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Flashcards in Respiratory - Pathology Deck (176):
1

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?

Fat emboli

2

Amniotic fluid emboli can lead to what dangerous hematologic condition in postpartum women?

Disseminated intravascular coagulation

3

A patient presents with sudden chest pain, tachypnea, and dyspnea. What is the most likely diagnosis?

Pulmonary embolus

4

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)

5

What is the origin of the majority of emboli that become lodged in the lungs?

Deep leg veins

6

Which three factors that promote blood coagulation are known as Virchow's triad?

Stasis, hypercoagulability, endothelial damage

7

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

8

What medication is used to prevent deep venous thrombosis?

Heparin (or modified heparin molecules such as enoxaparin)

9

What is the hallmark pulmonary function test finding in patients with obstructive lung disease?

Decreased forced expiratory volume1/forced vital capacity ratio

10

List four types of obstructive lung disease.

Chronic bronchitis, emphysema, asthma, and bronchiectasis

11

In obstructive lung disease, there is a(n) _____ (decrease/increase) in residual volume and a(n) ____ (decrease/increase) in functional vital capacity.

Increase; decrease

12

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

13

What histologic changes would be seen on lung biopsy in a patient with chronic bronchitis?

Hypertrophy of the mucus-secreting glands in the bronchioles

14

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%

15

How is the Reid index calculated?

Reid index = gland depth / total thickness of bronchial walls

16

What clinical findings are auscultated in the lungs of patients with chronic bronchitis?

Usually wheezing and crackles

17

What visible skin finding may be noted in patients with chronic bronchitis?

Cyanosis

18

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

19

Smoking is associated with _____ (centriacinar/panacinar) -type emphysema, whereas α1-antitrypsin deficiency is associated with _____ (centriacinar/panacinar) -type emphysema.

Centriacinar; panacinar

20

In addition to panacinar emphysema, α1-antitrypsin deficiency also causes what condition?

Liver cirrhosis

21

A deficiency of α1-antitrypsin results in the increased activity of what enzyme?

Elastase; the enzyme degrades elastic fibers in the lungs

22

What exam finding is often auscultated in the lungs of patients with emphysema?

Breath sounds are usually diminished with a decreased inspiratory/expiratory ratio

23

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

24

In emphysema, the decrease in lung recoil is a result of destruction of alveolar walls by increased activity of which enzyme?

Elastase

25

Paraseptal emphysema is associated with bullae that can rupture and lead to _____ _____ in otherwise young healthy males.

Spontaneous pneumothorax

26

Individuals with emphysema tend to exhale through pursed lips to increase _____ _____ and prevent _____ _____ during expiration.

Airway pressure; airway collapse

27

The definitive feature of the bronchoconstriction of asthma is that it is fully _____.

Reversible

28

In patients with asthma, there is hyperresponsiveness of what lung segment?

The bronchi

29

While chronic bronchitis is a disease of the _____ (bronchi/bronchioles), asthma is a disease of _____ (bronchi/bronchioles).

Bronchioles; bronchi

30

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

31

Cough and wheezing are noted in patients with what two types of obstructive lung disease?

Asthma and chronic bronchitis

32

Tachypnea and pulsus paradoxus are noted in patients with what type of obstructive lung disease?

Asthma

33

A child presents with cough, wheezing, dyspnea, tachypnea, hypoxemia, and mucus plugging. On exam, the patient also has a pulsus paradoxus. From what disease is this patient likely suffering?

Asthma

34

What finding is commonly noted on pulmonary function testing of patients with asthma as well as those with emphysema?

Decreased inspiratory/expiratory ratio; generally, obstructive diseases lengthen the expiratory phase

35

What blood pressure/pulse finding is often observed in patients with asthma?

Pulsus paradoxus

36

What are Curschmann's spirals?

Shed epithelium from mucous plugs associated with asthma

37

What two pathologic findings are associated with asthma?

Smooth muscle hypertrophy and mucous plugging

38

_____ is a chronic necrotizing infection of bronchi.

Bronchiectasis

39

In bronchiectasis, chronic necrotizing infection of the bronchi leads to what?

Permanent dilation of the airways

40

Patients with bronchiectasis often have a cough productive of what?

Blood and purulent sputum

41

Which two genetic diseases are associated with bronchiectasis?

Cystic fibrosis and Kartagener's syndrome

42

Individuals with bronchiectasis are prone to develop which fungal pulmonary infection?

Aspergillosis

43

What are three common triggers of asthma attacks?

Viral upper respiratory infections, allergens, and stress

44

Compare the onset of dyspnea and hypoxia in emphysema vs chronic bronchitis.

In emphysema, there is early-onset dyspnea and late-onset hypoxemia; in chronic bronchitis, there is early-onset hypoxemia and late-onset dyspnea

45

What causes late-onset hypoxemia in emphysema?

The eventual loss of capillary beds, which occurs with the loss of alveolar walls

46

What causes early-onset hypoxemia in chronic bronchitis?

Shunting

47

What two lung volumes are typically decreased in patients with restrictive lung disease?

Functional vital capacity and total lung capacity

48

Patients with restrictive lung disease typically have an forced expiratory volume1/forced vital capacity ratio within what range?

>80%; this differentiates restrictive from obstructive lung disease

49

What are the two general types of restrictive lung disease?

Poor breathing mechanics (caused by musculoskeletal or connective tissue disease) and interstitial lung diseases

50

Extrapulmonary causes of restrictive lung disease are generally the result of what?

Poor breathing mechanics, usually as a result of muscular dysfunction (eg, polio) or structural difficulty (eg, scoliosis, morbid obesity)

51

Pulmonary causes of restrictive lung disease are generally the result of what category of diseases?

Interstitial lung diseases

52

What infectious disease can cause poor muscular effort and thereby lead to extrapulmonary restrictive lung disease?

Polio

53

What disease of the neuromuscular junction can cause poor muscular effort and thereby lead to extrapulmonary restrictive lung disease?

Myasthenia gravis

54

What is the mechanism of extrapulmonary restrictive lung disease in scoliosis?

The curvature of the spine distorts the breathing mechanics of the rib cage

55

Other than scoliosis and muscle diseases, what condition can lead to extrapulmonary restrictive lung disease?

Morbid obesity

56

What category of interstitial lung diseases has a clear association with an environmental exposure?

Pneumoconioses

57

What disease is associated with repeated cycles of lung injury and wound healing with increased collagen deposition?

Idiopathic pulmonary fibrosis

58

Name three pneumoconioses that can cause restrictive lung disease.

Coal miner's disease, silicosis, asbestosis

59

What nongranulomatous disease that commonly affects the renal and pulmonary systems can cause interstitial lung disease?

Goodpasture's syndrome

60

What disease can cause restrictive lung disease due to eosinophilic granulomas in the lungs?

Histiocytosis X

61

Name three drugs that can cause interstitial lung disease.

Bleomycin, busulfan, and amiodarone

62

What processes cause restrictive lung disease due to poor muscular effort?

Polio and myasthenia gravis

63

What processes cause restrictive lung disease due to poor structural breathing mechanics?

Scoliosis and morbid obesity

64

What processes cause restrictive lung disease due to interstitial lung pathology?

Acute respiratory distress syndrome, neonatal respiratory distress syndrome, pneumoconioses, sarcoidosis, idiopathic pulmonary fibrosis, Goodpasture's syndrome, Wegener's granulomatosis, histiocytosis X, and certain drug toxicities

65

Which lobe of the lung is most affected in coal miner's disease?

Upper lobes

66

Coal miner's disease can be associated with what two additional pathologic conditions?

Cor pulmonale or Caplan's syndrome (the combination of pneumoconiosis and rheumatoid arthritis)

67

Patients with silicosis likely worked in what three fields?

Foundries, sandblasting, and mining

68

What cell type is responsible for the fibrosis induced by silica inhalation?

Macrophages

69

Silicosis increases the risk of what infectious disease?

Tuberculosis

70

What lobe of the lung is most affected by silicosis?

Upper lobes

71

The finding of eggshell calcification on chest x-ray would increase suspicion of what disease?

Silicosis

72

What substance, used for such things as shipbuilding and insulation, can result in a diffuse pulmonary interstitial fibrosis?

Asbestos

73

Patients with asbestosis are at increased risk of what two cancers?

Mesothelioma and bronchogenic carcinoma

74

What gross pathologic finding can be found on the pleura of patients who have been exposed to asbestos?

Ivory white pleural plaques

75

Asbestosis is most commonly seen in practitioners of what professions?

Shipbuilders, plumbers, and roofers

76

Asbestosis mainly affects the ____ (lower/upper) lung lobes, while coal worker's lung affects the _____ (lower/upper) lobes.

Lower; upper

77

What are asbestos bodies and where are they located?

Golden-brown fusiform rods found in macrophages

78

In neonatal respiratory distress syndrome, there is a deficiency of what chemical?

Surfactant

79

How does the lack of surfactant in neonatal respiratory distress syndrome impair gas exchange in the lungs?

Surfactant deficiency leads to an increase in surface tension, resulting in collapse of the alveoli

80

What cells make surfactant?

Type II pneumocytes

81

Surfactant is made most abundantly during which period of neonatal gestation?

After the 35th week

82

What ratio is used as a measure of lung maturity in neonates? How is it tested?

The lecithin/sphingomyelin ratio in the amniotic fluid

83

In neonatal respiratory distress syndrome, the lecithin-to-sphingomyelin ratio is usually within what range?

<1.5

84

Medical treatment for neonatal respiratory distress syndrome includes what treatment for the mother before birth?

Maternal steroids

85

What vascular pathology is associated with persistently low oxygen tension due to neonatal respiratory distress syndrome?

Patent ductus arteriosus; patent ductus arteriosus can cause pulmonary hypertension if not corrected medically or surgically

86

What are three risk factors for neonatal respiratory distress syndrome?

Prematurity, maternal diabetes (due to elevated insulin), and cesarean delivery (due to decreased release of fetal glucocorticoids)

87

How can neonates be treated for respiratory distress syndrome after birth?

With artificial surfactant

88

Use of supplemental oxygen in neonates can lead to what ocular pathology?

Retinopathy of prematurity

89

In acute respiratory distress syndrome, acute alveolar damage leads to a(n) _____ (decrease/increase) in alveolar capillary permeability.

Increase

90

Despite many etiologies, what pathophysiology is seen in all cases of acute respiratory distress syndrome?

Fluid leakage into alveoli causing hyaline membrane formation on the inside of the alveolus thus impeding gas exchange

91

Name seven conditions known to cause acute respiratory distress syndrome.

Trauma, sepsis, shock, gastric aspiration, acute pancreatitis, amniotic fluid embolism, uremia

92

What obstetric complication can result in adult respiratory distress syndrome?

Amniotic fluid embolism

93

A chronic alcoholic suffering from acute pancreatitis is experiencing difficulty breathing and oxygen desaturation. From what pulmonary complication of acute pancreatitis may she be suffering?

Acute respiratory distress syndrome

94

Name three molecular mechanisms that contribute to the initial damage to the alveoli in acute respiratory distress syndrome.

Neutrophilic toxins, activation of the coagulation cascade, and oxygen-derived free radicals

95

The forced expiratory volume1:forced vital capacity is what percent in normal lungs; in obstructive lung disease; in and restrictive lung disease?

Approximately 80%; <80%; >80%

96

Forced expiratory volume1 and forced vital capacity are reduced in both obstructive and restrictive pulmonary diseases; however, forced expiratory volume1 is more dramatically reduced in ____ (obstructive/restrictive) pulmonary disease.

Obstructive

97

In ____ (obstructive/restrictive) pulmonary disease, forced expiratory volume1/forced vital capacity <80% and lung volumes are increased.

Obstructive

98

In _____ (obstructive/restrictive) pulmonary disease, forced expiratory volume1/forced vital capacity >80% and lung volumes are decreased.

Restrictive

99

How do total lung volumes in obstructive lung disease compare with normal lung volumes?

Lung volumes in chronic obstructive pulmonary disease are greater than normal lung volumes

100

Is residual volume decreased, increased, or normal in obstructive lung disease?

Increased

101

How do total lung volumes in restrictive lung disease compare with normal lung volumes?

Lung volumes are less than normal in restrictive lung disease

102

In which type of lung disease, obstructive or restrictive, is the forced expiratory volume1/forced vital capacity ratio more dramatically reduced?

Obstructive

103

Define sleep apnea.

The condition that occurs when a person repeatedly stops breathing for at least 10 seconds during sleep

104

Define central sleep apnea.

Sleep apnea due to a lack of respiratory effort

105

Define obstructive sleep apnea.

Sleep apnea with which there is a drive to breathe but mechanical airway obstruction (usually obesity) prevents respiration

106

An obese man complains of chronic fatigue. His wife says he is an especially loud snorer. What condition may be contributing to this patient's fatigue?

Sleep apnea

107

Name three treatments of sleep apnea.

Weight loss, continuous positive airway pressure, surgery

108

Name five conditions potentially associated with sleep apnea.

Obesity, loud snoring, pulmonary hypertension, arrhythmias, and possible sudden death

109

In the case of bronchial obstruction, what happens to the breath sounds over the affected area?

They are decreased or absent

110

What are the physical exam findings in a patient with bronchial obstruction?

Hyporesonance to percussion, decreased fremitus, and if there is tracheal deviation, it is towards the side of the lesion

111

What are the physical exam findings in a patient with pleural effusion?

Decreased breath sounds, dullness to percussion, decreased fremitus

112

What are the physical exam findings in a patient with lobar pneumonia?

Bronchial breath sounds, dullness to percussion, increased fremitus, no tracheal deviation

113

What are the physical exam findings in a patient with pneumothorax?

Decreased breath sounds, hyperresonance, absent fremitus, and tracheal deviation away from the lesion

114

Pleural effusions cause a(n) _____ (decrease/increase) in fremitus, whereas pneumonia causes a(n) _____ (decrease/increase) in fremitus.

Decrease; increase

115

Bronchial obstructions may cause tracheal deviation _____ (away from/toward) the lesion, whereas pneumothoraces result in deviation _____ (away from/toward) the lesion.

Toward; away from

116

In what area of the lungs does squamous cell carcinomas typically arise?

Central

117

In what area of the lungs does small cell carcinoma typically arise?

Central

118

In what area of the lungs does adenocarcinoma typically arise?

Peripheral

119

In what area of the lungs does large cell carcinoma typically arise?

Peripheral

120

List the two lung cancers that have a link to smoking.

Squamous cell carcinoma and small cell carcinoma

121

Squamous cell carcinoma of the lungs is known for the ectopic production of what substance?

Parathyroid hormone-related peptide, the release of which causes hypercalcemia

122

List three forms of bronchogenic carcinoma that tend to arise peripherally in the lungs.

Adenocarcinoma, bronchioalveolar carcinoma, and large-cell carcinoma

123

What is the most common type of lung cancer in non-smokers?

Adenocarcinoma

124

What peripherally arising form of bronchogenic carcinoma is most anaplastic or undifferentiated?

Large-cell carcinoma

125

What are the classic symptoms of carcinoid syndrome and what is the cause?

Flushing, diarrhea, wheezing, salivation; the symptoms are caused by serotonin secretion into the bloodstream

126

Are metastases from primary lung cancers very rare, rare, common, or very common and to what three sites do they occur?

Very common; brain, bone, and liver

127

In association with a primary lung cancer, what finding suggests brain metastases?

Seizures

128

In association with a primary lung cancer, what finding suggests bone metastases?

Pathologic fractures

129

In association with a primary lung cancer, what two findings suggest liver metastases?

Jaundice and hepatomegaly

130

What type of cancer is the leading cause of cancer death?

Lung cancer

131

Lung cancer can present with what incidental radiologic finding?

Pulmonary "coin" lesions

132

How can the voice of a patient with lung cancer change?

Hoarseness; due to compression of the recurrent laryngeal nerve

133

Which potential spaces can develop effusions as a result of lung cancer?

Pleural and pericardial effusions

134

How does the mnemonic SPHERE help one to remember common complications associated with lung cancer?

SPHERE stands for Superior vena cava syndrome, Pancoast's tumor, Horner's syndrome, Endocrine (paraneoplastic) complications, Recurrent laryngeal symptoms, and Effusions

135

A cavitary hilar mass arising from the bronchus of a long-time smoker may suggest which disease process?

Squamous cell carcinoma

136

Histologically, which lung carcinoma forms keratin pearls and intercellular bridges?

Squamous cell carcinoma

137

Which lung carcinoma may develop in sites of prior pulmonary inflammation or injury and is the most common lung cancer in nonsmokers and females?

Bronchial adenocarcinoma

138

Which of the following is more common on x-ray of the chest in lung adenocarcinoma, a single lesion or multiple densities?

Multiple densities

139

Clara cells differentiate into type II pneumocytes in which type of lung cancer?

Adenocarcinoma (bronchial and bronchioloalveolar)

140

Which cells are the precursors to small-cell lung cancer?

Neuroendocrine Kulchitsky cells

141

Name three possible paraneoplastic syndromes associated with small cell carcinoma of the lung.

Adrenocorticotropic hormone syndrome, the syndrome of inappropriate antidiuretic hormone secretion, and Lambert-Eaton syndrome

142

What is Lambert-Eaton syndrome?

A paraneoplastic syndrome associated with small cell carcinoma of the lung in which autoantibodies form against presynaptic calcium channels, leading to muscle weakness

143

What is the usual approach to the treatment of large cell carcinoma of the lung?

Remove surgically (poorly responsive to chemotherapy)

144

Histologically, which lung cancer is associated with pleomorphic giant cells with leukocyte fragments in the cytoplasm?

Large-cell carcinoma

145

What is the approach to treatment of small-cell lung cancer?

This inoperable cancer is treated with chemotherapy

146

Patients with metastases to the lung present with symptoms of _____ (cough/dyspnea) and patients with primary lung cancer present with symptoms of _____ (cough/dyspnea).

Dyspnea; cough

147

Bronchioloalveolar adenocarcinoma can present similarly to which other non-cancer pathological lung disease?

Pneumonia

148

A long-time shipbuilder presents with difficulty breathing. X-ray demonstrates an effusion. On tap, the fluid is bloody. A biopsy shows psammoma bodies. What is the disease process?

Mesothelioma secondary to asbestos exposure

149

Small-cell carcinoma is associated with the production of what two hormones?

Adrenocorticotropic hormone or antidiuretic hormone

150

In what region of the lung does Pancoast's tumor occur?

The apex

151

Because of its location, Pancoast's tumor may affect what neurologic structure?

The cervical sympathetic plexus

152

When Pancoast's tumor disrupts the cervical sympathetic plexus, it can result in what condition?

Horner's syndrome

153

Horner's syndrome includes what three findings?

Ptosis, miosis, and anhidrosis

154

Lobar pneumonia is most frequently the result of infection with what organism?

Streptococcus pneumoniae

155

Which type of pneumonia is most often caused by viruses?

Interstitial (atypical) pneumonia

156

List two viruses that commonly cause interstitial pneumonia.

Respiratory syncytial virus and adenoviruses

157

In which type of pneumonia does an intra-alveolar exudate lead to consolidation?

Lobar pneumonia

158

Which type of pneumonia characteristically shows diffuse, patchy inflammation?

Interstitial (atypical) pneumonia

159

Interstitial pneumonia characteristically shows diffuse, patchy inflammation that is localized to what areas of the lung?

Interstitial areas at the alveolar walls

160

The distribution of interstitial pneumonia characteristically involves how many lobes?

At least one, usually more

161

Which type of category of pneumonia typically has a less acute presentation?

Interstitial pneumonia

162

List four bacterial etiologies of bronchopneumonia.

Staphylococcus aureus, Haemophilus influenzae, Klebsiella, Streptococcus pyogenes

163

List three bacterial causes of interstitial pneumonia.

Mycoplasma, legionella, chlamydia

164

What is a lung abscess?

A localized collection of pus in the lung parenchyma

165

What two conditions can predispose a patient to lung abscesses?

Bronchial obstruction (usually by a tumor) or the aspiration of gastric contents (often after seizures or heavy alcohol use)

166

What type of individuals are predisposed to developing lung abscesses, even in the absence of preexisting pulmonary disease?

Patients who are prone to loss of consciousness like alcoholics and epileptics; they are at increased risk of aspiration of gastric contents

167

Name two organisms (or classes of organisms) most commonly implicated in the development of lung abscesses.

Staphylococcus aureus and anaerobes

168

In terms of pleural effusions, transudates have _____ (less/more) protein than exudates.

Less

169

In terms of pleural effusions, exudates have _____ (less/more) protein than transudates.

More

170

What are three common causes of transudative pulmonary effusions?

Congestive heart failure, nephrotic syndrome, and hepatic cirrhosis

171

Name four causes of exudative pulmonary effusions.

Malignancy, pneumonia, collagen vascular disease, trauma

172

What makes an exudate cloudy?

Exudates are cloudy because of their higher protein content

173

Name the three types of pleural effusions.

Transudative, exudative, and lymphatic

174

Are pleural effusions that are secondary to trauma usually transudates or exudates?

Exudates, due to increased vascular permeability in the setting of trauma

175

Which type of pleural effusion consists of high levels of triglycerides and has a milky appearance grossly?

Lymphatic

176

For what reason does an exudative pleural effusion require drainage?

Exudates have a high infection risk; they can progress to empyema, which requires surgery

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