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113 Cards in this Set
- Front
- Back
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emboli types
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FAT BAT
fat air thrombi bacteria amniotic fluid tumor |
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pulmonary embolus sxs (3)
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chest pain
tachypnea dyspnea |
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imaging test for a PE
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helical CT
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how to prevent pulmonary embolus 2^ deep venous thrombosis
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heparin
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a sign of deep venous thrombosis
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homans' sign
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homans' sign
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dorsiflextion of foot -->
tender calf muscle |
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COPD
changes in pulmonary measurements |
^ RV
v FVC v v FEV1 v FVC --> v FEV1/FVC ratio |
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a few general things COPD causes (3)
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obstruction of air flow -->
air trapping airways close prematurely at high lung volumes V/Q mismatch |
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types of obstructive lung diseases
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chronic bronchitis
emphysema asthma bronchiectasis |
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chronic bronchitis
pathology |
hypertrophy of mucus-secreting glands
in the bronchioles Reid index > 50% |
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reid index is _
used as part of diagnosis of _ |
gland depth
/ total thickness in bronchial wall COPD: Reid index > 50% |
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early/late onset
dyspnea hypoxemia which COPD? |
bronchitis:
--early-onset hypoxemia --late-onset dyspnea emphysema --late-onset hypoxemia --early-onset dyspnea |
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chronic bronchitis sxs
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wheezing
crackles cyanosis (early onset hypoxemia) late-onset dyspnea |
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bronchitis:
_____ onset hypoxemia due to _ |
shunting
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emphysema:
_____ onset hypoxemia due to _ |
late-onset
loss of capillary beds (occurs with loss of alveolar walls) |
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smoking causes _ emphysema
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centriacinar
(mnemonic: think of a cigarette at the center of the acinus) |
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alpha1-antitrypsin deficiency causes _ emphysema
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panacinar
(mnemonic: the enzyme malfunction affects the entirety of the acinus) |
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emphysema
sxs |
dyspnea (early-onset)
v breath sounds tachycardia late-onset hypoxemia |
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three types of emphysema
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centriacinar -- smoking
panacinar -- alpha1-antitrypsin deficiency paraseptal |
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paraseptal emphysema
characteristics |
associated with bullae -->
can rupture--> spontaneous pneumothorax |
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paraseptal emphysema
epi |
often in young, otherwise healthy males
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asthma sxs (8)
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cough
wheezing dyspnea tachypnea v Inspiration/Expirtn ratio (duration) mucus plugging hypoxemia pulsus paradoxes |
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asthma pathology
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bronchial hyper responsiveness -->
bronchoconstriction smooth muscle hypertrophy Curschmann's spirals |
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asthma features _ spirals which are
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Curschmann's spirals
shed epithelium from mucus plugs |
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Curschmann's spirals are _
and seen in _ |
shed epithelium from mucus plugs
asthma |
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bronchiectasis
pathology features (5) |
chronic necrotizing infection of bronchi -->
permanently dilated airways purulent sputum recurrent infections hemoptysis |
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bronchiectasis
is associated with _ can lead to _ |
bronchial obstruction
CF poor ciliary motility Kartagener's aspergillosis |
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restrictive lung diseases
two types |
poor breathing mechanics
interstitial lung diseases |
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restrictive interstitial lung diseases have a lowered _ _
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diffusing capacity
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restrictive lung diseases with poor breathing mechanics include
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--polio, myasthenia gravis
--scoliosis, morbid obesity |
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interstitial lung diseases that are restrictive (9)
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ARDS
neonatal respiratory distress pneumoconiosis sarcoidosis idiopathic pulmonary fibrosis goodpasture's wegener's granulomatosis eosinophilic granuloma bleomycin, busulfan, amiodarone |
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neonatal respiratory distress syndrome is aka
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hyaline membrane disease
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_ --> idiopathic pulmonary fibrosis
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repeated cycles of lung injury and wound healing, with
^ collagen |
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eosinophilic granuloma is aka
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histiocytosis X
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histiocytosis X is aka
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eosinophilic granuloma
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hyaline membrane disease is aka
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neonatal respiratory disress syndrome
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4 core features of sarcoidosis
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bilateral hilar lymphadenopathy
noncaseating granuloma ^ ACE ^ calcium |
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pneumoconioses include
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coal miner's
silicosis asbestosis |
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coal miner's pneumoconiosis can result in
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cor pulmonale
Caplan's syndrome |
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coal miner's pneumoconiosis affects what part of the lung?
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upper lobes
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silicosis affects what part of the lung?
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upper lobes
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pathology process of silicosis
basic idea (3) |
macrophages respond to silica
release fibrogenic factors --> fibrosis |
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lymph node features of silicosis
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eggshell calcification
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silica may do ___
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disrupt phagolysosomes
impair macrophages increasing susceptibility to TB |
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asbestosis
gross pathology |
"ivory white" calcified pleural plaques
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asbestosis
histopathology (4) |
golden-brown
fusiform rods resembling dumbbells inside macrophages |
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asbestosis
is associated with |
^ risk of "BM"
bronchogenic carcinoma mesothelioma |
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surfactant is made most abundantly after _ week
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35th week of gestation
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surfactant is _
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dipalmitoyl phosphatidylcholine
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_ ratio is _ in neonatal respiratory distress syndrome
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lecithin-to-sphingomyelin ratio
usually < 1.5 in neonatal respiratory distress syndrome |
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neonatal respiratory distress syndrome --> risk of _ why?
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persistenly low O2 tension
--> risk of PDA supplemental O2 --> retinopathy of prematurity |
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risk factors for neonatal respiratory distress
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prematurity
maternal diabetes cesarean delivery |
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treatment for neonatal respiratory distress syndrome
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maternal steroids before birth
artificial surfactant thyroxine |
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ARDS may be caused by (6)
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trauma
sepsis shock gastric aspiration uremia acute pancreatitis amniotic fluid embolism |
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ARDS fluid leakage into alveoli: protein high or low?
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protein-rich
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ARDS pathology results
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diffuse alveolar damage -->
^ capillary permeability --> protein-rich leakage into alveoli intra-alveolar hyaline membrane |
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ARDS "initial damage is due to..." (3)
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neutrophilic substances toxic to alveolar wall
activation of coag cascade oxygen-derived free radicals |
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obstructive lung volumes that are increased
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TLC (total lung capacity)
FRC (functional residual capacity) RV (residual volume) |
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why the different FEV1/FVC ratio
between restrictive vs. obstructive? |
restrictive and obstructive:
--both FEV1 and FVC are reduced obstructive --FEV1 is more dramatically reduced |
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sleep apnea is associated with
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obesity
loud snoring systemic/pulmonary hypertension arrhythmias possibly sudden death |
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sleep apnea a lab finding and why
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hypoxia -->
^ EPO release --> erythrocytosis |
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physical findings (table)
bronchial obstruction (4) |
breath sounds: absent or v
resonance: v fremitus: v tracheal deviation: toward side of lesion |
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tracheal deviation:
toward side of lesion in _ away from side of lesion in _ |
toward lesion: bronchial obstruction
away from lesion: tension pneumothorax I think it's because obstruction causes lung collapse, so there's a pressure deficit, there's room / space for the trachea, "pulls on it". pneumothorax causes increased pressure, "pushes it away". |
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physical findings (table)
pleural effusion |
breath sounds: v over effusion
resonance: dullness fremitus: v |
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(table)
what causes ^ fremitus? |
lobar pneumonia
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(table)
what causes absent fremitus |
tension pneumothorax
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(table)
what causes dullness? |
pleural effusion
pneumonia (lobar) |
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(table)
what causes v resonance |
bronchial obstruction
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(table)
what causes hyper resonance? |
tension pneumothorax
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(table) physical findings
pneumonia (lobar) |
breath sounds: may have bronchial breath sounds over lesion
resonance: dullness fremitus: ^ |
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pneumonia vs. pleural effusion
resonance and fremitus |
pleural effusion
resonance: dullness fremitus: v pneumonia resonance: dullness fremitus: ^ |
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(table) physical findings
tension pneumothorax |
breath sounds: v
resonance: hyper resonant fremitus: absent tracheal deviation: away from side of lesion |
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lung cancer
sxs |
cough
hemoptysis bronchial obstruction wheezing |
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lung cancer radiology findings
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x-ray: pneumonic "coin" lesion
CT: non-calcified nodule |
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_ are common cancers that metastasize to the lung
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breast
colon prostate bladder cancer |
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lung cancer: sites of metastasis
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adrenals
brain (epilepsy) bone (pathologic fracture) liver (jaundice, hepatomegaly) |
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3 complications of lung cancer
besides pan coast tumor, hornet's syndrome, and endocrine (paraneoplastic) |
superior vena cava syndrome
recurrent laryngeal (hoarseness) effusions (pleural or pericardial) |
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Central lung cancers
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Squamous
Small cell |
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Peripheral lung cancers
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Adenocarcinoma
Large cell |
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Pleural lung cancers
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Mesothelioma
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Types of adenocarinoma
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Bronchial
Bronchioloalveolar |
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Physical aspects of squamous cell lung cancer
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Hilar mass arising from bronchus
Cavitation |
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Squamous cell lung cancer
Paraneopastic aspects |
PTHrP
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Squamous cell lung cancer
Histology |
Keratin pearls
Intercellular bridges |
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Bronchial adenocarinoma
Physical Features |
Develops in site of prior pulmonary inflammation or injury
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Bronchioloalveolar adenocarinoma
features |
Grows along airways
Can present like pneumonia |
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Bronchioloalveolar adenocarinoma
Sequelae |
Hypertrophic osteoarthropathy
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Lung Adenocarcinoma histology
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Both types of Lung adenocarcinoma:
Clara cells--> type II pneumocytes Multiple densities on cxr |
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Oncologic features of small cell lung cancer
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Undifferentiated
Aggressive Responds to chemotherapy Inoperable |
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Small cell lung cancer paraneoplastic features
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ACTH
ADH Lambert-Eaton |
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Lambert - eaton is, in a word
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Antibodies against Ca++ channel
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Small cell lung cancer histology
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Neoplasm of neuroendocrine Kulchitsky cells
--> small dark blue cells |
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4 oncology features of large cell lung cancer
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Anaplastic, undifferentiated
Poor prognosis Less responsive to chemotherapy Removed surgically |
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Large cell carcinoma
Histology |
Pleomorphic giant cells
Leukocyte fragments in cytoplasm |
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Carcinoid syndrome sxs
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Flushing
Diarrhea Wheezing Salivation |
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Mesothelioma physical pathology
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Hemorrhagic pleural effusions
Pleural thickening |
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Mesothelioma histology
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Psammoma bodies
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Which lung cancer has keratin pearls?
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Squamous cell
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Which lung cancer has psammoma bodies ?
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Mesothelioma
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Lobar pneumonia
Which bugs |
S. Pneumonia
Klebsiella |
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Bronchopneumonia
Which bugs |
S aureus
H influenzae Klebsiella S pyogenes |
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Which viruses are notable for causing interstitial peumonia
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RSV
Adenovirus |
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Lobar pneumonia is __
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Intra-alveolar exudate-->
Consolidation |
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Bronchopneumonia is __
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Acute inflammatory infiltrates from bronchioles into adjacent alveoli
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Bronchopneumonia physical distribution
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Patchy
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Lung abscess bugs: often
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S aureus
or anaerobes |
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Lung abscess is _ _ _
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Pus within parenchyma
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two causes of lung abscess
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Aspiration of oropharyngeal contents
bronchial obstruction e.g. cancer |
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three types of pleural effusions
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Transudate
Exudate Lymphatic |
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Lymphatic pleural effusions contents
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Milky fluid
^ triglycerides |
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Transudate pleural effusions are caused by
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CHF
Nephrotic syndrome Hepatic cirrhosis |
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Exudative pleural effusions are due to
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Malignancy
Pneumonia Collagen vascular diseases Trauma (occurs in states of ^ vascular permeability) |
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treatment point about pleural effusions
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Exudate pleural effusions must be drained b/c risk of infection
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