What are the four classic obstructive lung diseases?
What is the clinical definition of Chronic Bronchitis?
Productive cough for 3+ months in 2 consecutive years..
(small airway disease)
What is the underlying problem in COPD?
Obstruction to air flow leads to air trapping in the lungs
What volumes/capacities are altered in COPD?
Increased RV (residual volume) due to trapping of air in lungs
decreased Forced Vital Capacity due to obstruction.
What are the classic changes to Pulmonary function tests in COPD?
Decreased FEV1:FVC ratio
There is greater FEV1 decline than FVC
What happens to the DlCO in COPD?
Decreased, due to a decrease in surface area there is less ability to exchange gas.
What are characteristic oxygen sats of a Blue Bloater (Chronic Bronchitis?)
High pCO2 and low pO2...cannot get CO2 out of the lungs.
What is the underlying pathology in Chronic Bronchitis?
Hypertrophy of the mucus secreting glands in the bronchioles, leading to an increased REID index over .50.
Mucus causes obstruction.
Pathologically Chronic Bronchitis and Asthma look similar....How can you tell the difference?
Chronic Bronchitis will often have squamous metaplasia.
What are the clinical findings of a Chronic Bronchitis patient?
Early-onset hypoxemia due to shunting.
Late onset dyspnea.
What are 'Pink Puffers?'
Emphysema patients, with a barrel shaped chest and pursed lip breathing
What COPD has characteristic increase in elastase activity?
Emphysema....it is related either to smoking (centri-acinar)
A1AT deficiency... Panacinar
What is characteristic of the lungs of Emphysema patients?
Increased compliance due to decreased elastic recoil!
They breathe thru pursed lips to increase airway pressure and prevent airway collapse.
What is characteristic of a Chest X-ray of a patient with Emphysema?
Increased AP diameter
Lengthened cardiac silhouette.
What lobes of the lungs are usually affected by centriacinar destruction from smoking?
What lobes of the lungs are usually affected by panacinar destruction from A1AT deficiency?
What is Paraseptal emphysema associated with?
Bullae and blebs that can spontaneously rupture...
Seen in tall young males.... Might lead to pneumothorax
What is the role of A1AT?
Destroy elastase....ROIs can damage A1AT, often seen from smoking!
Clinical findings of an Emphysema patient?
Late Onset hypoxemia due to eventual loss of capillary beds in the alveolar septa.
Early onset Dyspnea
Decreased breath sounds and tachycardia
What is the underlying cause of most asthma?
Bronchial hyperresponsiveness to some agent causing reversible bronchoconstricition.
If you have a child with a polyp in their nose, it is indicative of...
CF! Not asthma or allergies
What is the extrinsic type of Asthma associated with?
Type 1 hypersensitivities
What is the intrinsic type of Asthma associated with?
What are Curshman-Spirals and in what disease are they seen?
Shed epithelium from mucus plugs..
Seen in Asthma
What are Charcot-Leiden Crystals?
Eosinophilic crystals seen in patients with an underlying disease causing increase in eosinophils. (Usually asthma, but can be parasites as well.)
Common findings in pts with Asthma?
What are the two main viral causes of Bronchiectasis?
Influenza virus and Adenovirus
What IS Bronchiectasis?
Chronic necrotizing infection of the bronchi leading to permanently dilated airways, purulent sputum and hemoptysis.
Associated causes of Bronchiectasis?
Obstruction! Esp from CF
Also caused by poor ciliary motilite or Kartagener's syndrome.
Possible long term consequence of Bronchiectasis?
Can develop colonizing aspergillosis
What are the Characteristic Pulmonary function test changes in Restrictive lung disease?
Normal or slightly increased FEV1 to FEV ratio.
TLC is decreased as the lungs cannot expand fully.
What are three causes of restrictive lung disease caused by poor muscular effort?
What are two causes of restrictive lung disease caused by structural defect?
Outline how ARDS causes restrictive lung disease?
Diffuse capillary damage allows for fibrin leakage such that it can line the alveolar spaces.
This blocks gas exchange, and then Capillary damage heals by fibrosis leading to restriction.
What is the the classic finding of an ARDS lung on X-ray?
What is ARDS AKA?
Hyaline membrane disease
What is the number one cause of ARDS and what are several other causes?
Amniotic fluid embolism
What is the initial cause of the damage in ARDS?
Neutrophilic sunstances toxic to the alveolar wall and type II pneumocytes....
Activation of the coagulation cascade
What drugs cause pulmonary fibrosis?
What lung parameters are elevated in Obstructive lung disease?
Total Lung capacity
Functional Residual capacity
Residual Volume... These are decreased in restrictive.
What is the one commonly asked about factor that is not relevant when determining normal spirometry values?
What is Caplan Syndrome?
What type of hypersensitivity is seen in Berylliosis?
Type 4! Granulomas are present!
Who is at risk for Berylliosis?
Anyone in the aerospace industry... Think astronauts.
Treatments for Sleep apnea?
Wt loss and CPAP
What is characteristic if Central sleep apnea?
No respiratory effort, problem is in brainstem
What is characteristic of Obstructive sleep apnea?
Respiratory effort against a blocked airway.
Common findings in Sleep apnea patients?
Arrhythmias, sudden death
What does asbestosis cause within the lungs?
Diffuse pulmonary INTERSTITIAL FIBROSIS of the lower lobes.
Who is at risk for Asbestosis?
People who work on Breaklines
What can be found in the lungs of Asbestosis patients?
Ferruginous bodies, esp of the Amphibole type. They are asbestos coated with hemosidderin.
What stain would be positive in a sample of lung tissue from an Asbestosis patient?
Prussian blue, from the iron on the asbestos fiber
Does smoking increased your risk of bronchogenic carcinoma if you have asbestosis?
Does smoking increase your risk of mesothelioma if you have asbestosis?
How does mesothelioma appear on gross?
As a 'white blanket' lining the lung pleura
How can u differentiate Mesothelioma from Adenocarcinoma based on EM findings?
Mesothelioma shows long thin microvilli on EM
Adenocarcinoma show short blunted microvilli.
What is atelectasis?
Areas of collapsed lung
What causes obstructive or resorptive atelectasis and what is seen on X-ray?
Blockage of the respiratory tree, from mucus plugs or aspiration. Air inside the lung gets resorbed away and the trachea will be seen deviating toward the side of the collapse.
What does Atelectasis predispose one to?
What causes compression atelectasis?
Compression of the lung pleura caused by fluid or air usually.
What is a Ghon complex?
A Ghon focus (seen in lower portion of the upper lobe or upper potion of the lower lobes) plus draining hilar lymph nodes.
Indicates PRIMARY TB
What causes cavitary lesions in the apex of the lungs?
How does miliary TB spread?
What are the three possible causes of an apical lung lesion on the USMLE?
What occurs WRT Breath Sounds, Resonance, Fremitus and Tracheal Deviation in: Bronchial obstruction?
Absent or decreased breath sounds over lesion
Deviation to the side of the lesion
What occurs WRT Breath Sounds, Resonance, Fremitus and Tracheal Deviation in: Pleural effusion?
Decreased breath sounds over the lesion
Dullness on resonance
What occurs WRT Breath Sounds, Resonance, Fremitus and Tracheal Deviation in: Pneumonia (lobar?)
Possible bronchial sounds over the lesion
Dullness on resonance
What occurs WRT Breath Sounds, Resonance, Fremitus and Tracheal Deviation in: Tension pneumothorax?
Decreased breath sounds
Deviation away from the lesion
Who is at risk of acquiring silicosis?
What is seen on X-ray in individuals with silicosis and what disease is it associated with?
Fibrotic nodules on X-ray (affects upper lobes)
Associated with TB
What is a 'coin' lung lesion associated with on lung X-ray?
What is the most common form of lung cancer?
A metastasis! Multiple nodules...
Pt present with dyspnea
What does a patient with primary cancer of the lung present with?
The presence of eosinophils in pleural fluid is indicative of. . .
What are the complications associated with lung cancer??
a SPHERE of complications!
Superior VC Syndrome (Increased distension above chest)
Endocrine associations (paraneoplastics)
Recurrent laryngeal symptoms (hoarseness)
Effusions! Pleural or pericardial
What is the location of a squamous cell carcinoma lesion and what is an associated cause?
What is characteristic of a Squamous cell carcinoma lesion?
A hilar mass arising from a bronchus...leads to cavitation
What is the paraneoplastic syndrome most often associated with Squamous cell Carcinoma?
Increased PTHrP leading to hypercalcemia!
Number one paraneoplastic condition of all time
What is characteristic of Squamous cell Carcinoma on histology?
Keritin pearls with intercellular Bridges
What is the location of a Bronchial or Bronchioloalveolar adenocarcinoma lesion?
Broncioloalveolar look like interstitial pneumonia as it lines the bronchioles.
Where does Bronchial carcinoma usually develop?
In the periphery at a sight of previous inflammation or injury
Who is usually affected by Bronchial carcinoma?
Females and NON smokers
What is characteristic of Bronchial carcinoma on histology?
Multiple densities on X-ray
What is the treatment for Broncial carcinoma or Squamous cell Carcinoma of the lung?
What is the treatment for Small Cell carcinoma?
Radiotherapy or Chemotherapy... Too aggressive it has likely already metastasized. Looks undifferentiated.
What is the location of Small cell carcinomas?
Central region of the lungs
What is an associated cause of Small cell carcinoma?
What are three common paraneoplastic syndromes associated with small cell carcinoma of the lung?
Cushing's caused by increased ACTH
Increased ADH, appearing as SIADH
Eaton-Lambert syndrome...autoantibodies against calcium channels of nerves, causing impaired neural transmission.
What is seen on histology of a Small cell carcinoma?
Small dark blue cells, AKA Kulchitsky cells
These are neuroendocrine in origin.
What is the location of a Large Cell carcinoma of the lung?
What are the salient characteristics of a Large Cell carcinoma of the lung?
Highly anaplastic and undifferentiated...
Poor prognosis, and little response to chemotherapy.
What is seen histologically in Large Cell Carcinoma of the lung?
Pleomorphic giant cells with leukocyte fragmentation in the cytoplasm
What is characteristic of Laryngeal squamous cell carcinoma?
What is Mikulicz Syndrome?
Uvea and Parotid involvement in a patient with Sarcoidosis
What are two features histologically of Sarcoidosis?
Schaumann bodies: Laminated dystrophic calcifications
Asteroid bodies: Stellate giant cell inclusions
What disease illustrates Schaumann bodies on histology?
What disease illustrates Asteroid bodies on histology?
What enzyme is often elevated in Sarcoid patients?
What electrolyte is often elevated in Sarcoid patients?
What is the appearance of a Sarcoid patient's X-ray?
Angel-Wing appearance on X-ray due to bilateral hilar lymphadenopathy?
Presenting symptoms of a Sarcoid patient?
Non-caseating granulomas on histology
Increased triglycerides in an effusion is indicative of
Lymphatic effusion.... Milky White
What is characteristic of transudate?
Decreased protein content
What conditions commonly lead to transudate effusions?
What conditions commonly lead to exudate effusions?
Collagen vascular disease
Trauma, in states of increased vascular permeability.
What is the appearance of an exudate?
Cloudy, due to increased protein content
Common causes of Lung abscesses?
Who is at increased risk to acquire a lung abscess?
Alcoholics and Epileptics (from aspiration)
Bronchial obstructions, commonly seen in cancer patients.
What is the appearance of Mycoplasma pneumonia on agar?
Friend egg appearance.. Use Eaton's Agar
Air fluid level to a Chest X-ray is often indicative of...
Number one cause of Lobar pneumonia?
S. pneumonia....rusty sputum
What is the number two cause of Lobar pneumonia?
Kleibsiella! Mucoid currant jelly sputum..
Common causes of lobular, or Bronchopneumonia?
S. aureus or S. pyogenes
What is characteristic on an X-ray of Bronchopneumonia?
Patchy distribution of infiltrates seen in one of more lobes
What are two common causes of hospital acquired pneumonia?
Typical X-ray finding of interstitial pneumonia?
Fluffy infiltrates, no consolitation
Viral causes of Interstitial pneumonitis in children
Treatments for Neonatal respiratory distress syndrome?
Maternal steroids before birth..
THYROXINE would also increase surfactant production
Artificial surfactant for baby after birth.
Risk factors for Neonatal respiratory distress syndrome?
Prematurity (decreased surfactant)
Maternal Diabetes (elevated insulin counteracts corticosteroids)
Cesarian section ( Decreased release of fetal glucocorticoids since their head is not smashed going thru the vagina.
What is the appearnance of neonatal distress syndrome on chest X-ray?
Ground glass appearance due to collapsed lungs
What are the different names for surfactant?
Lecithin to sphingomyelin ratio respiratory distress syndrome is usually:
Less than 1.5
What does neonatal respiratory distress syndrome out you at increased risk for?
PDA, due to the constant decrease in O2 tension.
What is Meigs syndrome?
Right sided pleural effusion
Fibroma of the ovary
Pulmonary HTN is most often caused by...
COPD and interstitial disease
Multiple ongoing pulmonary emboli...
Caused by pulmonary artery atherosclerosis with medial hypertrophy and intimal fibrosis
If tuberculosis is causing meningitis, what areas of the brain is most affected?
Basal surface of the brain...
Common features of Viral encephalitides?
What are three common causes of encephalitis?
HSV type 1---Children, temporal lobes
HIV--Multinucleated giant cells
What are two causes of ring enhancing lesions on CT or MRI?
Toxoplasmosis--Kitty litter or AIDS patients
Cerebral abscesses- These are seen at the grey-white junction and are often caused by endocarditis or cyanotic heart disease.