Block 1 Pulmonary (nasopharynx, larynx, & cancers) Flashcards

You may prefer our related Brainscape-certified 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Patho:
Inflammation in the nasal mucosa

Causes:
Rhinovirus

Symptoms:
1) Sneezing
2) Congestion
3) Runny nose

Describes which condition?

A

Rhinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the triad of aspirin-tolerant asthma?

A

1) Asthma
2) Aspirin induced bronchospasms
3) Nasal polyps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

1) Asthma
2) Aspirin induced bronchospasms
3) Nasal polyps

Are the triad of which condition

A

Aspirin tolerant asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the classical triad seen in pneumonia?

A

1) Lobar pneumonia
2) bronchopneumonia
3) interstitial pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

1) Lobar pneumonia
2) bronchopneumonia
3) interstitial pneumonia

Is a triad of which condition?

A

Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the following for lobar pneumonia:

What is it?

What are the causes
- 1st & other

What are the phases of this type of pneumonia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

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?

A

Lobar pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Describe the following for bronchopneumonia:

What is it?

What causes it?

A

An infection that causes scattered & patchy consolidation around bronchioles (usually presents multifocally & bilaterally)

Causes:
Bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

An infection that causes scattered & patchy consolidation around bronchioles (usually presents multifocally & bilaterally)

Causes:
Bacterial infection

Describes which condition?

A

bronchopneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Describe the following for Interstitial (atypical) pneumonia:

What is it?

What are the symptoms?

What are the causes?

A

Patho:
Infected lungs have diffuse interstitial infiltrates

Symptoms:
1) mild upper respiratory symptoms (minimal sputum & low fever)

Causes:
Bacteria & viruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Patho:
Infected lungs have diffuse interstitial infiltrates

Symptoms:
1) mild upper respiratory symptoms (minimal sputum & low fever)

Causes:
Bacteria & viruses

Describes which condition?

A

Interstitial (atypical) pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe the following for aspiration pneumonia:

What is it?
- who is at risk?

What causes it?

What is a complication?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

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?

A

Aspiration pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the causal agents of lobar pneumonia & for each one who is most at risk & why?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the bacteria specifically causing bronchopneumonia?

A

S. aureus
H. influenzae
Pseudomonas aeruginosa
Moraxella catarrhalis
Legionella pneumophilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which bacteria most commonly causing bronchopneumonia cause exasperation of COPD?

A

Legionella. H. influenzae, & Moraxella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which bacteria most commonly causing bronchopneumonia in patients with cystic fibrosis?

A

Pseudomonas aeruginosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which bacteria most commonly causing bronchopneumonia are often complicated by abscess or empyema

A

S. aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the organisms that cause atypical/interstitial pneumoniae?
-Most common
- Other

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the complications of atypical/interstitial pneumonia infected with mycoplasma ?

A

Autoimmune hemolytic anemia & erythema multiforme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Describe the following for TB:

What is the major cause?

A

Inhaling aerosolized mycobacterium TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Describe the following for primary TB?

What is the pathophysiology?

What are the symptoms?

What complications?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

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?

A

primary TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Describe the following for secondary TB?

What is the pathophysiology?

What are the symptoms?

What are the lab findings?

What complications?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

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?

A

Secondary TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

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?

A

Secondary TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Describe the following for Emphysema:

What is it?

What are the symptoms?

What causes it?
- Most common & others

What are the late complications?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

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?

A

Emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How does protease & antiprotease imbalance lead to emphysema?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How does smoking lead to emphysema?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How does an A1AT deficiency lead to emphysema?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which genotype of the A1AT mutation causes panacinar emphysema & liver cirrhosis?

A

PiZZ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

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?

A

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
Q

What are the causes of non-allergy induced asthma?

A

exercise
viral infections
Aspirin
Occupational hazards

56
Q

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?

A

Allergy-induced asthma

57
Q

Describe the following for bronchiectasis:

What is it?

What causes it?

A

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
Q

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?

A

Bronchiectasis

59
Q

Describe the following for Kartager syndrome:

What is it?

What are the symptoms?

What are the associated conditions?

What are the complications?

A

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
Q

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?

A

Kartager syndrome

61
Q

What are the key features of COPD type lung diseases? Which lung conditions are considered to be COPD?

A

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
Q

Describe the following for chronic bronchitis:

What is it?

What are they symptoms?

What are the lab findings?

What is an associated condition?
- risk

A

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
Q

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?

A

chronic bronchitis

64
Q

What are the key features of restrictive type lung diseases? Which lung conditions are considered to be restrictive?

A

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
Q

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?

A

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
Q

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?

A

Idiopathic pulmonary fibrosis

67
Q

Describe the following for pneumoconiosis:

What is it?

What causes it?

A

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
Q

How does Pneumoconiosis due to exposure to carbon dust (coal miner) present?

A

Massive exposure causes diffuse fibrosis aka black lung & minor exposure causes anthracosis which is not clinically significant

69
Q

How does Pneumoconiosis due to exposure to silica (sand blasters & silica miners) present?

A

causes fibrotic nodules in the upper lobes & increases the risk of TB infection (because the macrophages are impaired)

70
Q

How does Pneumoconiosis due to exposure to Berylliosis (beryllium miners & aerospace workers) present?

A

causes non-caseating granulomas in the lungs, hilar lymph nodes, & systemic organs. It also increases the risk of cancer

71
Q

How does Pneumoconiosis due to exposure to asbestos (construction workers, plumbers, & shipyard workers) present?

A

causes fibrosis of the lungs & pleura, & it increases the risk of lung cancer & mesothelioma

72
Q

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?

A

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
Q

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

A

sarcoidosis

74
Q

In sarcoidosis what are the infiltrates you would see within the GC granulomas?

A

Stellate inclusions (asteroid bodies)

75
Q

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?

A

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
Q

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?

A

Hypersensitivity pneumonitis with c. neoformans

77
Q

Describe the following for primary pulmonary HTN:

What is it?

What causes it?

What are the symptoms?

What are the complications?

A

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
Q

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?

A

Primary pulmonary HTN

79
Q

Describe the following for Secondary pulmonary HTN:

What causes it?

What are the symptoms?

What are the complications?

A

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
Q

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?

A

Secondary pulmonary HTN

81
Q

Describe the following for Acute respiratory distress syndrome:

What is it?

What are the symptoms?

What conditions is it secondary to?

A

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
Q

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?

A

Acute respiratory distress syndrome

83
Q

Describe the following for Neonatal respiratory distress syndrome:

What is it?

What causes it?

What are the symptoms?

What are the complications?

A

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
Q

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?

A

Neonatal respiratory distress syndrome

85
Q

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?

A

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
Q

What the are the tumor staging acronyms:
T
N
M

A

Tumor size & local extension
N- spread to regional lymph nodes
M unique metastases to adrenal gland

87
Q

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?

A

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
Q

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?

A

Small cell carcinoma

89
Q

Describe the following for a squamous cell carcinoma:

What is it?

What are the lab findings?

What is a complication?

A

Patho/cause:
The most common tumor in male smokers

Labs:
Keratin pearls or intracellular bridges

Comp:
I can increase production of PTHrP

90
Q

Patho/cause:
The most common tumor in male smokers

Labs:
Keratin pearls or intracellular bridges

Comp:
I can increase production of PTHrP

A
91
Q

Describe the following for Adenocarcinoma:

What is it?

What are the lab findings?

A

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
Q

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?

A

Adenocarcinoma

93
Q

Describe the following for large cell carcinoma:

WHat is it?

What causes it?

What are the lab findings?

A

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
Q

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

A

Large cell carcinoma

95
Q

Describe the following for Carcinoid tumor:

What is it?

What causes it?

What are the lab findings?

A

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
Q

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?

A

Carcinoid tumor

97
Q

Describe the following for metastasis to the lungs:

Which cancers commonly metastasize to the lungs?

What are the lab findings?

A

Breast & colon cancers

Labs:
Multiple cannon ball nodules on imaging in the lungs

These are more common than primary tumors

98
Q

Breast & colon cancers

Labs:
Multiple cannon ball nodules on imaging in the lungs

These are more common than primary tumors

Describes which condition?

A

Metastasis to the lungs

99
Q

Describe a spontaneous pneumothorax

A

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
Q

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?

A

Spontaneous pneumothorax

101
Q

Describe a tension pneumothorax

A

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
Q

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?

A

Tension pneumothorax

103
Q

Describe a mesothelioma

A

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
Q

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?

A

Mesothelioma

105
Q

What is a complication of myxoma?

A

Mitral valve stenosis

106
Q

Left to right shunts result in which complication?

A

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
Q

An early diastolic murmur can indicate which 2 conditions?

A

Aortic regurgitation/insuff
or
Pericarditis

108
Q

Restrictive cardiomyopathy can be due to which conditions? What are the complications?

A

Amyloidosis or hemochromatosis

Comps:
Arrythmia & CHF

109
Q

Describe the pathology of carcinoid syndrome

A

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
Q

What is the causal agent of endocarditis in patients with colorectal cancer & ulcerative colitis ?

A

S. bovis/ gallolyticus

111
Q

Mucin secreting tumors (paraneoplastic tumor) can cause what complication?

A

non-bacterial thrombus (due to being in a hyper coagulable state)

112
Q

Pneumonia acquired from hospital ventilators

A

Aspergillus

113
Q

What is the most common causal agent of pneumonia in nursing homes, alcoholics, & homeless patients?

A

Klebsiella pneumoniae (causes cavitations)

114
Q

Histology shows frothy cotton candy exudate in the alveoli with pink granulations, it may also look like a crushed pink pong ball

A

P. jirovecii

115
Q

Pneumonia in someone with pigeons

A

C. neoformans

116
Q

Pneumonia that causes hyponatremia (SIADH) causes which complications?

A

Caused by legionella

Comps:
Interstitial nephritis & CNS abnormalities

117
Q

Pneumonia that presents with staccato cough, conjunctivitis, & tachypnea is due to which causal agent?

A

Chlamydia trachomatis

118
Q

Air fluid level is seen on the chest x ray -what is it?

A

Lung abcess

119
Q

Pus in the pleural space in the mid-upper lobes what is the condition?

A

Empyema

120
Q

Empyema presents with what?

A

Pus in the pleural space in the mid-upper lobe

121
Q

Ferruginous bodies are a hallmark of which pneumonia causing bacteria

A

Asbestos (surrounds it with iron & protein)

122
Q

Curshmann spirals & charcot leyden crystals are findings of which condition?

A

Asthma

123
Q

Cor pulmonale presents with what?

A

There is right ventricle hypertrophy secondary to pulmonary HTN from COPD lung disease (chronic bronchitis & emphysema)

124
Q

The most common form of COPD is _______?

A

Chronic bronchitis that is associated with smoking it persists with cough & sputum

125
Q

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?

A

Sarcoidosis

Presents with Uveitis & blurry vision

Histology:
Asteroid bodies & potato LN (Enlarged hilar LN)

Labs:
High ACE
High Hypercalcemia

126
Q

Chest x-ray shows cannon ball nodules which is indicative of which condition?

A

Metastatic lung cancer that spreads from the breast or prostate to the bronchial epithelium

127
Q

Describe the pathology of Goodpasture syndrome:

What is it?
What type of reaction is it?

A

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
Q

A cancer that can produce paraneoplastic syndromes like Cushings or SIADH

A

Small cell lung cancer

129
Q

Small lung cancer can result in what complications? & what labs findings?

A

Cushings (high ACTH FROM ADRENAL TUMORS)

SIADH

labs:
S100 protein +ve

130
Q

Which type of cancer has keratin pearls?

A

Squamous cell cancer

131
Q

A patient has circular rings with erythema with central clearing what is this & what is the condition?

A

Migratory erythema

A symptom of Rheumatic fever

132
Q

Heart disease presenting with dysphagia is a complication of which condition & why?

A

Mitral stenosis resulting in left atrial hypertrophy which pushes on the esophagus

133
Q

What is a Caplan syndrome?

A

The combination of Rheumatoid arthritis & coal worker pneumoconiosis

134
Q

Which condition causes hemolytic anemia?

A

Aortic stenosis