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49 Cards in this Set

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Obstructive lung disease
(a) RV
(b) FVC
(c) FEV1
(d) FEV1/FVC
Obstruction of flow results in air trapping in lungs. Airways close at prematurely high lung volumes resulting in:
(a) RV incr
(b) FVC decr
(c) FEV1 decr (--)
(d) FEV1/FVC<80%
Restrictive lung disease
(a) lung volumes
(b) FEV1/FVC ratio
Restricted lung expansion causes:
(a) decreased
(b) FEV1/FVC >80%
4 major types of obstructive lung disease (COPD)
(1) Chronic Bronchitis
(2) Emphysema
(3) Asthma
(4) Bronchiectasis
2 general categories of restrictive lung disease
Poor breathing mechanics (extrapulmonary, peripheral hypoventilation)
Interstitial lung disease (pulmonary, lowered diffusing capacity)
Reid index
Gland depth/total thickness of bronchial wall
Chronic bronchitis
(a) definition
(b) findings
(c) pathology
Blue Bloater
(a) productive cough for >3 months in 2+ years; disease of small airways
(b) wheezing, crackles, cyanosis (early onset hypoxemia due to shunting), late obset dyspnea
(c) hypertrophy of mucus secreting glands in bronchioles; Red index>50%
Pink puffer
Emphysema
Barrel shaped chest
Emphysema
Emphysema (general)
(a) findings
(b) pathophys
(a) Increased elastase activity; exhale through pursed lips to increase airway pressure and prevent airway collapse; early onset dyspnea, decr breath sounds, rachycardia, late onest hypoxemia due to eventual loss of capiallary beds (occurs with loss of alveolar walls)
(b) Enlargement of airspaces and decreased recoil resulting from destruction of alveolar tissue
Cause of centriacinar emphysema
Smoking
Cause of panacinar emphysema
Alpha 1 antitrypsin deficiency (also liver cirrhosis)
Paraseptal emphysema associations and complications
Assoc w/bullae; can rupture leading to spontaneous pneumothorax in young, otherwise healthy men
Asthma
(a) pathology
(b) findings
(a) bronchial hyperresponsiveness causes reversible bronchoconstriction; smooth muscle hypertrophy and Curschmann's spirals (shed epithelium from mucous plugs)
(b) can be triggered; cough, wheezing, dyspnea, tachypnea, hypoxemia, decr I/E ratio, pulsus paradoxus, mucus plugs
Bronchiectasis
(a) pathology
(b) associations
(c) complication
(a) chronic necrotizing infection of bronchi causing permanently dilated airways, purulent sputum, recurrent infection, and hemoptysis
(b) bronchial obstruction
CF
Poor ciliary motility
Kartagener's syndrome
(c) can develop aspergillosis
Types of restrictive lung disease due to poor breathing mechanics
Polio, myasthenia gravis (poor muscular effort)
Scoliosis, morbid obesity (poor structural apparatus)
Types of interstitial (restrictive) lung diseases
ARDS
Hyaline membrane disease
Pneumoconioses (coal miner's, silicosis, asbestosis)
Sarcoidosis
Idiopathic pulmonary fibrosis (repeated cycles of lung injury and wound healing with increased collagen)
Goodpasture's syndrome
Wegener's granulomatosus
Eosinophilic granuloma (histiocytosis X)
Drug toxicity (bleomycin, busulfan, amiodarone)
Neonatal respiratory distress syndrome
(a) cause
(b) lecithin to sphinomyelin ratio
(c) possible sequelae of persistently low O2 tension
(d) risk factors
(e) treatment
(a) surfactant deficiency
(b) <1.5 in amniotic fluid (2 is normal)
(c) PDA
(d) prematurity, maternal diabetes (elevated insulin), cesarean delivery (decr release of fetal glucocorticoids)
(e) maternal steroids before birth; artificial surfactant for infant
Acute respiratory distress syndrome
(a) causes
(b) pathophys
(a) trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, amniotic fluid embolism
(b) diffuse alveolar damage incr capillary permeability allowing protein rich leakage into alveoli resulting in formation of intralveolar hyaline membranes; initial damage due to neutrophilic substances, activation of coag cascade or oxygen free radicals
Definition of sleep apnea
Personal stops breathing for at least 10s repeatedly during sleep
Central sleep apnea
No sleep effort
Obstructive sleep apnea
Respiratory effort against airway obstruction
Associations w/ sleep apnea (causal and result)
Obesity, loud snoring, systemic/pulmonary HTN, arrhythmias, and possible sudden death; may result in chronic fatigue
Treatment of sleep apnea
Wt loss, CPAP, surgery
Asbestosis
(a) define
(b) increased risk for?
(c) findings
(d) location in lung
(a) diffuse pulmonary interstitial fibrosis due to inhaled asbestos fibers
(b) pleural mesothelioma and bronchogenic carcinoma
(c) long latency; ferruginous bodies in lung (asbestos coated with hemosiderin); ivory white pleural plaques
(d) mainly affects lower lobes
What is the relationship b/w smoking and asbestosis with bronchogenic carcinoma and mesothelioma?
No additive risk for mesothelioma
Greatly increased risk for bronchogenic carcinoma
Where do most pneumocioses have their effect in the lung?
Upper lobes (not asbestosis)
Bronchial obstruction findings:
(a) breath sounds
(b) resonance
(c) fremitus
(d) tracheal deviation
(a) absent or decr over affected area
(b) decr resonance
(c) decr fremitus
(d) tracheal deviation towards side of lesion
Pleural effusion
(a) breath sounds
(b) resonance
(c) fremitus
(d) tracheal deviation
(a) decr over effusion
(b) dullness
(c) decr fremitus
(d) n/a
Pneumonia
(a) breath sounds
(b) resonance
(c) fremitus
(d) tracheal deviation
(a) may have bronchial breath sounds over lesion
(b) dullness to percussion
(c) increased fremitus
Tension pneumothorax
(a) breath sounds
(b) resonance
(c) fremitus
(d) tracheal deviation
(a) decreased breath sounds
(b) hyperresonant
(c) absent fremitus
(d) away from side of lesion
General presentation of lung cancer
Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic "coin" lesion on x ray film
Most common tumor in lung
Metastasis to lung most common cancer
Primary vs Metastatic lung cancer presentation
Met: dyspnea
Primary: cough
SCC of lung
(a) location
(b) risk factors
(c) description
(d) histology
(a) central
(b) smoking
(c) hilar mass from bronchus; cavitation; parathyroid like activity due to PTHrP
(d) keratin pearls and intracellular bridges
Adenocarcinoma: bronchial
(a) location
(b) risk factors
(c) description
(d) histology
(a) peripheral lung
(b) n/a -most common lung cancer in nonsmokers and females
(c) develops in site of prior pulmonary inflammation or injury
(d) clara cells transformed into type II pneumocytes;multiple densities on x ray of chest
Adenocarcinoma of lung: broncioloalveolar
(a) location
(b) risk factors
(c) description
(d) histology
(a) peripheral lung;
(b) NOT linked to smoking
(c) grows along airways; can present like pneumonia
(d) clara cells transformed into type II pneumocytes; multiple densities on CXR
Small cell (oat cell) carcinoma
(a) location
(b) risk factors
(c) description
(d) histology
(e) treatment
(a) central
(b) n/a
(c) Undifferentiated and very aggressive; often assoc w/ ectopic production of ACTH or ADH; may lead to Lambert Eaton syndrome.
(d) neoplasm of neuroendocrine Kulchitsky cells (small dark blue cells)
(e) responsive to chemo
Lambert Eaton syndrome
Autoantibodies against calcium channels
Large cell carcinoma
(a) location
(b) description
(c) histology
(d) treatment
(a) peripheral
(b) highly anaplastic undifferentiated tumor; poor prognosis; less responsive to chemo
(c) pleomorphic giant cells w/leukocyte frags in cytoplasm
(d) surgery (less responsive to chemo)
Carcinoid tumor presentation
Secretes serotonin; causes car cinoid syndrome (flushing, diarrhea, wheezing, salivation)
Metastases to lung characteristics of most common
Brain (epilepsy)
Bone (pathologic fracture)
Liver (jaundice, hepatomegaly)
Pancoast's tumor
(a) description
(b) clinical presentation
(a) occurs in apex of lung
(b) may affect cervical sympathetic plexus causing Horner's
Lobar pneumonia
(a) most frequent organism(s)
(b) characteristics
(a) pneumococcus
(b) intraalveolar exudate leading to consolidation; may involve entire lung
Bronchopneumonia
(a) most frequent organism
(b) characteristics
(a) S aureus, H flue, Klebsiella, S pyo
(b) acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving more than 1 lobe
Interstitial/atypical pneumonia
(a) most frequent organism(s)
(b) characteristics
(a) viruses (RSV, adeno), mycoplasma, legionella, chlamydia
(b) diffuse patchy inflammation localized to interstitial areas at alveolar wallsl generally involves more than 1 lobe; more indolent course than bronchopneumnia
Lung abscess
(a) definition
(b) organisms
(a) Collection of pus within parenchyma usually resulting from bronchial obstruction (e.g. cancer) or aspiration of oropharyngeal contents (esp patients predisposed to LOC -alcoholics, epileptics)
(b) S aureus or anaerobes
Pleural effusion: transudative
(a) describe composition
(b) major causes
(a) decr protein content
(b) CHF, nephrotic syndrome, hepatic cirrhosis
Pleural effusion: exudate
(a) composition/description
(b) major causes
(c) course of action
(a) increased protein content, cloudy
(b) malignancy, pneumonia, collagen vascular disease, trauma (basically anything that can increase vascular permeability)
(c) must drain in light of risk of infection
Lymphatic pleural effusion
(a) composition/description
(b) cause
(a) milky fluid
(b) increased triglycerides