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Pulmonary
FA complete review part 3 Patholgy
| Question | Answer |
|---|---|
| What is rhinosinusitis? | Obstruction of sinus drainage into nasal cavity leading to inflammation and pain over affected area. |
| What sinuses are most affected by rhinosinusitis? | Maxillary sinuses, which drain against gravity due to ostia located superomedial. |
| What is the most common cause of Rhinosinusitis? | Viral URI |
| In cases that rhinosinusitis affect the sphenoid or ethmoid sinuses, may lead to ----> | Cavernous sinus syndrome |
| Clinical term of nosebleed? | Epistaxis |
| What is most common location of developing Epistaxis? | Kiesselbach plexus |
| What is the Kiesselbach plexus? | Anterior segment of nostril |
| What arterial body may cause a fatal epistaxis? | Sphenopalatine artery, a branch of maxillary artery |
| What are the arteries are involved in the Kiesselbach plexus? | -Superior Labial artery - Anterior and Posterior Ethmoidal arteries -Greater palatine artery - Sphenopalatine artery |
| What kind of cancer is most common in head and neck? | Squamous cell carcinoma |
| Blood clot within a deep vein. Dx? | DVT (deep venous thrombosis) |
| What are most common symptoms /signs of DVT? | Swelling, redness, and pain |
| What codition is associted to Virchow triad? | DVT (deep venous thrombosis) |
| What are the components of Virchow triad? | 1. Stasis 2. Hypercoagulability 3. Endothelial damage |
| What kind of lab test is done to rule out DVT? | D-dimer |
| Where do most pulmonary emboli arise from? | Proximal deep veins of lower extremity |
| What is the most common treatment for DVT? | Unfractionated heparin or low-molecular-weight heparins |
| What is the most common drug used for long-term treatment for DVT? | Warfarin |
| What is the exam/imaging test for DVT? | Compression ultrasound with Doppler. |
| A pulmonary emboli causes: | V/Q mismatch, hypoxemia, and respiratory alkalosis |
| What are the clinical signs of PE? | Sudden-onset dyspnea, pleuritic chest pain, tachypnea, and tachycardia |
| What are Lines of Zahn? | Interdigitating areas of pink and red found only in thrombi formed before death |
| What feature can be used to distinguish between pre- and post mortem thrombi? | Lines of Zahn |
| What are the most common types of thrombi? | Fat, Air, Thrombus, Bacteria, Amniotic fluid, and Tumor |
| What are conditions associated with fat emboli? | Long bone fractures and liposuction |
| What is the classic triad of fat emboli? | Hypoxemia, neurologic abnormalities, and petechial rash |
| What kind of sport or aquatic event is associated with air emboli? | Ascending divers |
| What are the pathologies associated with air emboli? | Caisson disease/ Decompression sickness |
| What is the most severe complication of an amniotic fluid emboli? | DIC |
| What is the imaging test of choice for PE? | CT pulmonary angiography |
| What is the associated ECG abnormality with a PE? | S1Q3T3 |
| S1Q3T3. Dx? | Pulmonary embolism |
| What are the 3 Flow-Volume parameters DECREASED in Obstructive lung disease? | Greatly FEV1, and mild reductions in FVC, which together lead to a mild decrease in FEV1/FVC. |
| Which is most decreased, FEV1 or FVC, in obstructive lung disease? | FEV1 |
| The loop in a Flow-Volume lung graph, is shifted to which side in Obstructive lung disease? | Left shifted |
| Obstructive lung disease have ________ shift on Flow-Volume graph. | Left |
| What are the 3 parameters increased in Obstructive lung disease? | RV, FRC, and TLC. |
| FEV1 is decreased proportionately to FVC | Restrictive lung disease |
| How is he FEV1/FVC in the restrictive lung disease profile? | Normal or mildly increased |
| Restrictive lung disease have all parameters __________________. | Decreased |
| A grater FEV1 decrease is seen in _______________ lung disease. | Obstructive |
| A right shift of the loop in a flow-volume loop graph is seen with ______________________________ diseases. | Restrictive lung disease |
| Loop shifts to the right | Restrictive lung disease |
| Loop shifts to the left | Obstructive lung disease |
| Which lung profile describes obstruction of air flow leading to air trapping in lungs? | Obstructive lung disease |
| Airways close prematurely at high lung volumes? | Obstructive lung disease |
| What is the hallmark of Obstructive lung disease with respect to PFTs? | Decreased FEV1/FVC |
| What is the most severe consequence of chronic, hypoxic pulmonary vasoconstriction seen in Obstructive lung diseases? | Cor pulmonale |
| What are the types of Obstructive lung diseases? | 1. Chronic bronchitis 2. Emphysema 3. Asthma 4. Bronchiectasis |
| Common way to refer to a person with Chronic bronchitis? | "Blue bloater" |
| What are the findings of chronic bronchitis? | Wheezing, crackles, cyanosis, dyspnea, CO2 retention, and secondary polycythemia |
| Reason of clinical cyanosis in chronic bronchitis patients? | Hypoxemia due to shunting |
| Which type of obstructive lung disease is seen with secondary polycythemia? | Chronic bronchitis |
| Reid index > 50%. Dx? | Chronic bronchitis |
| How is the DLCO in a "blue bloater"? | Normal |
| Hypertrophy and hyperplasia of mucus-secreting glands in bronchi. Dx? | Chronic bronchitis |
| What is the Reid index? | Thickness of mucosal gland layer to thickness of wall between epithelium and cartilage. |
| Diagnostic criteria for Chronic bronchitis? | Productive cough for > 3 months in a year for > 2 consecutive years. |
| What is the refer term used for a emphysema patient? | "Pink puffer" |
| "Pink puffer". Dx? | Emphysema |
| What are the classical findings and/or presentation of a patient with emphysema? | - Barrel-shaped chest, - Exhalation through pursed lips |
| A patient that breathes through pursed lips. Dx? | Emphysema |
| What is the reason for emphysema patients to breath through pursed lips? | Increased airway pressure and prevents airway collapse |
| How is airway collapse often prevented by emphysematic patients? | Breath through pursed lips |
| What type of emphysema is associated with smoking? | Centricacinar |
| What are the two main types of Emphysema? | Centriacinar and Panacinar |
| Which lobes are most likely to be affected by Centriacinar emphysema? | Upper lobes |
| Upper lobes usually develop __________________ emphysema. | Centriacinar |
| What is the most common condition associated with development of Panacinar emphysema? | Alpha-1-antitrypsin deficiency |
| Which lobes, upper or lower, are often where Panacinar emphysema develops? | Lower lobes |
| a-1 antitrypsin deficiency develops _________________________ (respiratory). | Panacinar emphysema |
| Which Obstructive lung condition is seen with: enlargement of air spaces, decreased recoil, increases compliance, and decreased DLCO ? | Emphysema |
| What obstructive lung disorder is associated with smoking? | Centriacinar emphysema |
| What are the findings or features seen in CXR of a patient with emphysema? | Increased AP diameter, flattened diaphragm, and increase lung lucency. |
| Why is DLCO decreased in emphysema? | Due to destruction of alveolar walls |
| What is the initial insult or reason for increased in lung compliance in an patient with emphysema? | Imbalance of proteases and antiproteases, which lead to an increase in elastase activity leading to increase loss of elastic fibers |
| What is the classic clinical presentation and features of Asthma? | Cough, wheezing, tachypnea, dyspnea, hypoxemia, decreased inspiratory/expiratory ratio, pulsus paradoxus, and mucus plugging |
| What are some of the MC triggers for Asthma? | URIs, allergens, and stress. |
| What are supporting tests for diagnosing Asthma? | Spirometry and methacholine challenge |
| A person that recalls having done the Methacholine challenge, is suspected to have? | Asthma |
| What condition is often diagnosed by supporting evidence of a Methacholine challenge? | Asthma |
| Hyperresponsive bronchi. Dx? | Asthma |
| Asthma is considered what type of Hypersensitivity? | Type 1 |
| What is Aspirin-induced asthma? | A combination of COX inhibition , chronic sinusitis with nasal polyps, and asthma symptoms |
| COX inhbition causes --> | Leukotriene overproduction which causes airway constriction |
| What condition is associated with Curschmann spirals? | Asthma |
| What are Curschmann spirals? | Shed epithelium forms whorled mucous plugs |
| Eosinophilic, hexagonal, double-pointed crystals formed from breakdown of eosinophils in sputum. | Charcot-Leyden crystals |
| Charcot-Leyden crystals + Curschmann spirals. Dx? | Asthma |
| DLCO in Asthma: | Normal or mildly increased |
| What changes are seen in smooth muscle in a person with Asthma? | Hypertrophy and hyperplasia |
| What are important or key features found in sputum examination of asthmatic patient? | Curschmann spirals, Charcot-Leyden crystals, and smooth muscle hypertrophy and hyperplasia. |
| Nasal polyps + asthma symptoms + sinusitis. MC Dx? | Aspirin-induced asthma |
| Common presentation and findings of Bronchiectasis? | Purulent sputum, Recurrent infections Hemoptysis Digital clubbing |
| Chronic necrotizing infection of bronchi or obstruction leading to permanently dilated airways. | Pathology of Bronchiectasis |
| How are the airways in Bronchiectasis? | Permanently dilated |
| What are some associations to Bronchiectasis? | Bronchial obstruction, poor ciliary motility, cystic fibrosis, allergic bronchopulmonary aspergillosis. |
| What is a common AR disease associated with Bronchiectasis? | Cystic fibrosis |
| What is a common obstructive lung disease associated with Kartagener syndrome? | Bronchiectasis |
| What kind of aspergillus-associated condition is seen in a patient with Bronchiectasis? | Allergic bronchopulmonary aspergillosis |
| What are the two types of Restrictive lung diseases? | 1. Poor breathing mechanics 2. Interstitial lung diseases |
| Describe the main/overall features of Restrictive lung diseases due to poor breathing mechanics? | Extrapulmonary, peripheral hypoventilation, and a normal A-a gradient. |
| Which are the two main reasons for poor breathing mechanics producing a restrictive lung profile? | Poor muscular effort and poor structural apparatus |
| Examples of conditions/pathologies that cause a restrictive lung profile due to poor breathing mechanics caused by poor muscular effort? | Polio, Myasthenia gravis, and Guillain-Barre |
| What type of Restrictive lung disease category would Scoliosis and morbid obesity be part of? | Poor structural apparatus leading to poor breathing mechanics |
| What is seen as main features of all Interstitial lung diseases? | Pulmonary condition with decreased diffusing capacity and a increased A-a gradient. |
| If the restrictive lung condition shows an increase in A-a gradient, it indicates : | An interstitial lung disease |
| What are some (list) of examples of Interstitial lung diseases? | 1. Pneumoconiosis 2. Sarcoidosis 3. Idiopathic pulmonary fibrosis 4. Goodpasture syndrome 5. Granulomatosis with polyangiitis (Wegener) 6. Pulmonary Langerhans cell histiocytosis (Eosinophilic granuloma) 7. Hypersensitivity pneumonitis 8. Drug toxicity |
| Examples of Pneumoconiosis? | Coal workers' pneumoconiosis, silicosis, asbestosis |
| What are some key features of Sarcoidosis? | - Bilateral hilar lymphadenopathy - Noncaseating granuloma - Increased ACE and Ca2+ |
| What is Idiopathic pulmonary fibrosis? | Repeated cycles of lung injury and wound healing with increased collagen deposition, "honeycomb" lung appearance and digital clubbing |
| A lung tissue that is constantly damage by irritant and in the same way it is healed, leads to the development of what restrictive lung condition? | Idiopathic pulmonary fibrosis |
| Which Interstitial lung diseases is described often with lung with a "honeycomb" appearance and digital clubbing? | Idiopathic pulmonary fibrosis |
| What are some drugs which toxicity cause Interstitial lung disease, thus a restrictive lung profile? | Bleomycin, Busulfan, Amiodarone, and Methotrexate. |
| What type(s) of hypersensitivity is hypersensitivity pneumonitis? | Mixed type III/IV hypersensitivity reaction |
| What population is often seen with Hypersensitivity pneumonitis? | Farmers and those exposed to birds |
| Immune-mediated condition, widespread noncaseating granulomas, elevated serum ACE levels, and elevated CD4+/CD8+ ratio in bronchoalveolar lavage fluid. Dx? | Sarcoidosis |
| Who is most likely to be affected by Sarcoidosis? | African-American females |
| Sarcoidosis is mostly asymptomatic, except for: | Enlarged lymph nodes |
| What are the common CXR finding in Sarcoidosis? | Bilateral adenopathy and coarse reticular opacities |
| What are important associated conditions of Sarcoidosis? | 1. Bell palsy 2. Uveitis 3. Noncaseating granulomas 4. Lupus pernio 5. Interstitial fibrosis 6. Erythema nodosum 7. Rheumatoid arthritis-like arthropathy 8. Hypercalcemia |
| What is the treatment for symptomatic Sarcoidosis? | Steroids |
| What is Lupus pernio? | Associated condition of Sarcoidosis, characterised as skin lesions on face resembling lupus |
| Description of granulomas found/associated with Sarcoidosis? | Epithelioid, containing microscopic Schaumann and asteroid bodies; Noncaseating |
| Noncaseating granulomas. Dx? | Sarcoidosis |
| What is a common finding in physical examination of a patient with an inhalation injury? | Singed nasal hairs |
| What are findings in bronchoscopy of a inhalation injury patient? | Severe edema, congestion of bronchus, and soot deposition |
| How many days take for resolution from an inhalation injury? | 11 days |
| Which part of the lungs are most prone to be affected by Asbestos? | Lower lobes |
| Silica and coal affect the ____________ lobes of the lung. | Upper |
| What are the associated jobs/ professions that incrase Asbestos exposure? | Shipbuilding, roofing, and plumbing. |
| What are the pathognomonic features of Asbestosis? | "Ivory white", calcified supradiaphragmatic and pleural plaques. |
| Asbestosis causes increased risk of ________________________ carcinoma more than Mesothelioma. | Bronchogenic |
| Lobes affected by Asbestosis? | Lower lobes |
| What are the characteristic histological findings of Asbestosis? | Ferruginous bodies |
| What type of exposure leads to appearance of Ferruginous bodies? | Asbestos |
| What are Ferruginous bodies? | Golden-brown fusiform rods resembling dumbbells, found in alveolar sputum sample. |
| What type of stain is used to visualize Ferruginous bodies in Asbestosis? | Prussian blue stain |
| Prussian blue stain + lower lobes plaques. Dx? | Asbestosis |
| What histological compound is known to resemble dumbbells? | Ferruginous bodies in Asbestosis |
| What environments can have exposure to Beryllium most commonly? | Aerospace and manufacturing industries |
| How are the granulomas seen in Berylliosis? | Noncaseating |
| Which lung lobes are affected by Berylliosis? | Upper lobes |
| What conditions is associated with prolonged coal dust exposure? | Coal Workers' pneumoconiosis |
| Which lobes of the lung are affected by Coal workers' pneumoconiosis? | Upper lobes |
| Which pneumoconiosis is seen with macrophages laden with carbon? | Coal Workers' pneumoconiosis |
| What is another name for Coal Workers' pneumoconiosis? | Black lung disease |
| What condition is at increased risk of development with Black lung disease? | Caplan syndrome |
| What is Caplan syndrome? | Rheumatoid arthritis and pneumoconiosis with intrapulmonary nodules |
| Caplan syndrome is often develop after the patient had: | Coal Workers' pneumoconiosis |
| Small, rounded nodular opacities seen in Upper lung lobes imaging? | Coal Workers' pneumoconiosis |
| What is Anthracosis? | Asymptomatic conditions found in many urban dwellers exposed to sooty air. |
| "Eggshell" calcification of hilar lymph nodes on CXR. Dx? | Silicosis |
| Which jobs are associated with Silicosis? | Sandblasting, foundries, and mines |
| What condition may be reactivated in patients with Silicosis? | TB |
| What are associated risks of developing in a Silicosis patient? | Cancer, cor pulmonale, and Caplan syndrome |
| Which lobes of the lungs are most affected by Silicosis? | Upper lobes |
| Which is the only pneumoconiosis that affects the lower lobes of the lung? | Asbestosis |
| What is Mesothelioma? | Malignancy of the pleura associated with asbestosis. It may result in hemorrhagic pleural effusion (exudative), pleural thickening. |
| What is a common marker in almost all mesotheliomas? | Calretinin |
| Smoking is not a risk factor for ________________________ development. | Mesothelioma |
| Alveolar insult leading to proinflammatory cytokine release and eventually to leakage of protein-rich fluid into alveoli, leading to development of intra-alveolar hyaline membranes. Dx? | Acute respiratory distress syndrome (ARDS) |
| What is the criteria used to diagnose, by exclusion, ARDS? | - Abnormal CXR (bilateral lung opacities) - Respiratory failure within 1 wk of alveolar insult - Decreased PaO2/FiO2 ratio <300 - Symptoms of respiratory failure are not due to HF/fluid overload |
| Why is mechanical ventilation used in ARDS? | Decreased tidal volumes, and to Increase PEEP |
| What are the consequences of ARDS? | - Impaired gas exchange - Decreased lung compliance - Pulmonary hypertension |
| What is sleep apnea? | Repeated cessation of breathing > 10 seconds during sleep. |
| What are consequences of Nocturnal hypoxia seen in sleep apnea? | Systemic/pulmonary hypertension, arrhythmias, and sudden death |
| The hypoxia caused in sleep apnea causes ----> | Increase EPO release which leads to increased erythropoiesis. |
| Respiratory effort against airway obstruction. | Obstructive sleep apnea |
| What are associations to of Obstructive sleep apnea? | Obesity, loud snoring, and daytime sleepiness |
| Why do adults develop OSA? | Excess parapharyngeal tissue |
| What is the reason children develop OSA? | Adenotonsillar hypertrophy |
| What is Central sleep apnea? | Impaired respiratory effort due to CNS injury/toxicity, HF, opioids. |
| What is a characteristic breathing pattern seen in Central sleep apnea? | Cheyne-Stoke respirations |
| What is the treatment for Central Sleep apnea? | Positive airway pressure |
| What are Cheyne-Stokes respirations? | Oscillations between apnea and hyperpnea. |
| What is another name for Obesity hypoventilation syndrome? | Pickwickian syndrome |
| What are the arterial pressure changes of Oxygen and CO2 in Obesity hypoventilation syndrome during sleep? | Decrease in PaO2 Increase in PaCO2 |
| Hypoventilation in an obese person causes what changes to PaCO2 during waking hours? | Increased PaCO2 due to retention |
| What is the normal mean pulmonary artery pressure? | 10-14 mm Hg |
| At what pressure (mm Hg) is pulmonary hypertension diagnosed? | > or equal to 25 mm Hg at rest |
| What are the consequences of Pulmonary hypertension? | Arteriosclerosis, medial hypertrophy, intimal fibrosis of pulmonary arteries, and plexiform lesions. |
| What mutation causes hereditary form of Pulmonary arterial hypertension (PAH)? | Inactivating mutation in BMPR2 |
| What are the pulmonary vascular endothelial dysfunction results? | Increase of Vasoconstrictors and decrease of Vasodilators. |
| What are etiologies (causes) of Pulmonary hypertension? | 1. Pulmonary arterial hypertension 2. Left heart disease 3. Lung diseases or hypoxia 4. Chronic thromboembolic 5. Multifactorial |
| Why is Pulmonary HTN is caused by thrombotic events? | Recurrent microthrombi leading decreased cross-sectional area of pulmonary vascular bed |
| What lung conditions are seen with Hyperresonant percussion upon PE? | Simple pneumothorax and Tension pneumothorax |
| What lung condition is seen with increased fremitus? | Consolidation |
| What pathologies cause consolidation? | Lobar pneumonia and pulmonary edema |
| Atelectasis has tracheal deviation to: | Toward side of lesion |
| Tracheal deviation in Tension pneumothorax is to: | Away from side of lesion |
| If the trachea is deviated toward the affected side, which is the most common reason? | Atelectasis (bronchial obstruction) |
| Which pathologies or lung conditions demonstrate a tracheal deviation away from the side of injury? | Pleural effusion and Tension pneumothorax |
| What are pleural effusions? | Excess accumulation of fluid between pleural layers which produced a restrictive lung expansion during inspiration. |
| Is inspiration or exhalation, affected by pleural effusions? | Inspiration |
| What is a common treatment option for Pleural effusions? | Thoracentesis |
| What are the main types of pleural effusions? | Transudate, Exudate, and lymphatic |
| Which pleural effusion type is seen with decreased protein content? | Transudate |
| Transudate effusions are due to: | 1. Increase in hydrostatic pressure (HF) or, 2. Decrease in Oncotic pressure (nephrotic syndrome, cirrhosis) |
| An increase in hydrostatic pressure will produce ______________ (pleural effusion). | Transudate |
| What is a common pathology that leads to an increase in hydrostatic pressure? | Heart failure |
| A person with heart failure, will likely develop fluid in the lung pleural, which is known as ________________. | Transudate |
| What kind of pressure is decreased in nephrotic syndrome and cirrhosis that produce transudate? | Oncotic pressure |
| In transudate production, the hydrostatic pressure is _____________, and the oncotic pressure is _______________. | Increased; Decreased |
| Pleural effusion rich in protein content, and cloudy. | Exudate |
| Exudate is due to: | Malignancy, pneumonia, collagen vascular disease, trauma |
| Exudate occurs in states of: | Increased vascular permeability |
| Which type of pleural effusion imposes increased risk to infection? | Exudate |
| If the fluid extracted from the lung pleura is cloudy, it is classified as _______________. | Exudate |
| What is another name given to lymphatic pleural effusions? | Chylothorax |
| What is produced by trauma or malignancy of/to Thoracic duct? | Chylothorax or Lymphatic pleural fluid |
| Milky-appearing fluid | Chylothorax or Lymphatic pleural fluid |
| What serum condition is often associated with Chylothorax development? | Increased triglycerides |
| What is a Pneumothorax? | Accumulation of air in pleural space |
| What classic signs and symptoms of Pneumothorax? | Dyspnea, and uneven chest expansion |
| Abnormalities on lung auscultation, pain, etc are in the ____________ side of the pneumothorax. | Ipsilateral |
| What is the most common cause for Primary spontaneous pneumothorax? | Rupture of apical subpleural bleb or cyst |
| What type of pneumothorax is expected in a tall, thin, smoker, young male? | Primary spontaneous pneumothorax |
| The sudden rupture of a pleural bleb or cyst is the MCC of? | Primary spontaneous pneumothorax |
| What are the MCC of secondary spontaneous pneumothorax? | - Diseased lung ( bullae in emphysema, infections) - Mechanical ventilation with ouse of high pressures --> barotrauma |
| What type of pneumothorax is often due to blunt trauma to the chest/thorax? | Traumatic pneumothorax |
| A person just received a gunshot, it is probably to develop what kind of pneumothorax? | Traumatic pneumothorax |
| What is the key feature of a Tension pneumothorax? | Air enters pleural space but cannot exit. |
| List of types of Pneumonia: | 1. Lobar pneumonia 2. Bronchopneumonia 3. Interstitial (atypical) pneumonia 4. Cryptogenic organizing pneumonia |
| What are the characteristics of Lobar pneumonia? | 1. Intra-alveolar exudate (protein rich) ---> CONSOLIDATION 2. May involve entire lobe or the whole lung |
| What is the MCC of Lobar pneumonia? | S. pneumoniae |
| What are two less common organisms that are known to produce lobar pneumonia? | Legionella and Klebsiella |
| What are the characteristics of Bronchopneumonia? | 1. Acute inflammatory infiltrates from bronchioles into adjacent alveoli . PATCHY distribution involving 1 or more lobes. |
| What kind of pneumonia is seen with Patchy distribution in CXR? | Bronchopneumonia |
| What are the most common organisms causing Bronchopneumonia? | S. pneumoniae, S. aureus, H. influenzae, and Klebsiella |
| Another way to name or refer to an atypical pneumonia? | Interstitial |
| What are some of the MC organisms causing Interstitial (atypical) pneumonia? | Mycoplasma, Chlamydophila pneumoniae, Chlamydophila psittaci, Legionella, viruses (RSV, CMV, influenza, adenovirus) |
| Which type of pneumonia is seen with Diffuse patchy inflammation localized to interstitial areas at alveolar walls? | Interstitial (atypical) pneumonia |
| What are the key features of Atypical pneumonia? | 1. Diffuse patchy inflammatoin localized to interstitial areas at alveolar walls 2. Diffuse distribution involving more than 1 lobe 3. Follow an indolent course |
| "Walking pneumonia" | Interstitial (atypical) pneumonia |
| What is the old name for Cryptogenic organizing pneumonia? | Bronchiolitis Obliterans organizing pneumonia (BOOP) |
| Noninfectious pneumonia characterized by inflammation of bronchioles and surrounding structure. | Cryptogenic organizing pneumonia |
| What type of pneumonia is known to be caused by chronic inflammatory diseases or medication side effects? | Cryptogenic organizing pneumonia |
| What are the 4 stages of Lobar pneumonia (in order of appearance)? | 1. Congestion 2. Red hepatization 3. Gray hepatization 4. Resolution |
| Congestion phase of lobar pneumonia is during days ____________. | 1-2 |
| What are important finding of Congestion stage of Lobar pneumonia? | - Red-purple, partial consolidation of parenchyma - Exudate with mostly bacteria |
| Consolidation pneumonia = | Lobar pneumonia |
| At what stage of lobar pneumonia is it described as "Red-brown, consolidated"? | Red hepatization |
| What is found in exudate of lobar pneumonia at the Red hepatization stage? | Fibrin, bacteria, RBCs, and WBCs. |
| Uniformly gray lobe affected in lobar pneumonia, is a finding of? | Gray hepatization of Lobar pneumonia |
| Gray hepatization stage occurs in days ________. | 5-7 |
| What is the most common clinical presentation of Lung cancer? | Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic "coin" lesion on CXR or noncalcified nodule on CT. |
| What is characteristic description of lung cancer in an CXR? | "Coin" lesion |
| What are the most common complications of Lung cancer? | Superior vena cava/thoracic outlet syndromes Pancoast tumor Horner syndrome Endocrine (Paraneoplastic) Recurrent laryngeal nerve compression (hoarness) Effusions (pleural or pericardial) |
| What are the most important risk factors for developing Lung cancer? | Smoking, secondhand smoke, radon, asbestos, and family history. |
| Which lung cancer are central? | Squamous cell carcinoma and Small cell carcinoma |
| Squamous and Small cell carcinomas of the lung are most often caused by ___________________. | Smoking. |
| Oat cell carcinoma is the same as: | Small cell carcinoma of the lung |
| Which is the most aggressive type of lung cancer? | Small cell carcinoma of the lung |
| What are some possible complications or results from Small cell carcinoma of the lung? | 1. ACTH production ---> Cushing syndrome 2. SIADH 3. Antibodies against presynaptic Ca2+ channels --> Lambert-Eaton myasthenic syndrome. 4. Antibodies against neurons --> Paraneoplastic myelitis, encephalitis, subacute cerebellar degeneration. |
| Which type of lung cancer is known to cause Lambert-Eaton myasthenic syndrome? | Small cell carcinoma of the lung |
| Which oncogene is known to be amplified in Small cell carcinoma of the lung? | myc |
| Neoplasm of Neuroendocrine Kulchitsky cells? | Small cell carcinoma of the lung |
| What are (+) markers for Small cell carcinoma of the lung? | - Chromogranin A - Neuron-specific enolase - Synaptophysin |
| Histological view of a lung cancer depicts small dark blue cells and positive for Chromogranin A serum marker. Dx? | Small cell carcinoma of the lung |
| Which are the non-small cell lung cancer types? | 1. Adenocarcinoma 2. Squamous cell carcinoma 3. Large cell carcinoma 4. Bronchial carcinoid tumor |
| What is the most common primary lung cancer? | Adenocarcinoma of the lung |
| Which gender is more prone to developing Lung adenocarcinoma? | Women |
| Which kind of non-small lung cancer is seen in nonsmokers? | Adenocarcinoma of the lung |
| Female, nonsmoker. What kind of lung cancer is she most likely to develop? | Adenocarcinoma of the lung |
| What are the associated activating mutations of lung adenocarcinoma?l | KRAS, EGFR, and ALK |
| What is an important physical association of Lung adenocarcinoma? | Hypertrophic osteoarthropathy (clubbing) |
| Which type of lung cancer is seen with clubbing? | Adenocarcinoma of the lung |
| What type of lung cancer is seen histologically as: Glandular pattern, often stains mucin (+)? | Adenocarcinoma of the lung |
| Mucin (+) lung cancer | Adenocarcinoma of the lung |
| What is the subtype of Adenocarcinoma of the lugn? | Bronchioloalveolar |
| Description of Bronchioloalveolar subtype lung cancer | Grown along alveolar septa --> apparent "thickening" of alveolar walls. Tall, columnar cells containing mucus |
| Hilar mass arising from bronchus. Most likely lung cancer type? | Squamous cell carcinoma |
| What are the associated C's of Squamous cell lung carcinoma? | Central Cavitation Cigarettes hyperCalcemia |
| What substance produces the hypercalcemia seen in Squamous cell lung carcinoma? | PTHrP |
| What are the key histological findings in Squamous cell lung carcinoma? | Keratin pearls and intercellular bridges |
| Which lung cancer type is seen with "Keratin pearls" in histology? | Squamous cell carcinoma of the lung |
| Pleomorphic giant cells. Histological description of which type of lung cancer? | Large cell carcinoma of the lung |
| Highly anaplastic undifferentiated tumor. Peripherally located, with a strong association to smoking? | Large cell carcinoma of the lung |
| Location of Bronchial Carcinoid tumor | Central or peripheral |
| Which lung cancer type symptoms include mass effect or carcinoid syndrome ? | Bronchial carcinoid syndrome |
| What are histological features of Bronchial carcinoid tumor? | Nests of neuroendocrine cells Chromogranin A (+) |
| Air-fluid levels seen on CXR | Lung abscesses |
| What is a lung abscess? | Localized (lung) collection of pus within parenchyma |
| What are the two most important causes of Lung abscess formation? | 1. Aspiration of oropharyngeal contents 2. Bronchial obstruction |
| The presence of lung abscess suggest also the presence of : | Cavitation |
| MC organism causative of lung abscesses? | 1. Anaerobes (Bacteroides, Fusobacterium) 2. S. aureus |
| Which lung is more likely to develo lung abscess secondary to aspiration? | Right lung |
| What kind of patients are most prone to develop lung abscess due to aspiration? | Patients predisposed to loss of consciousness (alcoholics, epileptics). |
| What is another term for Pancoast tumor? | Superior sulcus tumor |
| Carcinoma that occurs in the apex of lung and causes Pancoast syndrome by invading the cervical sympathetic chain? | Pancoast tumor |
| What neurological structure is invaded by Pancoast syndrome? | Cervical Sympathetic chain |
| What are some findings of Pancoast tumor compression of locoregional structures? | 1. Recurrent laryngeal nerve ---> Hoarseness of voice 2. Stellate ganglion --> Horner syndrome 3. Superior vena cava ---> SVC syndrome 4. Brachiocephalic vein --> Brachiocephalic syndrome 5. Brachial plexus --> sensorimotor deficits |
| What structure is compressed by Pancoast tumor to produce the ipsilateral Horner syndrome? | Stellate ganglion |
| What are the constellation of symptoms that make up Horner syndrome? | Ipsilateral ptosis, miosis, and anhidrosis |
| Obstruction of the SVC that impairs blood drainage from the head, neck, and upper extremities. Dx? | Superior vena cava (SVC) syndrome |
| What are the head deficits seen in SVC syndrome? | "Facial plethora" |
| Facial plethora, common feature of ____________________. | Superior vena cava (SVC) syndrome |
| What re the MCC of SVC syndrome? | 1. Malignancy (mediastinal mass, Pancoast tumor) 2. Thrombosis from indwelling catheters |
| WHat is an important complication of SVC syndrome? | Increase in ICP --> increase risk of aneurysm/ rupture of intracranial arteries |
| What nerve is compressed, usually and commonly by malignancies, to cause development of hoarseness of voice? | Recurrent laryngeal nerve |
| Hoarseness of voice is commonly due to? | Compression of recurrent laryngeal nerve |
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rakomi
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