pulmonary_word association (2009)

7/31/2019 Pulmonary_Word Association (2009)

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Pulmonary PathologyGohara Word Association Game

200

Stimulus ResponseFracture of the long bones Fat embolismKid inhales peanuts (and climbing stairs?) Lung obstruction leading to reabsorption atelectasiHypercoagulable High risk for pulmonary emboli (Trousseaus sign)Bone Morphogenic Protein Receptor 2mutation

Pulmonary hypertension, patient will die of corpulmonale patient will develop hypertension

because of proliferation of smooth muscles in thewalls of vessels (BMPR-2)

Electromechanical Dissociation tracing on EKGs, but cannot feel a pulse (massivepulmonary embolism)

Antibodies to GM-CSF Alveolar proteinosisUremia Uremic pneumontitis (Hyaline Membrane*)

Young woman dies after delivery Amniotic fluid embolism or clot leading to embolus(particularly after c-section)

Increase in LDH3 Pulmonary infarctionLines of Zahn Pre-mortem clotEosinophil Protein Charcot-Leyden crystals (atopic)Reid Index = 2 Chronic bronchitisElastase EmphysemaInhibition of COX asthma (nonatopic)Lymph nodes of Sarcoidosis noncaseating GranulomasInfertility Cystic FibrosisPlexiform lesions of pulmonary arteries Pulmonary hypertension (BMPR-2 mutation)Increase Serum IgE atopic asthmaAdult Onset Asthma recent infections (MC-viral) or taking aspirin (COX

inhibition)PiZZ phenotype panacinar emphysema with -1 AT trypsin deficiencyHyperplasia of submucosal glands chronic bronchitisARDS Endothelium damage leading to flooding of lungs

Epithelial damage + neutrophils + hyaline membraneDyspnea, Fatigue, dysphagia, ReynaudsPhenomenon

Scleroderma

Eggshell calcifications SilicosisAlveolitis restrictive disease

TB SilicosisCaplan Syndrome Rheumatoid arthritis & pneumoconiosisPositive Scl70 or Anti-centromere SclerodermaAmphibole fibers asbestos (the worst kind)Serositis LupusErythema Nodosum SarcoidosisMesothelioma asbestos

Inhibition of COX non-atopic asthma (adult onset)Honey-comb lung End-stage restrictive diseaseBlue Bloater chronic bronchitisLow CD4 SarcoidosisPink Puffer emphysemaSteatorrhea & diabetes Cystic Fibrosis (or, stop eating MacDonalds)Hypercalcemia SarcoidosisReid Index = 0.4 NormalChemo agent that causes pulmonary fibrosis ChlorambucalDilation without tissue destruction Over inflationDefect in epithelial transport protein Cystic Fibrosis (7q31.2 autosomal recessive)


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Stimulus ResponseAir-Fluid Level on X-ray Lung abscessLobar Pneumonia (12hrs-3days) Red Hepatization (firm, red, airless)Sickle cell strept pneumonia (b/c of auto-splenectomy)Cold agglutinin Mycoplasma pneumoniaGhon complex Subpleural (only = Ghon focus) + Hilar (nodes)Ranke complex Healed, calcified Ghon complexEndemic in Ohio Histoplasma

Unpasteurized milk Q-feverGray Hepatization lobar pneumonia (fibrin + neutrophils, 3-8 days)Rapid urine Ag test LegionellaStrept pneumonia type 3 Sickle cell, low Ig, coexisting heart or lung diseaseMost common organism with abscess staph aureus*Cold autoimmune hemolytic anemia positive Coombs test (mycoplasmae)Chronic alcoholic lobar pneumonia, lung abscessCorona virus SARSCroupy cough Mycoplasma pneumoniaCMV retinitis Immunosuppressed patient (kids also get CMV, but it

not disseminated)Granulocytosis with Left shift bacteria, also see Dohle bodies, toxic granules

Hyperinflated lung emphysemaCaseating granuloma TBChronic cough with mucous chronic bronchitis

Obstructive Lung DiseasesStimulus Response65 year old

- Dyspnea, productive purulent cough x6 wks

- Walking Pneumonia w/productivecough last year for 2 months

Chronic bronchitis

35 year old with cystic fibrosis- 102F fever- Foul smelling sputum for 2 weeks

BronchiectasisDilation w/superimposed infection

55 year old - Back pain x 5 years- Recurrent attack of: x 5 years

o Dyspnea

o Wheezing

o Cough

- Analgesic use

Intrinsic asthma

Genetic asthma ADAM33 mutationCFTR CF

Lipooxygenase Intrinsic asthmaEosinophils Extrinsic asthma onlyPink puffers EmphysemaIgE Extrinsic asthmaPiMM Normal 1-anti-trypsinForeign Body Overinflation (also w/pneumonectomy)Barrel chest EmphysemaViral infections Intrinsic asthmaRespiratory bronchioles + spares distalalveoli

Centroacinar emphysema


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Restrictive lung diseaseStimulus Response35 year old

- Painful nodules on legs: Erythemanodosum

- Itchy eyes and water x 2 weeks

- Recurrent viral infections low CD4

- Tests: Ca

2+

- Biopsy (definitive): Noncaseatinggranulomas

- Chest X-ray: Hilar lymphadenopathy

Sacroidosis

65 year old shipyard worker- Dyspnea, fatigue x 6 months- Chest x-ray: honeycomb lung- Biopsy: asbestos fiber (amphibole)

Asbestosis

Honeycomb lung End stage restrictive lung diseaseAlveolitis Centerpiece of initial damage leading to

honeycomb lung+ ANA and chest pain that increases

w/inspiration

SLE, Will also find serositis, pneumonitisAntibodies to CM-CSF Alveolar proteinosisADAM33 Atopic AsthmaViral infections Intrinsic asthmaRecurrent pulmonary infections, infertility,fatty liver

Cystic Fibrosis

TB SilicosisEggshell calcification Silicosis X-ray: lymph node calcificationPleural plaques AsbestosisAmiodarone 1. Lung Fibrosis

2. Microvesicular steatosis of liver

3. HypothyroidismCaplan Syndrome Rheumatoid Arthritis & PneumoconiosisImpaired surfactant clearance Alveolar proteinosisAirway remodeling Asthma

Pulmonary Lab #1Stimulus ResponseMiddle aged

- Fingers hurt/change color in cold(Reynauds)

- Tight skin

- Goes to the freezer to pull meat out

ouch!- Dyspnea, Crackles, no wheezing

- Hypertension can be malignant- BUN/Creatinine - Urinalysis: Slight hematuria- ANA: high titer, speckled SCL70

Scleroderma

Hot tub (repeated) Hypertsensitivity pneumonitisConstruction worker/shipyard worker

- Dyspnea Asbestosis

Serpentine: flexible, less pathogenic dont breainto pieces


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Amphibole: break into pieces deeper into lungSequelae:- Pleaural plaque- Mesothelioma- Lung cancer (w/smoking: 55x risk)

Adult w/cold- Recurrent wheezing, cough- No eosinophelia

Adult-onset asthma

Atelectasis of the lung, acute lung injury, vascular diseasesStimulus Response65 year old construction worker

- Chest pain- Recurrent pleural effusion- Decreased breath sounds- Opacities on x-ray in pleura

AbestosisSee pleural plaques on xray or mesotheliomaOn biopsy:

- Serpentine / amphibole fibers

Young woman- Progressive dyspnea- Ankle edema- RUQ discomfort- Hemoptysis

Cor pulmonalePulmonary HTN (BMPR mutation)

Aspirated marble Atelectasis resorptionX-ray: white-out on the marble side

55 yo woman- History of RA- Silicosis after glass factory work

Caplan Syndrome- Pneumoconiosis- Rheumatoid Arthritis

Older man- Dyspnea- Productive Cough- Honeycomb cough on X ray

Pulmonary fibrosis- Initial injury: alveolitis (all restrictive lung

diseases)

4 year old jumps on trampoline, aspiratespeanut

Obstructive (resorption) atelectasis

16 year old

- Hits head while riding bike

@ risk for ARDS

Chronic Renal Failure patient lung changes Hyaline membrane (uremic pneumonitis) identical toARDS

Interstitial fibrosis- Has been on antiarrhythmic drug

Amiodarone- Also causes hypothyroid, microsteattosis in liv

(small fat globulesBlue bloaters Chronic bronchitisIncreased sweat Cl- CF

TB SilicosisLines of Zahn Pre-mortem clotIncreased LDH3 Pulmonary infarctionBarrel chest EmphysemaABs to GM-CSF Alveolar ProteinosisWedge shaped lesion Pulmonary InfarctionSteatorrhea CFNSAIDs AsthmaCharcot-Leiden Crystals Asthma

Lung TumorsStimulus ResponseSmall cell carcinoma ACTH (Cushings)Squamous cell Hypercalcemia: constipation, neurological


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manifestationsHyponatremic SIADHLambert Eaton Weakness of muscles + fatigue

Autoantibodies to Ca2+ channels- Looks like Myasthenia gravis (ok in morn, wors

@ night)

- BUT is worse in morning gets better as daygoes on

Dexamethasone suppression test Ectopic ACTH is notsuppressed (endogenous is)

pulmonary_word association (2009)

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