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102 Cards in this Set

  • Front
  • Back
Intra-alveolar accumulation of fluid
Pulmonary edema
2 general causes of Pulmonary Edema
1. Hemodynamic derangements
-congestive heart failure
-decreased plasma oncotic pressure

2. Increased capillary permeability due to direct microvascular injury
Most common cause of Pulmonary Edema
Left-sided heart failure
How much can Lymphatic drainage increase before appreciable pulmonary edema occurs?
Type of edema associated with alteration in Starling's pressure
-Congestive Heart Failure
Transudate = low protein content
Type of edema associated with microvascular or alveolar damage?
Edema with low protein content and low specific gravity
What are 4 possible causes of increased Hydrostatic pressure resulting in Hemodynamic edema?
1. Left heart failure
2. Mitral Stenosis
3. Volume overload
4. Pulmonary Vein obstruction
What are 3 diseases that would result in Hypoalbuminemia and therefore Pulmonary Edema
1. Nephrotic syndrome = losing protein in the urine

2. Liver disease/cirrhosis = not producing albumin

3. Protein-losing enteropathy = albumin is lost via the gut
How could Lymphatics be involved in Pulmonary Edema?
Lymphatic obstruction such as Metastatic Cancer could prevent fluid from being drained off
Auscultation sound heard with Pulmonary Edema?

Treatment for Pulmonary Edema?
Wet rales

Diuretic (Lasix = Furosemide)
"Diffuse Alveolar Damage" is the same thing as...
Acute Respiratory Distress Syndrome
Increase in Alveolar capillary permeability causing leakage of protein-rich fluid into alveoli
Acute Respiratory Distress Syndrome
Drug that is used to treat testicular cancer that can cause ARDS
Drug used to treat fungal infections that can cause ARDS
Amphotericin B
Drug used to treat Gout that can cause ARDS
What is the best way to treat ARDS?
remove the inciting cause
2 causes of Edema of Undetermined Origin
High Altitude Pulmonary Edema

Neurogenic edema -> severe brain trauma
Most common cause of ARDS
Pathognomonic feature of ARDS (5)
Hyaline Membranes
Clinical findings of ARDS
1. accelerated onset of respiratory insufficiency
2. progressive infiltrates on CXR
-CXR is normal initially
-progresses to diffuse bilateral infiltrates
3. Tachycardia
4. Cyanosis
5. Severe Arterial Hypoxemia which is refractory (unresponsive) to oxygen therapy
Cells that line the alveoli
Type I pneumocytes
Cells that secrete Surfactant
Type II Pneumocytes
Loss of lung volume due to inadequate expansion of the airspaces = lung collapse
When does Surfactant synthesis begin?
at or after 28th week of gestation
Major component of surfactant
Phosphatidylcholine (lecithin)
What is Surfactant stored in in Type II Pneumocytes
Lamellar bodies
Surfactant synthesis is increased by these 2 things
Cortisol (Glucocorticoids)

What causes decreased synthesis of Surfactant?
What are 3 possible causes of decreased surfactant in fetal lungs?
1. Prematurity

2. Maternal diabetes = fetal hyperglycemia increases insulin release = insulin decreases surfactant synthesis

3. C-section = lack of stress-induced increase in Cortisol from a vaginal delivery = Cortisol increases Surfactant synthesis
At what week is surfactant made most abundantly during gestation?
35th week
What are 4 complications of Hyaline Membrane Disease of the Newborn?
1. Pulmonary Interstitial Edema

2. Pneumothorax = accumulation of gas/air in pleural cavity

3. Retrolental Fibroplasia = abnormal replacement of the sensory retian by fibrous tissue and blood vessels, mostly due to high-O2 treatment

4. Ventricular Brain Hemorrhage
Parts of the Respiratory passages that Obstructive Lung Diseases can affect
From the Trachea to the Respiratory Bronchioles
3 Pulmonary Functional Tests decreased in COPD
1. FEV1 = amount of air expelled from the lungs in 1 second after a maximal inspiration

2. FEV1/FVC = 4L / 5L in a normal person

3. Arterial pressure of O2 (PaO2)

*FVC is usually normal or slightly increased in COPD
**FVC = total amount of air expelled after a maximal inspiration (normal is 5L)
What 2 Pulmonary Functional Tests are increased in Restrictive Lung Disease

2. A-a gradient = increase in the difference in O2 in the Alveoli compared to the Arteries = hypoxemia of pulmonary origin
Prognosis of Neonatal Respiratory Distress Syndrome
30-50% fatality rate
Prognosis for Acute Respiratory Distress Syndrome
60% fatality rate
Enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls
Increase in resistance to air flow out of the lungs, resulting in air trapped in the lungs
Obstructive Lung Disease
What is the major cause of Emphysema?

*alpha1-antitrypsin is another cause
Parts of the Respiratory passages that Obstructive Lung Diseases can affect
From the Trachea to the Respiratory Bronchioles
What is the most common type of Emphysema?
Centriacinar (Centrilobular)
What are 4 examples of Obstructive Lung Diseases
1. Asthma
2. Chronic Bronchitis
3. Emphysema
4. Bronchiectasis

Type of Emphysema caused by Smoking?
Type of Emphysema caused by Alpha-1-antitrypsin deficiency
What is Restrictive Lung Disease?
reduced expansion of the lung parenchyma and decreased total lung capacity
What is the most common type of Emphysema?
Centriacinar (Centrilobular)
Part of the acini that Centriacinar emphysema affects
central part, sparing the distal alveoli

Respiratory bronchioles are dilated
Type of Emphysema with anthracotic pigment
Type of Emphysema that primarily involves the apical segments of the upper lobe
Gender that Centriacinar emphysema is most common in
Type of Emphysema in which entire acinus is dilated
Emphysema associated with large subpleural bullae
Emphysema associated with risk for spontaneous pneumothorax
Emphysema that affects primarily the lower lobes
Emphysema with scarring (fibrosis) of the acinus within the walls of enlarged air spaces usually a complication of various inflammatory processes
Irregular emphysema
Enzyme that is at heightened activity in Emphysema
Neutrophil Elastase
Where is Alpha-1-antitrypsin synthesized?

What genotype interferes with AAT secretion?

piZZ homozygous state
*pi = proteinase inhibitor
Decent of people who primarily have AAT deficiency emphysema
Northern European decent
Explain the age differences in AAT deficiency emphysema and Smoking emphysema
AAT = patients are classically around 25 yoa

Smoking = classically around 40 yoa
Give 2 reasons why smoking causes emphysema
1. attracts neutrophils and macrophage = sources of Elastase

2. inactivates AAT = usually neutralize Elastase
How is diagnosis of AAT deficiency made?
DNA-based cheek swab test
Restrictive Lung Disease:
- increase or decrease in compliance?

- increase or decrease in elasticity?
decrease = difficult to take air in

increase = easy to push air out
chronic necrotizing infection of bronchi and bronchioles, resulting in abnormal dilation
4 diseases that Bronchiectasis is associated with
1. Bronchial obstruction
2. Cystic Fibrosis
3. Poor ciliary motility
4. Kartagener's syndrome
Disease with sinusitis, bronchiectasis, and situs inversus, sometimes with hearing loss and male sterility

*ultimate cause is due to a defect in the motility of respiratory, auditory, and sperm cilia = absent DYNEIN arm in cilia
Kartagener syndrome
Most common cause of Bronchiectasis in US?

Cystic Fibrosis (P. aeruginosa)

Bronchiectasis most commonly occurs in which lobes of the lungs?
Lower lobes
3 clinical findings with Bronchiectasis
1. Purulent sputum
2. Recurrent infections
3. Hemoptysis
At least 3 months of productive sputum for 2 or more consecutive years
Chronic Bronchitis
Hypertrophy of mucus-secreting glands in the bronchioles
Chronic Bronchitis
What is the Reid index?
= gland depth / total thickness of bronchial wall

-used in measuring Chronic Bronchitis
What is the Reid index greater than in Chronic Bronchitis?
Type of metaplasia in Chronic Bronchitis
Squamous metaplasia

*loss of ciliated epithelia
Describe Asthma
Bronchial hyperresponsiveness causes reversible bronchoconstriction resulting in trapping of air in the lungs
List 3 general causes of Asthma
1. Extrinsic = allergens = Type I HS = IgE mediated
2. Intrinsic = viral URI's
3. Aspirin sensitive = clinical triad = nonsteroidal drugs, asthma, nasal polyps
Mucus plugs containing denuded epithelium found in asthma
Curschmann spirals
Collection of crystalloid composed of eosinophil membrane protein in asthma patients
Charcot-leyden crystals
Type of hyperplasia found in Asthma
Goblet cell hyperplasia
COPD with Eosinophils
Adult Respiratory Distress Syndrome
- Hyaline membranes
- Bilateral infiltrates
A 60 year old man presented with Dyspnea, tachypnea, and cyanosis.

What is the diagnosis?
What is the therapy for Hyaline Membrane Disease of the Newborn?
- remove the initial insult

- Ventilator -> Positive end-expiratory Pressure
What are 4 examples of Chronic Obstructive Lung Disease?
1. Asthma
2. Chronic bronchitis
3. Emphysema
4. Bronchiectasis
Pink Puffer = slowing of forced expiration through pursed lips

What disease?
What is the mechanism of obstruction in Emphysema?
Loss of elastic recoil of the acini = air gets trapped in the acini
What is the cause of Chronic Bronchitis in 90% of cases?
Disease that affected are referred to as "Blue Bloaters"
Chronic Bronchitis
-Hypertrophy of Bronchial Smooth muscle
-Hyperplasia of bronchial submucosal glands
-Mucous plugs
-Bronchial cartilage at right
-Mucus plug at left
-Submucosa widened by Smooth Muscle Hypertrophy
What lung pathology?

Explain what you see
Hyperreactive airways, resulting in episodic bronchospasm when triggered by certain stimuli
List some causes of Intrinsic Asthma
1. Respiratory infections
2. Stress
3. Exercise
4. Cold
5. Aspirin -> Asthma, Nasal Polyps, Chronic pain syndrome
Asthma b/c there are Eosinophils present
What COPD would this be? Why?
Bronchiectasis = permanent dilation of bronchi and bronchioles
What COPD is this?
What is this picture showing?
- dilated bronchi and bronchioles
- P. aeruginosa with
What do these indicate?
- Dilated bronchioles with Signet-ring appearance
- Due to Cystic Fibrosis
What is this?
Panacinar Emphysema
AAT deficiency
Lower lobes (but all part can be affected)
What is this?
What causes it?
What part of lung is primarily affects?
Panacinar Emphysema
What are these showing?
Panacinar Emphysema
What is this?
Centriacinar Emphysema
-peripheral alveoli are normal
What is this?
Diffuse Alveolar Damage

Hyaline Membranes
What is this?
Centriacinar Emphysema
-holes are located around the terminal bronchioles

Rupture causing Pneumothorax
What is this?

What is a potential complication?