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84 Cards in this Set
- Front
- Back
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4 types of atelectasis
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Obstructive (resorption)
Compressive (passive, relaxation) Microatelectasis (non obstructive patchy) Contraction |
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What type of atalectasis: peanuts, mucus plug, tumor, tooth, blood, LN
no air exchange, air resorbed out of lung, collapses |
Obstructive
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What type of atalectasis: normal airway, but something is pressing on lung- pneumothorax (air), stab wound, blood, fluid, pus, tumor
-drain it to allow lung to expand |
Compression
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What type of atalectasis: acute resp distress syndrome (ARDS), patchy collapse in lungs, diffuse, reduced surfactant, pneumonia
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Microatalectasis
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What type of atalectasis: scarring, damage from pneumonia, cancer, will never re-expand, irreversible
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Contraction
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May cause death by interfering with oxygen and carbon dioxide exchange
fluid in alveolar septa and alveoli microhemorrhages |
Pulmonary edema
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when do you see hemosiderin laden macrophages in the lungs
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Pulmonary edema
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source of pulomonary embolism
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95% DVT from legs
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risks for PE
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Stasis
trauma CHF coagulation problems surgery on legs pregnancy disseminated cancer |
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occlusion of main pulmonary arteries causing sudden death
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Saddle embolus
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one PE carries what % chance of developing another
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30%
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idiopathic, women (20-40 yrs)
Chronic vasocontriction due to hyper-reactivity Raynauds |
Primary hypertension
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cardiopulmonary diseases involving pulmonary blood vessels
Increased blood flow or pulmonary resistance |
Secondary hypertension
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pulmonary vascular changes
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smaller arteries- intimal fibrosis, medial hypertrophy, plexiform lesion and, fibrinoid change, atherosclerosis
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right ventricular changes associated with pulmonary hypertension
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Cor pulmonale
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Cor pulmonale changes
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dilation early
hypertrophy later dysfunction/failure |
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obstructive diseases
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COPD
emphysema asthma chronic bronchitis bronchiectasis |
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FEV decreased
FVC normal or increased FEV/FVC decreased |
obstructive disease
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Restrictive diseases
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ARDS
pneumoconioses UIP (IPF) sarcoid |
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decreased compliance, increased elasticity
decreased lung volume airflow rates normal diffusing capacity decreased- hypoxia |
restrictive lung disease
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FEV normal or reduced
FVC reduced proportionately FEV/FVC near normal |
restrictive lung disease
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recurrent, reversible episodes of airway contraction and obstruction
exaggerated bronchoconstrictor response to stimuli |
asthma
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two types of asthma
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extrinsic allergen IgE mediated
intrinsic nonimmune trigger idiopathic- stress, cold |
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three types of extrinsic asthma
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allergen
occupational acute bronchopulmonary aspergillosis |
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atopic asthma
cytokines released by cd4 T helper cells |
IL4- IgE and mast cells
IL5- eosinophils |
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asthma acute phase
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Ag binds IgE mast cells
mediators released bronchospasm, edema, mucus secretion, recruitment of inflammatory cells |
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Late phase asthma
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basophils, eosinophils, neutrophils, lymphocytes
Residual IgE may trigger a fresh round of mediators persistent bronchospasm, edema, mucus secretion, leukocyte infiltration and epithelial cell necrosis eosinophils amplify and sustain the inflammatory response without further antigen stimulation epithelial damage may contribute to airway hyper-responsiveness |
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early phase asthma mediators
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leukotrienes
prostaglandins histamine PAF mast cell tryptases |
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late phase asthma mediators
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chemokines for neutrophils and eosinophils
IL4 IL5 PAF TNF |
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mucus with necrotic cells/ Curschmann’s spirals, eosinophils and Charcot-Leyden crystals
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asthma
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edema, hyperemia, inflammation
patchy shedding of epithelial cells increased mucus glands smooth muscle hypertrophy thickened basement membrane |
asthma
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permanent enlargement of alveoli
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emphysema
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cigarette smoking
alpha antitrypsin deficiency |
emphysema
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types of emphysema
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centroacinar (smokers, upper 2/3)
panacinar (antitrypsin deficiency, lower lobes) localized (bullous, spontaneous pneumothorax, surrounds scar) |
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airways collapse due to lack of elastic tissue
obstruction on expiration |
emphysema
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symptoms of emphysema
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dyspnea
weight loss secondary pulmonary hypertension pulmonary failure with hypoxia and acidosis |
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pink puffer
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emphysema with bronchitis
barrell chest hunched over |
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blue bloater
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bronchitis with chronic infection
retain CO2 and become hypoxic |
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persistent cough with sputum production at least 3 months for 2 years
associated with smoking and smog |
chronic bronchitis
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mucus gland hyperplasia
Reid index inflammatory cells |
bronchitis
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Permanent dilation of bronchi/ioles with inflammation and fibrosis
Destruction of elastic tissue and muscle due to persistent necrotizing infections can be from obstruction, congenital (Kartageners) or pneumonia |
bronchiectasis
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diffuse alveolar damage
pulmonary infiltrates decreased lung compliance from pneumonia, gastric aspiration, sepsis, trauma with shock |
ARDS
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hyaline membrane
type II proliferation congestion honeycomb lung |
ARDS
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ARDS phases
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exudative (hyaline memb)
proliferative (type II, fibroblasts, macros) endstage- honeycomb lung |
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multisystem granulomatous disease
diagnosis of exclusion cell mediated (IV) hypersensitivity to mystery antigen |
sarcoidosis
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sarcoidosis patient
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nonsmoker
black less than 40 years old anergic to skin tests hilar lAD |
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interstitial noncaseating granulomas
asteroid bodies schaumann bodies hypercalcemia affects other organ systems |
sarcoidosis
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normal areas and areas with interstitial inflammation
type II hyperplasia dysruption of alveolar walls nonfunctional alveoli scar, honeycomb lung, cor pulmonale |
Usual interstitial pneumonia UIP
Idiopathic pulmonary fibrosis IPF |
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necrotizing granulomas
may cavitate glomulonephritis CANCA abs |
Wegeners granulomatosis
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diffuse pulmonary hemorrhage and glomulonephritis
abs against basement membranes |
Goodpasture's syndrome
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most common community acquired bacterial pneumonia
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streptococcus pneumoniae
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lobar pneumonia
congestion, red, gray hepatization then resolution |
Strep pneumoniae
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at risk in strep pneumonia pneumonia
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At risk: infants, elderly, CHF, COPD, diabetes, ETOH, following URI (viral), splenectomy
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community acquired bronchopneumonia
milder children- empyema and extrapulmonary problems |
Heamophiius influenzae
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bronchopneumonia with abcesses
primary in chronic dz secondary postviral right sided endocarditis in IV drug users |
Staph aureus
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debilitated and alcoholics pneumonia
gelatinous sputum usually lobar |
Klebsiella
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endemic sporadic severe pneumonia
elderly |
legionella
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community acquired atypical pneumonia
more flu like |
Mycoplasma
chlamydia rickettsia |
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pneumonia with diffuse inflammation, minimal sputum, type I damage, ARDS
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Viral- CMV, influenza, adeno, parainfluenza, RSV, measles, chickenpox
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type IV hypersensitivity with caseous granulomas
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mycoplasma tuberculae
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primary TB (first exposure)
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Ghon focus and Ranke complex for Ghon focus
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single granulomatous lesion in primary TB
inferior upper lobe or superior lower lobe |
Ghon focus
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fibrotic calcified Ghon focus
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Ranke complex
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active TB infection
usually in apices cavitation and fibrosis fever, night sweats, hemoptysis |
Secondary TB
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hemoatogenous TB spread
minute foci infection of many organs |
Disseminated miliary TB
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TB involving neck LNs
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Scrofula
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Most common systemic fungal infection in US
bat, bird droppings in macrophages granulomatous |
Histoplasmosis
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Valley fever
inhale arthrospores granulomatous inflammation |
Coccidiomycoses
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granulomatous or suppurative
thick walled budding yeast |
Blastomycoses
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immunocomp host
thick walled yeast inhale bird droppings, disseminate to meninges granulomatous india ink stain |
Cryptococcus
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irregular cannonball abcesses which may be hemorrhagic
immunocompromised pseudohyphae |
Candidiasis
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ABPA
fungal ball septate hyphae at acute angles |
aspergillosis
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opportunistic
nonseptate hyphae at 90* vascular invasion |
Mucormycoses
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AIDS
interstitial inflammation intraalveolar foamy exudate trophozoites in sputum only 50% cysts/silver GMS stain |
pneumocystis carinii
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coin lesion on xray
chondroid |
hamartoma
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small oat cell
metastasize early central bronchi neuroendocrine cells |
Small cell carcinoma
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paraneoplastic syndromes
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small cell carcinoma
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central airway with obstruction
preceded by years of CIS men spread to LNs early |
Squamous cell carcinoma
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lung cancer in young women and nonsmokers
grow slowly metastasize early Kras defect |
adenocarcinoma
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undifferentiated
poor prognosis metastasize early |
large cell carcinoma
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most occur in main stem bronchi
mets to hilar LNs neuroendocrine differentiation monomorphous Kultchitsky cells |
carcinoid tumor
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Horner's sydrome
meiosis ptosis anyhydrosis |
pancoast tumor
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Hypercalcemia
Cushing’s disease SIADH Neuromuscular syndromes Hematologic manifestations Pulmonary osteoarthropathy Finger clubbing |
paraneoplastic syndrome
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treatment of small cell carcinoma
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chemo
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