Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
167 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
What incisions are at risk of penetrating the pleura
|
1. right part of infrasternal angle
2. right/left costovertebral angle (kidney access) |
|
|
|
atelectasis
|
collapse lung
(primary if at birth) |
|
|
|
What are the clinical signs of a collapsed lung?
|
1. elevation of the diaphragm
2. intercostal space narrowing 3. mediastinal shift away from side 4. denser at hilum/radiolucent cavity |
|
|
|
In an upright patient where is a thorocentesis conducted?
|
superior to ribs in the 9th IC space at the midaxillary line
|
|
|
|
Why would one conduct a pleurectomy/pleurodesis
|
prevention of spontaneous pneuomothorax
|
|
|
|
what is a pleurodesis?
|
adhesion of the pleura by a sclerosing agent to prevent spontaneous pneumothroax
|
|
|
|
Lung cancer can affect mediastnal nerves, which nerves are particularly relevant?
|
1. phrenic nerve and diaphramatic hemiparesis
2. recurrent laryngeal nerve in apical lung cancers and hoarsness of voice |
|
|
|
Where do aspirated foreign bodies typically lodge?
|
Right Main bronchus
|
|
|
|
What is a distored Carina a sign of?
|
Tracheobronchial lymphnode enlargement due to metastatic cancer cells.
Carina is widened post. distorted and immobile |
|
|
|
Lymphatic drainage after a pleural adhesion can follow what pattern?
|
To the lymph vessels in the axilla, and presence of carbon in these vessels suggests an adhesion.
|
|
|
|
An enlarged supraclavicular lymph node can indicate what significant disease process?
|
Thoracic or abdominal malignancies
|
|
|
|
What are three causes of mediastinal widening?
|
1. aortic/SVC laceration/dissection
2. malignant lymphoma 3. enlargement of the heart in congestive heart failure |
|
|
|
What is tidal volume?
|
inspired or expired air with each normal breath
|
|
|
|
Inspiratory reserve volume
|
volume inspired over and above tidal volume
|
|
|
|
Expiratory Reserve Volume
|
volume that can be expired after the expiration of a tidal volume
|
|
|
|
Residual volume
|
volume that remains in the lungs after maximal expiration
|
|
|
|
Formula for Physiological dead space is
|
Vd= VT x PACO2 - PECO2
PACO2 A= alveolar (PCO2 of arterial blood) E = expired |
|
|
|
Minute ventilation rate
|
tidal volume x breaths/minute
|
|
|
|
Alveolar respiration
|
tital volume - dead space x breaths/min
|
|
|
|
Inspiratory Capcity
|
sum of tidal volume and inspiratory reserve volume
|
|
|
|
Functional residual Capacity
|
sum of expiratory reserve volume and residual volume
|
|
|
|
Forced Vital Capacity
|
sum of air that can be forcibly expired after maximal inspiration
|
|
|
|
Total Lung Capcity
|
Sum of all lung volumes
|
|
|
|
Obstructive lung diseases cause what change in FEV1/FVC
|
FEV1 is reduced in obstructive lung diseases more then FVC so therefore the FEV1/FVC ratio is decreased (normal is 80%)
e.g. asthma |
|
|
|
Restrictive Lung diseases cause what change in FEV1/FVC?
|
In restrictive lung disease both are decreased the same.
FEV1/FVC can be slightly increased. |
|
|
|
What is hysteresis?
|
Difference in compliance of lungs during inflation and deflation
|
|
|
|
In terms of compliance what occurs at functional reserve capacity normally?
|
collapsing force of lungs and expanding force of chest wall are at equalibrium.
|
|
|
|
What occurs in terms of compliance during emphysema and what is the result of this change?
|
lung compliance is increased and the tendancy of the lungs to collapse decreases
this causes a new FRC to be reached which is higher (barrel chested). |
|
|
|
What occurs in terms of compliance during fibrosis and what is the result of this change?
|
Lung compliance is decreased and the tendancy of the lungs to collapse increases
a new FRC is acheived which is lower than the original |
|
|
|
What is breathing through "pursed lips" a sign of, and why?
|
Chronic obstructive pulmonary disease
Airway resistance is increased and to prevent airway collapse patients breath through pursed lips to increase alveolar pressure. |
|
|
|
What is COPD?
|
a combination of chronic bronchitis and emphysema
obstructive lung disease with increased compliance in which expiration is impaired. |
|
|
|
In someone with COPD what occurs to the FEV1/FEV and FRC?
|
FEV1/FEV are all decreased, and FRC is increased with a barrel chest shape.
|
|
|
|
Patients that are "pink puffers" suffer from mainly what in COPD?
|
Emphysema
mild hypoxemia and because they maintain alveolar ventilation, normocapnia. |
|
|
|
Blue Bloaters suffer from mainly what in COPD, what are the clinical symptoms?
|
1. Chronic Bronchitis
2. severe hypoxemia with cyanosis 3. hypercapnia (respiratory acidosis) 4. right ventricular failure (increased pulmonary resistance due to destruction of capillaries) 5. systemic edema (due to right sided heart failure) |
|
|
|
What type of effect does fibrosis have on compliance, lung volumes and FEV1/FVC?
|
decreased compliance
decrease in all lung volumes FEV1 is decreased less than FVC FEV1/FVC is raised or normal |
|
|
|
What is Dalton's Law of Partial pressure?
|
Pp = total pressure x Fractional gas concentration
|
|
|
|
Dissolved 02 =
|
P02 x Solubility of 02 in blood
|
|
|
|
How can the diffusion of gas be increased in perfusion limited exchange?
|
increase in blood flow
|
|
|
|
What disease states is diffusion limited exchange exemplified in and why?
|
Fibrosis (thickening of alveolar wall)
Emphysema (decreased area for diffusion) |
|
|
|
What occurs in diffusion limited exchange?
|
Gas does NOT EQUILIBRATE by the time blood reaches the end of the pulmonary capillary
|
|
|
|
What occurs in perfusion limited exchange?
|
Gas equilibrates by the end of pulmonary capillary (must increase blood flow to increase diffusion)
|
|
|
|
If iron in heme is at Fe 3+ what is it?
|
methomoglobin (does not bind to 02)
|
|
|
|
Fetal hemoglobin is made up of what chains?
|
2-alpha, 2-gamma
higher affinity for 02 than adult alpha beta hemaglobin |
|
|
|
Why does fetal hemaglobin have a higher affinity for oxygen?
|
Because DPG binds less avidly.
|
|
|
|
02 content of blood =
|
o2 binding capacity x % saturation + dissolved oxygen
|
|
|
|
What is positive cooperativity responsible for in the hemoglobin dissociation curve?
|
The sigmoid shape (as one 02 molecule binds, it increases the affinity for the next 02 molecule)
|
|
|
|
What causes a rightward shift in the hemoglobin-oxygen dissociation curve?
|
decreased affinity for oxygen
increase in PCO2, decrease in pH, increased temperature, increase in DPG eg. excercise |
|
|
|
What causes a leftward shift (increased affinity) in the hemoglobin-oxygen dissociation curve?
|
decreased temperature, decreased CO2, increased pH, decreased DPG, fetal hemoglobin
|
|
|
|
What is the affinity of CO for haemoglobin?
|
200 times greater than 02, CO causes a greater affinity for 02 at the remaining sites causes a leftward shift as well
|
|
|
|
What is hypoxemia and how can it be measured?
|
a decrease in arterial P02
A-a gradient = Alveolar PA02 and arterial Pa02 (normal less than 10 mm hg) |
|
|
|
What is hypoxia how can it be measured?
|
decreased 02 delivery to tissues
O2 delivery = cardiac output x O2 content of the blood |
|
|
|
What causes hypoxia?
|
1. decrease in CO
2. hypoxemia 3. Anemia 4. CO poisoning 5. cyanide poisoning (decrease 02 utilization by tissues) |
|
|
|
What causes hypoxemia?
|
1. right to left shunts (A-a decreased)
2. V/Q defects (A-a decreased) 3. Diffusion defect (A-a decreased) 4. High altitude 5. hypoventilation |
|
|
|
C02 transport equation
|
C02 + H20 = H2CO3 = H+ +HCO3-
|
|
|
|
what is HCO3- exchanged for?
|
Cl- and is transported in the plasma to the lungs
|
|
|
|
What is the H+ buffered by in RBC?
|
deoxyhaemoglobin
|
|
|
|
In the lungs, what happens to HCO3-?
|
It is exchanged for Cl- and enters the RBC, eventually becoming CO2 and leaving via diffusion.
|
|
|
|
What is pulmonary arterial pressure in the lungs?
|
15 mm Hg
|
|
|
|
Where and in what situations can high alveolar pressure compress capillaries in the lungs?
|
Zone 1, during haemorrhage or possitive pressure breathing machines
|
|
|
|
Where is blood flow in the lungs the greatest?
|
Zone 3 at the base
Arterial pressure > Venous Pressure > Alveolar Pressure |
|
|
|
In the lungs what does hypoxia cause and why?
|
Vasoconstriction, to redirect blood to regions of lung that are better ventilated
|
|
|
|
Why is fetal pulmonary vascular resistance so high?
|
Due to hypoxic vasoconstriction
|
|
|
|
What does a right to left shunt result in?
|
Always a decrease in arterial P02 (e.g. Tetralogy of Fallot)
|
|
|
|
What does a left to right shunt result in?
|
P02 will be elevated on the right side of the heart due to the admixture of arterial and venous blood
|
|
|
|
What is the normal V/Q and why is it important?
|
ventilation perfusion ratio of .8 (fz, tidal volume, cardiac output) to achieve the ideal exchange of 02 and C02
|
|
|
|
Where is the V/Q ratio the highest?
What is the result? |
at the apex of the lung
P02 is highest and PCO2 is lowest at the apex |
|
|
|
What happens to V/Q in airway obstruction?
|
Ventilation is 0 and V/Q is 0, this is a SHUNT
P02 and PCO2 approach values of mixed venous blood |
|
|
|
What happens to V/Q in a pulmonary embolism?
|
V/Q approaches infinity and the lung that is ventilated but not perfused is called dead space
|
|
|
|
What is the dorsal respiratory group responsible for?
what is its input/output? |
control of inspiration and generates the basic rhythm for breathing
input = 10 and 9 output = phrenic |
|
|
|
What is the ventral respiratory group responsible for?
|
expiration
only active during excercise |
|
|
|
Where is the apneustic centre? What is it?
|
lower pons
stimulates inspiration |
|
|
|
Where is the pneumotaxic centre? What is it?
|
Upper pons
Inhibits breathing and therefore regulates inspiratory volume and respiratory rate |
|
|
|
How do chemoreceptors in the medulla respond to hypercapnia?
What about hypocapnia? |
Increased diffusion of CO2 into the CSF (crosses BBB better)
CO2 + H20 (CSF) --> H + HC03- H+ acts directly on chemorecptors to increase ventilation rate Opposite for hypocapnia |
|
|
|
What are the chemoreceptors in the aortic arch and carotid bodies sensitive to?
|
Decreases in arterial P02 below 60 mm Hg
Increases in Arterial PC02 (increase breathing) Increases in Arterial H+ (regardless of CO2) |
|
|
|
What is the Hering-Breur reflex?
|
stretch receptors of the lungs are stimulated by distention and the produce a reflex decrease in breathing Fz
|
|
|
|
What do Juxtacapillary receptors (J) respond to and what is their response?
|
engorgement of pulmonary capillaries (e.g. left heart failure) causes rapid shallow breathing
|
|
|
|
Joint and muscle receptors are involved in what aspect of breathing?
|
Involved in the early stimulation of breathing during exercise
|
|
|
|
What happens to the mean values of P02 and PC02 and pH during excerise?
|
They do not change. Arterial pH decreases with strenuous exercise due to lactic acid
|
|
|
|
What happens to venous PC02 during exercise?
|
Venous PC02 increases due to excess C02 produced
|
|
|
|
What happens to V/Q throughout the lung during exercise?
|
The distribution of V/Q ratios is more even during exercise and there is a decrease in physiological dead space
|
|
|
|
What occurs to arterial P02 at high altitude?
|
PaO2 is decreased (hypoxemia) because PA02 is decreased (lower barometric pressure) and the result is hypoxemia
|
|
|
|
What does the resultant hypoxemia at altitude stimulate and what is the result?
|
1. Peripheral chemoreceptors cause hyperventilation which causes respiratory alkalosis.
2. Renal production of erythropoietin (increased hemoglobin concentration, increase 02 content of blood) 3. Increased 2,3-DPG concentrations shifting dissociation curve to the right (decreased affinity faciliates unloading of 02 to tissues) 4. Pulmonary Vasoconstriction (can cause right ventricular hypertrophy) |
|
|
|
What drug is given to treat respiratory alkalosis at altitude?
|
acetazolamide
(A CET A ZOL AMIDE) |
|
|
|
Acute Rhinitis is most often caused by what?
|
Most common of all illnesses and is caused by viruses, especially the adenoviruses
|
|
|
|
Allergic rhinitis is mediated by what?
What is it characterised by? |
IgE type 1 immune reaction involving mucosal and submucosal mast cells. It is characterised by increased eosinophils in the peripheral blood/nasal discharge.
|
|
|
|
What is the most common cause of bacterial acute rhinitis?
|
Superimposed on acute viral/allergic rhinitis caused by streptococci, staphylococci or H. influenza
|
|
|
|
What is sinusitis and what is it normally caused by?
|
inflammation of paranasal sinuses resulting in obstructed drainage outlets. Caused by extension of the nasal cavity/dental infection
|
|
|
|
What is Acute Epiglottitis?
In children what are the symptoms? |
inflammation of the epigolottis and may be life threatening in young children.
1. fever 2. difficulty swallowing 3. stridor 4. drooling |
|
|
|
What is acute Epiglottitis usually caused by?
|
S. pneuomonia/S. pyogens infection
|
|
|
|
When is laryngeotracheobronchitis life threatening and what is it caused by?
What are the symptoms? |
In infants caused by viruses.
1. Stridor 2. harsh cough |
|
|
|
What is nasopharyngeal carcinoma ( mucosal epithelium ) associated with?
|
1. east asia/africa
2. caused by the Epstein Barr Virus |
|
|
|
What is the most frequent type of nasal tumor?
|
Squamous cell carcinoma
|
|
|
|
What percent of nose and throat cancers are adenocarcinomas?
|
5%
|
|
|
|
What is a singers nodule and what aer the causes?
|
Small benign laryngeal polyp
1. heavy smoking 2. irritation |
|
|
|
In children what are laryngeal papilloma caused by?
|
HPV infection/ reoccur after ressection
|
|
|
|
What is the most common larygeal cancer? What is it associated with?
|
Squamous cell neoplasm
1. Male 2. 40+ 3. smoking 4. alcoholism |
|
|
|
What are the differences between glottic carcinoma and sub/supraglottic carcinoma?
|
glottic more common better prognosis than sub/supraglottic carcinoma
|
|
|
|
What are the four types of COPD?
|
1. Bronchial Asthma
2. Chronic Bronchitis 3. Emphysema 4. Bronchiactstasis |
|
|
|
What are the characteristic spirometry tests indicating COPD?
|
1. decreased FEV1 (largest)
2. FVC 3. FEV1/FVC 4. V/Q mistmatch (below .8) |
|
|
|
What are the clinical characteristics of Bronchial Asthma?
|
1. Episodic dyspnea
2. wheezing on expiration 3. increased sensitivity to irritants 4. accessory muscles of breathing utilised |
|
|
|
What are the morphological manifestations of Bronchial Asthma?
|
1. hypertrophy of smooth muscle
2. Hyperplasia of submucosal and goblet glands 3. Airway blockage by mucus containing Curschmann spirals, eosinophils and Charcot-Leyden crystals |
|
|
|
What are some complications of asthma?
|
1. superimposed bacterial infection
2. chronic bronchitis 3. pulmonary emphysema 4. STATUS ASTHMATICUS |
|
|
|
What is STATUS ASTHMATICUS?
|
prolonged asthma attack that can last for days, intractable and can lead to death.
|
|
|
|
What is the clinical criteria for chronic bronchitis?
|
Productive cough that occurs for 3 consecutive months for 2 or more consecutive years
|
|
|
|
What is chronic bronchitis linked too?
What can it lead to? |
1. Early smoking
2. pollution 3 infection Can lead to cor pulmonale |
|
|
|
What are the typical morphological characteristics of chronic bronchitis?
What are the clinical characteristics of CB? |
1. hypersecretion of mucus due to hyperplasia of mucus-secreting submucosal glands
2. Reid index over 50% (gland depth/total thickness of epithelium wall) |
3. wheezing, crackles and cyanosis
|
|
|
In chronic bronchitis what is the early onset hypoxemia?
|
shunting
There is also late onset dyspnea |
|
|
|
what are the pathological finings in Emphysema?
|
Dilation of airspaces with destruction of alveolar walls and loss of elastin (elastic recoil)
|
|
|
|
What are theclinical characteristics in Emphysema?
|
1. increased AP diameter,
2. increased total vital capacity (due to increased residual volume) 3. hypoxia 4. cyanosis 5. respiratory acidosis (inc. PC02) 2 |
|
|
|
What are the different types of Emphysema?
|
1. Centrilobular emphysema (isolated to upper part of pulmonary lobes)
2. Panacinar Emphysema (of all of the respiratory zone) 3. Paraseptal Emphysema (distal acinus/ducts adjacent to pleura) 4. Irregular Emphysema |
|
|
|
What genetic mutation is associated with panacinar emphysema?
|
piZ allele causing a mutation in alpha1-antitrypsin (can no longer be excreted by liver, can cause chirrosis)
|
|
|
|
What is alpha1-antitrypsin important for?
|
neutrilzation of elastase in the lung (which can cause acinar breakdown)
|
|
|
|
What is paraseptal emphysema assoc. with and what can it result in?
|
Large subpleural bullae/blebs.
Can result in spontaneous pneumothorax |
|
|
|
In COPD which two obstructive lung diseases often co-exist?
|
Chornic broncitis and emphysema
|
|
|
|
What is bronchiactstasis?
|
permanent bronchial dilation filled with mucus and neutrophils caused by chronic infection with inflammation and necrosis of the bronchial wall
(bronchi = conducting zone) |
|
|
|
What are the predisposing factors to Bronchiacstasis?
|
1. Bronchial obstruction (eg. tumor, CF, Kartagner's Syndrome
2. Chronic Sinusitis |
|
|
|
What is Kartagner's Syndrome?
|
Primary ciliary dyskinesia (caused by defect in dynein arms)
1. sinusitis 2. bronchiacstasis 3. situs inversus 4. hearing loss 5. male sterility |
|
|
|
What lobes are most often affected in bronchiacstasis? What are the clinical characteristics of bronchiacstasis?
|
1. Lower Lobes
2. copius purulent sputum 3. hemoptysis 4. recurrent infection may lead to abscess |
|
|
|
What are restrictive pulmonary diseases characterised by?
What are some examples? |
1. Reduced expansion of the lung and reduction in total lung capacity
2. Chest wall abnormalities from bony or neuromusclar disease that restrict lung expansion Also included are interstitial lung diseases |
|
|
|
What are some forms of interstitial lung diseases?
|
1. Acute conditions: Adult and neonatal respiratory distress syndromes
2. Pneumoconiosises: coal worker's, silicosis, asbestosis 3. Unknown Etiology: Sarcoidosis, idiopathic pulmonary fibrosis 4. Other: Hypersensitivity pneomonitits, chemical drug associated disorders berylliosis, bleomycin toxicity 5. Immune Disorders: SLE, SCLERODERMA, WEGENER granulomatosis and Goodpastures Syndrome |
|
|
|
What is Adult Respiratory distress syndrome produced by?
What is the result to gas exchange in the lung? |
1. diffuse alveolar damage, inc in alveolar perm. causing leakage of protein rich fluid (intra-alveolar hyaline membrain- fibrin and cellular debris
2. severe impairment of gas exchange and severe hypoxemia/hypoxia |
|
|
|
What can cause ARDS?
|
toxic agents, shock, sepsis, trauma, uremia, aspiration of gastric contents, acute pancreatitis, inhalation of chemical irritants, oxygen toxicity, OD from heroin, and bleomycin therapy
|
|
|
|
What is SARS caused by?
What does it destroy? |
Corona virus that destroys type II pneumocytes and causes diffuse alveolar damage (ARDS)
|
|
|
|
What is the pathogenic steps involved in ARDS?
|
1. Neutrophils release substances toxic to alveolar wall.
2. activation of coagulation cascade (microemboli) 3. Oxygen toxicity by the formation of oxygen derived free radicals |
|
|
|
What is neonatal respiratory distress syndrome? What are the clinical characteristics?
|
1. Also known as Hyaline membrane disease is most common cause of resp failure in new born due to lack of surfactant
2. dyspnea, cyanosis and tachypnea |
|
|
|
What are 3 predisposing factors to NRDS?
|
1. pre-maturity
2. diabetic mother 3. C-section |
|
|
|
What are the pathological findings in NRDS?
|
1. lungs are heavier that usual with areas of atelectasis
2. small pulmonary vessels are engorged with leakage of blood products into alveoli forming hyaline membranes |
|
|
|
What are four complications of NRDS?
|
1. Bronchopulmonary dysplasia: Inflammation and scarring of lungs caused by 02 and mechanical ventilation
2. Patent Ductus arteriosus 3. intraventricular hemmorhage 4. Necrotising enterocollitis |
|
|
|
What is Pneumoconiosis?
|
Inhalation of inorganic dust particles
|
|
|
|
What is anthracosis?
|
Inhalation of carbon dust, esp prom in urban areas
usually no harm |
|
|
|
What is coal workers pneumoconiosis caused by?
What can it progress to? |
1. Inhalation of dust containing silica and carbon with coal macules around bronchioles (inconsequential)
2. It can progress to progressive massive fibrosis. |
|
|
|
What is progressive massive fibrosis?
What are the causes of death? |
1. fibrotic nodules filled with black fluid
2. bronchiacstasis with pulmonary hypertension 3. respiratory failure or right sided heart failure. |
|
|
|
What is silicosis?
What is the pathological progression? What is someone with silicosis more susceptible to? |
1. Exposure to free silica with silicotic nodules obstructing airways and blood vessels
2. ingestion of silica by macs, damage to macs, lysosomal enzyme and chemical release mediate inflammatory response 3. More susceptible to tuberculosis |
|
|
|
What is the pathological response in Asbestosis?
|
Macs uptake asbestos and reslease FBGF, fibroblastic response resulting in diffuse interstitial fibrosis in lower lobes
|
|
|
|
What histological body is associated with asbestosis?
|
Ferruginous body: Yellow/brown rod shpaed bodies with clubbed ends that stain prussian blue
|
|
|
|
What are two cancers caused by asbestosis?
|
1. Brochogenic carcinoma (increased further by smoking)
2. Malignant mesothelioma of pleura/peritoneum |
|
|
|
What is the histological characteristic of Sarcoidosis?
What is the etiology of sarcoidosis? |
1. non-casseating granulomas in almost any organ system
2. Africans, teenage to adult years |
|
|
|
What are the characteristics seen in sarcoidosis?
|
1. interstitial lung disease
2. enlarged hilar lymph nodes 3. anterior uveitis (inflammation of middle part of eye) 4. erythema nodosum 5. poly arthritis |
|
|
|
What are the immunological phenomenon associated with sarcoidosis?
|
1. decreased immunological response to skin prick test.
2.polyclonal hyperglobunaemia |
|
|
|
What are the classical clinical findings of sarcoidosis?
|
1. bilateral hilar lymphadenopathy
2. interstitial lung disease with diffuse reticular densities |
|
|
|
What are the lab findings in sarcoidosis?
What do you need for a definitive diagnosis? |
1. hypercalcemia
2. hypergammaglobunemia 3. increased ACE activity DEF DIAGNOSIS: Need biopsy with non-casseating granuloma formation |
|
|
|
What is idiopathic pulmonary fibrosis?
what is its prognosis? |
1. Chonic inflammation and fibrosis of alveolar wall resulting in alveolitis, fibrosis and finally distorted fibrotic lung filled with cystic spaces (honeycomb lung)
2. Death within five years |
|
|
|
What are eosinphilic granulomas?
|
1. localised proliferation of histiocytic cells related to Langhans Cells
2. Characteristic Birbeck granules |
|
|
|
What is Histiocytosis X syndrome?
|
1. Macrophage/monocytic granulomas that contain Langhans cells
2. Hand Schuller Christian disease and Lettener Sivve Syndrome etc. |
|
|
|
What is hypersensitivity pneumonitis?
What is a an oft cited example? |
1. interstitial pneumonia cuased by inhalation of various antigenic substances
2. Farmer's lung caused by inhalation of thermophilic actinmycetes from moldy hay. |
|
|
|
List 5 types of venous stasis that result in PE?
|
1. primary vascular disease
2. congestive heart failure 3. prolonged bed rest/imob 4. prolonged sitting whilst travelling 5. cancer, multiple fractures (fat), contraceptives, bullet frags |
|
|
|
What type of infarct results from a PE?
|
1. red infarct
2. non at all because of dual supply |
|
|
|
What is primary pulmonary hypertension? What is its prognosis?
|
1. PH of unknown etiology in absence of heart/lung disease
2. Poor prognosis |
|
|
|
What are the causes of secondary pulmonary hypertension?
|
1. COPD
2. Increase in pulmonary flow (e.g. left to right shunt) 3. Increased resistance to flow (e.g. embolism or hypoxic vasoconstriction 4. increased blood viscosity due to polycythemia all causes of RVH |
|
|
|
What are two physiological causes of pulmonary edema?
|
1. Increased hydrostatic pressure (eg. left ventricular failure, mitral valve stenosis)
2. increased alveolar capillary permeability (e.g inhalation of gases, pneumonia, shock, sepsis, pancreatitis, uremia, drug OD) 3. Rapid ascent to high altitude |
|
|
|
Causes of aquired atelectasis?
|
1. bronchial obstruction
2. external compression by tumors or pleural accum of fluid |
|
|
|
What are the two types of atelectasis neonatum?
|
1 primary
2. secondary |
|
|
|
What is pulmonary alveolar proteonosis
|
an uncommon accumulation of amorphus periodic acid schiff positive material in the alveolar air spaces
sometimes appears to be surfactant |
|
|
|
What is the most common cause of lung cancer?
|
Metastatic cancer arising from other primary tumours
|
|
|
|
What is the leading cause of death from cancer in men and women?
|
Lung cancer (5 year survival is less than 10%)
|
|
|
|
Aside from smoking, what are some other etiopathogenic factors?
|
1. air pollution
2. radiation 3. asbestos 4. industrial exposure to nickle and chromate |
|
|
|
What are some clinical characteristics of lung cancer and its spread?
|
1. cough
2. hemoptysis 3. bronchial obstruction 4. atelectasis 5. pneumonitis 6. spread to pleura, ribs, and pericardium |
|
|
|
What is superior vena cava syndrome?
|
1. compression or invasion
2. facial swelling, cyanosis and increased JVD, as well as in arms. |
|
|
|
What is pancoast tumor?
|
1. tumor in apex of lung
2. associated with Horner's Syndrome (PAM) 3. hoarseness due to recurrent laryngeal nerve paralysis |
|
|
|
What are the paraneoplastic endocrine syndromes associated with small cell lung carcinoma?
|
1. adenocorticotrophic like acitivity
2. syndrome of inappropriate ADH secretion |
|
|
|
What is the paraneoplastic endocrine syndrome associated with squamous cell lung carcinoma?
|
1. parathyroid like activity and resultant hypercalcaemia.
|
|
|
|
What are the four different classifications of lung cancers?
|
1. squamous cell carcinoma
2. adenocarcinoma 3. small cell carcinoma (not amenable to surgery) 4. large cell carcinoma |
|
|
|
What are the characteristics of squamous cell carcinoma?
|
1. central location
2. appears as hilar mass with caviations 3. inc. in smokers (linked to cig/day, years) 4. parathyroid like activity with hypercalcemia |
|
|
|
What are the characterstics of adenocarcinomas of the lung
|
1. Bronchial derived: develops on site of previous injury/inflammation (scar cancer)
2. Bronchioalveolar: Peripheral, columnar or cuboidal tumor cells line alveolar walls and can mimic pneumonia |
|
|
|
What are the characteristics of small cell lung carcinoma?
|
1. undiff
2. most agressive 3. metastatic at diagnosis 4. paraneoplastic endocrine syndromes (ACTH/ADH) 5. increased in smokers 6. small cells stain blue |
|
|
|
What are the characteristics of Large Cell Carcinoma?
|
1. peripheral
2. undiff 3. squamous/adeno characteristics on ECM |
|
|
|
Carcinoid Lung Cancer
|
1. major Bronchi
2. low malignancy 3. may result in carcinoid syndrome. |
|
