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Flashcards in Lung Pathology - Witrak Deck (59)
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1
Q

Commonest cause of pulmonary edema?

A

Heart failure

cardiogenic pulmonary edema

2
Q

What are the most common causes of left heart disease/dysfunction leading to cardiogenic pulmonary edema

A
coronary disease (myocardial ischemia or infarction), chronic hypertension, cardiomyopathy, aortic valve disease, new-onset arrhythmias, and mitral stenosis (now uncommon). 
- minority of cases:  volume overload (blood or fluid)
3
Q

What do you see on physical exam with cardiogenic pulmonary edema?

A

Tachypnea, tachycardia, cool extremities, rales, rhonchi and wheezes, cardiac murmurs, JVD

4
Q

Commonest cause of non-cardiogenic pulmonary edema?

How does it present?

A

Acute respiratory distress syndrome ARDS

Dyspnea, Hypoxemia, and diffuse bilateral pulmonary inflitrates

5
Q

Pathology of ARDS?

A

diffuse alveolar damage with alveolar hyaline membranes - can resolve normally or lead to pulmonary fibrosis and death

6
Q

You are overseas in a war zone. A young man comes in with a traumatic leg injury from a mortar shell. He has developed symptoms of pulmonary edema and has diffuse inflitrates on CXR. You discover he does not have pneumonia. What is the diagnosis?

A

Trauma-induced ARDS

7
Q

How is acute lung injury similar and different from ARDS?

A

Acute interstitial pneumonia leading to respiratory failure without a clear precipitating etiology (can follow URI)
High mortality rates

8
Q

Describe Interstitial Parenchymal Lung Diseases: (ILD)

A

Restrictive, noninfectious lung disease - risk of pulmonary fibrosis
decreased TLC and FVC

9
Q

Describe how a physician would go about diagnosing chronic pulmonary infiltrates of unknown type?

A

Pulmonary Medicine consultation will attempt to classify as either:

1) Fungal, mycobacterial, or other bug.
2) Neoplasm simulating pneumonia or ILD.
3) ILD with known causation
4) Idiopathic ILD: what subtype?

10
Q

Idiopathic ILD in a young Black person, think:

A

Sarcoidosis

11
Q

What is the most lethal, common ILD?

70-80% mortality

A

Idiopathic pulmonary fibrosis

often seen in male smokers older than 40

12
Q

Histology of idiopathic pulmonary fibrosis:

A

Usual interstitial pneumonia -patchy interstitial fibrosis alternating with normal/near-normal lung parenchyma: both old (fibrotic) and young (fibroblastic) areas of scarring
(with honeycomb change!)

13
Q

Commonest worldwide cause of environmental ILD?

A

Silicosis
(silica inhalation, like sandblaster workers)
Fibrotic nodules lead to massive fibrosis

14
Q

Feared risk of asbestos exposure:

A

mesothelioma (even with small exposure)

also increased lung cancer risk

15
Q

best tx for hypersensitivity pneumoonitis?

A

Avoid the offending agent!

16
Q

Key features of eosinophilic pneumonia:

A

Allergic/hypersensitive rxns

  1. ) Acute = febrile illness with cough, dyspnea, diffuse pulmonary infiltrates: life-threatening hypoxemia - esp. new smokers.
  2. ) Chronic – subacute/chronic respiratory symptoms with peripheral pulmonary infiltrates: 30-50% of patients have underlying asthma.
  3. ) Simple pulmonary eosinophilia – migratory pulmonary opacities: minimal symptoms. - drug rxns

Tx with corticosteroid

17
Q

African American Former smoker presents with painful bumps on shins, cough, dyspnea, chest pain, fever, weight loss, and fatigue. Lung shows bilateral hilar adenopathy with pulmonary opacities. What is the diagnosis?

A

Sarcoidosis!

Know this one!

Look for the non-caseating granulomas along lympathatics too!
Dx of exclusion!

18
Q

After srugery a patient has a drop in systolic BP, increased central venous pressure, right heart failure and then death.
Possible diagnosis?

A

Massive PE!

19
Q

A 40 year old patient suffers a DVT and then PE following a long plane ride. Any important things to consider?

A

Patients under 50 that are otherwise healthy and have a DVT/PE should be evaluated for an underlying hyper-coagulable state

20
Q

Name some of those PE symptoms you know and love:

A

hypotension, dyspnea, tachycardia, pleuritic chest pain, hemoptysis, cough, calf/thigh pain and swelling, RV failure

21
Q

Pulmonary hypertension is defined as:

A

Pulmonary artery pressure greater than 25 mmHg at rest

22
Q

How do you treat pulmonary hypertension?

A

Treat underlying disease if you can

Supplementary Oxygen, cardiac meds, diuretics, pulmonary vasoactive drugs

23
Q

Commonest causes of hemoptysis

A

Bronchogenic pneumonia
Bronchiectasis
Tuberculosis (outside of U.S.)

24
Q

Common causes of ARDS (acute respiratory distress syndrome):

A
Sepsis**
Pulm. Infection
Gastric aspiration
general trauma/head injury (shock lung)**
Inhaled irritants
Drug overdose/drowning
transfusion
25
Q

Tx for idiopathic pulmonary fibrosis?

A

Pretty much just lung transplant

Death comes with hypoxemia, cyanosis, and digital clubbing

26
Q

Requirement for pneumonia dx?

A

Imaging!

27
Q

Name for chronic infection/inflammation of larger airways unrelated to smoking leading to irreversible bronchial dilation:

A

Bronchiectasis

28
Q

Commonest cancer death in males and females:

A

Lung cancer for both males and females

29
Q

Compare your differential in acute vs chronic shortness of breath presentations:

A

Acute: anaphylaxis, bronchospasm, MI, PE, penumothorax, aspiration, toxic inhalation, massive hemorrhage

Chronic: COPD, CHF, Progressive anemia, obesity/deconditioning

30
Q

Imagine Witrak saying this:

“Fever and chills with respiratory symptoms is ______ until proven otherwise.”

A

Pneumonia!!!!!!!

31
Q

Patient presents with pneumonitis with diffuse infiltrates. Hx reveals she is has taken a medication for a heart arrythmia. What’s going on?

A

Amiodarone has pulmonary toxic effects. Probably caused the pneumonitis.

32
Q
Explain what lung auscultation finding can tell us in regards to specifying respiratory disease:
Expiratory wheeze:
Rhonchi:
Inspiratory Stridor:
Crackles/rales:
Decreased Breath Sounds:
A

Expiratory wheeze: COPD, asthma
Rhonchi: bronchitis, bronchiectasis, COPD
Inspiratory Stridor: Upper airway obstruction (larynx or trachea)
Crackles/rales: Pneumonia, pulmonary edema, interstitial/fibrosing disease
Decreased Breath Sounds: emphysema, pneumothorax, pleural effusion, pulmonary consolidation

33
Q

What is Resorptive atelectasis vs Compression atelectasis?

What are some common causes?

A

Resorptive:
Alveolar collapse due to pneumonia or poor lung ventilation. Poor ventilation can occur from neuromuscular weakness/poor cough reflex and post-general anesthesia

Compression:
collapse due to mass effect.
Pleural effusion, pneumothorax, tumor, cysts, congenital anomalies, blebs

34
Q

What does asthma usually look like on CXR?

A

Usually no CXR findings unless its real complicated.

35
Q

Explain to me please, the etiological differences between Centriacinar and Panacinar emphysema:

A

Centriacinar = vast majority of cases. Predominately affects upper lobes of lung.
(affects more proximal respiratory bronchioles)

Panacinar = Very advanced common emphysema of ALPHA-1-Antitrypsin deficinecy. Upper and lower lung lobes are involved. (affects more distal alveolar ducts)

Emphysema Clinical Pearl: Under 50 and NOT a smoker –> you should think about panacinar w/ alpha1 antitrypsin deficinency

36
Q

Mechanism of emphysema pathology:

A

Neutrophil elastase causes alveolar tissue damage, destroying alveolar walls and merging alveolar sacs.
Neutrophil elastase is increased by either congenital alpha-1-antitrypsin deficiency or tobacco smoke that causes free radicals to inactivate antiproteases. Without these anti-trypsins and antiproteases, they are free to wreak havoc on alveolar tissue.

37
Q

Young child with over 1 month of unexplained respiratory symptoms. Think ________.

A

Foreign body aspiration

38
Q

Kartagner’s syndrome. How does it relate to pulmonary disease?

A

It is a classic disease association with bronchiectasis.

Ciliary dyskinesia prevents the individual from coughing up enough mucus

39
Q

Commonest lethal adult infection?

A

Pneumonia yo!

40
Q

If you are ID’ing a viral cause of pneumonia using PCR it’s impossible to tell if the organism is causative or a colonizer. What is the one exception to this rule?

A

Influenza - always causative.

Likewise in bacterial pneumonia with: legionella, Tb, and bioterror stuff like anthrax

41
Q

What is the commonest cause of bacterial pneumonia?

Hint: Tends to cause lobar pneumonia

A

Strep Pneumonia

42
Q

What is the commonest cause of bacterial pneumonia in COPD patients?

A

Strep Pneumo
Hemophilus Influenza
M. Catarrhalis

43
Q

Cause of pneumonia that likes water reservoirs and patients with predisposing chronic diseases - elderly.

Also associated with hyponatremia

A

Legionella Pneumophilia

44
Q

ARDS presentation in patient in the southwestern U.S. Mice infestation discovered in the patient’s motor home. What are you thinking?

A

Hanta virus

45
Q

Patient in clinic with pneumonia after a splunking trip to the ohio/mississippi river valley. Empiric treatment with antibacterials for gram +/- bacteria was ineffective. What do you think?

A

Histoplasmosis!

46
Q

What kind of fungal pneumonia would be common in Minnesota?

A

Blastomycosis!

Systemically shows up often as non-healing lumps and bumps on skin

47
Q

If you were going to get fungal pneumonia in the Southwest USA, what would the organism be?

A

Coccidiomycosis

Often has systemic signs in skin, joints, just like blastomycosis

48
Q

With what disease will you find serum anti-GBM antibody?

A

Goodpasture’s Syndrome

49
Q

How do you treat Wegener’s?

A

Steroids and cytoxan (cytotoxic immunosuppression)

cytoxan AKA cyclophosphamide

50
Q

What are the three non-small cell carcinomas?

A

Adenocarcinoma - female dominant, can have lack of smoking hx

Squamous Carcinoma

Large cell

51
Q

Name for a well-differentiated neuroendocrine carcinoma:

A

carcinoid tumors (1-5%)

If you get a lung cancer, get this one, its not too bad

52
Q

Typical clinical presentation of common lung cancer:

A
  • Over 40yo smoker
  • cough, hemoptysis, chest pain, dysnea, hoarseness
  • mass
  • atelectasis or pneumonitis
  • hilar/mediastinal adenopathy
  • pleural/pericardial effusion
53
Q

If a smoker has hoarseness, what are a couple serious things on your differential?

A

Recurrent nerve paralysis from mediastinal metastases BUT ALSO laryngeal carcinoma

54
Q

What is superior vena cava syndrome?

A

SVC can be compressed by upper mediastinal adenopathy

Pts present with puffy upper body and face

55
Q

What kind of paraneoplastic syndromes are produced by small cell carcinoma?

A
  • Syndrome of inappropriate ADH with HYPONATREMIA (SIADH)
  • Cushing’s Syndrome (from ACTH)
  • Neuro syndromes from autoantibodies (lambert-eaton, cerebellae ataxia)
56
Q

what are survival rates like for non-small cell and small cell carcinoma?

A

non-small cell = 15%

small cell = 5%

57
Q

Survival rate for carcinoid lung cancer?

A

87%

usually resectable

58
Q

commonest site of metastatic neoplasm

A

lungs

59
Q

commonest congenital lung lesion?

A

CPAM
Congenital Pulmonary Airway Malformation

Has cystic nature

Spectrum of presentaion ranges from lack of lung development to milder incidental discovery later in life