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193 Cards in this Set
- Front
- Back
What is the term for the obstruction of sinus drainage into the nasal cavity, leading to inflammation and pain over the affected area? What is the most likely affected area? |
Rhinosinusitis
- Often in maxillary sinuses in adults (yellow arrows) |
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What happens in Rhinosinusitis? What is the most common cause?
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- Obstruction of sinus drainage into the nasal cavity, leading to inflammation and pain over the affected area (usually maxillary sinuses in adults)
- Most common acute cause is VIRAL URI, may cause superimposed bacterial infection (S. pneumoniae, H. influenzae, M. catarrhalis) |
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What is the most common acute cause of rhinosinusitis?
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Viral URI
|
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What are the most common causes of superimposed bacterial infection on rhinosinusitis?
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- S. pneumoniae
- H. influenzae - M. catarrhalis |
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What predisposes to a deep venous thrombosis?
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Virchow's Triad:
- Stasis - Hypercoagulability - Endothelial damage |
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What can cause hypercoagulability? What is this a component of?
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- Eg, defect in coagulation cascade proteins, most commonly Factor V Leiden
- Component of Virchow's triad |
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What are the characteristics of endothelial damage that is a component of Virchow's triad?
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Exposed collagen triggers clotting cascade
|
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What is the most likely location for pulmonary emboli to arise from?
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Deep leg veins
|
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What is the Homan sign?
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Dorsiflexion of the foot → calf pain
|
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What drug can be used to prevent deep vein thrombosis?
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Heparin
|
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What drug can be used for acute management of deep vein thrombosis?
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Heparin
|
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What drug can be used for long-term prevention of deep vein thrombosis recurrence?
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Warfarin
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What are the signs / symptoms of Pulmonary Embolism?
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- V/Q mismatch → hypoxemia → respiratory alkalosis
- Sudden-onset dyspnea - Chest pain - Tachypnea - May present as sudden death |
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What are the types of Pulmonary Emboli?
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"An embolus moves like a FAT BAT"
- Fat - Air - Thrombus - Bacteria - Amniotic fluid - Tumor |
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What are fat pulmonary emboli associated with?
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Associated with long bone fractures and liposuction
|
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What is the classic triad of fat emboli?
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- Hypoxemia
- Neurologic abnormalities - Petechial rash |
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What can an amniotic fluid emboli lead to?
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Can lead to DIC, especially post-partum
|
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Who is likely to get gas emboli? How do you treat them?
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Nitrogen bubbles can precipitate in ascending divers; treat with hyperbaric oxygen
|
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What is the best way to image a patient you think has a pulmonary embolism? What do you look for?
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CT pulmonary angiography (look for filling defects)
|
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What is this gross image of?
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Pulmonary Embolism
- Note large embolus (arrows) in the pulmonary artery |
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What does this image show?
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Pulmonary Thromboembolus
- Lines of Zahn are interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in thrombi formed BEFORE death - Helps distinguish pre- and post-mortem thrombi |
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What can you look for to determine whether a thrombus formed pre-mortem or post-mortem?
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Lines of Zahn are interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in thrombi formed BEFORE death
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What are the consequences of obstructive lung diseases?
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- Leads to air trapping in the lungs
- Airways close prematurely at high lung volumes → ↑ RV and ↓ FVC - PFTs: ↓↓ FEV1, ↓ FVC → ↓ FEV1/FVC ratio - V/Q mismatch |
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What can chronic, hypoxic pulmonary vasoconstriction lead to?
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Cor Pulmonale
|
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What are the types of obstructive lung diseases?
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- Chronic Bronchitis ("blue bloater")
- Emphysema ("pink puffer", barrel-shaped chest) - Asthma - Bronchiectasis |
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What happens to the pulmonary function tests in patients with obstructive lung disease?
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- ↓↓ FEV1
- ↓ FVC - ↓ FEV1/FVC ratio |
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What are the types of COPD?
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- Chronic Bronchitis
- Emphysema |
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What happens pathologically in patients with Chronic Bronchitis?
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Hyperplasia of mucus-secreting glands in the bronchi → Reid index >50%
|
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What is the Reid Index? Utility?
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Ratio of thickness of gland layer / total thickness of bronchial wall
>50% is supportive of Chronic Bronchitis |
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What are the diagnostic criteria for Chronic Bronchitis?
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Productive cough for >3 months / year (not necessarily consecutive) for >2 years
|
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Chronic bronchitis is a disease of what airways?
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Small airways
|
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What signs and symptoms does a patient with Chronic Bronchitis have?
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- Wheezing
- Crackles - Cyanosis (early onset hypoxemia due to shunting) - Late onset dyspnea - CO2 retention |
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What happens pathologically in patients with Emphysema?
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- Enlargement of air spaces
- ↓ Elastic recoil - ↑ Compliance - ↓ DLCO resulting from destruction of alveolar walls |
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What are the types of emphysema? What is each associated with?
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- Centriacinar: associated with smoking
- Panacinar: associated with α1-antitrypsin deficiency |
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What causes increased lung compliance in patients with emphysema?
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↑ Elastase activity → loss of elastic fibers → ↑ lung compliance
|
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How do patients with emphysema breathe?
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Exhale through pursed lips to increase airway pressure and prevent airway collapse during respiration
|
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What is the pathology responsible for asthma?
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Bronchial hyperresponsiveness causes reversible bronchoconstriction
|
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What are the histologic findings of asthma?
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- Smooth muscle hypertrophy
- Curschmann spirals (shed epithelium forms mucus plugs) - Charcot-Leyden crystals (formed from breakdown of eosinophils in sputum) |
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What is the term for shed epithelium that forms mucus plugs? What pathology is it a sign of?
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Curschman Spirals - sign of asthma
|
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What is the term for the crystals formed by the breakdown of eosinophils in the sputum? What pathology is it a sign of?
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Charcot-Leyden crystals - sign of asthma
|
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What can trigger asthma?
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- Viral URIs
- Allergens - Stress |
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What test can you use to diagnose asthma?
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Methacholine challenge
|
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What are the findings of asthma?
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- Cough
- Wheezing - Tachypnea - Dyspnea - Hypoxemia - ↓ I/E ratio - Pulsus paradoxus - Mucus plugging |
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What pathology is seen in Bronchiectasis?
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Chronic necrotizing infection of bronchi → permanently dilated airways, purulent sputum, recurrent infections, and hemoptysis
|
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What part of the respiratory tract is affected by bronchiectasis? How is it affected?
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Bronchi: chronic necrotizing infection
- Permanently dilates the airways - Forms purulent sputum - Recurrent infections - Hemoptysis |
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What is bronchiectasis associated with?
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- Bronchial obstruction
- Poor ciliary motility (smoking) - Kartagener syndrome (primary ciliary dyskinesia) - Cystic fibrosis - Allergic bronchopulmonary aspergillosis |
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What are the characteristics of all restrictive lung diseases?
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Restricted lung expansion causes:
- ↓ Lung volumes (↓ FVC and TLC) - PFTs: FEV1/FVC ratio ≥ 80% |
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What are the types of restrictive lung disease?
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- Restrictive lung disease due to poor breathing mechanics
- Restrictive lung disease due to interstitial lung disease |
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What are the characteristics of restrictive lung diseases due to poor breathing mechanics? Causes?
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- Extrapulmonary, peripheral hypoventilation, normal A-a gradient
Causes: - Poor muscular effort: polio and myasthenia gravis - Poor structural apparatus: scoliosis and morbid obesity |
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What are the characteristics of interstitial lung diseases?
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- Pulmonary ↓ diffusing capacity
- ↑ A-a gradient |
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What are the types of interstitial lung diseases?
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- Acute Respiratory Distress Syndrome (ARDS)
- Neonatal Respiratory Distress Syndrome - Pneumoconioses - Sarcoidosis - Idiopathic pulmonary fibrosis - Goodpasture syndrome - Granulomatosis with Polyangiitis (Wegener) - Langerhans cell Histiocytosis - Hypersensitivity Pneumonitis - Drug toxicity |
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What histologic finding is characteristic of neonatal respiratory distress syndrome?
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Hyaline membrane (disease)
|
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What are the findings in Sarcoidosis that affects the lungs?
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Restrictive lung disease
- Bilateral hilar lymphadenopathy - Non-caseating granuloma - ↑ ACE and Ca2+ |
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What are the characteristics of idiopathic pulmonary fibrosis?
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Restrictive lung disease
- Repeated cycles of lung injury and wound healing with increased collagen deposition |
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What kind of granulomas occur in Langerhans Cell Histiocytosis?
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Eosinophilic Granulomas
|
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What drugs can cause restrictive lung disease?
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- Bleomycin
- Busulfan - Amiodarone - Methotrexate |
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What type of reaction causes hypersensitivity pneumonitis?
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Mixed type III/IV hypersensitivity reaction to environmental antigens
|
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Which symptoms occur in hypersensitivity pneumonitis?
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- Dyspnea
- Cough - Chest tightness - Headache |
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Who is most likely to get hypersensitivity pneumonitis?
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- Farmers
- Those exposed to birds |
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What are the types of pneumoconioses?
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- Asbestosis
- Coal Workers' Pneumoconiosis - Silicosis |
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What do Coal Workers' Pneumoconiosis, Silicosis, and Asbestosis increase the risk for?
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- Cor pulmonale
- Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules) |
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What is Caplan Syndrome?
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Rheumatoid Arthritis and Pneumonconioses with Intrapulmonary Nodules
|
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What lung pathology is associated with shipbuilding, roofing, and plumbing?
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Asbestosis
|
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What are the characteristic findings on imaging of asbestosis?
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"Ivory white" calcified pleural plaques are pathognomonic of asbestos exposure, but they are not precancerous
|
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What are these findings associated with?
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Asbestosis:
- Associated with increased risk of bronchogenic carcinoma and mesothelioma |
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What part of the lungs are affected by asbestosis?
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Affects lower lungs:
"Asbestos is from the roof (common in insulation), but affects the base (lower lobes)" |
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What is the appearance of asbestos histologically?
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Asbestos (ferruginous) bodies are golden-brown fusiform rods resembling dumbbells
|
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What part of the lungs are affected by silicosis?
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Affects upper lobes:
"Silica is from the base (earth), but affect the roof (upper lobes)" |
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What part of the lungs are affected by coal?
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Affects upper lobes:
"Coal is from the base (earth), but affect the roof (upper lobes)" |
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What is the other name for "black lung disease"?
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Coal Workers' Pneumoconiosis
|
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What happens if someone has prolonged exposure to coal dust?
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Macrophages become laden with carbon → inflammation and fibrosis → Coal Workers' Pneumoconiosis
|
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What condition is found in many urban dwellers exposed to sooty air? Symptoms?
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Anthracosis - asymptomatic
|
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What is associated with foundries, sandblasting, and mines?
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Silicosis
|
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What happens if someone has exposure to silica?
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- Macrophages respond to silica and release fibrogenic factors → fibrosis → Silicosis
- Silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB |
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What is there increased risk of in patients with Silicosis?
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- Increased susceptibility to TB
- Bronchogenic carcinoma |
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What is the characteristic appearance of silicosis?
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"Eggshell" calcification of hilar lymph nodes
|
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What causes Neonatal Respiratory Distress Syndrome?
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Surfactant deficiency → ↑ surface tension → alveolar collapse
|
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What can predict whether a neonate will have neonatal respiratory distress syndrome?
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Lecithin:Sphingomyelin ratio <1.5 in amniotic fluid
|
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What is a potential complication of neonatal respiratory distress syndrome?
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- Persistently low O2 tension → risk of PDA
- Therapeutic supplementation of O2 can result in RETINOPATHY of prematurity and BROCHOPULMONARY DYSPLASIA |
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What are the risk factors for neonatal respiratory distress syndrome?
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- Prematurity
- Maternal diabetes (due to ↑ fetal insulin) - C-section delivery (↓ release of fetal glucocorticoids) |
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How do you treat a neonate at risk for neonatal respiratory distress syndrome?
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Give mother steroids before birth to stimulate surfactant production
|
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How do you treat an infant with neonatal respiratory distress syndrome?
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Artificial Surfactant
|
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What can cause acute respiratory distress syndrome?
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- Trauma
- Sepsis - Shock - Gastric aspiration - Uremia - Acute pancreatitis - Amniotic fluid embolism |
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What changes occur in acute respiratory distress syndrome?
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- Diffuse alveolar damage → ↑ alveolar capillary permeability → protein-rich leakage into alveoli and non-cardiogenic pulmonary edema (normal PCWP)
- Formation of intra-alveolar hyaline membrane |
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What does this x-ray show?
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Acute Respiratory Distress Syndrome
- Near complete opacification of the lungs - Obscured cardiomediastinal silhouette |
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What does this histology show?
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Acute Respiratory Distress Syndrome
- Alveolar fluid (clear and frothy) - Thickened hyaline membranes (pink) |
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What causes the initial damage in acute respiratory distress syndrome?
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- Release of neutrophilic substances toxic to alveolar wall
- Activation of coagulation cascade - Oxygen-derived free radicals |
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What is the normal FEV1/FVC ratio?
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80%
|
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What is the FEV1/FVC ratio in obstructive lung disease?
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< 80%
|
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What is the FEV1/FVC ratio in restrictive lung disease?
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≥ 80%
|
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Which lung disease has increased lung volumes (↑ TLC, ↑ FRC, and ↑ RV)?
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Obstructive lung disease
|
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Which lung disease has decreased lung volumes (↓ TLC, ↓ FRC, and ↓ RV)?
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Restrictive lung disease
|
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How does the change in FEV1 and FVC compare in obstructive vs restrictive lung disease?
|
In both obstructive and restrictive disease, FEV1 and FVC are reduced
- In obstructive, however, FEV1 is more dramatically reduced compared to FVC, resulting in ↓ FEV1/FVC ratio |
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What is the normal pulmonary artery pressure?
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10-14 mmHg
|
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What is the definition of pulmonary hypertension?
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≥ 25 mmHg at rest
|
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What are the consequences of pulmonary hypertension?
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- Arteriosclerosis
- Medial hypertrophy - Intimal fibrosis of pulmonary arteries |
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What causes Primary Pulmonary Hypertension? Prognosis?
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- Inactivating mutation in BMPR2 gene (normally functions to inhibit vascular smooth muscle proliferation)
- Poor prognosis |
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What causes Secondary Pulmonary Hypertension? Prognosis?
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- COPD
- Mitral stenosis - Recurrent thromboemboli - Auto-immune disease - L → R shunt - Sleep apnea - Living at high altitude |
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How does COPD affect the pressure in the pulmonary circulation?
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Destroys lung parenchyma → 2° pulmonary hypertension
|
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Which valvular problem can affect the pressure in the pulmonary circulation? How?
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Mitral Stenosis → ↑ Resistance → ↑ Pressure → 2° pulmonary hypertension
|
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How do thromboemboli affect the pressure in the pulmonary circulation?
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Recurrent thromboemboli → ↓ cross-sectional area of pulmonary vascular bed → 2° pulmonary hypertension
|
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Which auto-immune diseases affect the pressure in the pulmonary circulation? Implications?
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Systemic Sclerosis
- Inflammation → Intimal Fibrosis → Medial Hypertrophy → 2° Pulmonary Hypertension |
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What type of cardiac shunt can affect the pressure in the pulmonary circulation? Implications?
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Left-to-Right Shunt → ↑ shear stress → endothelial injury → 2° pulmonary hypertension
|
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How does sleep apnea affect the pressure in the pulmonary circulation?
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Hypoxic vasoconstriction → 2° pulmonary hypertension
|
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How does living at a high altitude affect the pressure in the pulmonary circulation?
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Hypoxic vasoconstriction → 2° pulmonary hypertension
|
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What is the course of having pulmonary hypertension?
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Pulmonary hypertension → severe respiratory distress → cyanosis and RVH → death from decompensated cor pulmonale
|
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What happens in sleep apnea? Consequences?
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Repeated cessation of breathing >10 seconds during sleep → disrupts sleep → daytime somnolence
|
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What happens to the PaO2 during the day and night in a patient with sleep apnea?
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- Normal PaO2 during day
- Nocturnal hypoxia |
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What are the complications of sleep apnea?
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Nocturnal hypoxia → systemic / pulmonary HTN, arrhythmias (atrial fibrillation / flutter), and sudden death
|
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What are the types of sleep apnea? How do they differ?
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- Central sleep apnea: no respiratory effort
- Obstructive sleep apnea: respiratory effort against airway obstruction, associated with obesity and loud snoring |
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How do you treat sleep apnea?
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- Weight loss
- CPAP - Surgery |
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How does sleep apnea affect erythropoiesis?
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Hypoxia → ↑ EPO release → ↑ erythropoiesis
|
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What variation of sleep apnea is seen in obese patients?
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Obesity Hypoventilation Syndrome:
- Obesity (BMI ≥ 30 kg/m2) → hypoventilation → ↓ PaO2 and ↑ PaCO2 during waking hours |
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In what lung pathology are there the following findings:
- Breath sounds: ↓ - Percussion: dull - Fremitus: ↓ - Tracheal deviation: - |
Pleural Effusion
|
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In what lung pathology are there the following findings:
- Breath sounds: ↓ - Percussion: Dull - Fremitus: ↓ - Tracheal deviation: Toward side of lesion |
Atelectasis (bronchial obstruction)
|
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In what lung pathology are there the following findings:
- Breath sounds: ↓ - Percussion: hyperresonant - Fremitus: ↓ - Tracheal deviation: - |
Spontaneous pneumothorax
|
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In what lung pathology are there the following findings:
- Breath sounds: ↓ - Percussion: hyperresonant - Fremitus: ↓ - Tracheal deviation: away from side of lesion |
Tension pneumothorax
|
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In what lung pathology are there the following findings:
- Breath sounds: bronchial breath sounds; late inspiratory crackles - Percussion: dull - Fremitus: ↑ - Tracheal deviation: - |
Consolidation (lobar pneumonia, pulmonary edema)
|
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In what lung pathologies are there decreased breath sounds?
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- Pleural effusion
- Atelectasis (bronchial obstruction) - Spontaneous pneumothorax - Tension pneumothorax |
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In what lung pathologies are there bronchial breath sounds and late inspiratory crackles?
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Consolidation (lobar pneumonia or pulmonary edema)
|
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In what lung pathologies are the lungs dull to percussion?
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- Pleural effusion
- Atelectasis (Bronchial obstruction) - Consolidation (lobar pneumonia or pulmonary edema) |
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In what lung pathologies are the lungs hyperresonant to percussion?
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- Spontaneous pneumothorax
- Tension pneumothorax |
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In what lung pathologies do the lungs have decreased fremitus?
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- Pleural effusion
- Atelectasis (bronchial obstruction) - Spontaneous pneumothorax - Tension pneumothorax |
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In what lung pathologies do the lungs have increased fremitus?
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Consolidation (lobar pneumonia or pulmonary edema)
|
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In what lung pathologies is there a tracheal deviation toward the side of the lesion?
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Atelectasis (bronchial obstruction)
|
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In what lung pathologies is there a tracheal deviation away the side of the lesion?
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Tension pneumothorax
|
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What is the leading cause of cancer death?
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Lung cancer
|
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What is the classic presentation of lung cancer?
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- Cough
- Hemoptysis - Bronchial obstruction - Wheezing - Pneumonic "coin" lesion on x-ray film or non-calcified nodule on CT |
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What finding on x-ray is characteristic of lung cancer?
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Pneumonic "coin" lesion
|
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What finding on CT is characteristic of lung cancer?
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Non-calcified nodule
|
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What is more common: primary neoplasms or metastases to the lungs?
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In the lung, metastases (usually multiple lesions) are more common than 1° lesions
|
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What are the most common sites that metastasize to the lungs?
|
Cancer of:
- Breast - Colon - Prostate - Bladder |
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What are the most common sites of metastases from the lungs?
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- Adrenals
- Brain - Bone (pathologic fracture) - Liver (jaundice, hepatomegaly) |
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What are the types of lung cancer?
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- Adenocarcinoma
- Squamous cell carcinoma - Small cell (oat cell) carcinoma - Large cell carcinoma - Bronchial carcinoid tumor |
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What types of lung cancer are located peripherally?
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- Adenocarcinoma
- Large cell carcinoma - Bronchial carcinoid tumor (either peripheral or central) |
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What types of lung cancer are located centrally?
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- Squamous cell carcinoma
- Small cell (oat cell) carcinoma - Bronchial carcinoid tumor (either peripheral or central) |
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What is the most common type of lung cancer (except for metastases)?
|
Adenocarcinoma
|
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What is the most common type of lung cancer in non-smokers?
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Adenocarcinoma
|
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What genetic changes are associated with Lung Adenocarcinoma?
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Activating mutations:
- k-ras - EGFR - ALK |
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What is a specific physical sign of Lung Adenocarcinoma?
|
Hypertrophic osteoarthropathy (clubbing)
|
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Which subtype of lung adenocarcinoma is associated with hazy infiltrates on CXR (similar to pneumonia)? Why this appearance? Prognosis?
|
Bronchioloalveolar Subtype of Adenocarcinoma:
- Tumor grows along alveolar septa giving an apparent "thickening" to the alveolar walls - Excellent prognosis |
|
What type of cancer does this show? What are the characteristics of it that tell you that?
|
Squamous Cell Carcinoma
- Keratin pearls and intercellular bridges - Sheets of large dysplastic squamous cells (arrows) surrounding dark, pink keratin pearls (lower right) |
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What is the location of lung Squamous Cell Carcinoma? Other characteristics indicative of it?
|
- Central location
- Hilar mass arising from bronchus - Cavitation, Cigarettes, and HyperCalcemia |
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What type of lung cancer is associated with hypercalcemia? How?
|
Squamous Cell Carcinoma
- Hypercalcemia because tumor produces PTHrP |
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What type of cancer does this show? What are the characteristics of it that tell you that?
|
Small Cell (Oat Cell) Carcinoma
- Sheets of dark purple tumor cells with nuclear molding, high mitotic rate, necrosis, and "salt and pepper" neuroendocrine-type chromatin - Neoplasm of neuroendocrine Kulchitsky cells → small dark blue cells |
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What type of lung cancer is known for producing certain substances that can cause seemingly unrelated symptoms? What substances?
|
Small Cell (Oat Cell) Carcinoma:
- May produce ACTH or ADH - May also produce Antibodies against pre-synaptic Ca2+ channels causing Lambert-Eaton Myasthenic Syndrome |
|
What genetic change is sometimes associated with Small Cell (Oat Cell) Carcinoma?
|
Ampification of myc oncogenes common
|
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What is the prognosis of Small Cell (Oat Cell) Carcinoma? How do you treat it?
|
- Undifferentiated → very aggressive
- Inoperable, treat with chemotherapy |
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Which type of lung cancer is associated with pleomorphic giant cells?
|
Large Cell Carcinoma
|
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What are the characteristics of a Large Cell Carcinoma of the lung? Location?
|
- Peripheral locatoin
- Highly anaplastic undifferentiated tumor |
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What is the prognosis for Large Cell Carcinoma? How do you treat?
|
- Poor prognosis
- Less responsive to chemotherapy, removed surgically |
|
What type of lung cancer is composed of nests of neuroendocrine cells and is chromogranin A positive?
|
Bronchial Carcinoid Tumor
|
|
What is the prognosis for Bronchial Carcinoid Tumor? Symptoms?
|
- Excellent prognosis, metastasis rare
- Symptoms usually due to mass effect - Occasionally causes carcinoid syndrome (5-HT secretion → flushing, diarrhea, wheezing) |
|
What type of lung cancer is associated with Carcinoid Syndrome? What does that mean?
|
Bronchial Carcinoid Tumor
- 5-HT secretion → flushing, diarrhea, wheezing |
|
Which types of lung cancer have a good prognosis?
|
- Bronchioalveolar subtype of Adenocarcinoma
- Bronchial Carcinoid Tumor |
|
What is the name of the malignancy of the pleura? What is it associated with?
|
Mesothelioma
- Associated with asbestosis |
|
What are the complications of a Mesothelioma?
|
Results in hemorrhagic pleural effusion and pleural thickening
|
|
What are the histologic signs of Mesothelioma?
|
Psamomma bodies
|
|
What type of lung cancer occurs in the apex of the lung? What can it do?
|
Pancoast tumor:
May affect cervical sympathetic plexus causing: - Horner syndrome (ipsilateral ptosis, miosis, and anhidrosis) - SVC syndrome - Sensorimotor deficits - Hoarseness |
|
What are the symptoms of Horner syndrome?
|
Ipsilateral ptosis, miosis, and anhidrosis
|
|
What happens in Superior Vena Cava Syndrome?
|
Obstruction of the SVC impairs blood drainage from the head, neck, and upper extremities
|
|
What are the implications of the blood drainage obstruction of the head, neck, and upper extremities in superior vena cava syndrome?
|
- Head → facial plethora
- Neck → jugular venous distention - Upper extremities → edema Medical emergency |
|
What can cause Superior Vena Cava Syndrome?
|
Commonly caused by malignancy and thrombosis from indwelling catheters
|
|
What can Superior Vena Cava Syndrome cause if the obstruction is severe?
|
Can raise intracranial pressure → headaches, dizziness, and ↑ risk of aneurysm / rupture of intracranial arteries
|
|
What are the types of pneumonia?
|
- Lobar
- Bronchopneumonia - Interstitial (atypical) pneumonia |
|
What are the typical causative organisms responsible for lobar pneumonia?
|
- S. pneumoniae most frequently
- Also Legionella and Klebsiella |
|
What are the typical causative organisms responsible for bronchopneumonia?
|
- S. pneumoniae
- S. aureus - H. influenzae - Klebsiella |
|
What are the typical causative organisms responsible for interstitial (atypical) pneumonia?
|
- Viruses (influenza, RSV, adenoviruses)
- Mycoplasma - Legionella - Chlamydia |
|
What are the characteristics of lobar pneumonia?
|
Intra-alveolar exudate → consolidation
- May involve entire lung |
|
What are the characteristics of bronchopneumonia?
|
- Acute inflammatory infiltrates from bronchioles into adjacent alveoli
- Patchy distribution involving ≥ 1 lobe |
|
What is the histologic appearance of bronchopneumonia?
|
Neutrophils in alveolar space
|
|
What are the characteristics of interstitial (atypical) pneumonia?
|
- Diffuse patchy inflammation localized to interstitial areas at alveolar walls
- Distribution involving ≥ 1 lobe - Generally follows a more indolent course |
|
What does this chest x-ray show?
|
Interstitial Pneumonia: coarse bilateral reticular opacities, worse on the right side
|
|
What is wrong in a lung abscess?
|
Localized collection of pus within the parenchyma
|
|
What can cause a lung abscess?
|
Bronchial obstruction (eg, cancer) or aspiration of oropharyngeal contents (especially in patients predisposed to loss of consciousness [eg, alcoholics or epileptics])
|
|
What does this chest x-ray show?
|
Lung Abscess
- Localized collection of pus within parenchyma - Air-fluid levels can be seen by arrows |
|
What are the most common causes of lung abscesses?
|
- S. aureus
- Anaerobes (Bacteroides, Fusobacterium, or Peptostreptococcus) |
|
What is wrong in a pleural effusion?
|
Excess accumulation of fluid between the two pleural layers → restricts lung expansion during inspiration
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What does this chest x-ray show? How would you describe it?
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Pleural Effusion
- Blunting of the left costophrenic angle (arrow) due to fluid in the pleural space |
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What are the types of pleural effusions?
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- Transudate
- Exudate - Lymphatic |
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What are the components of transudative pleural effusions? What can cause this?
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- ↓ Protein content
- Due to CHF, nephrotic syndrome, or hepatic cirrhosis |
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What are the components of exudative pleural effusions? What can cause this?
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- ↑ Protein content
- Due to malignancy, pneumonia, collagen vascular disease, trauma (occurs in states of ↑ vascular permeability) |
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What are the components of lymphatic pleural effusions / chylthorax? What can cause this?
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- ↑ Triglycerides, milky-appearing fluid
- Due to thoracic duct injury from trauma or malignancy |
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What type of pleural effusion needs to be drained? Why?
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Exudative: must be drained due to risk of infection
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Which type of fluid is found in a pleural effusion caused by CHF, nephrotic syndrome, or hepatic cirrhosis?
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Transudate: ↓ protein content
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Which type of fluid is found in a pleural effusion caused by malignancy, pneumonia, collagen vascular disease, or trauma?
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Exudate: ↑ protein content
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Which type of fluid is found in a pleural effusion caused by thoracic duct injury from trauma or malignancy?
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Lymphatic / Chylothorax: ↑ triglycerides (milky-appearing)
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What is wrong in a pneumothorax?
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Accumulation of air in the pleural space
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What signs and symptoms occur in patients with pneumothorax?
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All on affected side:
- Unilateral chest pain - Dyspnea - Unilateral chest expansion - ↓ Tactile fremitus - Hyperresonance - Diminished breath sounds |
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What are the types of pneumothorax?
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- Spontaneous pneumothorax
- Tension pneumothorax |
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What are the characteristics of a spontaneous pneumothorax? Cause?
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- Accumulation of air in the pleural space
- Occurs most frequently in tall, thin, young males because of rupture of apical blebs |
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What are the characteristics of a tension pneumothorax? Cause?
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- Air is capable of entering pleural space but not exiting
- Trachea deviates AWAY from the affected lung - Usually occurs in setting of trauma or lung infection |
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A rupture of an apical bleb in a tall, thin, young male is likely to cause what?
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Spontaneous Pneumothorax: accumulation of air in pleural space
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