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Pulmonary > First Aid and Pathoma Supplemental Review > Flashcards

First Aid and Pathoma Supplemental Review Flashcards

1
Q

What is rhinitis?

A

It is inflammation of the nasal mucosa - most commonly caused by rhinovirus

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2
Q

What is allergic rhinitis and what is it associated with?

A

It is a type of rhinitis due to a type 1 hypersensitivity.

Characterized by inflammatory eosinophils and is associated with asthma and eczema

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3
Q

What are nasal polyps and what can cause them?

A

Protrusion of edematous nasal mucosa

Most often caused by repeated bouts of rhinitis (also seen in ASA intolerant asthma patients)

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4
Q

What is an angiofibroma and who does it present in?

A

It is a benign tumor of nasal mucosa composed of large blood vessels. Clinically seen in adolescent males.

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5
Q

What is a nasopharyngeal carcinoma? What is it associated with? What population does it present in?

A
  1. It is a malignany tumor of nasopharyngeal epithelium
  2. Associated with EBV, pleomorphic keratin positive cells, and involved with cervical lymph node
  3. Classically see in African children and chinese adults
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6
Q

What is this an image of?

A

Lobar pneumonia with neutrophilic infiltrate

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7
Q

What is this an image of?

A

Red hepatization from lobar pneumonia

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8
Q

What is this an image of?

A

Bronchopneumonia - Notice the splotchiness

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9
Q

What is this an image of?

A

Interstitial pneumonia - notice there is infiltrate in the interstitium and not the air sacs

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10
Q

What is this an image of? What is the stain?

A

This is TB

The stain is AFB (acid fast bacilli)

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11
Q

In basic terms what is pneumonia?

A

Infection of lung parenchyma

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12
Q

What must occur to have pneumonia?

A

Pneumonia occurs when normal defenses are impaired

eg. cough reflex, damage to mucociliary escalator or mucus plugging

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13
Q

What is lobar pneumonia?

A

Infection, usually bacterial, affecting the entire lobe of the lung.

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14
Q

What two organisms are most often associated with lobar pneumonia?

A

Strep pneumo

Klebsiella pneumoniae

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15
Q

What causes pneumonia from Klebsiella pneumoniae?

A

Usually enteric flora that has been aspirated. This most often affects debilitated populations. Nursing home members, alcoholics and diabetics.

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16
Q

What causes congestion with lobar pneumonia?

A

Congestion of vessels and edema

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17
Q

What causes red hepatization associated with lobar pneumonia?

A

due to exudate, neutrophils and hemorrhage filling the alveolar air spaces, giving the normally spongy lung as solid characteristic

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18
Q

What causes Gray hepatization in lobar pneumonia?

A

This is due to degradation of red cells within the exudate

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19
Q

How is resolution achieved in lobar pneumonia?

A

Getting rid of the edema, and if needed the T2 pneumocyte will proliferate and repopulate the lost cells

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20
Q

What is bronchopneumonia?

A

This is characterized by scattered patchy consolidation centered around bronchioloes

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21
Q

What is interstitial pneumonia?

A

Connective tissue of alveolar sac is infected

Patients present with upper respiratory infections

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22
Q

Who is most at risk for aspiration pneumonia and where does it tend to affect?

A

Alcoholics and comatose patients are most at risk, and it most often affects the RLL

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23
Q

What patients are most at risk for atypical pneumonia caused by CMV?

A

This atypical pneumonia is seen with posttransplant immunosuppressive therapy

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24
Q

What disease would this image be associated with?

A

Chronic bronchitis - Mucous cell hyperplasia

25
Q

What causes the cyanosis associated with chronic bronchitis?

A

Mucus plugs trap carbon dioxide, which increases the PaCO2 and thus decreases PaO2

26
Q

Why is emphysema characterized as an obstructive disease?

A

It is due the the loss of elastic recoil of the alveoli. Normally the elasticity of the alveoli help keep the airways open during exhalation. Loss of this will lead to collapse of the airways during exhalation leading to obstruction and air trapping

27
Q

How can smoking lead to a disruption in the protease/anti-protease imbalance associated with emphysema?

A

Smoking leads to inflammation which leads to increased levels of proteases in the lungs

28
Q

What is this an image of?

A

Charcot-Leyden crystals derived from eosinophils

Sputum

Characteristic of asthma

29
Q

What is bronchiectasis?

A

Permanent dilation of bronchioles and bronchi

Caused by loss of tone resulting in airway trapping

30
Q

What are in the bottom left of this image? What disease is this characteristic of?

A

Dilation of the bronchioles

Bronchiectasis

31
Q

An obstructive disease is a problem in? While a restrictive disease is a problem in what?

A

Obstructive disease is a problem in emptying the lung while restrictive disease is a problem filling the lung

32
Q

What is the basic principle in restrictive diseases?

A

These have decreased TLC, FEV1, and a super decrease in the FVC.

The FEV1/FVC ratio is increased though

33
Q

What is this an image of?

A

Interstitial pulmonary fibrosis

34
Q

What is a main player in interstitial pulmonary fibrosis?

A

TGF-Beta

35
Q

What is pneumoconioses?

A

Interstitial fibrosis due to occupational exposure - chronic exposure to small particles that are fibrogenic

Macrophages engulf foreign particles and induces fibrosis

36
Q

What is silicosis?

A

It is a type of pneumoconioses that leaves patients at increased risk for TB

Silica impairs phagolysosome formation by macrophages

37
Q

What population does sarcoidsis most often affect? Where are the most common locations of granulomas?

A

African american females

Granulomas commonly involve hilar lymph nodes and lungs

38
Q

What are the characteristics of Acute Respiratory syndrome?

A

Diffuse damage to the alveolar-capillary interface. This leads to leakage of protein-rich fluid causing edema. This combines with necrotic epithelial cells to form hyaline membranes in the alveoli

39
Q

What are the clinical features of Acute Respiratory Syndrome?

A

Hypoxemia and cyanosis with respiratory distress - due to thickened diffusion barrier and collapse of air sacs from increased surface tension.

White out CXR

40
Q

What is the role of neutrophils in ARDS?

A

Neutrophils are activated which induce protease and free radical mediated damage of type I and II pneumocytes

41
Q

What can make recovery complicated in ARDS?

A

Recovery can be complicated by interstitial fibrosis - caused by damage to T2 pneumocytes

42
Q

What can the effects of supplemental oxygen be on a neonate in NRDS?

A

This increases the risk for free-radical injury. Retinal injury leads to blindness and lung damage leads to bronchopulmonary dysplasia

43
Q

Where is ventilation highest in the lung?

A

The base

44
Q

Where is perfusion the highest in the lung?

A

The base

45
Q

How are emphysema and pulmonary fibrosis going to affect the diffusion of gases?

A

Emphysema will decrease the area on which gas exhange can occur

Fibrosis will increase the thickness of the barrier the gases needs to cross

46
Q

What are some causes of increased A-a gradient?

A

Shunting

V/Q mismatch

Fibrosis

47
Q

V/Q of zero is characteristic of what?

A

Airway obstruction

48
Q

V/Q of infinity is characteristic of what?

A

Blood flow obstruction

49
Q

Will putting someone on O2 with a V/Q have any effect?

A

PaO2 will not improve when placing them on 100% O2

These patients have airway obstructions

50
Q

To compensate for respiratory alkalosis what will happen to bicarb levels?

A

They will drop due to excretion in the urine

51
Q

Ivory white calcified supradiaphragmatic and pleural plaques are characteristic of what?

A

Asbestosis

52
Q

Central sleep apnea is caused by?

A

CNS problems

53
Q

Hyper-resonance upon percussion is characteristic of what disease?

A

Pneumothorax

54
Q

Situs inversus leaves a person at increased risk of what?

A

Bronchiectasis

55
Q

Buffered charcoal yeast and hyponatremia are characteristic of what disease?

A

Legionella

56
Q

Central chemoreceptors sense what?

A

H+ ions that have entered as CO2 ions

57
Q

What syndrome is characteristic of small cell?

A

Cushing syndrome

58
Q

After CO2 is converted into carbonic acid what happens?

A

It is transported into the blood in exchange for Cl-

59
Q

How can CF predispose a person to bronchiectasis?

A

Pulmonary (42 decks)

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