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128 Cards in this Set
- Front
- Back
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What is the hallmark of diffuse alveolar damage (DAD)?
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Hyaline membrane
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Most of ARDS/DAD is due to what?
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1. Sepsis
2. Diffuse pulmonary infections 3. Trauma 4. Gastric aspiration |
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In the early and late phase of ARDS/DAD, what cytokines are released by macrophages?`
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Early phase = TNF-alpha, IL-1, IL-8
Late phase = TGF-beta, PDGF |
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How do compression and resorption atelectasis differ in lung deviation?
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Resorption = shift to side of lesion
Compression = shift to opposite side of lesion |
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What is the only type of atelectasis that is NOT reversible?
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Contraction atelectasis
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What is the only treatment for ARDS/DAD that improves survival?
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Lung protective strategy -- tidal volume titrated to 6 ml/kg of predicted body weight
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How do you tell the difference between ARDS and ALI?
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ALI P/F ratio <300 but >200
ARDS P/F ratio <200 |
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In which phase of ARDS/DAD would you see a normal CXR?
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Early phase
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What is considered normal pulmonary pressure? Hypertension?
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Normal: 1/8 of systemic pressure
HTN: >1/4 of systemic pressure |
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Which mutation is seen in familial pulmonary HTN?
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BMPR2 mutation -- causes proliferation of smooth muscle in pulmonary vasculature
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When and where are atheromas seen?
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Main elastic arteries; pulmonary HTN
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What is the pathogenesis of Goodpasture Syndrome?
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IgG antibody against basement membrane (collagen Type IV)
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What organ systems are affected by Goodpasture and Wegeners syndrome?
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Lungs
Kidneys -- see renal failure |
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Idiopathic pulmonary hemosiderosis is commonly seen in which age group?
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Children and young adults
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Hypersensitivity pneumonitis is due to which type of hypersensitivity?
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Acute - type III
Chronic - type IV |
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Eosinophils is seen in which type of hypersensitivity?
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Type I
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ALI/ARDS destruction is mediated by which type of white blood cells?
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Neutrophils
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Mechanical ventilation for ARDS/ALI patients may put them at risk for what?
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Ventilation pneumonia
Ventilation associated lung injury |
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Pulmonary wedge pressure of what would indicate that there is not left sided heart failure?
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Less than or equal to 18 mmHg
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What happens to the surfactant and alveoli surface tension in ARDS?
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Inactivated surfactant; increased surface tension
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Bronchoalveolar lavage will show what in a patient with ARDS vs healthy?
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ARDS--50% PMNs
Normal -- 3% PMNs, mostly macrophages |
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Patients who develop cough, dyspnea and hypoxemia within 6 hours of transfusion most likely has which disease?
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TRALI (transfusion related acute lung injury)
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A FI O2 of what is associated with increased inflammation and fibrosis?
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0.60
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Honeycomb lung is usually seen in which type of diseases?
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Chronic restrictive diseases
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How much does risk of ventilation associated pneumonia increase with intubation?
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1-3% per day of intubation
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Late VAP (ventilation associated pneumonia) occurs when?
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At least 5 days after ventilation/intubation
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What is the morphology of idiopathic pulmonary fibrosis?
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Usual interstitial pneumonia
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What type of cells are type II pneumocytes?
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Cuboidal cells
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What are the 2 main differences in morphology of nonspecific interstitial pneumonia and idiopathic pulmonary fibrosis?
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NIP--no fibroblastic foci or regional/temporal heterogeneity
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What do Schaumann bodies contain?
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Calcium and protein
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What do asteroid bodies contain?
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Stellate inclusions within granulomas
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In which disease can Schaumann bodies and asteroid bodies be found?
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Sarcoidosis
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What type of hypersensitivity is found in Hypersensitivity Pneumonitis?
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Type III (acute)
Type IV (chronic) |
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Where does coal usually accumulate in the lung?
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Upper lobes
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TLC in restrictive lung disease is less than what percent predicted?
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80%
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Ground glass opacities on CXR is indicative of what type of diseases?
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Interstitial lung disease (group of chronic restrictive lung disorders)
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What type of lung sounds do you hear in interstitial pulmonary fibrosis?
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Crackles
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What is the usual treatment for sarcoidosis?
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Steroids (or resolve on own)
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Lymphocyte proliferative testing is useful to distinguish between which two diseases?
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Sarcoidosis and berylliosis
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Which type of lung disease is most often associated with connective tissue disorders?
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Nonspecific interstitial pneumonia
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Patients with what conditions have worse prognosis with PE?
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Hemodynamic instability (ie. RV dysfunction, shock)
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There is a synergy action of DVT risk factors and what other condition?
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Thrombophilias
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What is the clinical triad of PE?
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Dyspnea, chest pain, hemoptysis
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Why do pulmonary infarction and hemorrhage occur mostly in the lower lobe?
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Because there is more blood flow at the base of the lung
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What abnormalities in EKG may you might see in PE?
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Large S wave in lead I
Q wave in lead III T wave inversion in lead III |
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Ventricular septal bowing can occur with which condition?
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Pulmonary embolism.
Ventricular septal bowing can lead to LV dysfunction |
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What factors released during PE causes vasoconstriction?
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Serotonin
Thromboxane A2 |
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What is the role of BMPR-2?
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Decreases proliferation of vascular smooth muscle cells and increases apoptosis
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What condition is BMPR-2 associated with?
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Pulmonary HTN
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What histological features do you see in Goodpasture's syndrome?
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Alveolar septal thickening/fibrosis, alveolar hemorrhage, alveolar necrosis
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How is inflammation different in Goodpasture's vs. Wegener's?
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Both necrotizing but Wegener's is granulomatous
Goodpasture = IgG Wegeners = cANCA |
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Idiopathic pulmonary hemosiderosis usually affects what age group?
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Young adults and children
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Hemoptysis with renal insufficiency may indicate which disease?
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Goodpasture syndrome
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What symptoms would you see in idiopathic pulmonary hemosiderosis?
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Hemoptysis; anemia; weight loss
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What is the age difference between Wegener and Goodpasture?
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Goodpasture - 2nd and 3rd decade
Wegener - 5th decade |
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Granulomatous formation is an example of what type of hypersensitivity?
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Type IV
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Which type of bronchogenic carcinoma is most common in both males and females?
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Adenocarcinoma
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Which type of cancer is most common among NON-smokers?
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Adenocarcinoma
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Immunohistochemical stain shows mucin. Which type of cancer is it?
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Adenocarcinoma
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What is the survival for bronchogenic carcinoma?
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5 year survival rate
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What is the difference between typical and atypical carcinoid?
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Typical --no necrosis and less than 2 mitotic figures / hpf
Atypical -- necrosis and greater than 2 mitotic figures / hpf |
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Bibasilar crackles and non-productive cough are symptoms of what disease?
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Interstitial lung disease
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Deficient or inactive GM-CSF is associated with what condition?
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Pulmonary alveolar proteinosis
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How does COP (cryptogenic organizing pneumonia) differ from most other interstitial diseases in its fibrosis pattern?
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Fibrosis NOT in interstitium, but in lumina of bronchiole, alveoli etc.
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What are the two smoking related restrictive lung diseases?
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Desquamative Interestitial pneumonitis
Respiratory bronchiolitis associated interstitial lung disease |
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Which two diseases are PAS positive?
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Desquamative interstitial pneumonitis
Pulmonary alveolar proteinosis |
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What are pleural plaques associated with?
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Asbestosis--focus of dense collagen and calcification
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What tidal volume is used in PEEP with protective strategy?
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Titration to ~6ml/kg of predicted body weight
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What is the main cause of death in patients with ARDS/ALI?
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Multiorgan system failure
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Why wouldn't you necessarily treat a patient with ARDS/ALI with IV fluids?
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Can increase hydrostatic pressure and worsen the edema
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What is the peak pressure?
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Maximum airway pressure achieved by mechanical ventilation; represents resistance in proximal airways + ventilator
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What is the plateau pressure?
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Pressure that balances elastic recoil when airflow is ZERO
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What does an increase in plateau pressure in mechanical ventilation indicate?
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Decrease in compliance--greater pressure needed to overcome the elastic recoil
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Ventilator associated lung injury can be seen as an increase in peak or plateau pressure?
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Plateau pressure--decrease in compliance results in increase plateau pressure
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How can hypotension occur with PEEP?
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Too much PEEP decreases venous return--hypotension
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Sarcoidosis occurs more often in which groups?
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African american; women
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Farmer's lung is an example of what type of restrictive lung disease?
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Hypersensitivity pneumonitis
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What is the histological feature that differentiates eosinophils from other leukocytes?
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Bilobed nucleus
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Congo red stain?
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Amyloidosis
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Where are the macrophages found in desquamative interstitial pneumonitis versus respiratory bronchiolitis interstitial disease?
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Desquamative--clumps of macrophages in airsplaces
Respiratory--patchier clumps of macrophages in bronchiole and airspaces |
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What other structure can cryptogenic organizing pneumonia affect other than alveoli?
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Bronchiole
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Pleural plaques are associated with which type of pneumoconioses?
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Asbestos -- they are clinically insignificant
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Which type of pneumoconioses is associated with diffuse alveolar damage?
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Berylliosis
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Organizing pneumonia is associated with...?
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Cryptogenic organizing pneumonia
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What is the TLC of patients with restrictive lung disease?
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<80%
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What are the three hallmark features of interstitial lung disease?
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1. Dyspnea upon exertion
2. PFT--restrictive pathology 3. Diffuse reticular opacities (ground glass) |
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Reduced survival in interstitial pulmonary fibrosis is seen due to which co-morbidities?
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Pulmonary HTN and emphysema
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Most common eosinophilic lung disorder?
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Loeffler's syndrome
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On CT/HRCT, how can you tell if an infiltrate is due to edema or eosinophilic pneumonia?
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Eosinophilic pneumonia--subpleural, peripheral
Edema--central, perihilar |
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Gelatinous chunks?
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Pulmonary alveolar proteinosis
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What are some regional patterns of lung diseases?
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Upper--silicosis, coal, sarcoidosis, Langerhan's
Lower--asbestos, metal dust Base/subpleural--idiopathic pulmonary fibrosis |
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What is the treatment for interstitial lung disease?
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Lung transplant
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What lung disease may a cancer patient who is on bleomycin or cyclophosphamide be at risk for?
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Interstitial lung disease
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BAL from patient with ILD reveals foamy phospholipid laden macrophages. What drug exposure might a patient have?
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Amiodarone
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Patients with interstitial lung disease have a productive or non-productive cough?
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NON-productive
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What changes in a patients fingers might you see with advanced interstitial lung disease?
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Clubbing
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What is the imaging modality of choice to dx ILD?
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HCRT--will show any abnormalities in symptomatic patients
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Which disease has frequent pneumothorax?
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Langerhaan's
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Which interstitial lung disease has an obstructive pattern on PFT?
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Lymphangioleiomyomatosis---abnormal smooth muscle proliferation
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Bronchoscopy with transbronchial lung biopsy is useful to diagnose which restrictive lung diseases?
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Granulomatous or infectious
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What class of drugs do you give to patients with pneumoconioses?
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None--usually don't treat pharmacologically
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Pulmonary rehabilitation is a good treatment for which restrictive lung disease?
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Idiopathic pulmonary fibrosis
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What is the P/F ratio an indicator of?
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Possible hypoxia
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Ventilation with protective strategy indicates that plateau pressure should be no more than what?
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30 cmH2O
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What should be a ddx if your patient has a large A-a gradient?
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Pulmonary embolism
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What is the gold standard for diagnosing PE?
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Pulmonary angiography
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LDH plasma has to be greater than what upper limit of LDH serum to be considered an exudate?
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2/3
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Which bronchogenic CA is highly associated with lymphadenopathy?
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Small cell CA
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Which bronchogenic CA is most associated with smoking?
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Small cell CA
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Pancoast tumors typically have what morphology?
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Squamous cell
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Harlequin sign is associated with...?
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Horner's syndrome--Pancoast/sulcus tumor impinging on sympathetic ganglion
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How do you distinguish epitheloid malignant mesothelioma from adenocarcinoma?
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Malignant mesothelioma will have microvilli
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Hypercalcemia seen in which type of cancer?
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Squamous cell CA. NOT SCCA!!!
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What is the second leading cause of lung cancer?
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Radon/uranium exposure
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After how many years will a former smoker see a 80-90% decrease in risk of lung cancer?
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15 years
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Type of bronchogenic CA that grows along alveolar septa?
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Bronchioloalveolar CA
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Intracellular bridges?
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Squamous cell CA
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Type of cancer that can cause cavitary lesion?
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Squamous cell CA
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Tumor that can affect brachial plexus?
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Sulcus/Pancoast tumor
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Most common organs lung cancer metastasizes to?
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Liver (asymptomatic), adrenal glands (asymptomatic), bones, brain
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Cushing's syndrome due to inappropriate secretion of...?
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ACTH
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Inappropriate ADH secretion causes...
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Seizure, coma, confusion
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Hypercalcemia causes...
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Confusion, constipation, dehydration
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Bleomycin and amiodarone can cause what lung diseases?
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Pnemonitis and fibrosis
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What is the morphology of acute radiation pneumonitis vs chronic?
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Acute--diffuse alveolar damage
Chronic--interstitial fibrosis |
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Acute radiation pneumonitis can occur how long after radiation?
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1-6 months
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What is the hallmark morphology of acute rejection after transplant?
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Perivascular lymphocytic inflammatory infiltrate
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What is the hallmark morphology of the lung in chronic rejection after transplant?
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Bronchiolitis obliterans and sometimes bronchiectasis
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