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71 Cards in this Set
- Front
- Back
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What are the different types of emboli?
Where do the majority of them arise from? |
FAT BAT
Fat, air, thrombus, bacteria, amniotic fluid, tumor *majority of them arise from deep leg veins |
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symptoms of PE?
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dyspnea, chest pain, tachypnea
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What are fat emboli associated with?
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long bone fractures and liposuction
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What can amniotic fluid emboli lead to?
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DIC - especially in postpartum
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What are deep venous thrombosis (DVT) predisposed by? What can they lead to?
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Virchow's triad
1. Stasis 2. Hypercoagulability (defect in coagulation cascade - factor V lieden) 3. Endothelial injury (exposed collagen provides impetus for clotting cascade *can lead to PE |
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Homans' sign
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dorsiflexion of foot - tender calf muscle
*if positive person could have a DVT |
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How do you prevent DVT's?
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Heparin
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Obstructive lung disease characterisitcs?
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obstruction of air flow resulting in air trapping in the lungs - Airways close prematurely at high lung volumes, resulting in increased RV and decreased FVC
On pulmonary function testing see very decreased FEV1 and decreased FVC so decreased FEV1/FVC ratio (hallmark), V/Q mismatch |
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Chronic bronchitis pathology and how to diagnose
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blue bloater - hypertrophy of mucous secreting glands in the bronchioles - reid index = gland depth/total thickness of bronchial wall; in COPD, Reid index >50%
diagnosis: 3 or more months with cough for at least 2 consecutive years |
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findings on chronic bronchitis
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wheezing, crackles, cyanosis (early-onset hypoxemia due to shunting), late-onset dyspnea.
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What disease are under COPD?
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chronic bronchitis, empysema, asthma, bronchiectasis
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Empysema what happens and the types
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pink puffer; barrel chested
enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls types: centriacinar (smoking) panacinar (a1-antitrypsin deficiency) Paraseptal (bullae) |
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centriacinar emphysema
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caused by smoking
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Panacinar emphysema
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caused by a1-antitrypsin deficiency (can also cause liver cirrhosis)
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Paraseptal emphysema
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associated with bullae - can rupture - spontaneous pneumothorax; often in young, otherwise healthy males
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Findings in emphysema and symptoms
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symptoms: dyspnea, decreased breath sounds, tachycardia, late-onset hypoexmia due to eventual loss of capillary beds (occurs with loss of alveolar walls), early-onset dyspnea
Other: increased elastase activity, increased lung compliance due to loss of elastic fibers. exhale through pursed lips to increase airway pressure and prevent airway collapse during exhalation |
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Asthma pathology
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COPD - bronchial hyperresponsiveness causes reversible bronchoconstriction. Smooth muscle hypertrophy and curshmann's spirals (shed epithelium from mucous plugs)
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curshmann's spirals are seen in what condition?
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Asthma (shed epithelium from mucous plugs)
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What are findings with asthma - what can it be triggered by?
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triggers: viral URIs, allergens, and stress
findings: cough, wheezing, dyspnea, tachypnea, hypoxemia, decreased I/E ratio, pulsus paradoxus, mucous plugging |
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Bronchiectasis pathology and what it is associated with.
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Pathology: chronic necrotizing infection of bronchi - permanently dilated airways, purulent sputum, recurrent infections, hemoptysis
associated with: bronchial obstruction, CF, poor ciliary motility, Kartanger's syndrome. Can develop aspergillosis |
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Restrictive lung disease
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restricted lung expansion causes decreased FVC and TLC
Pulmonary function tests sow FEV1/FVC ratio > 80% |
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What are the 2 broad groups of things that cause restrictive lung disease?
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1. poor breathing mechanics (poor muscular effort and moor structural apparatus)
2. insterstitial lung diseases (ARDS, pneumoconioses, sarcoidosis, idiopathic pul fibrosis, goodpastures, wegeners, eosionophilc granuloma, drug toxicity) |
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Restrictive lung disease caused by poor breathing mechanics - what are the examples?
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poor muscular effort - polio, myasthenia gravis
poor structural apparatus - scoliosis, morbid obesity |
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Restrictive lung disease caused by interstitial lung disease - what are the examples?
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- ARDS
- Neonatal respiratory distress syndrome (hyaline membrane disease) - Pneumoconioses (coal miner's, silicosis, asbestosis) - sarcoidosis - idiopathic pulmonary fibrosis (repeated cycles of lung injury and wound healing with increased collagen - Goodpastures - Wegener's granulomatosis - Eosinophilic granuloma (histiocytosis X) - drug toxicity (bleomycin, busulfan, amiodarone) |
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What are drugs that can cause restrictive lung disease?
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Bleomycin, busulfan, amiodarone
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Coal miner's
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- cause restrictive lung disease
coal miner's - associated with coal mines. can result in cor pulmonale, Caplan's syndrome (RA and pneumoconioses) - *affects upper lobes |
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Silicosis
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type of pneumoconioses
associated with foundries, sandblasting, and mines - macrophages resound to silica and release fibrogenic factors, leading to fibrosis. It is thought that the silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB *affects upper lobes *eggshell calcification of hilar lymph nodes |
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Asbestosis
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restrictive lung disease - pneumoconioses
- associated with shipbuilding, roofing, and plumbing. results in "ivory white", calcified plaques. Associated with increased incidence of bronchogenic carcinoma and mesothelioma - affects lower lobes. Asbestos bodies are golden-brown fusiform rods resembling dumbbells, located inside macrophages (ferruginous bodies) |
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What does asbestosis put you at an increased risk of developing?
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bronchogenic carcinoma and mesothelioma
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What do you see microscopically in someone with asbestosis?
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ferruginous bodies inside macrophages - golden brown fusiform rods resembling dumbbells (inside the marcophages)
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Neonatal respiratory distress syndrome
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caused by surfactant deficiency - surfactant is usually made by type II pneumocytes a lot after 35 weeks of gestation - if baby born before that time - has decreased surfactant and increased chance of alveolar collapse
see lectin to sphyingomyelin ratio below 1.5 have a persistantly low O2 tension - risk of PDA Therapeutic O2 can result in retinopathy of prematurity |
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What are risk factors for neonatal respiratory distress syndrome?
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prematurity, maternal diabetes (because of elevated insulin), cesaran delivery (decreased release of fetal glucocorticoids)
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Treatment for neonatal respiratory distress syndrome?
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maternal steroids before birth; artificial surfactant for infant; thyroxine
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ARDS
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adult respiratory distress syndrome
may be caused by trauma, sepsis, shock, gastric aspiration, uremia, actue pancreatitis, or amniotic fluid emoblism. diffuse alveolar damage - increased alveolar capillary permeability - protein rich leakage into alveoli results information of intra-alveolar hyaline membrane initial damage due to netrophilic substances toxic to alveolar wall, activation of coagulation cascade, or O2 derived free radicals |
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What disease do you see an intralveolar hyaline membrane?
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ARDS
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what causes initial damage in ARDS?
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neutrophilic substances toxic to alveolar wall then activation of coagulation cascade, or oxygen-derived free radicals
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When will you see a FEV1/FVC = 80%
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normal
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When will you see a FEV1/FVC < 80%?
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obstructive lung disease - have problems breathing air out - so very decreased FEV1
Increased TLC, RV, FRC |
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When will you see a FEV1/FVC< 80%?
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restrictive lung disease - decreased TLC and FVC - so increased ratio
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What is the definition of sleep apnea?
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person stops breathing for at least 10 seconds repeatedly during the night
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What are the 2 types of sleep apnea?
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Central - no respiratory effort
Obstructive - respiratory effort against airway obstruction |
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What is sleep apnea associated with?
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obesity, loud snoring, systemic/pulmonary hypertension, arrhythmias, and possibly sudden death
*individuals can become chronically tired |
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Treatment for sleep apnea?
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weight loss, CPAP, surgery
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Bronchial obstruction will show what for breath sounds, resonance, fremitus , and tracheal deviation
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decreased or absent breath sounds, decreased resonance, decreased fremitus, and tracheal deviation towards side of lesion
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Pleural effusion
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decreased breath sounds over area, dullness for resonance, decreased fremitus, no trachea deviation
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Pneumonia (lobar)
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bronchial breath sounds over lesion, dullness for resonance, increased fremitus, no trachea deviation
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Tension pneumothorax
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decreased breath sounds over area, hyperresonant, absent fremitus, trachea deviates away from lesion
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lung cancer facts, presentation
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leading cause of cancer death
presentation: cough, hemoptysis, bronchial obstruction, wheezing, pneumonic "coin" lesion on x-ray film |
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If mets in lung what is the most frequent presenting symptom?
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dyspnea
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If primary cancer what is the most common presenting symptom?
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cough
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Complications of lung cancer?
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SPHERE
Superior vena cava syndrome (compression or invasion of SVC - facial swelling and cyanosis) Pancoast tumor - in apex of ulung Horner's syndrome Endocrine (paraneoplastic - ACTH from small cell carcinoma Recurrent laryngeal symptoms - hoarsness Effusions - pleural or pericardial (often bloody) |
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Squamous cell carcinoma: location, characterisitcs, histology
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central location
characteristics: hilar mass arising from bronchus; cavitation; linked to smoking; PTH like activity Histology: keratin pearls and intercellular bridges |
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lung cancer that has a central location and is related to smoking what do you see on histology? What hormone can it release
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squamous cell carcinoma (Squamous, Smoking, Sentral)
histology: keratin pearls and intracellular bridges *can release PTH like hormone |
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Adenocarcinoma of lung types, location, characteristics, histology
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types: bronchial and bronchoioloalveolar
location: central characteristics: develops in site of prior pulmonary inflammation or injury (most common lung cancer in nonsmokers and females) *grows along airways - can present like pneumonia *can result in hypertrophic osteoarthropathy histology: clara cells - type II pneumocytes; multiple densities on x-ray of chest |
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Small cell (oat cell) carcinoma location, characterisitics, histology
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central location
characterisitics: undifferentiated - very aggressive; often associated with ectopic production of ACTH or ADH; may lead to lambert eaton (autoantibodies to Ca+ channels). responsive to chemo. Inoperable histology: neoplasm of neuroendocrine cells - Kulchitsky cells - small dark blue cells |
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What lung cancer is most common in nonsmokers and females?
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adenocarcinoma - bronchial or bronchioloalveolar
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What lung cancer can release ADH or ACTH?
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small cell (oat cell) carcinoma
see Kulchitsky cells - small dark blue cells |
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Large cell carcinoma of the lung location, characterisitics, histology
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peripheral location
characterisitics: highly anaplastic; undifferentiated tumor; poor prognosis; less responsive to chemo. Removed surgically histology: pleomorphic giant cells with leukocyte fragments in cytoplasm |
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Carcinoid tumor of the lung
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originally from GI tract - mets to liver and then to heart and lung - secretes serotonin, can cause carcinoid syndrome (flushing, diarrhea, wheezing, salivation), associated with right sided heart lesions
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Mesothelioma characterisitics and histology
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malignancy of pleura associated with asbestosis. results in hemorrhagic pleural effusions and pleural thickening
histology: psammoma bodies |
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Mets of lung cancer
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very common
go to adrenals, brain (epilepsy), bone (pathologic fractures), and liver (jaundice, hepatomegely) |
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Pancoast tumor
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carcinoma in the apex of the lung that can affect cervical sympathetic plexus, causing horners syndrome (ptosis, anhydrosis, miosis)
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What are the types of pneumonia?
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lobar, intersitital, bronchopneumonia
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lobar pneumonia - organisms and characterisitics?
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pneumococcus most frequently (strep pneumo), klebsiella
characteristics: intra-alveolar exudate - consolidation; may involve entire lung |
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Bronchopneumonia organisms and characterisitics
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S. aureus, H. flu, Klebsiella, S. pyogens
characterisitics: acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving >1 lobes |
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Intersitial (atypical) pneumonia organisms and characterisitics
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viruses (RSV, adenoviruses), mycoplasma, legionella, chlamydia
characterisitcs: diffuse patchy inflammation localized to interstitial areas at alveolar walls; distribution involving >1 lobes. generally follow a more indolent course than bronchopneumonia |
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lung abscess
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localized collection of pus within parencyma, usually resulting from bronchial obstruction (cancer) or aspiratoin of oropharyngeal contents (especially in patients predisposed to loss of consciosness eg. alcoholics and epileptics). Often due to S. aureus or anaerobes
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Pleural effusions types:
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tranudate
exudate lymphatic |
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transudate pleural effusion
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decrease protein content - due to CHF, nephrotic syndrome or hepatic cirrhosis
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exudate pleural effusion
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increased protein content, cloudy. due to malignancy, pneumonia, collagen vascular disease, trauma (occurs in states of increased vascular permeability). Must be drained in light of risk of infection
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lymphatic pleural effusion
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milky fluid; increased triglycerides
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