A patient presents with sudden-onset dyspnea one hour after suffering a femur fracture. He is found to have a ventilation/perfusion mismatch. What is your diagnosis?
Amniotic fluid emboli can lead to what dangerous hematologic condition in postpartum women?
Disseminated intravascular coagulation
A patient presents with sudden chest pain, tachypnea, and dyspnea. What is the most likely diagnosis?
Name the six most common causes of emboli to the lungs.
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor (remember: An embolus moves like a FAT BAT)
What is the origin of the majority of emboli that become lodged in the lungs?
Deep leg veins
Which three factors that promote blood coagulation are known as Virchow's triad?
Stasis, hypercoagulability, endothelial damage
Describe Homan's sign.
In Homan's sign, dorsiflexion of the foot causes a tender calf muscle because of the presence of deep venous thromboses
What medication is used to prevent deep venous thrombosis?
Heparin (or modified heparin molecules such as enoxaparin)
What is the hallmark pulmonary function test finding in patients with obstructive lung disease?
Decreased forced expiratory volume1/forced vital capacity ratio
List four types of obstructive lung disease.
Chronic bronchitis, emphysema, asthma, and bronchiectasis
In obstructive lung disease, there is a(n) _____ (decrease/increase) in residual volume and a(n) ____ (decrease/increase) in functional vital capacity.
What criteria must a patient meet to be considered to have chronic bronchitis?
A chronic productive cough at least three consecutive months in at least two years
What histologic changes would be seen on lung biopsy in a patient with chronic bronchitis?
Hypertrophy of the mucus-secreting glands in the bronchioles
The mucus gland hypertrophy seen in chronic bronchitis can be quantified using the _____ _____, which tends to be greater than what value in symptomatic patients?
Reid index; 50%
How is the Reid index calculated?
Reid index = gland depth / total thickness of bronchial walls
What clinical findings are auscultated in the lungs of patients with chronic bronchitis?
Usually wheezing and crackles
What visible skin finding may be noted in patients with chronic bronchitis?
What pathologic changes are seen in the lungs of a patient with emphysema?
Enlargement of the air spaces; decrease in recoil resulting from the destruction of alveolar walls
Smoking is associated with _____ (centriacinar/panacinar) -type emphysema, whereas α1-antitrypsin deficiency is associated with _____ (centriacinar/panacinar) -type emphysema.
In addition to panacinar emphysema, α1-antitrypsin deficiency also causes what condition?
A deficiency of α1-antitrypsin results in the increased activity of what enzyme?
Elastase; the enzyme degrades elastic fibers in the lungs
What exam finding is often auscultated in the lungs of patients with emphysema?
Breath sounds are usually diminished with a decreased inspiratory/expiratory ratio
In emphysemic lungs, there is a(n) (decrease/increase) _____ in recoil and, subsequently, a(n) _____ (decrease/increase) in compliance.
Decrease; increase. As a result, the residual volume of the lungs increases as the disease progresses
In emphysema, the decrease in lung recoil is a result of destruction of alveolar walls by increased activity of which enzyme?
Paraseptal emphysema is associated with bullae that can rupture and lead to _____ _____ in otherwise young healthy males.
Individuals with emphysema tend to exhale through pursed lips to increase _____ _____ and prevent _____ _____ during expiration.
Airway pressure; airway collapse
The definitive feature of the bronchoconstriction of asthma is that it is fully _____.
In patients with asthma, there is hyperresponsiveness of what lung segment?
While chronic bronchitis is a disease of the _____ (bronchi/bronchioles), asthma is a disease of _____ (bronchi/bronchioles).
Kartagener's syndrome is associated with what types of lung disease?
Bronchiectasis and obstructive lung disease due to the failure of cilia to clear mucus from the lungs