lobes
Asbestos is from the **roof**, but affects the **base** (lower lobes)
70
This image is pathognomonic for what disease?
Asbestosis
Shown is a diaphragm specimen with "ivory white" calcified supradiaphragmatic plaques
71
Coal Workers' Pneumoconiosis
"Black Lung Disease"
Prolonged coal exposure --\> macrophages laden with carbon --\> inflammation and fibrosis
72
What lobes are affected in Coal Workers' Pneumoconiosis?
Upper lobes
Silica and coal are from the **base** (earth), but affect the **roof** (upper lobes)
73
Anthracosis
asymptomatic condition found in many urban dwellers exposed to pollution
74
Silicosis is associated with what occupations?
Foundries (factories producing metal castings), sandblasting, and mining.
75
Silicosis pathology:
Macrophages respond to silica and release fibrogenic factors, leading to fibrosis.
May disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB.
76
Silicosis patients are at increased risk for....
bronchogenic carcinoma, and possibly TB
77
What lobes are affected in Silicosis?
Upper lobes
78
White arrows point to what feature of what disease?
"Eggshell" calcification of hilar lymph nodes
Silicosis
79
Neonatal respiratory distress syndrome: Cause
Prematurity - get surfactant deficiency which leads to INCREASED surface tension and alveolar collapse.
80
Lecithin:sphyngomyelin ratio predictive of neonatal respiratory distress syndrome:
\<1.5 in amniotic fluid
\<2 is abnormal
81
Persistently low O2 tension in Neonatal respiratory distress syndrome leads to risk of....
Patent ductus arteriosus
82
Therapeutic supplemental O2 in Neonatal Respiratory Distress Syndrome can result in
Retinopathy of Prematurity (ROP) and bronchopulmonary dysplasia
83
Risk factors for Neonatal Respiratory Distress Syndrome:
**Prematurity**
**Maternal Diabetes** (due to increased fetal insulin)
**C-section delivery** (decreased release of fetal glucocorticoids)
84
Treatment for Neonatal Respiratory Distress Syndrome
**Maternal steroids** (glucocorticoids) before birth: (speeds up production of surfactant)
**Artificial surfactant** (synthetic or derived from cow) through endotracheal tube
85
Acute Respiratory Distress Syndrome (ARDS) cause
trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, or amniotic fluid embolism
86
ARDS pathology:
Diffuse alveolar damage leads to increased alveolar capillary permeability --\> protein-rich leakage into alveoli and noncardiogenic pulmonary edema
Formation of **intra-alveolar hyaline membrane**
87
This "ground-glass" appearance of lung fields is seen in what disease?
Neonatal Respiratory Distress Syndrome
88
ARDS is characterized by:
Acute onset respiratory failure, bilateral lung opacities, decreased PaO2/FiO2 (normal 300-500 mmHg), and no HF.
89
ARDS Management:
Mechanical ventilation with low tidal volumes
Address underlying cause
90
Near-complete opacification of the lungs with obscured cardiomediastinal silhouette is seen in what disease?
ARDS
91
Name the pathology and disease.
Thickened hyaline membranes (pink), and alveolar fluid (clear frothy)
ARDS
92
The initial damage in ARDS is due to ?
Release of neutrophilic substances toxic to alveolar wall, activation of coagulation cascade, and oxygen-derived free radicals.
93
Normal FEV1/FVC Ratio = 80%
94
Obstructive Lung Disease
FEV1/FVC \<80%
In both obstructive and restrictive, FEV1 and FVC are reduced. In obstructive, however, FEV1 is more dramatically reduced compared to FVC, resulting in a decreased ratio.
95
Restrictive Lung Disease
FEV1/FVC \>/= 80%
In both obstructive and restrictive, FEV1 and FVC are reduced.
96
Pulmonary Hypertension =
\>/= 25mmHg at rest
97
Normal pulmonary artery pressure =
10-14 mmHg
98
Pulmonary Hypertension results in...
arteriosclerosis, medial hypertrophy, and intimal fibrosis of pulmonary arteries
99
Primary (Idiopathic) Pulmonary Hypertension is caused by what?
Inactivating mutation in BMPR2 gene, which normally functions to inhibit proliferation of vascular smooth muscle.
Heritable
Poor Prognosis
100
Secondary Pulmonary Hypertension can be due to...
COPD, mitral stenosis, recurrent thromboemboli, autoimmune disease, left-to-right shunt, sleep apnea, certain drugs, HIV infection, Congenital Heart Disease, Schistosomiasis, or living at high altitude
101
Why would a left-to-right shunt cause PAH?
Increases shear stress which leads to endothelial injury
102
Why would living at high altitude cause Pulmonary HTN?
Causes hypoxic vasoconstriction
103
What drugs can cause Pulmonary HTN?
Cocaine, Amphetamines
104
Sleep apnea is defined by
Repeated cessation of breating \> 10 seconds during sleep.
Leads to disrupted sleep, and daytime somnolence.
105
How is PaO2 affected during the day in someone who suffers from sleep apnea?
Normal
106
How is PaO2 affected at night in someone with sleep apnea?
Nocturnal hypoxia, which leads to systemic/pulmonary hypertension, arrhythmias (A-Fib/A-flutter), and sudden death.
107
Central sleep apnea is due to? Outcome?
CNS injury / toxicity
no respiratory effort
108
Obstructive sleep apnea is due to? Result?
Airway obstruction caused by excess parapharyngeal tissue in adults, adenotonsillar hypertrophy in children.
Respiratory effort against airway obstruction
109
Obstructive sleep apnea is associated with
obesity, lound snoring
110
Sleep apnea treatment:
weight loss, CPAP, surgery
111
Sleep apnea can cause polycethmia becauase...
hypoxia leads to increase EPO release which leads to erythropoiesis
112
Obesity hypoventilation syndrome:
BMI \>/= 30 which leads to hypoventilation during sleep, decreased PaO2 and Increased PaCO2 during waking hours
113
Breath sounds, percussion, and fremitus in pleural effusion:
Breath sounds: decreased
Percussion: Dull
Fremitus: decreased
No tracheal deviation
114
Breath sounds, percussion, fremitus, and tracheal deviation in atelectasis
Breath sounds: decreased
Percussion: dull
Fremitus: decreased
Deviation: toward side of lesion
115
Breath sounds, percussion, fremitus, and tracheal deviation in spontaneous pneumothorax:
breath sounds: decreased
Percussion: hyperresonant
Fremitus: decreased
No tracheal deviation
116
Breath sounds, percussion, fremitus, and tracheal deviation in tension pneumothorax
breath sounds: decreased
percussion: hyperresonant
fremitus; decreased
tracheal deviation: AWAY from side of lesion
117
Percussion to normal lung:
resonance
118
Breath sounds, percussion, fremitus, and tracheal deviation in lung consolidation (lobar pnumonia, pulmonary edema)
breath sounds: bronchial breath sounds; late inspiratory crackles
Percussion: dull
Fremitus: INCREASED
tracheal deviation: none
119
Leading cause of cancer death
Lung cancer
120
Lung cancer often presents with:
cough, hemoptysis, bronchial obtruction, wheezing, pneumonic "coin" lesion on xray or noncalcified nodule on CT
121
Most common type of lung cancer
Secondary (metastases) from other areas
122
Lung metastases are more common than primary neoplasms. Most often from:
breast, colon, prostate, and bladder
123
Lung cancer often metastasizes to these areas:
adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly)
124
Lung cancer complications:
SPHERE
**S**uperior vena cava syndrome
**P**ancoast tumor
**H**orner syndrome
**E**ndocrine (paraneoplastic)
**R**ecurrent laryngeal symptoms (hoarseness)
**E**ffusions (pleural or pericardial)
125
Risk factors of lung cancer:
smoking, second hand smoke, radon, asbestos, family history
126
Adenocarcinoma location
peripheral
127
Most common lung cancer in nonsmokers
Adenocarcinoma
128
Most common lung cancer overall (except for metastases)
Adenocarcinoma
129
k-ras, EGFR, and ALK are activating mutations in what cancer?
Adenocarcinoma
130
Clubbing is associated with what lung cancer?
Adenocarcinoma
Clubbing = hypertrophic osteoarthropathy
131
Lung cancer in which chest x-ray shows hazy infiltrates similar to pneumonia:
Bronchioalveolar subtype of Adenocarcinoma
132
What lung cancer grows along alveolar septa and leads to apparent "thickening" of alveolar walls?
Bronchioloalveolar subtype of Adenocarcinoma
133
What lung cancer has a glandular pattern on histology, and often stains mucin + ?
Adenocarcinoma
134
This is an image of what type of lung pathology?
Adenocarcinoma: Glandular pattern on histology, often stains mucin +
135
Squamous cell carcinoma is located where?
Centrally
(**S**quamous and **S**mall cell carcinomas are **S**entral (central))
136
Hilar mass arising from bronchus is indicative of what lung cancer?
Squamous cell carcinoma
137
Cavitation, Cigarettes, hyperCalcemia (produces PTHrP) are characeteristics of what lung cancer?
Squamous cell carcinoma
138
Keratin pearls and intercellular bridges are indicative of what lung pathology?
Squamous cell carcinoma
139
Name lung pathology and histological charactersitics:
Squamous cell carcinoma
Keratin pearls and intracellular bridges
Note sheets of large, dysplastic squamous cells (arrows) surrounding dark pink keratin pearls (lower right)
140
Small cell (oat cell) carcinoma is located where?
Centrally
141
Undifferentiated and very aggressive form of lung cancer:
small cell (oat cell) carcinoma
142
ACTH, ADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome) are often produced in this lung cancer:
small cell (oat cell) carcinoma
143
Amplification of *myc* oncogenes is common in this type of lung cancer
small cell (oat cell) carcinoma
144
How is small cell (oat cell) carcinoma treated?
Chemotherapy. Inoperable
145
This image is characteristic finding in what lung pathology?
small cell (oat cell) carcinoma
Neoplasm of neuroendocrine or **Kulchitsky** cells -\> small cark blue cells
Sheets of dark purple tumor cells with nuclear molding, high mitotic rate, necrosis, and "salt and pepper" neuroendocrine-type chrmatin
146
Large cell carcinoma is located where?
Periphery
147
This lung cancer characteristically has anaplastic undifferentiated tumors
Large cell carcinoma
148
How do you treat large cell carcinoma?
Surgical removal. Less responsive to chemotherapy
149
Histologically, this lung cancer has pleomorphic giant cells and can secrete beta-hCG
large cell carcinoma
150
This lung cancer has an excellent prognosis
Bronchial carcinoid tumor (metastasis is rare)
151
Symptoms in bronchial carcinoid tumor are usually due to
mass effect; occasionally carcinoid syndrome (5-HT secretion, flushing, diarrhea, wheezing)
152
What is carcinoid syndrome?
Seen in bronchial carcinoid tumor
5-HT secretion --\> flushing, diarrhea, wheezing
153
What is shown in this xray?
Hilar mass arising from bronchus (squamous cell carcinoma)
154
Nests of neuroendocrine cells are indicative of what type of lung pathology?
Bronchial carcinoid tumor
155
These lung cancers are chromogranin A +:
bronchial carcinoid tumor
small cell (oat cell) carcinoma
Why? Both consist of neuroendocrine cells, and chromogranin A is located in the secretory granules of neurons and endocrine cells
156
Malignancy of the pleura associated with asbestosis:
Mesothelioma
157
Mesothelioma results in ...
hemorrhagic pleural effusions and pleural thickening
158
What characteristic finding is seen on histology of mesothelioma?
Psammoma bodies
159
Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus
Pancoast Tumor
160
Pancoast tumor that impinges on cervical sympathetic plexus may result in:
Horner syndrome (ispilateral ptosis, miosis, and anhidrosis)
SVC syndrome
Sensorimotor deficits
Hoarseness
161
Superior Vena Cava Syndrome
An obstruction of the SVC that impairs blood drainage from the head ("facial plethora"), neck (jugular venous distention), and upper extremities (edema).
162
What causes SVC syndrome?
Commonly caused by malignancy (Pancoast Tumor) and thrombosis from indwelling catheters.
163
Is SVC syndrome a serious problem?
It is a medical emergency. Can raise intracranial pressure (severe obstruction) which can lead to headaches, dizziness, and increased risk of aneurysm/rupture of intracranial arteries
164
This MRI shows what lung pathology?
Pancoast tumor. See mass at Right lung apex.
165
What are these characteristic structures, and in what lung pathology are they found in?
Psammoma bodies
Mesothelioma
166
Most common organism to cause lobar pneumonia?
S. pneumoniae
Legionella and Klebsiella are also common
167
Characteristics of lobar pneumonia:
intra-alveolar exudate --\> consolidation; may involve entire lung
168
Typical organisms in bronchopneumonia:
S. pneumoniae, S. aureus, H. influenzae, Klebsiella
169
Characteristics of Bronchopneumonia:
Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving \>/= 1 lobe
170
This Xray shows what?
Lobar pneumonia. Dense right upper lobe consolidation with branching air-bronchograms; sharp inferior margin represents the horizontal fissure.
171
This gross specimen shows what lung pathology?
Lobar pneumonia
172
What cells are whinin the alveolar spaces, and what lung pathology is this indicative of?
Neutrophilic infiltrate
Bronchopneumonia
173
Name consolidation pattern and lung pathology:
Patchy distribution involving \>1 lobe
Bronchopneumonia
174
Interstitial (atypical) pneumonia is most commonly caused by what organisms?
Viruses (influenza, RSV, adenoviruses), *Mycoplasma, Legionella, Chlamydia*
175
Interstitial pneumonia is characterized by:
diffuse patchy inflammation localized to interstitial areas at alveolar walls
Distribution \>/= 1 lobe
Follows more indolent course
176
This xray shows what characteristics and what lung pathology?
Course bilateral reticular opacities, worse on right
Interstitial pneumonia (diffuse, patchy interstitial inflammation)
177
Localized collection of pus within parenchyma:
lung abscess
178
Lung absesses are caused by:
bronchial obstruction (cancer) or aspiration of oropharyngeal contents (especially in pts predisposed to loss of consciousness [alcoholics or epileptics])
179
This specimen shows what lung pathology?
lung abscess
180
This xray shows what characteristics and what lung pathology?
Air fluid levels and cavitation.
Lung abscess
181
Lung abscesses are often caused by what organisms?
Anaerobes (*Bacteroides, Fusobacterium, Peptostreptococcus*) or *S. aureus*
182
Treatment for Lung Abscess
Clindamycin
183
Pleural Effusion:
Excess accumulation of fluid between the two pleural layers --\> restricted lung expansion during inspiration
184
Transudate:
Decreased protein content.
Due to CHF (increased hydrostatic pressure), nephrotic syndrome (proteinuria -\> decreased colloid oncotic pressure), or hepatic cirrhosis (decreased colloid oncotic pressure)
185
Exudate:
Increased protein content, cloudy.
Due to malignancy, pneumonia, collagen vascular disease, trauma
Occurs in states of Increased vascular permeability
186
Must be drained in light of risk of infection:
Exudate
187
Lymphatic/Chylothorax:
Due to thoracic injury from trauma, malignancy.
Milky-white appearing fluid; Increased triglycerides
188
Xray shows what pathology?
Pleural effusion (excess accumulation of fluid between the 2 pleural layers)
189
CT shows what pathology?
Pleural Effusion
190
What is seen on Xray and CT after treatment of pleural effusion?
Almost complete resolution after therapy.
191
Pneumothorax:
Accumulation of air in the pleural space
192
Pneumothorax signs and symptoms:
Unilateral chest pain and dyspnea, unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminished breath sounds, **all on the affected side.**
193
Spontaneous pneumothorax:
Accumulation of air in the pleural space.
Occurs most frequently in tall, thin, young males because of rupture of apical blebs.
194
Tension pneumothorax:
Usually occurs in setting of trauma or lung infection. Air is capable of entering pleural space but not exiting. Trachea deviates away from affected lung.
195
What is shown on this CT?
Pneumothorax (collapsed lung)
196
What is shown on the xray?
Tension pneumothorax.
Deviation of trachea away from hyperlucent left lung. Low left hemidiaphragm.
