Block 1 Pulmonary (nasopharynx, larynx, & cancers) Flashcards
1
Q
Describe the following for Rhinitis:
What is it?
What causes it?
What are the symptoms?
A
Patho:
Inflammation in the nasal mucosa
Causes:
Rhinovirus
Symptoms:
1) Sneezing
2) Congestion
3) Runny nose
2
Q
Patho:
Inflammation in the nasal mucosa
Causes:
Rhinovirus
Symptoms:
1) Sneezing
2) Congestion
3) Runny nose
Describes which condition?
A
Rhinitis
3
Q
Describe the following for Allergic Rhinitis:
What is it?
What causes it?
What are the symptoms?
What are the lab findings?
What are the associated conditions?
A
Patho/causes
A subtype of rhinitis typically triggered by allergens (pollen) causing a type 1 hypersensitivity reaction
Symptoms = Same as rhinitis
Labs:
Inflammatory infiltrate with eosinophils
Ass:
Asthma
Eczema
Chrug-strauss syndrome
4
Q
Patho/causes
A subtype of rhinitis typically triggered by allergens (pollen) causing a type 1 hypersensitivity reaction
Symptoms = Same as rhinitis
Labs:
Inflammatory infiltrate with eosinophils
Ass:
Asthma
Eczema
Chrug-strauss syndrome
Describes which condition?
A
Allergic Rhinitis
5
Q
Describe the following for nasal polyps:
What is it?
What causes it?
A
Patho:
When the nasal mucosal becomes inflamed & swollen (edematous) to the point that it protrudes out
Causes:
#1 Repeated bouts of rhinitis
Cystic fibrosis
Aspirin-tolerant asthma
6
Q
Patho:
When the nasal mucosal becomes inflamed & swollen (edematous) to the point that it protrudes out
Causes:
#1 Repeated bouts of rhinitis
Cystic fibrosis
Aspirin-tolerant asthma
Describes which condition?
A
Nasal polyps
7
Q
What is the triad of aspirin-tolerant asthma?
A
1) Asthma
2) Aspirin induced bronchospasms
3) Nasal polyps
8
Q
1) Asthma
2) Aspirin induced bronchospasms
3) Nasal polyps
Are the triad of which condition
A
Aspirin tolerant asthma
9
Q
Describe the following for Angiofibroma:
What is it?
Who does it appear in most?
What are the symptoms?
A
Patho:
A benign tumor of the nasal mucosa that is made up of large blood vessels & fibrous tissue
Etiology:
Teen boys
Symptoms:
1) Profuse epistaxis (nosebleeds)
10
Q
Patho:
A benign tumor of the nasal mucosa that is made up of large blood vessels & fibrous tissue
Etiology:
Teen boys
Symptoms:
1) Profuse epistaxis (nosebleeds)
Describes which condition?
A
Angiofibroma
11
Q
Describe the following for nasopharyngeal carcinomas:
What is it?
What are the associated conditions?
What are the lab findings?
What are the symptoms?
A
Patho:
A malignant tumor of the nasopharyngeal epithelium
Ass:
EBV (African kids & Chinese adults)
Labs:
- Biopsy shows pleomorphic keratin =ve epithelial cells that are poorly differentiated squamous cell cancer
Symptoms:
1) Cervical lymph node involvement
12
Q
Patho:
A malignant tumor of the nasopharyngeal epithelium
Ass:
EBV (African kids & Chinese adults)
Labs:
- Biopsy shows pleomorphic keratin =ve epithelial cells that are poorly differentiated squamous cell cancer
Symptoms:
1) Cervical lymph node involvement
Describes which condition?
A
Nasopharyngeal carcinoma
13
Q
Describe the following for acute epiglottitis:
What is it?
What causes it?
What are the symptoms?
What is a complication/risk?
A
Patho:
Inflammation of the epiglottis
Causes:
#1 H. Influenzae type B (especially in kids without immunization)
Symptoms:
1) High fever
2) Sore throat
3) Drooling & dysphagia
4) Muffled voice
5) Inspiratory stridor
Risk:
Airway obstruction
14
Q
Patho:
Inflammation of the epiglottis
Causes:
#1 H. Influenzae type B (especially in kids without immunization)
Symptoms:
1) High fever
2) Sore throat
3) Drooling & dysphagia
4) Muffled voice
5) Inspiratory stridor
Risk:
Airway obstruction
Describes which condition?
A
acute epiglottitis
15
Q
Describe the following for Laryngotracheobronchitis (Croup):
What is it?
What is the cause?
What are the symptoms?
A
Patho:
Inflammation of the upper of upper airway
Causes:
#1 Parainfluenza
Symptoms:
1) Hoarse “barking” cough
2) Inspiratory stridor
16
Q
Patho:
Inflammation of the upper of upper airway
Causes:
#1 Parainfluenza
Symptoms:
1) Hoarse “barking” cough
2) Inspiratory stridor
Describes which condition?
A
Laryngotracheobronchitis (Croup)
17
Q
Describe the following for vocal cord nodules:
What are they?
What causes them?
What are the lab findings?
What are the symptoms?
How do you treat it?
A
Path/cause:
Nodules on the vocal cords (bilateral) that happen due to excessive use
Labs/biopsy:
Show the nodes are made of degenerative (myxoid) connective tissue
Symptoms:
1) Hoarseness
Rx: Rest
18
Q
Path/cause:
Nodules on the vocal cords (bilateral) that happen due to excessive use
Labs/biopsy:
Show the nodes are made of degenerative (myxoid) connective tissue
Symptoms:
1) Hoarseness
Rx: Rest
Describes which condition?
A
Vocal cord nodes
19
Q
Describe the following for a laryngeal carcinoma:
What is it?
What causes it?
-risks
What are the symptoms?
A
Patho:
A squamous cell cancer of the epithelial lining of the vocal cords
Causes/risks
Alcohol
Tobacco #1
Laryngeal papilloma (rare)
Symptoms:
1) Hoarseness
2) Cough
3) Stridor
20
Q
Patho:
A squamous cell cancer of the epithelial lining of the vocal cords
Causes/risks
Alcohol
Tobacco #1
Laryngeal papilloma (rare)
Symptoms:
1) Hoarseness
2) Cough
3) Stridor
Describes which condition?
A
laryngeal carcinoma
21
Q
Describe the following for a laryngeal papilloma:
What is it?
What causes it?
What are the symptoms?
A
Patho:
A benign papillary tumor on the vocal cords that is single in adults or can be multiple in children
Causes:
HVP-6 & 11 viruses
Symptoms:
1) Hoarseness
22
Q
Patho:
A benign papillary tumor on the vocal cords that is single in adults or can be multiple in children
Causes:
HVP-6 & 11 viruses
Symptoms:
1) Hoarseness
Describes which condition?
A
laryngeal papilloma
23
Q
Describe the following for pneumonia:
What is it?
What causes it?
What are the symptoms?
What are the lab findings?
A
Patho:
An infection of the lung parenchyma that happens when our normal respiratory defenses fail
Causes:
Impaired cough reflex from either a mucociliary escalator or mucus plug
Symptoms:
1) Fever & chills
2) Productive cough (yellow-green or rusty sputum)
3) Tachypnea with pleuritic chest pain
4) Decreased breath sounds
5) Dullness to percussion
Labs:
Elevated WBC
Chest x-ray (infiltrates)
+ve sputum & blood gram staining
24
Q
Patho:
An infection of the lung parenchyma that happens when our normal respiratory defenses fail
Causes:
Impaired cough reflex from either a mucociliary escalator or mucus plug
Symptoms:
1) Fever & chills
2) Productive cough (yellow-green or rusty sputum)
3) Tachypnea with pleuritic chest pain
4) Decreased breath sounds
5) Dullness to percussion
Labs:
Elevated WBC
Chest x-ray (infiltrates)
+ve sputum & blood gram staining
Describes which condition?
A
Pneumonia
25
What is the classical triad seen in pneumonia?
1) Lobar pneumonia
2) bronchopneumonia
3) interstitial pneumonia
26
1) Lobar pneumonia
2) bronchopneumonia
3) interstitial pneumonia
Is a triad of which condition?
Pneumonia
27
Describe the following for lobar pneumonia:
What is it?
What are the causes
- 1st & other
What are the phases of this type of pneumonia?
Patho:
A lung infection that causes consolidation of the entire lung lobe
Causes:
#1 S. pneumoniae
Klebsiella pneumoniae
Phases:
1) congestion (from blood vessels & edema)
2) Red hepatization
(from exudate, neutrophils, & hemorrhages in the alveolar spaces that make the lung texture more firm)
3) Gray hepatization (there is degeneration of the red cells within the exudate)
4) Resolution
28
Patho:
A lung infection that causes consolidation of the entire lung lobe
Causes:
#1 S. pneumoniae
Klebsiella pneumoniae
Phases:
1) congestion (from blood vessels & edema)
2) Red hepatization
(from exudate, neutrophils, & hemorrhages in the alveolar spaces that make the lung texture more firm)
3) Gray hepatization (there is degeneration of the red cells within the exudate)
4) Resolution
Describes the lobar pneumonia?
Lobar pneumoniae
29
Describe the following for bronchopneumonia:
What is it?
What causes it?
An infection that causes scattered & patchy consolidation around bronchioles (usually presents multifocally & bilaterally)
Causes:
Bacterial infection
30
An infection that causes scattered & patchy consolidation around bronchioles (usually presents multifocally & bilaterally)
Causes:
Bacterial infection
Describes which condition?
bronchopneumonia
31
Describe the following for Interstitial (atypical) pneumonia:
What is it?
What are the symptoms?
What are the causes?
Patho:
Infected lungs have diffuse interstitial infiltrates
Symptoms:
1) mild upper respiratory symptoms (minimal sputum & low fever)
Causes:
Bacteria & viruses
32
Patho:
Infected lungs have diffuse interstitial infiltrates
Symptoms:
1) mild upper respiratory symptoms (minimal sputum & low fever)
Causes:
Bacteria & viruses
Describes which condition?
Interstitial (atypical) pneumonia
33
Describe the following for aspiration pneumonia:
What is it?
- who is at risk?
What causes it?
What is a complication?
Patho:
Happens in patients that are likely to choke or have inhaled food into lungs i.e Alcoholics or comatose patients
Causes:
Anaerobic bacteria in the oropharynx (bacteriodes, fusobacterium, & peptococcus)
Comp:
Right-lower lobe abscess
34
Patho:
Happens in patients that are likely to choke or have inhaled food into lungs i.e Alcoholics or comatose patients
Causes:
Anaerobic bacteria in the oropharynx (Bacteroides, fusobacterium, & peptococcus)
Comp:
Right-lower lobe abscess
Describes which condition?
Aspiration pneumonia
35
What are the causal agents of lobar pneumonia & for each one who is most at risk & why?
S. pneumoniae:
most common in community acquired pneumoniae & secondary pneumoniae in middle-aged to elderly people
S. klebsiella:
Mostly effects malnourished & debilitated individuals like the elderly (nursing homes), alcoholics, & diabetics
36
What are the bacteria specifically causing bronchopneumonia?
S. aureus
H. influenzae
Pseudomonas aeruginosa
Moraxella catarrhalis
Legionella pneumophilla
37
Which bacteria most commonly causing bronchopneumonia cause exasperation of COPD?
Legionella. H. influenzae, & Moraxella
38
Which bacteria most commonly causing bronchopneumonia in patients with cystic fibrosis?
Pseudomonas aeruginosa
39
Which bacteria most commonly causing bronchopneumonia are often complicated by abscess or empyema
S. aureus
40
What are the organisms that cause atypical/interstitial pneumoniae?
-Most common
- Other
Most common:
Mycoplasma pneumoniae
Other:
Chlamydia pneumoniae (young adults)
RSV (infants)
CMV (Posttransplant immunosuppressive therapy)
Influenza (Elderly, immunocompromised, & those with pre-existing lung conditions)
Coxiella (Atypical pnuemonia with Q fever in farmers & vetrenarians)
41
What are the complications of atypical/interstitial pneumonia infected with mycoplasma ?
Autoimmune hemolytic anemia & erythema multiforme
42
Describe the following for TB:
What is the major cause?
Inhaling aerosolized mycobacterium TB
43
Describe the following for primary TB?
What is the pathophysiology?
What are the symptoms?
What complications?
Patho:
Initial exposure to aerosolized mycobacterium TB causes focal caseating necrosis in the lower lobe & hilar lymph nodes that results in fibrosis & calcification to form a Ghon complex in the lung
Symptoms:
Asymptomatic
Comps:
It can to a +ve PPD
44
Patho:
Initial exposure to aerosolized mycobacterium TB causes focal caseating necrosis in the lower lobe & hilar lymph nodes that results in fibrosis & calcification to form a Ghon complex in the lung
Symptoms:
Asymptomatic
Comps:
It can to a +ve PPD
Describes which condition?
primary TB
45
Describe the following for secondary TB?
What is the pathophysiology?
What are the symptoms?
What are the lab findings?
What complications?
Patho:
Reactivation of Mycobacterium TB in AIDs patients of elderly causes cavitary foci of caseous necrosis in the apex of the lung
Symptoms:
1) fevers
2) night sweats
3) hemoptysis + cough
4) weight loss
Labs/biopsy:
Biopsy will show caseating granulomas
AFB stain will show acid fast bacilli
Comps:
Miliary pulmonary TB
TB bronchopneumonia
Systemic spread
- Meninge (meningitis)
- Cervical lymph node
- Kidneys (sterile polyuria)
- Lumbar spine (pott's disease)
46
Patho:
Reactivation of Mycobacterium TB in AIDs patients of elderly causes cavitary foci of caseous necrosis in the apex of the lung
Symptoms:
1) fevers
2) night sweats
3) hemoptysis + cough
4) weight loss
Labs/biopsy:
Biopsy will show caseating granulomas
AFB stain will show acid fast bacilli
Comps:
Miliary pulmonary TB
TB bronchopneumonia
Systemic spread
- Meninge (meningitis)
- Cervical lymph node
- Kidneys (sterile polyuria)
- Lumbar spine (pott's disease)
Describe which condition?
Secondary TB
47
Comps:
Miliary pulmonary TB
TB bronchopneumonia
Systemic spread
- Meninge (meningitis)
- Cervical lymph node
- Kidneys (sterile polyuria)
- Lumbar spine (pott's disease)
aRE COMPLICATIONS OF WHICH CONDITION?
Secondary TB
48
Describe the following for Emphysema:
What is it?
What are the symptoms?
What causes it?
- Most common & others
What are the late complications?
Patho:
It's when there is destruction of the alevolar air sacs which results in a loss of elastic recoil & collapse of the airways during exhalation causing obstruction & trapped air
Symptoms:
1) Dyspnea + cough
2) Pink puffer (long expiration with pursed lips)
3) Weight loss
4) Barrel Chest
Causes:
Imbalances in proteases & antiprotease levels
Smoking (most common!!)
A1AT deficiency
Late comps:
Hypoxemia
Cor pulmonale
49
Patho:
It's when there is destruction of the alevolar air sacs which results in a loss of elastic recoil & collapse of the airways during exhalation causing obstruction & trapped air
Symptoms:
1) Dyspnea + cough
2) Pink puffer (long expiration with pursed lips)
3) Weight loss
4) Barrel Chest
Causes:
Imbalances in proteases & antiprotease levels
Smoking (#1)
A1AT deficiency
Late comps:
Hypoxemia
Cor pulmonale
Describes which condition?
Emphysema
50
How does protease & antiprotease imbalance lead to emphysema?
Normally inflammation in the lungs would trigger a cascade where neutrophils & macrophages would release proteases & then A1AT would neutralize them.
In emphysema there's either too much protease or too little A1AT from the excessive inflammation resulting in alveolar air sacs being destroyed
51
How does smoking lead to emphysema?
The most common cause of emphysema it leads to excessive inflammation of the lungs& too little A1AT levels resulting in centriacinar emphysema that is worse in the UPPER LOBES
52
How does an A1AT deficiency lead to emphysema?
It's a rare cause of emphysema, where A1AT antiproteases are misfolded resulting in lower circulating levels worst in the LOWER lobes & accumulation of the misfolds in the liver (cirrhosis)
PiMM normal
PiZ most common mutation = low A1AT
PiZZ worst kind with a risk of panacinar emphysema & cirrhosis
53
Which genotype of the A1AT mutation causes panacinar emphysema & liver cirrhosis?
PiZZ
54
Describe the following for Asthma (allergy induced):
What is it?
What are the symptoms (during an attack)?
What conditions are associated with it?
What are the complications if left untreated?
Patho:
It usually presents in childhood,
1. Initial exposure to an allergen triggers CD4+T cells to switch to a TH2 phenotype. These secrete:
- IL4 (increase class switching to IgE)
- IL5 (recruit eosinophils)
- IL10 (stimulate more TH2 cells & inhibit TH1)
2. During re-exposure to the same allergen, there is a type 1 hypersensitivity reaction mediated by IgE. It causes mast cells to release preformed histamine & leukotrienes (C4, D4, & E4) resulting in bronchospasms, inflammation, & edema
Symptoms:
1) Dyspnea + wheezing
2) Productive cough (Crushmann spiral mucus plugs & Charcot Leyden (eosinophil) crystals)
Ass cond:
Allergic rhinitis
Eczema
Family history of atopy
Chrug-strauss syndrome
Comp of severe attack untreated:
Status asthmaticus & death
55
What are the causes of non-allergy induced asthma?
exercise
viral infections
Aspirin
Occupational hazards
56
Patho:
It usually presents in childhood,
1. Initial exposure to an allergen triggers CD4+T cells to switch to a TH2 phenotype. These secrete:
- IL4 (increase class switching to IgE)
- IL5 (recruit eosinophils)
- IL10 (stimulate more TH2 cells & inhibit TH1)
2. During re-exposure to the same allergen, there is a type 1 hypersensitivity reaction mediated by IgE. It causes mast cells to release preformed histamine & leukotrienes (C4, D4, & E4) resulting in bronchospasms, inflammation, & edema
Symptoms:
1) Dyspnea + wheezing
2) Productive cough (Crushmann spiral mucus plugs & Charcot Leyden (eosinophil) crystals)
Ass cond:
Allergic rhinitis
Eczema
Family history of atopy
Chrug-strauss syndrome
Comp of severe attack untreated:
Status asthmaticus & death
Describes which condition?
Allergy-induced asthma
57
Describe the following for bronchiectasis:
What is it?
What causes it?
Patho:
Permanent dilation of the bronchioles & bronchi resulting in lost airway tone with air being trapped
Causes:
Necrotizing inflammation & damaged airways in conditions like
- Cystic fibrosis
- Kartagener syndrome
58
Patho:
Permanent dilation of the bronchioles & bronchi resulting in lost airway tone with air being trapped
Causes:
Necrotizing inflammation & damaged airways in conditions like
- Cystic fibrosis
- Kartagener syndrome
Describes which condition?
Bronchiectasis
59
Describe the following for Kartager syndrome:
What is it?
What are the symptoms?
What are the associated conditions?
What are the complications?
Patho:
A defect in ciliary dynein arms
Symptoms:
1) Cough
2) Dyspnea
3) Foul-smelling sputum
Ass cond:
Sinusitis
Infertility
Situs inversus (organ positions are revesed)
Tumor or foreign body
Necrotizing infection
Allergic bronchopulmonary aspergillosis
Comps:
Hypoxemia with cor pulmonale & secondary (AA) amyloidosis
60
Patho:
A defect in ciliary dynein arms
Symptoms:
1) Cough
2) Dyspnea
3) Foul-smelling sputum
Ass cond:
Sinusitis
Infertility
Situs inversus (organ positions are revesed)
Tumor or foreign body
Necrotizing infection
Allergic bronchopulmonary aspergillosis
Comps:
Hypoxemia with cor pulmonale & secondary (AA) amyloidosis
Associated with which condition?
Kartager syndrome
61
What are the key features of COPD type lung diseases? Which lung conditions are considered to be COPD?
Obstructive lung diseases have trapped air (lungs don't empty) & present with:
- Low FVC (especially during first second of exhalation)
- Low FEV:FVC ratio
- High TLC
Conditions include:
Chronic bronchitis
Emphysema
Asthma
Bronchiectasis
62
Describe the following for chronic bronchitis:
What is it?
What are they symptoms?
What are the lab findings?
What is an associated condition?
- risk
Patho:
A chronic productive cough lasting 3 months over a minimum 2yr period
Symptoms:
1) productive cough (lots of mucus)
2) Cyanosis
3) Higher risk of infections & cor pulmonale
Labs:
Hypertrophied mucinous glands (mucus traps CO2)
- Increased PaCO2
- Decreased PaO2
Reid INDEX > 50% (normal is 40%)
Ass/risk:
smoking
63
Patho:
A chronic productive cough lasting 3 months over a minimum 2yr period
Symptoms:
1) productive cough (lots of mucus)
2) Cyanosis
3) Higher risk of infections & cor pulmonale
Labs:
Hypertrophied mucinous glands (mucus traps CO2)
- Increased PaCO2
- Decreased PaO2
Reid INDEX > 50% (normal is 40%)
Ass/risk:
smoking
Describes which condition?
chronic bronchitis
64
What are the key features of restrictive type lung diseases? Which lung conditions are considered to be restrictive?
When there is restricted filling of the lungs it presents as:
- Low TLC
- Low FEV
- Very Low FVC
- FEV:FVC ratio increase
Conditions include:
Idiopathic pulmonary fibrosis
Pneumoconiosis
Sarcoidosis
Hypersensitivity pneumonitis
65
Describe the following for Idiopathic pulmonary fibrosis:
What is it?
What possibly causes it?
- primary
What are the symptoms?
What are the lab findings?
What is the treatment?
Patho:
Fibrosis of the lung interstitium
Causes (primary)
Cyclical lung injury (releases TGF-B from injured pneumocytes which induce fibrosis)
Symptoms:
1) Progressive dyspnea + cough
Labs:
Show fibrosis of the lung in a honeycomb pattern (late stage)
Rx: Lung transplant
66
Patho:
Fibrosis of the lung interstitium
Causes (primary)
Cyclical lung injury (releases TGF-B from injured pneumocytes which induce fibrosis)
Symptoms:
1) Progressive dyspnea + cough
Labs:
Show fibrosis of the lung in a honeycomb pattern (late stage)
Rx: Lung transplant
Describes which condition?
Idiopathic pulmonary fibrosis
67
Describe the following for pneumoconiosis:
What is it?
What causes it?
Patho:
It's interstitial fibrosis of the lung that occurs when alveolar macrophages engulf small foreign particles
Causes:
Occupational hazards
- Coal miners
- Sandblasters/silica miners
-Beryllium miners
- Construction/plumbers/shipyard workers (asbestos)
68
How does Pneumoconiosis due to exposure to carbon dust (coal miner) present?
Massive exposure causes diffuse fibrosis aka black lung & minor exposure causes anthracosis which is not clinically significant
69
How does Pneumoconiosis due to exposure to silica (sand blasters & silica miners) present?
causes fibrotic nodules in the upper lobes & increases the risk of TB infection (because the macrophages are impaired)
70
How does Pneumoconiosis due to exposure to Berylliosis (beryllium miners & aerospace workers) present?
causes non-caseating granulomas in the lungs, hilar lymph nodes, & systemic organs. It also increases the risk of cancer
71
How does Pneumoconiosis due to exposure to asbestos (construction workers, plumbers, & shipyard workers) present?
causes fibrosis of the lungs & pleura, & it increases the risk of lung cancer & mesothelioma
72
Describe the following for sarcoidosis:
What is it?
What causes it?
What are the symptoms?
What are the lab findings?
How would you treat it?
Patho:
A systemic disease with non-caseating granulomas in multiple organs (usually in afro-american women). The granulomas usually involve the hilar LN or lungs resulting in restrictive lung disease
Causes:
Likely from a CD4+T helper response to an unknown antigen
Symptoms
1) Dyspnea or Cough
Labs:
Elevated serum ACE
Stellate inclusions (asteroid bodies) within GC granulomas
Hypercalcemia
Rx:
Steroids
73
Patho:
A systemic disease with non-caseating granulomas in multiple organs (usually in afro-american women). The granulomas usually involve the hilar LN or lungs resulting in restrictive lung disease
Causes:
Likely from a CD4+T helper response to an unknown antigen
Symptoms
1) Dyspnea or Cough
Labs:
Elevated serum ACE
Stellate inclusions (asteroid bodies) within GC granulomas
Hypercalcemia
Rx:
Steroids
sarcoidosis
74
In sarcoidosis what are the infiltrates you would see within the GC granulomas?
Stellate inclusions (asteroid bodies)
75
Describe the following for Hypersensitivity pneumonitis:
What is it?
What causes it?
What are the symptoms?
How do you treat it?
What is a complication?
Patho/cause:
It happens when there is a granulomatous reaction to inhaled organic antigens (i.e pigeon poop with pigeon breeders)
Symptoms:
1) Fever
2) Cough
3) Dyspnea
(hrs post exposure)
Rx: remove organic agent
Comp:
Chronic exposure can lead to interstitial fibrosis
76
Patho/cause:
It happens when there is a granulomatous reaction to inhaled organic antigens (i.e pigeon poop with pigeon breeders)
Symptoms:
1) Fever
2) Cough
3) Dyspnea
(hrs post exposure)
Rx: remove organic agent
Comp:
Chronic exposure can lead to interstitial fibrosis
Describes which condition?
Hypersensitivity pneumonitis with c. neoformans
77
Describe the following for primary pulmonary HTN:
What is it?
What causes it?
What are the symptoms?
What are the complications?
Patho/causes:
Usually in young women it can be from either:
1) Atherosclerosis of the pulmonary trunk & smooth muscle hypertrophy of the pulmonary arteries with intimal fibrosis
OR
2) BMPR2 mutation (increase smooth muscle proliferation in pulmonary arteries)
Symptoms:
1) Exertional dyspnea or right sided heart failure
Comps:
It can lead to right ventricular hypertrophy with eventual cor pulmonale
78
Patho/causes:
Usually in young women it can be from either:
1) Atherosclerosis of the pulmonary trunk & smooth muscle hypertrophy of the pulmonary arteries with intimal fibrosis
OR
2) BMPR2 mutation (increase smooth muscle proliferation in pulmonary arteries)
Symptoms:
1) Exertional dyspnea or right sided heart failure
Comps:
It can lead to right ventricular hypertrophy with eventual cor pulmonale
Describes which condition?
Primary pulmonary HTN
79
Describe the following for Secondary pulmonary HTN:
What causes it?
What are the symptoms?
What are the complications?
Can be due to a number of conditions:
1) Hypoxemia (COPD & interstitial lung disease)
2) Congenital heart diseases (that increase pulmonary congestion)
3) Recurrent pulmonary embolism
4) Atherosclerosis of the pulmonary trunk & smooth muscle hypertrophy of the pulmonary arteries with intimal fibrosis
Symptoms:
1) Exertional dyspnea or right sided heart failure
Comps:
It can lead to right ventricular hypertrophy with eventual cor pulmonale
80
Can be due to a number of conditions:
1) Hypoxemia (COPD & interstitial lung disease)
2) Congenital heart diseases (that increase pulmonary congestion)
3) Recurrent pulmonary embolism
4) Atherosclerosis of the pulmonary trunk & smooth muscle hypertrophy of the pulmonary arteries with intimal fibrosis
Symptoms:
1) Exertional dyspnea or right sided heart failure
Comps:
It can lead to right ventricular hypertrophy with eventual cor pulmonale
Rx:
Treat the underlying condition & give ventilation with +ve end expiration (PEEP)
Describes which condition?
Secondary pulmonary HTN
81
Describe the following for Acute respiratory distress syndrome:
What is it?
What are the symptoms?
What conditions is it secondary to?
Pathp:
It is diffuse damage to the alveolar-capillary interface causing protein-rich fluid leakage resulting in edema & necrotic epithelial cells to form hyaline membranes throughout the alveoli spaces (poor gas exchange)
Symptoms:
1) Hypoxemia with cyanosis
2) White-out chest xray
Ass conditions:
(Anything that causes neutrophils to release proteases & damage type I&II pneumocytes)
Sepsis/infection
Shock/trauma
DIC
Aspirations
Hypersensitivity reactions
Drugs
Rx:
Treat the underlying condition & give ventilation with +ve end expiration (PEEP)
82
Pathp:
It is diffuse damage to the alveolar-capillary interface causing protein-rich fluid leakage resulting in edema & necrotic epithelial cells to form hyaline membranes throughout the alveoli spaces (poor gas exchange)
Symptoms:
1) Hypoxemia with cyanosis
2) White-out chest xray
Ass conditions:
(Anything that causes neutrophils to release proteases & damage type I&II pneumocytes)
Sepsis/infection
Shock/trauma
DIC
Aspirations
Hypersensitivity reactions
Drugs
Describes which condition?
Acute respiratory distress syndrome
83
Describe the following for Neonatal respiratory distress syndrome:
What is it?
What causes it?
What are the symptoms?
What are the complications?
Patho:
When the is low surfactant in the lungs at birth (made by type II pneumocytes). To test for this you can test the amniotic fluid for the lethicin:sphingomyelin ratio (anything less than 2 = inadequate)
Causes:
1) premature baby (lungs develop between the 28-34 weeks anything under 34 is too early)
2) C-section (not enough stress-induced hormone)
3) Maternal diabetes (insulin decreases surfactant)
Symptoms:
1) Increasing breathing effort with tachypnea & the use of all their accessory muscles with grunting
2) Hypoxia with cyanosis
3) ground glass opacities on xray (diffuse granularity in lungs)
Comps:
Hypoxemia (risk of persisting PDA & necrotizing enterocolitis)
&
Supplemental O2 given as a treatment risks free radical damage (retina = blindness & lungs= bronchopulmonary dysplasia)
84
Patho:
When the is low surfactant in the lungs at birth (made by type II pneumocytes). To test for this you can test the amniotic fluid for the lethicin:sphingomyelin ratio (anything less than 2 = inadequate)
Causes:
1) premature baby (lungs develop between the 28-34 weeks anything under 34 is too early)
2) C-section (not enough stress-induced hormone)
3) Maternal diabetes (insulin decreases surfactant)
Symptoms:
1) Increasing breathing effort with tachypnea & the use of all their accessory muscles with grunting
2) Hypoxia with cyanosis
3) ground glass opacities on xray (diffuse granularity in lungs)
Comps:
Hypoxemia (risk of persisting PDA & necrotizing enterocolitis)
&
Supplemental O2 given as a treatment risks free radical damage (retina = blindness & lungs= bronchopulmonary dysplasia)
Describes which condition?
Neonatal respiratory distress syndrome
85
Describe the following for lung cancers:
What are the Major risk factors?
What are the non-specific symptoms?
What are the general non-specific symptoms?
What are the common lab findings?
MRF:
1# Smoking
2# Radon (soil & basement living)
Asbestos
Non-specific symptoms:
1) cough
2) hemoptysis
3) Dyspnea
4) Weight loss
5) Post-obstructive pneumonia
86
What the are the tumor staging acronyms:
T
N
M
Tumor size & local extension
N- spread to regional lymph nodes
M unique metastases to adrenal gland
87
Describe the following for Small cell carcinoma:
What is it?
What usually causes it?
How do you treat it?
What are the lab findings?
What are the complications?
Patho/cause:
Poorly differentiated small cells that are centrally located & arise from neuroendocrine (Kuchinsky) cells. It grows fast & has early metastases which may produce certain endocrine hormones (ADH & ACTH). Most commonly caused by smoking in men.
Rx:
Chemo & radiation
Labs:
Chromogranin +ve
Comps:
Nervous symptoms (Lambert-Eaton Myasthenia syndrome) or paraneoplastic syndromes
88
Patho/cause:
Poorly differentiated small cells that are centrally located & arise from neuroendocrine (Kuchinsky) cells. It grows fast & has early metastases which may produce certain endocrine hormones (ADH & ACTH). Most commonly caused by smoking in men.
Labs:
Chromogranin +ve
Rx:
Chemo & radiation
Comps:
Nervous symptoms (Lambert-Eaton Myasthenia syndrome) or paraneoplastic syndromes
Describes which condition?
Small cell carcinoma
89
Describe the following for a squamous cell carcinoma:
What is it?
What are the lab findings?
What is a complication?
Patho/cause:
The most common tumor in male smokers
Labs:
Keratin pearls or intracellular bridges
Comp:
I can increase production of PTHrP
90
Patho/cause:
The most common tumor in male smokers
Labs:
Keratin pearls or intracellular bridges
Comp:
I can increase production of PTHrP
91
Describe the following for Adenocarcinoma:
What is it?
What are the lab findings?
Patho/cause:
a common tumor in non-smokers & in female smokers, it is located peripherally in the lungs & can present with pneumonia-like consolidation on imaging
Labs:
In-situ (columnar cells that grow along the existing bronchioles & alveoli)
Lots of glands or mucin
92
Patho/cause:
a common tumor in non-smokers & in female smokers, it is located peripherally in the lungs & can present with pneumonia-like consolidation on imaging
Labs:
In-situ (columnar cells that grow along the existing bronchioles & alveoli)
Lots of glands or mucin
Describes which condition?
Adenocarcinoma
93
Describe the following for large cell carcinoma:
WHat is it?
What causes it?
What are the lab findings?
Patho/cause:
A poorly differentiated tumor made of large cells that are centrally or peripherally distributed they tend to have a poor prognosis
Cause: Smoking
Labs:
Immunochemistry for TTF1 (adeno), P40 (squamous), or chromogranin (neuroendo) for a more specific classification
94
Patho/cause:
A poorly differentiated tumor made of large cells that are centrally or peripherally distributed they tend to have a poor prognosis
Cause: Smoking
Labs:
Immunochemistry for TTF1 (adeno), P40 (squamous), or chromogranin (neuroendo) for a more specific classification
Describes which condition
Large cell carcinoma
95
Describe the following for Carcinoid tumor:
What is it?
What causes it?
What are the lab findings?
Patho/causes:
A well-differentiated tumor of neuroendocrine cells (nests) that can be located peripherally or centrally (form polyp-like masses in bronchus)
It has a low grade malignancy & rarely causes carcinoid syndrome
Labs:
Chromogranin +ve
96
Patho/causes:
A well-differentiated tumor of neuroendocrine cells (nests) that can be located peripherally or centrally (form polyp-like masses in bronchus)
It has a low grade malignancy & rarely causes carcinoid syndrome
Labs:
Chromogranin +ve
Describes which condition?
Carcinoid tumor
97
Describe the following for metastasis to the lungs:
Which cancers commonly metastasize to the lungs?
What are the lab findings?
Breast & colon cancers
Labs:
Multiple cannon ball nodules on imaging in the lungs
These are more common than primary tumors
98
Breast & colon cancers
Labs:
Multiple cannon ball nodules on imaging in the lungs
These are more common than primary tumors
Describes which condition?
Metastasis to the lungs
99
Describe a spontaneous pneumothorax
an accumulation of air into the pleural space which compresses the lung & prevents it from expanding. These are usually caused by ruptures of emphysematous blebs (younger people)
**Note the trachea will shift to the SAME side as the collapse**
100
an accumulation of air into the pleural space which compresses the lung & prevents it from expanding. These are usually caused by ruptures of emphysematous blebs (younger people)
**Note the trachea will shift to the SAME side as the collapse**
Describes which condition?
Spontaneous pneumothorax
101
Describe a tension pneumothorax
An injury that penetrates the chest wall lets air leak into the chest cavity but not escape this crushes the lung (collapse)
** Note the trachea is pushed to the OPPOSITE side of the injury**
102
An injury that penetrates the chest wall lets air leak into the chest cavity but not escape this crushes the lung (collapse)
** Note the trachea is pushed to the OPPOSITE side of the injury**
Describes which condition?
Tension pneumothorax
103
Describe a mesothelioma
A malignant neoplasm made of mesothelial cells that encases the lung
It's associated with exposure to asbestos
Symptoms include:
1) recurrent pleural effusion
2) dyspnea
3) chest pain
104
A malignant neoplasm made of mesothelial cells that encases the lung
It's associated with exposure to asbestos
Symptoms include:
1) recurrent pleural effusion
2) dyspnea
3) chest pain
What is the condition?
Mesothelioma
105
What is a complication of myxoma?
Mitral valve stenosis
106
Left to right shunts result in which complication?
Eisenmenger syndrome (Right ventricular hypertrophy caused by pulmonary HTN overriding the left resulting in tardive cyanosis
(O2 poor blood pushes back into the left side of the heart)
107
An early diastolic murmur can indicate which 2 conditions?
Aortic regurgitation/insuff
or
Pericarditis
108
Restrictive cardiomyopathy can be due to which conditions? What are the complications?
Amyloidosis or hemochromatosis
Comps:
Arrythmia & CHF
109
Describe the pathology of carcinoid syndrome
In carcinoid syndrome there is over secretion of serotonin depending on where it metastasis. The serotonin causes fibrous of the heart valves (TRICUSPID) resulting in tricuspid insufficiency & pulmonary stenosis
110
What is the causal agent of endocarditis in patients with colorectal cancer & ulcerative colitis ?
S. bovis/ gallolyticus
111
Mucin secreting tumors (paraneoplastic tumor) can cause what complication?
non-bacterial thrombus (due to being in a hyper coagulable state)
112
Pneumonia acquired from hospital ventilators
Aspergillus
113
What is the most common causal agent of pneumonia in nursing homes, alcoholics, & homeless patients?
Klebsiella pneumoniae (causes cavitations)
114
Histology shows frothy cotton candy exudate in the alveoli with pink granulations, it may also look like a crushed pink pong ball
P. jirovecii
115
Pneumonia in someone with pigeons
C. neoformans
116
Pneumonia that causes hyponatremia (SIADH) causes which complications?
Caused by legionella
Comps:
Interstitial nephritis & CNS abnormalities
117
Pneumonia that presents with staccato cough, conjunctivitis, & tachypnea is due to which causal agent?
Chlamydia trachomatis
118
Air fluid level is seen on the chest x ray -what is it?
Lung abcess
119
Pus in the pleural space in the mid-upper lobes what is the condition?
Empyema
120
Empyema presents with what?
Pus in the pleural space in the mid-upper lobe
121
Ferruginous bodies are a hallmark of which pneumonia causing bacteria
Asbestos (surrounds it with iron & protein)
122
Curshmann spirals & charcot leyden crystals are findings of which condition?
Asthma
123
Cor pulmonale presents with what?
There is right ventricle hypertrophy secondary to pulmonary HTN from COPD lung disease (chronic bronchitis & emphysema)
124
The most common form of COPD is _______?
Chronic bronchitis that is associated with smoking it persists with cough & sputum
125
Non-caseating granulomas in many tissues but especially in the lungs, skin, face, salivary & glands
What is the condition?
what does it present with?
What are the labs?
Sarcoidosis
Presents with Uveitis & blurry vision
Histology:
Asteroid bodies & potato LN (Enlarged hilar LN)
Labs:
High ACE
High Hypercalcemia
126
Chest x-ray shows cannon ball nodules which is indicative of which condition?
Metastatic lung cancer that spreads from the breast or prostate to the bronchial epithelium
127
Describe the pathology of Goodpasture syndrome:
What is it?
What type of reaction is it?
A deposition of IgG in the basement membranes of the lungs &/or kidneys causing necrosis with hemorrhaging
It's a type III hypersensitivity reaction
128
A cancer that can produce paraneoplastic syndromes like Cushings or SIADH
Small cell lung cancer
129
Small lung cancer can result in what complications? & what labs findings?
Cushings (high ACTH FROM ADRENAL TUMORS)
SIADH
labs:
S100 protein +ve
130
Which type of cancer has keratin pearls?
Squamous cell cancer
131
A patient has circular rings with erythema with central clearing what is this & what is the condition?
Migratory erythema
A symptom of Rheumatic fever
132
Heart disease presenting with dysphagia is a complication of which condition & why?
Mitral stenosis resulting in left atrial hypertrophy which pushes on the esophagus
133
What is a Caplan syndrome?
The combination of Rheumatoid arthritis & coal worker pneumoconiosis
134
Which condition causes hemolytic anemia?
Aortic stenosis
