Respiratory- Phatology Flashcards
(27 cards)
Rhinosinusitis
Obstruction of sinus drainage into nasal cavity inflammation and pain
Most common acute cause is viral URI; may lead to superimposed bacterial infection, most commonly S pneumoniae, H influenzae, M catarrhalis.
Epistaxis
Common causes include foreign body, trauma, allergic rhinitis, and nasal angiofibromas (common in adolescent males)
Kiesselbach plexus
LEGS: superior Labial artery, anterior and posterior Ethmoidal arteries, Greater palatine artery, Sphenopalatine artery.
Head and neck cancer
Mostly squamous cell carcinoma.
Risk factors include tobacco, alcohol, HPV-16 (oropharyngeal), EBV (nasopharyngeal).
Deep venous thrombosis
Blood clot within a deep vein swelling, redness, warmth, pain
d-dimer lab test used clinically to rule out DVT (high sensitivity, low specificity).
Imaging test of choice is compression ultrasound with Doppler
Virchow triad (SHE)
Stasis
Hypercoagulability
Endothelial damage
Pulmonary emboli
- O2 disturbance and clinical manifestations
- Types
- maging test of choice
V˙/Q˙ mismatch, hypoxemia, respiratory alkalosis. Sudden-onset dyspnea, pleuritic chest pain, tachypnea, tachycardia.
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor
CT pulmonary angiography
Lines of Zahn
are interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in thrombi formed before death; help distinguish pre- and postmortem thromb
Flow-volume loops
Pag. 655
Obstructive lung diseases
- Chronic bronchitis (“blue bloater”)
Reid index > 50%. DLCO usually normal.
Diagnostic criteria: productive cough for > 3 months in a year for > 2 consecutive years
Obstructive lung diseases
- Emphysema (“pink puffer”)
Centriacinar—associated with smoking . Frequently in upper lobes (smoke rises up). Panacinar—associated with α1-antitrypsin deficiency. Frequently in lower lobes.
Enlargement of air spaces low recoil, high compliance,
low DLCO from destruction of alveolar walls.
síndrome de Widal, triada de Samter o tríada ASA
10% de los asmáticos
Asma, poliposis nasal e intolerancia a AINEs.
Obstructive lung diseases
- Asthma
Smooth muscle hypertrophy and hyperplasia, Curschmann spirals (shed epithelium forms whorled mucous plugs), and Charcot-Leyden crystals (formed from breakdown of eosinophils in sputum).
Diagnosis supported by spirometry and methacholine challenge.
Obstructive lung diseases
- Bronchiectasis
Findings: purulent sputum, recurrent infections, hemoptysis, digital clubbing
Associated with bronchial obstruction, poor ciliary
motility, cystic fibrosis, allergic bronchopulmonary
aspergillosis.
Restrictive lung diseases
- Types
Poor breathing mechanics (normal A-a gradient)
Interstitial lung diseases (pulmonary decrease diffusing capacity, high A-a gradient)
Pag. 657
Hypersensitivity pneumonitis
III/IV hypersensitivity reaction to environmental
antigen.
Causes dyspnea, cough, chest tightness, headache.
Often seen in farmers and those exposed to birds
Sarcoidosis
- Findings
- Imagen
immune-mediated, widespread noncaseating granulomas, elevated serum ACE levels, and elevated CD4+/CD8+ ratio in bronchoalveolar lavage fluid. More common in African-American females.
Findings on CXR of bilateral adenopathy and coarse reticular opacities; CT of the chest better demonstrates
the extensive hilar and mediastinal adenopathy
Sarcoidosis
- Manifestations
Associated with Bell palsy, Uveitis, Granulomas (epithelioid, containing microscopic Schaumann and asteroid bodies), Lupus pernio (skin lesions on face resembling lupus), Interstitial fibrosis (restrictive lung disease), Erythema nodosum, Rheumatoid arthritis-like arthropathy, hypercalcemia (due to 1α-hydroxylase–mediated vitamin D activation in macrophages)
Pneumoconioses
Asbestos is from the roof (was common in insulation), but affects the base (lower lobes).
Silica, Berylliosis, coal are from the base (earth), but affect the roof (upper lobes)
Asbestosis
Associated with shipbuilding, roofing, plumbing. “Ivory white,” calcified, supradiaphragmatic and pleural plaques are pathognomonic of asbestosis.
Asbestos (ferruginous) bodies are golden-brown fusiform rods resembling dumbbells, found in alveolar sputum sample, visualized using Prussian blue stain
Risk of bronchogenic carcinoma > risk of mesothelioma.
Berylliosis
in aerospace and manufacturing industries. Granulomatous (noncaseating) on histology.
risk of cancer and cor pulmonale.
Coal workers’
pneumoconiosis (black lung disease)
coal dust exposure macrophages laden with carbon inflammation and fibrosis.
risk for Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules).
Small, rounded nodular opacities seen on
imaging. Anthracosis
Silicosis
Associated with sandblasting, foundries, mines. Fibrosis
increasing susceptibility to TB, of cancer, cor pulmonale, and Caplan syndrome.
“Eggshell” calcification of hilar lymph nodes on CXR.
Mesothelioma
Malignancy of the pleura associated with asbestosis.
May result in hemorrhagic pleural effusion (exudative), pleural thickening
Psammoma bodies, Calretinin ⊕ in almost all mesotheliomas, ⊝ in most carcinomas.
