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46 Cards in this Set

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Emboli types & associations
Emboli types & associations

embolus moves like a FAT BAT
**Fat
**Air
**Thrombus
**Bacteria
**Amniotic fluid
**Tumor

Fat emboli - long bone fractures & liposuction
Amniotic fluid - DIC, especially postpartum
"lines of Zahn"
plumonary thromboembolus

interdigitating areas of pink & red in embolus form "___"
represent layers of RBCs, platelets, & fibrin laid down if thrombus formed before death
Virchow's Triad
Virchow's Triad
-predispose to DVT --> tx w/heparin

1.) Stasis
2.) Hypercoagulability (defect in coagulative cascade prtns)
3.) Endothelial damage (exposed collagen triggers clotting cascade)
Homan's sign
tender calf mm on passive dorsiflexion of foot
(UpToDate - NOT pain/tenderness, but resistance to abrupt dorsiflexion by examiner when knee is fully extended)

-indicative of DVT
PFTs:

very decreased FEV1
decreased FVC
--> decreased FEV1 / FVC ratio
V/Q mismatch
PFTs:

very decreased FEV1
decreased FVC
--> decreased FEV1 / FVC ratio
V/Q mismatch

**Obstructive Lung Dz (COPD)
-obstruction of air flow resulting in air trapping in the lungs
-airways close prematurely at high lung volumes
--increased RV
--decreased FVC
PFTs:

FEV1/FVC ratio > 80%
decreased FVC & TLC
PFTs:

FEV1/FVC ratio > 80%
decreased FVC & TLC

**Restrictive Lung Dz
Types of Obstructive Lung Dz
Types of Obstructive Lung Dz

Chronic Bronchitis
Emphysema
Asthma
Bronchiectasis
Chronic Bronchitis

-pathologic features
-criteria
-what airways?
-what findings?
Chronic Bronchitis
**"Blue Boater"
**Obstructive Lung Dz

-pathologic features
**hypertrophy of mucus-secreting glands in bronchioles
**reid index = gland depth / total thickness of bronchiol wall
**COPD reid index > 50%

-criteria
**productive cough > 3 mos / yr for >2 years

-what airways?
**small airway dz

-what findings?
**wheezing
**crackles
**cyanosis (early onset hypoxemia from shunting)
**late-onset dyspnea
Emphysema

-pathologic features
-findings
Emphysema
**"pink puffer"
**barrel shaped chest
**Obstructive Lung Dz

-pathologic features
**enlargement of air spaces
**decreased recoil (from alveolar wall destruction)

-what findings?
**increased elastase activity
**increased compliance (loss of elastic fibers)
**exhalation thru pursed lips to increase airway pressure, prevent airway collapse during respiration
Asthma

-pathologic features
-triggers
-diagnostic test
-findings
Asthma
**bronchial hyperresponsiveness --> reversible bronchoconstriction
Obstructive Lung Dz

-pathologic features
**smooth mm hypertrophy
**Curschmann's spirals (shed epithelium from mucous plugs)

-triggers
**viral URIs
**alergens
**stress

-diagnostic test
**mathacholine challenge

-findings
**cough
**wheezing
**tachypnea
**dyspnea
**hypoxemia
**decreased I/E ratio (b/c expiratory phase is prolonged)
**pulsus paradoxus
**mucous plugging
Bronchiectasis

-pathophys
-findings
-associations
-leads to
Bronchiectasis
**Obstructive lung dz

-pathophys
**chronic necrotizing infection of bronchi --> permanently dilated airways

-findings
**purulent sputum
**recurrent infections
**hemoptysis

-associations
**bronchial obstruction
**poor ciliary motility (smoking)
**Kartagener's (cilia problem - situs inversus; chronic infections)

-leads to
**can --> aspergillosis
Types of Restrictive lung Dz
Types of Restrictive lung Dz

1.) Poor breathing mechanics (extrapulmonary, peripheral hypoventilation)
**a. poor muscular effort --> polio, myasthenia gravis
**b. poor structural apparatus - scoliosis, morbid obesity

2.) Interstitial lung dz's (pulmonary, lowered diffusing capacity)
**a. Acute respiratory distress syndrome (ARDS)
**b. Neonatal respiratory distress syndrome (hyaline membrane dz)
**c. Pneumoconioses (coal miner's, silicosis, asbestosis)
**d. Sarcoidosis - bilateral hilar lymphadenopathy, noncaseating granuloma; increased ACE & calcium
**e. Idiopathic pulmonary fibrosis (repeated cycles lung injury & wound healing w/increased collagen)
**f. Goodpasture's syndrome
**g. Wegener's granulomatosis
**h. Eosinophilic granuloma (histiocytosis X)
**i. Drug toxicity (bleomycin, busulfan, amiodarone)
"Eggshell" calcification of hilar lymph nodes
Silicosis
"ivory white" calcified pleural plaques
Asbestosis
golden-brown fusiform rods resembling dumbbells, inside macrophages
Asbestosis
shipbuilding, roofing, plumbing
Asbestosis

*increased incidence: bronchogenic carcinoma & mesothelioma
foundries, sandblasting, mines
Silicosis

-macrophages release fibrogenic factors --> fibrosis
Neonatal Respiratory Distress Syndrome:

-gestational age
-dx test
-risk of therapy
-risk factors
-tx
Neonatal Respiratory Distress Syndrome:

-gestational age
**surfactant made by type II pneumocytes after 35th week

-dx test
**lecithin to sphingomyelin ratio
**often < 1.5 in NRDS

-risk of therapy
**persistantly low O2 tension --> risk of PDA
**therapeutic O2 can result in retinopathy of prematurity

-risk factors
**prematurity
**maternal diabetes (from elevated insulin)
**cesarean deliver (decreased release of fetal glucocorticoids)

-tx
**maternal steroids before birth
**artificial surfactant for infant
**thyroxine
Acute Respiratory Distress Syndrome (ARDS)

-pathophys
-findings
-causes
Acute Respiratory Distress Syndrome (ARDS)

-pathophys
**diffuse alveolar damage
**increased capillary permeability
**protein rich leakage into alveoli
**initial damage due to release of neutrophilic substances toxic to alveolar wall, activation of coagulation cascade, & oxygen-derived free radicals

-findings
**intra-alveolar hyaline membrane
**alveolar fluid

-causes
**trauma
**sepsis
**shock
**gastric aspiration
**uremia
**acute pancreatitis
**amniotic fluid embolism
chronically tired w/erythrocytosis
sleep apnea
**hypoxia --> epo release --> erythrocytosis
Trachea deviates:

-towards side of lesion -->
-away from side of lesion -->
Trachea deviates:

-towards side of lesion --> spontaneous pneumothorax, bronchial obstruction
-away from side of lesion --> tension pneumothorax
"coin" lesion on X-ray
lung cancer
pneumonic non-calcified nodule on CT
lung cancer
Metastases to lung MC from:
Metastases to lung MC from:

-breast
-colon
-prostate
-bladder
Lung cancer MC metastasize to:
Lung cancer MC metastasize to:

-adrenals
-brain
-bone
-liver
Lung cancer complications:
Lung cancer complications:

SPHERE of Complications

Superior vena cava syndrome
Pancoast tumor
Horner's syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial)
Lung cancer w/ectopic ACTH or ADH
Lung cancer w/ectopic ACTH or ADH

Small cell carcinoma
Kulchitsky cells
Kulchitsky cells

small cell carcinoma
Most common lung cancer in non-smokers
Adenocarcinoma
Most common lung cancer in females
Adenocarcinoma
Lung cancer w/keratin pearls & intercellular bridges
Squamous cell carcinoma
Lung cancer w/cavitation, smoking
Squamous cell carcinoma
Lung cancer w/pleomorphic giant cells w/leukocyte fragments in cytoplasm
Large cell carcinoma

(poor prognosis, less responsive to chemo, must remove surgically)
Lung neoplasm secreting serotonin
Carcinoid tumor

fibrous deposits in right heart --> tricuspid insufficiency, pulm stenosis, rt heart failure
Flushing, diarrhea, wheezing, salivation
Carcinoid syndrome
Hemorrhagic pleural effusions & pleural thickening
Mesothelioma

malignancy
associated with asbestosis
psammoma bodies
Lung tumor - ptosis, miosis, anhidrosis
Pancoast tumor
**tumor in apex of lung
**may affect cervical sympathetic plexus --> Horner's syndrome
Facial plethora, JVD, edema of upper extremities
Superior Vena Cava syndrome
**MCC by neoplasms & thromboses
**raise intracranial pressure --> headaches/dizziness
**increase risk of aneurysm/rupture of cranial arteries
MCC Lobar Pneumonia
Pneumococcus (aka strept pneumoniae) most frequently
Klebsiella
MCC Bronchopneumonia
Staph aureus
Haemophilus influenza
Klebsiella
Strept pneumoniae
MCC Interstitial (atypical) pneumonia
Viruses (RSV, adenovirus)
Mycoplasma
Legionella
Chlamydia
MCC Lung abscesses
S. aureus
Anaerobes (bacteroides, fusobacterium, peptostreptococcus)

-bronchial obstruction (cancer)
-aspiration (alcoholics, epileptics)
Transudative Pleural Effusion
decreased protein content

Due to:
CHF
nephrotic syndrome
hepatic cirrhosis
Exudative Pleural Effusion
increased protein content, cloudy

Due to:
malignancy
pneumonia
collagen vascular dz
trauma (w/increased vascular permeability)

*must drain b/c of infection risk
Lymphocytic Pleural Effusion
aka chylothorax

Milky-appearing
increased triglycerides
Spontaneous vs Tension Pneumo
Spontaneous Pneumo
-tall, thin, young males
-rupture of apical blebs
-trachea deviates TOWARDS affected lung
-accumulation of air in pleural space

Tension Pneumothorax
-setting of trauma, lung infection
-air can enter pleural space but not exit
-trachea deviates AWAY from affected lung