First Aid and Pathoma Supplemental Review Flashcards
What is rhinitis?
It is inflammation of the nasal mucosa - most commonly caused by rhinovirus
What is allergic rhinitis and what is it associated with?
It is a type of rhinitis due to a type 1 hypersensitivity.
Characterized by inflammatory eosinophils and is associated with asthma and eczema
What are nasal polyps and what can cause them?
Protrusion of edematous nasal mucosa
Most often caused by repeated bouts of rhinitis (also seen in ASA intolerant asthma patients)
What is an angiofibroma and who does it present in?
It is a benign tumor of nasal mucosa composed of large blood vessels. Clinically seen in adolescent males.
What is a nasopharyngeal carcinoma? What is it associated with? What population does it present in?
- It is a malignany tumor of nasopharyngeal epithelium
- Associated with EBV, pleomorphic keratin positive cells, and involved with cervical lymph node
- Classically see in African children and chinese adults
What is this an image of?
Lobar pneumonia with neutrophilic infiltrate
What is this an image of?
Red hepatization from lobar pneumonia
What is this an image of?
Bronchopneumonia - Notice the splotchiness
What is this an image of?
Interstitial pneumonia - notice there is infiltrate in the interstitium and not the air sacs
What is this an image of? What is the stain?
This is TB
The stain is AFB (acid fast bacilli)
In basic terms what is pneumonia?
Infection of lung parenchyma
What must occur to have pneumonia?
Pneumonia occurs when normal defenses are impaired
eg. cough reflex, damage to mucociliary escalator or mucus plugging
What is lobar pneumonia?
Infection, usually bacterial, affecting the entire lobe of the lung.
What two organisms are most often associated with lobar pneumonia?
Strep pneumo
Klebsiella pneumoniae
What causes pneumonia from Klebsiella pneumoniae?
Usually enteric flora that has been aspirated. This most often affects debilitated populations. Nursing home members, alcoholics and diabetics.
What causes congestion with lobar pneumonia?
Congestion of vessels and edema
What causes red hepatization associated with lobar pneumonia?
due to exudate, neutrophils and hemorrhage filling the alveolar air spaces, giving the normally spongy lung as solid characteristic
What causes Gray hepatization in lobar pneumonia?
This is due to degradation of red cells within the exudate
How is resolution achieved in lobar pneumonia?
Getting rid of the edema, and if needed the T2 pneumocyte will proliferate and repopulate the lost cells
What is bronchopneumonia?
This is characterized by scattered patchy consolidation centered around bronchioloes
What is interstitial pneumonia?
Connective tissue of alveolar sac is infected
Patients present with upper respiratory infections
Who is most at risk for aspiration pneumonia and where does it tend to affect?
Alcoholics and comatose patients are most at risk, and it most often affects the RLL
What patients are most at risk for atypical pneumonia caused by CMV?
This atypical pneumonia is seen with posttransplant immunosuppressive therapy
What disease would this image be associated with?
Chronic bronchitis - Mucous cell hyperplasia
What causes the cyanosis associated with chronic bronchitis?
Mucus plugs trap carbon dioxide, which increases the PaCO2 and thus decreases PaO2
Why is emphysema characterized as an obstructive disease?
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
How can smoking lead to a disruption in the protease/anti-protease imbalance associated with emphysema?
Smoking leads to inflammation which leads to increased levels of proteases in the lungs
What is this an image of?
Charcot-Leyden crystals derived from eosinophils
Sputum
What is bronchiectasis?
Permanent dilation of bronchioles and bronchi
Caused by loss of tone resulting in airway trapping
What are in the bottom left of this image? What disease is this characteristic of?
Dilation of the bronchioles
Bronchiectasis
An obstructive disease is a problem in? While a restrictive disease is a problem in what?
Obstructive disease is a problem in emptying the lung while restrictive disease is a problem filling the lung
What is the basic principle in restrictive diseases?
These have decreased TLC, FEV1, and a super decrease in the FVC.
The FEV1/FVC ratio is increased though
What is this an image of?
Interstitial pulmonary fibrosis
What is a main player in interstitial pulmonary fibrosis?
TGF-Beta
What is pneumoconioses?
Interstitial fibrosis due to occupational exposure - chronic exposure to small particles that are fibrogenic
Macrophages engulf foreign particles and induces fibrosis
What is silicosis?
It is a type of pneumoconioses that leaves patients at increased risk for TB
Silica impairs phagolysosome formation by macrophages
What population does sarcoidsis most often affect? Where are the most common locations of granulomas?
African american females
Granulomas commonly involve hilar lymph nodes and lungs
What are the characteristics of Acute Respiratory syndrome?
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
What are the clinical features of Acute Respiratory Syndrome?
Hypoxemia and cyanosis with respiratory distress - due to thickened diffusion barrier and collapse of air sacs from increased surface tension.
White out CXR
What is the role of neutrophils in ARDS?
Neutrophils are activated which induce protease and free radical mediated damage of type I and II pneumocytes
What can make recovery complicated in ARDS?
Recovery can be complicated by interstitial fibrosis - caused by damage to T2 pneumocytes
What can the effects of supplemental oxygen be on a neonate in NRDS?
This increases the risk for free-radical injury. Retinal injury leads to blindness and lung damage leads to bronchopulmonary dysplasia
