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73 Cards in this Set
- Front
- Back
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PFT's for Obstructive Lung Diseases?
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Big Dec in FEV1
Dec FVC Dec FEV1/FVC ratio (hallmark) |
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types of COPD?
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Chronic Bronchitis
Emphysema Asthma Bronchiectasis |
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Pathology of Chronic Bronchitis?
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Hypertrophyof mucus-secreting glands in bronchioles--->Reid Index > 50%
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What is the Reid Index?
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Gland Depth/Total Thickness of Bronchial Wall
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Dx of Chronic Bronchitis requires?
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Productive cough for > 3 consecutive moths in > 2 years
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Sx's of Chronic Bronchitis?
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Wheezing
Crackles Cyanosis (early onset hypoxemia due to shunting) Late-Onset Dyspnea |
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Pathology of Emphysema?
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Enlargement of air spaces and dec recoil due to destruction of alveolar walls
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3 Types of Emphysema?
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Centriacinar
Panacinar Paraseptal Emphysema |
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Cause of different types of Emphysema?
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Centriacinar: smoking
Panacinar: alpha-1-antitrypsin def (also liver cirrhosis) Paraseptal: not so sure |
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Who gets Paraseptal Emphysema? why?
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Associated w/ Bullae--->rupture--->spontaneous pneumothorax
often in young, otherwise healthy males |
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Sx's of Emphysema?
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Dyspnea
Dec breath sounds Tachycardia Late-onset hypoxemia from eventual loss of capillary beds Inc Elastase Activity Inc Lung Compliance |
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Pathology of Asthma?
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Bronchial Hyperresponsiveness causes reversible bronchoconstriction
Smooth Muscle hypertrophy Curschmann's Spirals |
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what are Curschmann's Spirals?
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Shed epithelium from mucous plugs
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Possible Asthma triggers?
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Viral URI's
Allergens Stress |
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Sx's of Asthma?
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Cough
Wheezing Dyspnea Tachypnea Hypoxemia dec I/E ratio Pulsus Paradoxus Mucus Plugging |
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pathology of Bronchiectasis?
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Chronic Necrotizing infection of bronchi--->permanently dilated airways, purulent sputum, recurrent infections, and hemoptysis
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5 Associations w/ Bronchiectasis?
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Bronchial Obstruction
CF Poor Ciliary Motility Kartagener's Syndrome can lead to Aspergillosis |
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PFT's for Restrictive Lung Disease?
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FEV1/FVC ratio > 80% (i.e. its normal or inc)
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2 broad categories of Restrictive Lung Disease?
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1. Poor Breathing Mechanics
2. Interstitial Lung diseases |
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Types of conditions---> poor breathing mechanics?
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Poor Muscular Effort (polio, myasthenia gravis)
Poor Structural Apparatus (scoliosis, morbid obesity) |
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Types of Interstitial Lung diseases?
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ARDS
Neonatal RDS Pneumoconioses Sarcoidosis Idiopathic Pulmonary Fibrosis Goodpasture's Wegener's Eosinophilic Granulomatosis (histiocytosis X) Drug Toxicity |
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What drugs can cause Interstitial Lung Disease?
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Bleomycin
Busulfan Amiodarone |
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Cause of Neonatal RDS?
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Surfactant Deficiency
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When is surfactant production usually adequate for survival?
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after 35th week
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Lecithin:Sphingomyelin ratio in Neonatal RDS?
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usually < 1.5
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Risk factors for Neonatal RDS?
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Prematurity
Maternal Diabetes Cesarean Delivery (dec release of fetal glucocorticoids) |
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Rx for Neonatal RDS?
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Maternal steroids before birth
Artificial surfactant for infant |
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Causes of ARDS?
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Trauma
Sepsis Shock Gastric Aspiration Uremia Acute Pancreatitis Amniotic Fluid Embolism |
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Pathogenesis of ARDS?
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Diffuse alveolar damage--->Inc alveolar cap perm--->protein-rich leakage into alveoli--->formation of intra-alveolar hyaline membrane
Initial damage from neutrophilic substances toxic to alveolar wall, activation of coag cascade, or oxygen-derived free radicals |
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Dx of Sleep Apnea?
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person stops breathing for at least 10 seconds repeatedly during sleep
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2 Types of Sleep Apnea?
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Central: no resp effort
Obstructive: resp effort against airway obstruction |
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Sleep apnea is associated w/?
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Obesity
Loud Snoring Systemic/Pulmonary HTN Arrhythmias Possibly sudden death May become chronically tired |
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Rx for Sleep Apnea?
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Wt Loss
CPAP Surgery |
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What is Asbestosis?
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Diffuse pulmonary interstitial fibrosis from inhaled asbestos
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Asbestosis inc risk for?
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Pleural mesothelioma
Bronchogenic carcinoma |
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Morphology of Asbestosis?
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Ferruginous bodies in lung (asbestos fibers coated w/ hemosiderin)
Ivory-white pleural plaques |
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Lobe Involvement in Asbestosis? so?
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Mainly Lower Lobes
Other pneumoconioses usually affect upper lobes |
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What is the leading cause of cancer death?
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LUNG CANCER
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Presentation of Lung Cancer?
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Cough
Hemoptysis Bronchial Obstruction Wheezing Pneumonic "coin" lesion on x-ray |
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Difference between presentation of primary vs metastatic lung cancer?
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Primary: presents w/ cough
Metastatic (more common): presents w/ dyspnea |
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Complications w/ Lung Cancer? mnemonic?
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SPHERE
SVC syndrome Pancoast's Tumor Horner's Syndrome Endocrine (paraneoplastic) Recurrent Laryngeal Sx's (hoarseness) Effusions (pleural or pericardial) |
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4 primary Lung Cancers and their Location?
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Squamous Cell Carcinoma (Central)
Adenocarcinoma (peripheral) Small Cell Carcinoma (Central) Large Cell Carcinoma (Peripheral) |
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Link for Squamous Cell Carcinoma? paraneoplastic?
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SMOKING
Parathyroid activity |
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Histo of Squamous CC?
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Keratin Pearls and Intercellular Bridges
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Types of pulmonary Adenocarcinoma?
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Bronchial
Bronchioloalveolar |
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What is the most common lung cancer in non-smokers and women?
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Bronchial Adenocarcinoma
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Origin of Bronchial Adenocarcinoma?
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In site of prior inflammation or injury
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Kickers for Bronchioloalveolar Adenocarcinoma?
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Not linked to smoking
Grows along airways Can present like pneumonia |
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Histo of Adenocarcinomas?
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Clara Cells--->type 2 pneumocytes
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Course of Small CC?
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VERY AGGRESSIVE
undifferentiated |
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What can accompany or come from Small CC?
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Ectopic production of ACTH or ADH
May lead to Lambert-Eaton Syndrome |
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What is Lambert-Eaton?
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Autoantibodies against Ca Channels
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Histo of Small CC?
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Neoplasm of neuroendocrine Kulchitsky cells---> small dark blue cells
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Rx for Small CC?
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responsive to chemo
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Path of Large CC?
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Highly anaplastic, undifferentiated tumor
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Px of Large CC?
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POOR
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Rx for Large CC?
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Chemo less responsive
Surgery is key |
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Histo of Large CC?
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Pleomorphic Giant Cells w/ leukocyte fragments in cytoplasm
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Kickers for Carcinoid Tumor?
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Secretes Serotonin and can cause Carcinoid Syndrome?
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Sx's of Carcinoid Syndrome?
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Flushing
Diarrhea Wheezing Salivation |
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Common places that lung cancer metastasizes to? sx's?
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Brain-->epilepsy
Bone-->pathologic fracture Liver-->jaundice, hepatomegaly |
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What is a Pancoast's Tumor?
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Carcinoma in apex of lung and may affect cervical sympathetic plexus--->horner's syndrome
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Sx's of Horner's Syndrome?
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Ptosis
Miosis Anhidrosis |
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Types of Pneumonia?
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Lobar
Bronchopneumonia Interstitial (atypical) |
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usual organism(s) causing each type of pneumonia/
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Lobar: Pneumococcus
Broncho: staph aureus, H. flu, Kleb, Strep.pyogenes Interstitial: Viruses (RSV, adeno), Mycoplasma, Legionella, Chlamydia |
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Characteristics of Lobar Pneumonia?
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Intra-alveolar exudate--->consolidation
May involve entire lung |
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Characteristics of Bronchopneumonia?
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Acute inflammatory infiltrates from bronchioles into adjacent alveoli
Patchy distribution involve at least 1 lobe |
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Characteristics of Interstitial/Atypical Pneumonia?
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Diffuse, patchy inflammation localized to interstitial areas at alveolar walls
Usually a more indolent course than broncho |
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What is a lung abscess? usually cause by?
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Localized collection of pus w/in parenchyma
Usually from bronchial obstruction (cancer) or aspiration of oropharyngeal contents (esp in folks like alcoholics and epileptics) |
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Bugs commonly causing Lung Abscesses?
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Staph. aureus
Anaerobes |
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Causes of Pleural Transudate Effusions?
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CHF
Nephrotic Syndrome Hepatic Cirrhosis |
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Causes of Pleural Exudate Effusions?
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Malignancy
Pneumonia Collagen vascular disease Trauma |
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What is a Lymphatic Pleural Effusion like?
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Milky Fluid
Inc TG's |
