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Pathology Block 11 > Respiratory System II > Flashcards

Respiratory System II Flashcards

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1
Q

Epidemiology and pathogenisis of pulmonary thromboembolism

A

Third most common cardiovascular cause of death after acute MI and stroke

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2
Q

Source of Pulmonary thromboembolism

A

Majority (90%) originate from the deep veins of the lower extremities and pelvis

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3
Q

Risk factors for pulmonary thromboembolism

A

Stasis of blood flow (prolonged bed rest, plane rides)

hypercoagulable states

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4
Q

Size of embolus in pulmonary thromboembolism

A

Determines the pulmonary vessel that is occluded

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5
Q

Large embolis in pulmonary thromboembolism

A

Occlude the main pulmonary arteries (saddle embolus)

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6
Q

Small emboli in pulmonary thromboembolism

A

Occlude medium sized and small pulmonary arteries

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7
Q

Consequences of pulmonary thromboembolism

A
  • increase in pulmonary artery pressure
  • decreased blood flow to pulmonary parenchyma
  • may cause hemorrhagic infarction
  • red-blue raised, wedge-shaped area that extends to the pleural surface
  • hemorrhagic pleural effusion May also occur
  • majority in lower lobes
  • perfusion is greater than ventilation in the lower lobes
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8
Q

Clinical findings in pulmonary thromboembolism

A
  • saddle embolus
  • sudden onset of dyspnea and tachypenia
  • pleuritis chest pain, friction rub
  • fever
  • experitory wheezing
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9
Q

Saddle embolus in pulmonary thromboembolism

A

Sudden death

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10
Q

Formed elsewhere that detaches and travels throughout the vasculatiure

A

Thrombus

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11
Q

DX for pulmonary thromboembolism

A
  • CT scan
  • X ray
  • Abnormal perfusion radionuclide scan
  • Ventilation scan is normal, but the perfusion scan is abnormal
  • positive D-dimers-non-specific
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12
Q

Smokers and high dose contraceptives can cause

A

Pulmonary thromboembolism

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13
Q

Mean pulmonary artery pressure >25mmHg at rest and mean pulmonary artery pressure >30mmHg with exercise

A

Pulmonary HTN

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14
Q

Primary PH

A

More common in women, genetic predisposition

-vascular hyperreactivity with proliferation of smooth muscle

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15
Q

Secondary PH

A
  • endothelial cell dysfunction, loss of vasodilator (NO), increas in vasoconstrictors
  • hypoxemia and respiratory acidosis stimulate vasoconstriction of pulmonary arteries, causes smooth muscle hyperplasia and hypertrophy
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16
Q

Hypoxia and respiratory acidosis in PH

A

Stimulate vasoconstriction of pulmonary arteries

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17
Q

Mechanism secondary PH

A

Respiratory acidosis/hypoxemia, vasoconstriction

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18
Q

TX for PH

A

Cialis, lol

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19
Q

Combination of PH and RVH leading to right sided heart failure

A

Cor pulmonae

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20
Q

Causes of cor pulmonae

A

-chronic hypoxemia, chronic lung disease, living at high altitude
-chronic respiratory acidosis
—

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21
Q

Pathological findings of cor pulmonae

A

Enlarged right side of heart

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22
Q

Condition caused by excess fluid in the lungs, this fluid collects in the numerous air sacs in the lungs, making it difficult to breathe, in most cases, heart problems causes it

A

Pulmonary edema

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23
Q

Increases hydrostatic pressure in lung capillaries in PE

A

Left sided heart failure, volume overload, mitral stenosis

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24
Q

Decrease oncotic pressure in PE

A

Nephrotic syndrome and cirrhosis

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25
PE due to microvascular or alveolar injury (exudate)
- Infections-sepsis, pneumonia - aspiration-drowning and gastric contents - drugs (heroin) - high altitude
26
Fibrosis disorders, granulomatous disease
Chronic intestinal lung disease
27
Pathogenisis of interstitial fibrosis
Earliest manifestation is alveolitis | Leukocytes release cytokines, which stimulate fibrosis
28
Effects of interstitial fibrosis
- decreases lung compliance (capacity to expand), decreased expansion of the lung parenchyma during inspiration, functional loss of alveolar capillary units - increases lung elasticity (stiffness)
29
Clinical findings of interstitial lung disease
Dry cough and exertion all dyspnea | Potential for cor pulmonae
30
Ability of lungs to expand
Compliance
31
Stiffness
Increased lung elasticity
32
What is idiopathic pulmonary fibrosis more common in
Smoking males than in females | Occurs in individuals 40 to 70 years old
33
Pathogenisis of idiopathic pulmonary fibrosis
- repeated cycles of alveolitis are triggered by an unknown agent - release of cytokines produces interstitial fibrosis - alveolar fibrosis leds to proximal dilation of the small airways - lung has a honeycomb appearance
34
Clinical findings of idiopathic pulmonary fibrosis
- fever - progessing dyspnea and exertion - choleric, nonproductive cough - late inspiration crackles
35
Honey comb lung
Idiopathic pulmonary fibrosis
36
Inhalation of mineral dust unto the lungs leading to interstitial fibrosis, mineral dust includes coal dust, silica, asbestos
Pneumoconiosis
37
Particles size in pneumoconiosis
- >5um are captured in the mucus of large bronchi and eliminated by coughing - <0.5um: reach the alveoli and are phagocytosed by alveolar macrophages - 1-5um: tend to get stuck at the bifurcation of respiratory bronchioles
38
Anthracosis
Coal workers pneumoconiosis - usually benign - sources of coal dust - usually asymptomatic
39
Coal workers pneuoconiosis: simple CWP
Fibrosis opacities are smaller than 1cm in the upper lobes and upper portions of lower lobes
40
Coal workers pneumoconiosis: crippling CWP
Progressive massive fibrosis - fibrotic opacities larger than 1-2cm with or without necrotic centers - crippling lung disease (black lung)
41
Multisystem noninfection granulomatous disease that produces chronic interstitial fibrosis
Sarcoidosis
42
Who is more likely to get sarcoidosis
Common in black and non smokers, women, 20-39 years old
43
Pathogenisis of sarcoidosis
Disorder in immune regulation
44
Dx of sarcoidosis
Dx of exclusion, must rule out other granulomatous disease
45
Pathology of sarcoidosis
Granuloma contain multinucleated giant cells
46
Primary target of sarcoidosis
Lungs - granuloma located int he interstitial and mediastinal and hilarious nodes - dyspnea is the most common symptom
47
Most common symptom of sarcoidosis
Dyspnea
48
Skin lesion of sarcoidosis
Modular lesions containg granuloma
49
Eye lesions in sarcoidosis
Produces uveitis
50
Lab findings in sarcoidosis
Increases ACE enzyme
51
Tx in sarcoidosis
- majority have spontaneous remission in 3 years and do not require treatment - steroids
52
Most common fatal cancer in both men and women worldwide
Lung cancer
53
Accounts for >30% of cancer deaths in men
Lung cancer
54
>25% of cancer deaths in women
Lung cancer
55
Peak incidence of lung cancer
55-65
56
Causes of lung cancer
- smoking - risk increases with quantity and duration of smoking - men who smoke - asbestos - certain metals - secondhand smoke
57
Primary lung cancer by specific type in decrease incidence
- adenocarcinoma - squamous cell carcinoma - small cell lung carcinoma - large cell carcinoma - bronchial carcinoid
58
Clinical classification of lung cancer
Non-small cell and small cell carcinoma (small cell there is nothing that can be done)
59
Common sites for metastasis in lung cancer
``` Hilarious lymph nodes Adrenal gland Liver Brain Bone ```
60
Scar tissue in lungs
Common sites of lung cancer development
61
What most often underlies the development of lung cancer
Genetic mutations - oncogenes (HER2 and BCL-2) - suppressor genes (P53)
62
What is inevitably connected with cancer development
mutations to P53
63
Major gene to regulate cell damage
P53
64
Clinical findings of lung cancer
``` Cough-most common Weight loss Hemoptysis-most worrying Dyspnea Chest pain ```
65
Adenocarcinoma lung cancer
Derived from Clara cells, mucin severeting bronchioar cells or type II pneumocystes
66
Most common primary cancer in non smokers and women
Adenocarcinoma
67
What is the best prognosis cancer type for lung cancer
Adenocarcinoma
68
Central, more common in men, strong association with smoke, high frequency of P53 mutations
Squamous and small cell carcinaom
69
Pancoast tumor
Lung carcinoma localized in the apex of the lungs, can cause horners syndrome
70
Horner syndrome
Ptosis Miosis Anhydrosis Caused by compression of the superior sympathetic ganglion most often by tumors originating from the apex of the lung
71
Pneumothorax
Air in thoracic cavity
72
Hemothorax
Blood in thoracic cavity
73
Loss of lung volume caused by collapse of alveoli
Atelectasis - results in shunting to indeaquatly oxygenated blood from pulmonary arteries to the pulmonary veins - ventilation-perfusion imbalance - hypoxia
74
Excessive snoring with intervals of breath cessation (apnea)
Obstructive sleep apnea
75
Causes of obstructive sleep apnea
Obesity is the most common cause | -pharyngeal muscles collapse
76
Clinical findings of obstructive sleep apnea
Excessive snoring with episodes of apnea, daytime somnolence and tiredness

Pathology Block 11 (8 decks)

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