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Block 4 > Week 8 > Flashcards

Week 8 Flashcards

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1
Q

What are the two causes pulmonary hypoplasia?

A
  1. insufficient intrathoracic space
  2. inadequate amniotic fluids
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2
Q

What can lead to insufficient intrathoracic space? (3)

A
  1. diaphragmatic hernia
  2. chest wall deformities
  3. large effusions leading to less thoracic space
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3
Q

What can lead to inadequate amniotic fluids? (3)

***one category is decreased fluid levels and another is normal fluid levels***

A

DECREASED FLUID LEVELS

  1. PROM (premature rupture of membranes)
  2. Insufficient fetal urine entering amniotic cavity (because urine makes up most of amniotic fluid)

NORMAL FLUID LEVELS
3. inadequate movement of amniotic fluid in and out of lungs bc of neurological/neuromuscular conditions

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4
Q

What are bronchogenic cysts derived from?

A

the foregut (from embyro) - the cysts is due to abnormal budding

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5
Q

Where are bronchogenic cysts normally located?

A

in middle mediastinum

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6
Q

What is histology of bronchogenic cysts? (2)

A
  1. unilocular cysts
  2. pseudostratified columnar epithelial cells (blue lines)
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7
Q

Prognosis of bronchogenic cysts?

A
  1. good prognosis after excision
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8
Q

What is pulmonary sequestration?

A
  1. Area of lung tissue that is not connected to the airways and has abnormal blood supply from the aorta or its branches
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9
Q

What are the two types of pulmonary sequestration?

A
  1. Intralobar - within the lung
  2. Extralobar - external to the lung and has its own visceral pleura
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10
Q

Intralobar pulmonary sequestration

  1. Where does the venous blood drain into?
  2. Typical patient?
A
  1. through azygous pathway
  2. presents in infants as a mass lesion
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11
Q

Extralobar pulmonary sequestration

  1. Where does the venous blood drain into?
  2. Typical patient?
A
  1. Drains into the pulmonary system
  2. presents in older children as recurrent localized infections or bronchiectasis

*lacks its own pleura*

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12
Q

What does the anterior mediastinum contain? (5)

A
  1. thymus
  2. mammary arteries
  3. lymph nodes
  4. connective tissue
  5. fat
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13
Q

What does the middle mediastinum contain? (5)

A
  1. pericardium
  2. heart
  3. great vessels
  4. airway
  5. esophagus
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14
Q

What does the posterior mediastinum contain? (6)

A
  1. proximal intercostals
  2. neurovascular bundles
  3. spinal ganglia
  4. sympathetic chain
  5. Lymphatic tissue
  6. Connective tissue
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15
Q

What different masses are found in anterior mediastinum? (4) “terrible T’s”

A
  1. thymoma
  2. teratoma
  3. terrible lymphoma
  4. thyroid tissue
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16
Q

What different masses are found in middle mediastinum? (3)

A
  1. lymphadenopathy
  2. cysts
  3. esophageal tumors
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17
Q

What different masses are found in posterior mediastinum? (2)

A
  1. neurogenic tumors
  2. thoracic spine lesions
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18
Q

What is a thymoma?

A

Neoplastic thymic epithelial cells plus thymocytes (an immune cell present in the thymus, before it undergoes transformation into a T cell)

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19
Q

Thymoma

  1. What typical age does this occur?
  2. are thymomas symptomatic?
A
  1. middle age
  2. # depends
  3. 30% are asymptomatic
  4. 30-40% are symptomatic from impingement on other structures
  5. remainder are symptomatic from paraneoplastic syndromes
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20
Q

What are the three classifications of thymoma?

  1. Cytologically benign and noninvasive
  2. Cytologically benign, yet infiltrative and locally aggressive
  3. (Blank)
A
  1. Cytologically benign and noninvasive
  2. Cytologically benign, yet infiltrative and locally aggressive
  3. Thymic carcinoma: cytologically and biologically malignant
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21
Q

What are the three classifications of thymoma?

  1. Cytologically benign and noninvasive
  2. Blank
  3. Thymic carcinoma: cytologically and biologically malignant
A
  1. Cytologically benign and noninvasive
  2. Cytologically benign, yet infiltrative and locally aggressive
  3. Thymic carcinoma: cytologically and biologically malignant
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22
Q

What are the three classifications of thymoma?

  1. Blank
  2. Cytologically benign, yet infiltrative and locally aggressive
  3. Thymic carcinoma: cytologically and biologically malignant
A
  1. Cytologically benign and noninvasive
  2. Cytologically benign, yet infiltrative and locally aggressive
  3. Thymic carcinoma: cytologically and biologically malignant
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23
Q

Histology of thymoma

  1. What are the two different ways that thymoma can appear microscopically
A
  1. spindled (left) or mixed w/plumper rounder epithelial cells (right)
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24
Q

A CT/MRI can identify (Blank A) mediastinal mass

  • and it can also determine if its (Blank B) or (Blank C)
A
  1. Blank A = anterior mediastinal mass
  2. Blank B = circumscribed
  3. Blank C = infiltrating
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25
What is the purpose of tissue examination for thymoma?
1. needed for definitive diagnosis
26
Treatment of thymoma?
1. surgical resection 2. radiation or chemo for advanced disease
27
How does the sensitivity to PO2 and PCO2 change during REM sleep?
the sensitivity to PO2 and PCO2 are decreased during REM * leads to PaCO2 increased and PaO2 decreased (hypoventilation)
28
What happens to * minute ventilation * intercostals and diaphragm during sleep
1. reduced in sleep 2. in REM sleep only diaphragm is used
29
What is obstructive sleep apnea?
* is due to an obstruction of the airway that does not let proper ventilation occur
30
What is central sleep apnea?
* is due to the brain not sending signals to breathe
31
What two things are seen with obesity hypoventilation syndrome?
* obstruction of the airway due to fat crushing the airway, especially when lying supine. * Chest wall also becomes harder to expand due to fat deposits
32
What are the symptoms of sleep apnea? (7)
* Snoring * Witnessed apnea * Daytime sleepiness * Waking * Dry mouth * Morning headache (due to hypoxemia) * Nocturia
33
How does obstructive sleep apnea or obesity hypoventilation syndrome lead to hypercapnia (4)
* Obesity leads to increased mechanical load on chest and upper airway collapse (or just chronic obstruction if not due to obesity) * Then there is hypoventilation and hypercapnia - which body compensates for while awake * Chronic hypoventilation and hypercapnia lead to impaired chemoreceptor functionality * This ends with patient having chronic hypercapnia even when awake not just when asleep
34
What are the demographic risk factors for sleep apnea and obesity hypoventilation?
1. male 2. 40-70 years old 3. family history
35
What are the comorbidities with sleep apnea and obesity hypoventilation? (5)
1. HTN 2. Heart failure 3. Stroke 4. DM 5. end stage renal disease
36
What does a polysomnography do?
* uses many sensors to measure breathing effort, brain patterns, video, and muscular patterns to diagnose sleep problems
37
What does type 1 test of polysomnography analyze?
1. sleep stages 2. breathing 3. sleep movements
38
What does type 4 test of polysomnography analyze?
1. breathing - this is the at home test
39
What is the difference between CPAP and BPAP
* CPAP is continuous positive airway pressure - machine will apply continuous pressure to keep airway open * BPAP - bi-level positive airway pressure - machine will apply inspiratory and expiratory pressure, with inspiratory pressure being higher pressure
40
What does the hypoglossal nerve stimulator do for patients with sleep apnea?
* when chest rises the stimulator will cause the tongue to move forward
41
What markers can be seen in X-Ray of someone with congestive heart failure?
42
What do lung metastases look like on X ray and CT
1. cannonball lesions
43
What can you see on Xray to indicate aortic dissection?
1. aortic knob/knuckle
44
what findings are found in X ray for COPD patients?
1. hyperinflated lungs 2. flattened diaphragm 3. possibly diaphragm tenting
45
What findings are seen on X-ray for pulmonary tumors (primary tumors)
1. coin lesions - can appear in different sizes and locations 2. Usually only on one side if its a primary tumor
46
What findings are seen on x ray for pleural effusion?
1. meniscus line 2. Air fluid level 3. No air bronchogram
47
What is pulmonary edema? what causes it?
1. Fluid in alveoli due to increase in intravascular hydrostatic pressure 2. With increased hydrostatic pressure - fluid leaks into interstitium and eventually alveoli
48
What are the three major causes of edema?
1. hemodynamic 2. capillary damage 3. idiopathic
49
Describe the hemodynamic cause of pulmonary edema?
* Due to increased passive congestion/ hydrostatic pressure or also obstructed lymphatic drainage * Starling fluid balances are shifted → increased vascular efflux
50
1. Describe what capillary damage leads to pulmonary edema? 2. How does capillary damage lead to pulmonary edema
1. Can be due to infection, toxic smoke, severe burns, shock/trauma, etc 2. This leads to acute lung injury, alveolar damage, and ARDS * With damage you can see * Impaired gas exchange * Inflammation * Loss of compliance * Pulmonary hypertension due to hypoxia induced vasoconstriction
51
What is the main idiopathic cause of pulmonary edema?
1. high altitude edema
52
How does hypoxia from high altitude edema affect 1. PO2 and tissue oxygenation 2. vasoconstriction/vasodilation 3. capillaries
* decreased PO2 and tissue oxygenation * With hypoxia you get pulmonary vasoconstriction and pulmonary hypertension (leading to right ventricular overload) * Overload can cause capillary damage and high pressures induce vascular permeability (hydrostatic pressure) …finally get edema
53
What are the two types of pulmonary embolism?
1. hemodynamically unstable - cause hypotension, reduced blood return to the heart, and low CO. 2. Hemodynamically stable - do not meet above criteria
54
What preventative measures can be done to avoid pulmonary embolism?
1. ambulation after surgery 2. elastic stockings 3. anticoagulant therapy
55
What is definition of pulmonary hypertension
1. pulmonary artery pressure is \> 25 mmHg at rest
56
What abnormality in what gene can predispose pulmonary hypertension?
* Abnormality in BMPR2 gene
57
pulmonary hypertension falls into what five categories?
1. Due to pulmonary artery disease 2. Left side heart failure 3. Secondary to pulmonary parenchymal disease 4. Chronic repeated thromboembolism 5. Multifactorial
58
Histology of pulmonary hypertension includes what changes to 1. pulmonary artery walls 2. inside of pulmonary artery 3. muscle changes to heart 4. vascular changes seen under microscope
1. pulmonary arterial hypertrophy 2. pulmonary artery atherosclerosis 3. right ventricular hypertrophy 4. plexiform arteriopathy (severe)
59
1. What is goodpastures? 2. Who does this mostly affect
1. an autoimmune disease against the NC1 domain of alpha3 chain in type IV collagen (that is present in kidney and lungs) - needs to affect both kidney and lungs 2. mostly affects adults
60
1. What is idiopathic pulmonary hemorrhage
* intermittent alveolar hemorrhage in children. * Causes productive cough, hemoptysis, and anemia. * Similar to goodpasture but no antibodies to collagen IV
61
1. What is Granulomatosis with polyangiitis 2. what antibodies does it show?
1. an uncommon disorder that causes inflammation of the blood vessels in your nose, sinuses, throat, lungs and kidneys 2. PR3- ANCA antibodies
62
What is the classical triad of Granulomatosis with polyangiitis
* necrotizing granulomas (area of inflammation) in the upper respiratory tract * vasculitis in medium sized vessels * glomerulonephritis
63
What does chest x ray of Granulomatosis with polyangiitis show?
* diffuse, bilateral circular lesions that are non consolidated with an air fluid level.
64
Aspiration tends to affect what area of lungs?
lower lobes
65
The kerley B lines indicate what about pulmonary edema?
If it is only Kerley B lines then the fluid build up has only gone into interstitium but if there is even more fluid build up then it will go into alveoli and lead to the opacities in lung around hilum (this is typically seen with congestive heart failure)
66
what diseases can cause air fluid level in chest x ray? (2)
infection and cancer
67
Round pneumonia is most common in what type of patient?
A young child
68
What does meniscus typically mean for chest x ray?
pleural effusion
69
what is pulmonary edema?
Fluid from vessels leak into the interstitium and eventually this fluid goes into the alveoli is edema is more advanced
70
What can cause increased intravascular hydrostatic pressure that eventually leads to pulmonary edema? (3)
1. most commonly cardiogenic causes 2. Excess fluid administration paired with heart dysfunction 3. pulmonary vein obstruction which increases pressure in capillaries
71
What can cause decreased intravascular oncotic pressure that eventually leads to pulmonary edema? (1)
1. protein loss - albumin loss which can be because of nutritional deficiency or impaired albumin production
72
What can cause increased extravascular oncotic pressure that eventually leads to pulmonary edema? (1)
1. protein in interstitial space due to infection or inflammation most commonly (happens when capillary permeability is often implicated)
73
What can cause decreased extravascular hydrostatic pressure that eventually leads to pulmonary edema? (1)
1. RARE - strong inspiratory effort against closed glottis - leading to negative pleural pressure which pulls fluid out of blood vessels and into the interstitial space * seen with near drowning
74
1. Describe high altitude edema
1. beginning at around 2000 meters 2. Hypoxia leads to decreased PO2 and decreased tissue oxygenation 3. due to hypoxia you get pulmonary vasoconstriction and pulmonary hypertension leading to right ventricular overload 4. Overload can cause capillary damage and high pressure means high hydrostatic pressure → you get edema
75
What are the “non-cardiac” causes for pulmonary edema? (its a mnemomic)
N= near drowning O= O2 therapy T = trauma/transfusion C = CNS/neurogenic A = allergic alveolitis R = renal failure D = drugs I = inhaled toxins A= altitude C= contusion
76
What is hamptons hump?
* **a radiological sign consisting of a peripheral, wedge-shaped opacification adjacent to the pleural surface, which represents pulmonary infarction distal to a pulmonary embolus**.
77
What is westermark sign
* Westermark sign - clearing in area of unperfused lung
78
What is pulmonary hypertension?
is a type of high blood pressure that affects the arteries in the lungs and the right side of the heart
79
What are the two types of pulmonary hypertension?
1. pre-capillary hypertension 2. isolated post capillary hypertension
80
What is isolated post capillary pulmonary hypertension
1. meaning the issue is post capillary 2. usually have normal pulmonary vascular resistance so the issue is a heart disease or multifactorial
81
What is pre capillary pulmonary hypertension
1. the issue causing PH is before capillaries so there is high resistance within the pulmonary vasculature 2. seen with pulmonary arterial hypertension, respiratory disease, chronic thromboembolism, or multifcatorial
82
What is 1. mPAP ( mean pulmonary artery pressure) 2. PAWP (“pulmonary arterial wedge pressure) of pre-capillary Pulmonary hypertension
1. \>20 mmHg 2. = 15 mmHg
83
What is 1. mPAP ( mean pulmonary artery pressure) 2. PAWP (“pulmonary arterial wedge pressure) of isolated post-capillary Pulmonary hypertension
1. \>20 mmHg (same as pre-capillary) 2. ≥ 15 mmHg
84
What is seen in IHC with goodpastures?
* green lining around alveoli are antibodies attacking basement membrane
85
(80% or 10-15%) of lung cancers occur in active smokers BUT lung cancer develops in (80% or 10-15%) of smokers
1. 80% 2. 10-15%
86
(males/females) are more susceptible to develop lung cancer from smoking
females
87
What are the most common class/types of lung cancer? 1. (A) 2. (B) 3. (C) 4. (D) 5. other
1. Adenocarcinoma (50%) 2. Squamous cell carcinoma (20%) 3. Small cell carcinoma (15%) 4. Large cell carcinoma (2%) 5. Other
88
Primary adenocarcinoma 1. most common cancer in (Blank- this is a two part answer) 2. What gene mutations are found typically (2)
1. nonsmokers who are women 2. EGFR and ALK
89
Primary Adenocarcinoma 1. What kind of structure does the tumor take on? 2. What stains show up positive for this lung cancer type (2)
1. glandular - may also have mucin production 2. TTF and Mucin
90
Primary Adenocarcinoma 1. does tumor occur peripherally or centrally
1. Peripherally - smaller tumor size
91
Adenocarcinoma in-situ 1. How is this different from regular adenocarcinoma 2. What are the two types of adenocarcinoma in situ?
1. Adeno in situ means that there are abnormal cells in these mucus-producing glands, but they aren't cancerous and have not spread 2. Mucinous type and non-mucinous type
92
Adenocarcinoma in situ 1. Differentiate between how mucinous vs non-mucinous looks like under microscope? (what the dysplastic cells derive from and characteristics of image)
1. Mucinous: derived from goblet cells…columnar cells lining septa **(very light purple)** 2. Non-Mucinous: derived from clara cells or type II pneumocytes **(very purple)**
93
Adenocarcinoma in situ (Mucinous vs non-mucinous) 1. What mutations are more likely in mucinous 2. what about non-mucinous?
1. KRAS 2. EGFR and ALK
94
Squamous cell carcinoma 1. more common in (Blank - two parts) 2. common mutations
1. male smokers 2. TP53, CDKN2A mutations and FGFR1 amplification * no approved therapy to target these mutations
95
Squamous cell carcinoma 1. tumors arise peripherally or centrally? 2. What characteristics in microscopic imaging is unique for squamous cell carcinoma
1. centrally from segmental or sub-segmental bronchi 2. Keratin pearls and intercellular bridges
96
Squamous cell carcinoma 1. What stains are positive, indicating squamous cell carcinoma 2. what paraneoplastic syndrome is seen with SCC
1. P63 and P40 2. hypercalcemia
97
Small Cell Carcinoma 1. mainly affect (blank) 2. most non-aggressive or aggressive cancer?
1. smokers 2. most aggressive lung cancer, metastasize early
98
Small Cell Carcinoma 1. typically mutations? (4)
1. TP53 and RB inactivation 2. 3p chromosome loss 3. Amplification of MYC family genes * does not have to have all mutations
99
Small cell carcinoma 1. What type of tumor is this (has a special name due to its function) 2. What paraneoplastic syndromes are seen with SCC?
1. Neuroendocrine tumor 2. SIADH (syndrome of inappropriate secretion of ADH) ;;;; Cushing syndrome (hormone release);;;;; Lamber-Eaton syndrome (Autoimmune syndrome)
100
Small Cell Carcinoma 1. What characteristics are found on histology? (3)
1. dense areas of purple nuclei - all nuclei and no cytoplasm 2. Cell grow in clusters 3. Necrosis is common
101
Small Cell Carcinoma 1. Where does this tumor typically arise? 2. What special reaction does this have to chemo? 3. Prognosis?
1. major bronchi or periphery of lung 2. Treated with chemo - they respond right away but then grow back pretty quickly and then nothing really can help - just give relief for some time 3. Worst prognosis
102
Large Cell Carcinoma 1. Mostly occurs in (Blank) 2. Where in the lung does this tumor arise?
1. smokers 2. Centrally or peripherally
103
Large Cell Carcinoma 1. What is characteristic of histology of LCC? 2. Prognosis?
1. Large nuclei, prominent nuclei - moderate amount of cytoplasm 2. Poor prognosis
104
Bronchial Carcinoid 1. Occurs in what type of patient? 2. What special type of tumor is this based on its function?
1. Non-smokers, mostly \<60 YO 2. Neuroendocrine tumor
105
Bronchial Carcinoid 1. What stain is positive to indicate bronchial carcinoid? 2. What patterns are found in histology?
1. Chromogranin positive (this is for neuroendocrine tumors) 2. Organoid (in this image), trabecular, palisading, ribbon or rosette like arrangements of cells separated by delicate fibrovascular stroma (in image)
106
Bronchial Carcinoid ***Can arise centrally or peripherally*** 1. What differences are seen between the two?
1. CENTRAL ---- Well circumscribed spherical mass that is covered by intact mucosa - confined to main bronchus 2. PERIPHERAL — solid and nodular
107
Pulmonary Hemartoma 1. malignancy status? 2. where is it typically found?
1. little to no malignancy 2. Lung parenchyma (portion of the lungs involved in gas exchange)
108
Pulmonary Hemartoma 1. What does this look like on radiology?
1. Often as a coin lesion
109
Person exposed to asbestos are more commonly to have (lung carcinoma/mesothelioma)?
Lung cancer - even higher risk if they smoke
110
Malignant Mesothelioma 1. related to what exposure? 2. What part of lungs is this confined to?
1. asbestos exposure for long period (25-45 years) 2. lesion from visceral or parietal pleura that spread widely into the pleural space
111
Malignant Mesothelioma What is typically described of the lesion? 1. large effusions are usual 2. invades adjacent structures directly 3. (texture) (color) tumor 4. often spread to (Blank) then to liver and distant organs
Texture: soft, gelatinous Color: gray-pink Blank - Hilar lymph nodes * White stuff is malignant mesothelioma and black part is lungs being squished
112
Malignant Mesothelioma 1. What can the histology resemble? 2. What stains are positive or negative in the epitheliod variant of malignant mesothelioma?
1. Adenocarcinoma due to glandular process 2. Calretinin is positive;;; TTF-1 negative (but positive in adenocarcinoma which helps differentiate)
113
What are the three types of malignant mesothelioma?
1. Epithelioid variant 2. Sarcomatoid type 3. Biphasic type
114
Malignant Mesothelioma 1. Sarcomatoid type resembles what?
1. fibrosarcoma
115
Malignant mesothelioma 1. What is biphasic type described as?
1. has both epithelioid and sarcomatoid patterns
116
1. What is solitary fibrous tumor? 2. What does histology show? 3. Is it malignant
1. tumors are rare growths of soft tissue cells 2. Whorls of reticulin and collagen fibers with interspersed spindle cells. There are vessels dispersed within tumor 3. Rarely malignant *image shows left part is lungs but right side is tumor*
117
What does solitary fibrous tumor stain positive and negative for?
* Negative for keratin * Positive for CD34 * Positive for STAT6
118
Drug treatments for Non-Small Cell Lung Cancer Cetuximab 1. what mutation does it target?
1. EGFR inhibitor
119
Drug treatments for Non-Small Cell Lung Cancer Crizotinib 1. what mutation does it target?
1. ALK inhibitor
120
Drug treatments for Non-Small Cell Lung Cancer Pembrolizumab 1. what mutation does it target? 2. What are side effects?
1. PD-L1 inhibitor (give alone only when expression is \>50%) 2. “itis” - pneumonitis
121
Drug treatments for Non-Small Cell Lung Cancer Pemetrexed 1. Major side effects? (2)
1. reduced blood counts 2. rash
122
Drug treatments for Non-Small Cell Lung Cancer Carboplatin 1. Major side effects? (3)
1. myelosuppresion 2. nephrotoxicity 3. ototoxicity
123
When is chemoimmunotherapy used?
First line of treatment for those who do not have a targetable alteration
124
1. What is hemoptysis 2. Clinical finding
1. Hemoptysis: coughing of blood from a source below the glottis 2. Clinical finding is bright red blood
125
1. What is pseudohemoptysis 2. Clinical finding
1. blood that comes from the sinuses or nasal cavity and not form the lower respiratory tract 2. Clinical finding: Bright red- Darker blood
126
1. What is Hematemesis 2. Clinical finding
* Vomiting blood * Clinical finding: darker colored blood
127
1. What is Non-massive hemoptysis vs massive hemoptysis
Non-massive hemoptysis * Less than 500ml per day * Usually not immediately life threatening Massive Hemoptysis * Greater than 500ml per day or 100 ml per hour * Potentially life threatening * Can impair gas exchange * Hemodynamically instability
128
Exudate vs transudate??
Exudate - increased protein (seen with pneumonia) Transudate - reduced protein (seen with CHF)
129
What does bloody exudate mean in pleural effusion?
1. malignancy
130
What does milky pleural effusion mean?
1. increased triglycerides

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