Fa: Respiratory - Pathology - 3

Front 1

What type of lung cancer occurs in the apex of the lung? What can it do?

Back 1

Pancoast tumor:

May affect cervical sympathetic plexus causing:
- Horner syndrome (ipsilateral ptosis, miosis, and anhidrosis)
- SVC syndrome
- Sensorimotor deficits
- Hoarseness

Front 2

What are the symptoms of Horner syndrome?

Back 2

Ipsilateral ptosis, miosis, and anhidrosis

Front 3

What happens in Superior Vena Cava Syndrome?

Back 3

Obstruction of the SVC impairs blood drainage from the head, neck, and upper extremities

Front 4

What are the implications of the blood drainage obstruction of the head, neck, and upper extremities in superior vena cava syndrome?

Back 4

- Head → facial plethora
- Neck → jugular venous distention
- Upper extremities → edema

Medical emergency

Front 5

What can cause Superior Vena Cava Syndrome?

Back 5

Commonly caused by malignancy and thrombosis from indwelling catheters

Front 6

What can Superior Vena Cava Syndrome cause if the obstruction is severe?

Back 6

Can raise intracranial pressure → headaches, dizziness, and ↑ risk of aneurysm / rupture of intracranial arteries

Front 7

What are the types of pneumonia?

Back 7

- Lobar
- Bronchopneumonia
- Interstitial (atypical) pneumonia

Front 8

What are the typical causative organisms responsible for lobar pneumonia?

Back 8

- S. pneumoniae most frequently
- Also Legionella and Klebsiella

Front 9

What are the typical causative organisms responsible for bronchopneumonia?

Back 9

- S. pneumoniae
- S. aureus
- H. influenzae
- Klebsiella

Front 10

What are the typical causative organisms responsible for interstitial (atypical) pneumonia?

Back 10

- Viruses (influenza, RSV, adenoviruses)
- Mycoplasma
- Legionella
- Chlamydia

Front 11

What are the characteristics of lobar pneumonia?

Back 11

Intra-alveolar exudate → consolidation
- May involve entire lung

Front 12

What are the characteristics of bronchopneumonia?

Back 12

- Acute inflammatory infiltrates from bronchioles into adjacent alveoli
- Patchy distribution involving ≥ 1 lobe

Front 13

What is the histologic appearance of bronchopneumonia?

Back 13

Neutrophils in alveolar space

Front 14

What are the characteristics of interstitial (atypical) pneumonia?

Back 14

- Diffuse patchy inflammation localized to interstitial areas at alveolar walls
- Distribution involving ≥ 1 lobe
- Generally follows a more indolent course

Front 15

What does this chest x-ray show?

Back 15

Interstitial Pneumonia: coarse bilateral reticular opacities, worse on the right side

Front 16

What is wrong in a lung abscess?

Back 16

Localized collection of pus within the parenchyma

Front 17

What can cause a lung abscess?

Back 17

Bronchial obstruction (eg, cancer) or aspiration of oropharyngeal contents (especially in patients predisposed to loss of consciousness [eg, alcoholics or epileptics])

Front 18

What does this chest x-ray show?

Back 18

Lung Abscess
- Localized collection of pus within parenchyma
- Air-fluid levels can be seen by arrows

Front 19

What are the most common causes of lung abscesses?

Back 19

- S. aureus
- Anaerobes (Bacteroides, Fusobacterium, or Peptostreptococcus)

Front 20

What is wrong in a pleural effusion?

Back 20

Excess accumulation of fluid between the two pleural layers → restricts lung expansion during inspiration

Front 21

What does this chest x-ray show? How would you describe it?

Back 21

Pleural Effusion
- Blunting of the left costophrenic angle (arrow) due to fluid in the pleural space

Front 22

What are the types of pleural effusions?

Back 22

- Transudate
- Exudate
- Lymphatic

Front 23

What are the components of transudative pleural effusions? What can cause this?

Back 23

- ↓ Protein content
- Due to CHF, nephrotic syndrome, or hepatic cirrhosis

Front 24

What are the components of exudative pleural effusions? What can cause this?

Back 24

- ↑ Protein content
- Due to malignancy, pneumonia, collagen vascular disease, trauma (occurs in states of ↑ vascular permeability)

Front 25

What are the components of lymphatic pleural effusions / chylthorax? What can cause this?

Back 25

- ↑ Triglycerides, milky-appearing fluid
- Due to thoracic duct injury from trauma or malignancy

Front 26

What type of pleural effusion needs to be drained? Why?

Back 26

Exudative: must be drained due to risk of infection

Front 27

Which type of fluid is found in a pleural effusion caused by CHF, nephrotic syndrome, or hepatic cirrhosis?

Back 27

Transudate: ↓ protein content

Front 28

Which type of fluid is found in a pleural effusion caused by malignancy, pneumonia, collagen vascular disease, or trauma?

Back 28

Exudate: ↑ protein content

Front 29

Which type of fluid is found in a pleural effusion caused by thoracic duct injury from trauma or malignancy?

Back 29

Lymphatic / Chylothorax: ↑ triglycerides (milky-appearing)

Front 30

What is wrong in a pneumothorax?

Back 30

Accumulation of air in the pleural space

Front 31

What signs and symptoms occur in patients with pneumothorax?

Back 31

All on affected side:
- Unilateral chest pain
- Dyspnea
- Unilateral chest expansion
- ↓ Tactile fremitus
- Hyperresonance
- Diminished breath sounds

Front 32

What are the types of pneumothorax?

Back 32

- Spontaneous pneumothorax
- Tension pneumothorax

Front 33

What are the characteristics of a spontaneous pneumothorax? Cause?

Back 33

- Accumulation of air in the pleural space
- Occurs most frequently in tall, thin, young males because of rupture of apical blebs

Front 34

What are the characteristics of a tension pneumothorax? Cause?

Back 34

- Air is capable of entering pleural space but not exiting
- Trachea deviates AWAY from the affected lung
- Usually occurs in setting of trauma or lung infection

Front 35

A rupture of an apical bleb in a tall, thin, young male is likely to cause what?

Back 35

Spontaneous Pneumothorax: accumulation of air in pleural space