First Aid - Respiratory - Pathology

Front 1

Emboli types & associations

Back 1

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

Front 2

"lines of Zahn"

Back 2

plumonary thromboembolus

interdigitating areas of pink & red in embolus form "___"
represent layers of RBCs, platelets, & fibrin laid down if thrombus formed before death

Front 3

Virchow's Triad

Back 3

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)

Front 4

Homan's sign

Back 4

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

Front 5

PFTs:

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

Back 5

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

Front 6

PFTs:

FEV1/FVC ratio > 80%
decreased FVC & TLC

Back 6

PFTs:

FEV1/FVC ratio > 80%
decreased FVC & TLC

**Restrictive Lung Dz

Front 7

Types of Obstructive Lung Dz

Back 7

Types of Obstructive Lung Dz

Chronic Bronchitis
Emphysema
Asthma
Bronchiectasis

Front 8

Chronic Bronchitis

-pathologic features
-criteria
-what airways?
-what findings?

Back 8

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

Front 9

Emphysema

-pathologic features
-findings

Back 9

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

Front 10

Asthma

-pathologic features
-triggers
-diagnostic test
-findings

Back 10

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

Front 11

Bronchiectasis

-pathophys
-findings
-associations
-leads to

Back 11

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

Front 12

Types of Restrictive lung Dz

Back 12

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)

Front 13

"Eggshell" calcification of hilar lymph nodes

Back 13

Silicosis

Front 14

"ivory white" calcified pleural plaques

Back 14

Asbestosis

Front 15

golden-brown fusiform rods resembling dumbbells, inside macrophages

Back 15

Asbestosis

Front 16

shipbuilding, roofing, plumbing

Back 16

Asbestosis

*increased incidence: bronchogenic carcinoma & mesothelioma

Front 17

foundries, sandblasting, mines

Back 17

Silicosis

-macrophages release fibrogenic factors --> fibrosis

Front 18

Neonatal Respiratory Distress Syndrome:

-gestational age
-dx test
-risk of therapy
-risk factors
-tx

Back 18

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

Front 19

Acute Respiratory Distress Syndrome (ARDS)

-pathophys
-findings
-causes

Back 19

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

Front 20

chronically tired w/erythrocytosis

Back 20

sleep apnea
**hypoxia --> epo release --> erythrocytosis

Front 21

Trachea deviates:

-towards side of lesion -->
-away from side of lesion -->

Back 21

Trachea deviates:

-towards side of lesion --> spontaneous pneumothorax, bronchial obstruction
-away from side of lesion --> tension pneumothorax

Front 22

"coin" lesion on X-ray

Back 22

lung cancer

Front 23

pneumonic non-calcified nodule on CT

Back 23

lung cancer

Front 24

Metastases to lung MC from:

Back 24

Metastases to lung MC from:

-breast
-colon
-prostate
-bladder

Front 25

Lung cancer MC metastasize to:

Back 25

Lung cancer MC metastasize to:

-adrenals
-brain
-bone
-liver

Front 26

Lung cancer complications:

Back 26

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)

Front 27

Lung cancer w/ectopic ACTH or ADH

Back 27

Lung cancer w/ectopic ACTH or ADH

Small cell carcinoma

Front 28

Kulchitsky cells

Back 28

Kulchitsky cells

small cell carcinoma

Front 29

Most common lung cancer in non-smokers

Back 29

Adenocarcinoma

Front 30

Most common lung cancer in females

Back 30

Adenocarcinoma

Front 31

Lung cancer w/keratin pearls & intercellular bridges

Back 31

Squamous cell carcinoma

Front 32

Lung cancer w/cavitation, smoking

Back 32

Squamous cell carcinoma

Front 33

Lung cancer w/pleomorphic giant cells w/leukocyte fragments in cytoplasm

Back 33

Large cell carcinoma

(poor prognosis, less responsive to chemo, must remove surgically)

Front 34

Lung neoplasm secreting serotonin

Back 34

Carcinoid tumor

fibrous deposits in right heart --> tricuspid insufficiency, pulm stenosis, rt heart failure

Front 35

Flushing, diarrhea, wheezing, salivation

Back 35

Carcinoid syndrome

Front 36

Hemorrhagic pleural effusions & pleural thickening

Back 36

Mesothelioma

malignancy
associated with asbestosis
psammoma bodies

Front 37

Lung tumor - ptosis, miosis, anhidrosis

Back 37

Pancoast tumor
**tumor in apex of lung
**may affect cervical sympathetic plexus --> Horner's syndrome

Front 38

Facial plethora, JVD, edema of upper extremities

Back 38

Superior Vena Cava syndrome
**MCC by neoplasms & thromboses
**raise intracranial pressure --> headaches/dizziness
**increase risk of aneurysm/rupture of cranial arteries

Front 39

MCC Lobar Pneumonia

Back 39

Pneumococcus (aka strept pneumoniae) most frequently
Klebsiella

Front 40

MCC Bronchopneumonia

Back 40

Staph aureus
Haemophilus influenza
Klebsiella
Strept pneumoniae

Front 41

MCC Interstitial (atypical) pneumonia

Back 41

Viruses (RSV, adenovirus)
Mycoplasma
Legionella
Chlamydia

Front 42

MCC Lung abscesses

Back 42

S. aureus
Anaerobes (bacteroides, fusobacterium, peptostreptococcus)

-bronchial obstruction (cancer)
-aspiration (alcoholics, epileptics)

Front 43

Transudative Pleural Effusion

Back 43

decreased protein content

Due to:
CHF
nephrotic syndrome
hepatic cirrhosis

Front 44

Exudative Pleural Effusion

Back 44

increased protein content, cloudy

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

*must drain b/c of infection risk

Front 45

Lymphocytic Pleural Effusion

Back 45

aka chylothorax

Milky-appearing
increased triglycerides

Front 46

Spontaneous vs Tension Pneumo

Back 46

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