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43 Cards in this Set
- Front
- Back
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What will aspiration of a foreign body result in the lung?
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Obstruction atelectasis
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Presence of fluid, air or tumor in the pleural space results in what type of atelectasis?
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Compression atelectasis
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Contraction atelectasis is due to what cause?
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Fibrosis of the lung
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Causes of patchy atelectasis
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Lack of surfactant (hyaline membrane disease of newborn or ARDS)
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Clinical features of typical pneumonia
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Sudden onset, high fever, productive cough, tachypnea, pleuritic chest pain, consolidation on x-ray
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Clinical features of atypical pneumonia
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Insidious onset, low fever, no cough, no consolidation
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Differential diagnosis of rusty sputum
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Strep pneumonia, CHF, mitral stenosis, Goodpasture syndrome
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Features of sarcoidosis
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"GRAIN": gammaglubilinemia, rheumathoid arthritis, ACE increase, interstitial fibrosis, non-casseating granuloma, bilateral lymphadenopathy
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Causes of restrictive pulmonary disease
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Kyphoscoliosis, obesity, pneumoconiosis, ARDS, pulmonary fibrosis, sarcoidosis
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Causes of obstructive pulmonary disease
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Asthma, emphysema, chronic brnchitis, bronchiectasis
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Lung volumes in obstructive pattern
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Increased TLC, FRC and RV. Decreased FEV1, FVC, FEV1/FVC
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Lung volumes in restrictive pattern
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Decreased, TLC, FEV1, FVC, FRC, RV. Increased or normal FEV1/FVC
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Diagnosis criteria for chronic bronchitis
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Persistent cough and copius sputum production for at least 3 months in 2 consecutive years
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Clinical features of chronic bronchitis
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Cough, sputum production, dyspnea, infections, hypoxia, cyanosis, weight gain. "Blue bloater"
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Microscopic findings in chronic bronchitis
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Hypertrophy of bronchial mucous glands, globlet cell hyperplasia, mucus hypersecretion, bronchial metaplasia
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Complications of chronic bronchitis
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Recurrent infections, cor pulmonale, lung cancer
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Definition of emphysema
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destruction of alveolar septa resulting in enlarged air spaces and loss of elastic recoil
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Etiology of emphysema
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Protease/antiprotease imbalance. Proteases are made by macrophages and neutrophils. Antiproteases are alpha-1-antitrypsin, alpha-1-macroglubulin and secretory leukoprotease inhibitor
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Features of centriacinar emphysema
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Proximal brnchioles involved, distal brnchioles spared, most common (95%), associated with smoking, worst in apical segments of upper lobes
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Features of panacinar emphysema
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Entire acinus invololved, alpha-1-antitrypsin deficincy, worse in bases of lower lobes
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Clinical features of emphysema
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Progressive dyspnea, pursing of lips and accesory muscles, barrel chest, weight loss, "Pink puffer"'
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Clinical features of asthma
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Wheezing, severe dyspnea, coughing
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Microscopic features of asthma
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Charcot-leyden crystals, mucous plugs, goblet cell hyperplasia and hypertrophy, eosinophils, edema, hypertrophy of smooth muscle, thick basement membranes
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Clinical features of bronchiectasis
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cough, fever, malodorous purulent sputum, dyspnea, dilated bronchi extending out to pleura on x-ray
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Etiology of bronchiectasis
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Bronchial obstruction, necrotizing pneumonia, cystic fibrosis, Kartagener syndrome
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Definition of acute respiratory distress syndrome
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damage of alveolar epithelium and capillaries resulting in respiratory failure that is unresponsive to O2 treatment
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Causes of ARDS
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shock, sepsis, trauma, gastric aspiration, radiation, O2 toxicity, drugs, infections
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Clinical features of ARDS
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dyspnea, tachypnea, hypoxemia, cyanosis, use of accesory respiratory muscles. Bilateral lung opacity on x-ray
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Microscopic features of ARDS
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interstitial and alveolar edema, interstitial inflamation, loss of type I pneumocytes, hyaline membrane formation
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RDS of newborn
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Deficiency of surfactant in prematures (<28 weeks) and sons of diabetic mothers. Dyspnea, tachypnea, nasal flaring and cyanosis. Lecithin:sphyngomyelin < 2. Rx.: surfactant and dexamethasone
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Causes of pulmonary edema
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left heart failure, mitral stenosis, fluid overload, nephrotic syndrome, liver disease
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Microscopic features of pulmonary edema
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Intra-alveolar fluid, engorged capillaries, hemosiderin-ladden macrophages
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Risk factors and genetics of bronchogenic CA
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Cigarette smoking, pneumoconiosis, pollution. Oncogenes: L-myc (SCC), K-ras (adeno). Suppressor genes: p53 and Rb
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Clinical features of bronchogenic CA
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Cough, sputum production, weight loss, anorexia, fatigue, dyspnea, hemoptysis, chest pain. Obstruction may produce emphysema, atelectasis, bronchiectasis or pneumonia
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Lung adenocarcinoma
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Most common - 35%. More common in women. Peripheral gray mass, scarring and mucin-producing glands
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Squamous cell carconima
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2nd most common - 30%. More common in males, related to smoking. Centrally located. Invasive squamous cells with desmosomes and keratin production, PTH production
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Small cell carcinoma
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20%. More common in males, associated to smoking. Central location. Basophilic neurosecretory granules and paraneoplastic syndromes (ACTH, ADH)
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Pancoast tumor
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Apical tumor causing Horner syndrome (ptosis, miosis, anhidrosis, enopthalmos)
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Superior vena cava syndrome
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Obstruction, distended head and neck veins, plethora, facial edema
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Effects of lung masses within the thorax structures
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Pancoast tumor, superior vena cava syndrome, esopahgeal obstruction, recurrent laryngeal nerve hoarseness, Eaton-Lambert syndrome
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Sites of metastasis of lung cancer
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Adrenals (>50%), liver, brain, bone
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Eaton-lambert syndrome
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auto-antibodies against presynaptic Ca channels in neuromuscular junction
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Metastasis to the lung
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Breast (most common)
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