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Respiratory > First Aid Pathology > Flashcards

First Aid Pathology Flashcards

1
Q

What is the most common cause of rhinitis (common cold)?

A

Rhinovirus

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2
Q

What bugs most commonly superimpose on viral URI?

A

S. pneumo H. influenzae M. catarrhalis

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3
Q

Allergic rhinitis is what type of hypersensitivity? What is it characterized by?

A

Type 1 hypersensitivity

Inflammatory infiltrate w/ eosinophils

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4
Q

What is the Virchow triad for deep venous thrombosis?

A
  1. Stasis
  2. Hypercoagulability
  3. Endothelial damage
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5
Q

Where do most pulmonary emboli arise from?

A

Deep leg veins

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6
Q

Repeated bouts of rhinitis can cause what?

A

Nasal polyp

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7
Q

Nasal polyps in children….

Nasal polyps in adults….

A

Children = CF

Adults = Aspirin-intolerant asthma

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8
Q

Aspirin-intolerant asthma

A

Asthma, aspirin-induced bronchospasm, nasal polyp

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9
Q

Who are angiofibromas (nasal mucosa) commonly seen in? How does it present?

A

Adolescent males

Profuse epistaxis

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10
Q

Nasopharyngeal carcinoma is a malignant tumor of the nasopharyngeal epithelim - what is it associated with? What will a biopsy show?

A

EBV - African Children and Chinese Adults

  1. Pleomorphic, keratin⊕ epithelial cells -poorly diff SCC
  2. In background of lymphocytes

Cervical LN involvement

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11
Q

What bug causes acute epiglottitis? What are the symptoms?

A

H. influenzae type B

High fever, sore throat, drooling w/ dysphagia, muffled voice, stridor

**risk of airway obstruction**

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12
Q

What bug causes croup?

A

Parainfluenza virus

Hoarse, barking cough, stridor

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13
Q

Vocal cord nodule that arises due to excessive use occurs where and is composed of what?

A

True vocal cords

Myxoid (degenerative) CT

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14
Q

What bug causes laryngeal papilloma?

A

HPV 6 & 11

Single in adults, multiple in children

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15
Q

What are risk factors for ** laryngeal carcinoma (SCC)**? How does it present

A

Alcohol and tobacco - rarely from papilloma (6 & 11)

Hoarsenss, cough, stridor

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16
Q

What are fat emboli associated with?

A

Long bone fractures and liposuction

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17
Q

Wht is the classic triad of presenting symptoms w/ a Fat Emboli?

A
  1. Hypoxemia
  2. Neurologic abnormalities
  3. Petechial rash
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18
Q

What can an amniotic fluid emobli lead to?

A

DIC - postpartum

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19
Q

How do you treat gas emboli in a diver?

A

Hyperbaric oxygen

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20
Q

What is the test of choice to look for a PE?

A

CT

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21
Q

V/Q mismatch → hypoxemia → ________________

A

Respiratory alkalosis

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22
Q

Lines of Zahn are only found in thrombi formed ________ death.

A

Before

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23
Q

How might this present?

A

Sudden onset dyspnea, chest pain, tachypnea

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24
Q

What are the 4 types of obstructive lung disease - what is the hallmark finding?

A

↓ FEV1/FVC

  1. Chronic bronchitis
  2. Emphysema
  3. Asthma
  4. Bronchiectasis
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25
Q

What disease do these symptoms belong to:

“A productive cough for > 3 months/year, for > 2 years”

What other findings might there be?

A

Chronic Bronchitis

Wheezing, crackles, cyanosis (shunting), late-onset dyspnea, CO2 retention

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26
Q

What causes the productive cough in chronic bronchitis?

A

Hyperplasia of mucus glands in the bronchi

Reid index >50%

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27
Q

What is the most common cause of emphysema?

A

Smoking

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28
Q

What is the main defense at the bottom of the lung (i.e. alveolar air sacs)?

A

Alveolar Mφ - release proteases

**α1-antitrypsin breaks down proteases**

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29
Q

What are the two causes of emphysema?

A

Smoking: ↑ inflammation, ↑Mφ, ↑proteases

α1-antitrypsin deficiency: can’t deal w/ normal amounts of proteases

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30
Q

What type of emphysema does smoking result in? A1AT deficiency?

A

Centriacinar - upper lobes

Panacinar - lower lobes

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31
Q

Which type of emphysema also leads to liver cirrhosis? What would a liver biopsy show?

A

A1AT deficiency is due to a misfolding of mutated protein

mt. A1AT accumalates in the ER of hepatocytes → liver damage

BX: pink, PAS-⊕ globules in hepatocytes

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32
Q

What is the most common clinically relevant mutation causing emphysema?

A

PiZ

PiZZ - ↑↑ risk of panacinar emphysema & cirrhosis

PiMZ - asymptomatic w/ ↓circulating A1AT - ↑ risk w/ smoking

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33
Q

What leads to air trapping in emphysema? How do pts attempt to correct it?

A

Loss of elastic recoil and collapse of airways during exhalation

Breathing out thru pursed lips - ↑ back pressure

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34
Q

What type of hypersenstivity causes asthma? What is the stimuli?

A

Type 1 hypersensitivity

Allergic - associated w/ allergic rhinitis, eczema, family hx

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35
Q

What results from the first exposure to an allergen in a genetically susceptible individual?

A

TH2 cells secrete

IL-4: IgE switch

IL-5: attract eosinophils

IL-10: ↑TH2 ↓TH1

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36
Q

What results from re-exposure to allergens?

A

IgE medated activation of mast cells

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37
Q

What is involved in the early phase reaction of mast cell degranulation?

A

Release of histamine and LT C4, D4, and E4

Bronchoconstriction, inflammation, edema

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38
Q

What is involved in the late phase reaction of mast cell degranulation?

A

Major basic protein from eosinophils

Cell damage & Bronchoconstriction

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39
Q

What does the productive cough from asthma produce?

A
  1. Spiral shaped mucus plugs - Curschmann spirals
  2. Eosinophil derived crystals - Charcot-Leyden crystals
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40
Q

Asthma can also arise from what nonallergic causes?

A

Exercise, viral infection, aspirin, and occupational exposure

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41
Q

What is bronchiectasis?

A

Permament dilatation of bronchioles and bronchi due to necrotizing inflammation

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42
Q

What causes bronchiectasis?

A
  1. CF
  2. Kartagener syndrome
  3. Tumor/foreign body
  4. Necrotizing infection
  5. Allergic bronchopulmonary aspergillosis
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43
Q

Besides hypoxemia and cor pulmonale, what other complication can bronchiectasis cause?

A

2˚ amyloidosis

Chronic inflammation → ↑ SAA → ↑AA

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44
Q

What is characterisitic of restrictive lung disease?

A

FEV1/FVC ratio ≥ 80%

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45
Q

What are structural causes of restrictive lung disease?

A

Polio, myasthenia gravis

Scoliosis, morbid obesity

46
Q

What drugs can cause restrictive lung disease?

A

Belomycin

Busulfan

Amiodarone

Methotrexate

47
Q

Caplan syndroe

A

RA + pneumoconioses w/ intrapulmonary nodule

48
Q

What are the causes of restricitive lung disease from intertittial problems?

A
  1. Idiopathic pulmonary fibrosis
  2. Pneumoconioses
  3. Sarcoidosis
  4. Hypersenstivity Pneumonitis
49
Q

What is thought to cause idiopathic pulmonary fiboriss?

A

Cyclic injury: TGF-β from injured pneumocytes → fibrosis

50
Q

How do the pneumoconioses cause fibrosis?

A

Occupational exposure → chronic exposure to small particles that are fibrogenic (Alveolar Mφ)

51
Q

What does carbon dust cause?

A

Coal Workers’ Pneumoconiosis

Massive exposure = “black lung”

Mild i.e. pollution = anthracosis

52
Q

What does silica cause? Who is it seen in?

A

Fibrotic nodules in upper lobes

↑ risk for TB - impairs phagolysosome formation (Mφ)

Sandblasters and silica miners

53
Q

What does berylliosis cause? What occupations could yield this?

A

Noncaseating granulomas in lung, hilar LN, and systemic organs

↑ risk for lung CA

Miners and aerospace industry

54
Q

What does asbestos exposure cause? Who is at risk for exposure?

A

Fibrosis of lung and pleura → CA of lung and pleura (mesothelioma)

**Lung CA >> mesothelioma**

Construction workers, plumbers, and shipyard workers

55
Q

What is characteristic of asbestos lesions?

A

long, golden brown fibers, w/ associated iron (asbestos bodies)

Lower lobes

56
Q

What is the charcteristic lesion of silicosis?

A

Eggshell calcification of hilar LN

57
Q

Sarcoidosis

A

Systemic disease characterized by noncaseating granulomas in multiple organs - AA females, CD4+ response to unknown antigen

58
Q

Stellate inclusions or “asteroid bodies” in giant cells of granulomas in lung indicate whwat?

A

Sarcoidosis

59
Q

Besides the lung, what other organs does sarcoidosis affect?

A

Uvea - uveitis

Skin - nodules or erythema nodosum

**Salivary/lacrimal glands **

60
Q

What are clnical features of sarcoidosis?

A
  1. Cough or dyspnea - most common
  2. ↑ serum ACE
    1. Hypercalcemia
61
Q

Why is hypercalcemia seen in sarcoidosis?

A

1-α hydroxylase of epithelioid histiocytes converts vitamin D to its active form

62
Q

What type is Hypersensitivity Pneumonitis? How does it present

A

Mixed type 3/4 to inhaled organic antigens (farmers/bird exposure)

Fever, cough, dyspnea hours post exposure - resolves w/ removal

63
Q

What forms hyaline membranes in an alveoli?

A

Leakage of protein rich fluid

Necrotic epithelial cells

64
Q

What causes damage in acute RDS?

A

Activation of neutrophils induce protease and free radical mediated damage of type I and type II pneumocyes

65
Q

How do you treat acute RDS?

A

Treat underlying cause

Ventilation w/ PEEP

66
Q

When does surfactant production begin, when is it typically adequate? How can you tell

A

Week 28

Week 34

Lecithin : sphingomyelin > 2

67
Q

What cells make surfactant?

A

Type II Pneumocytes - Phosphatidylcholine (lecithin)

68
Q

Neonatal RDS can cause hypoxemia and lead to the use of supplemental oxygen - what are complications of both?

A

Hypoxemia: PDA & necrotizing enterocolitis

Supplemental O2: retinopathy of prematurity & bronchopulmonary dysplasia

69
Q

What 3 things can lead to neonatal RDS?

A

Prematurity, maternal diabetes, and C-section

70
Q

What is this?

A

Acute RDS

71
Q

Pulmonary HTN?

A

≥ 25 mmHg (nl=10-14)

72
Q

What does pulmonary HTN lead to?

A

Atherosclerosis of pulmonary trunk

SM hypertrophy of pulmonary arteries

Intimal fiborsis

Plexiform lesions

RVH

Cor pulmonale

73
Q

What causes primary HTN?

A

BMPR2 mutation → Proliferation of vascular SM

Young adult females

74
Q

What causes 2˚ pulmonary HTN?

A

Hypoxemia from COPD, interstitial lung disease

↑ volume in pulmonary circuit

Recurrent PE

Mitral stenosis

Sleep apnea

High altitude

Systemic sclerosis

75
Q

Obesity hypoventilation syndrome

A

BMI ≥ 30

Hypoventilate → ↓PaO2 → ↑PaCO2 (while awake)

76
Q

Sleep apnea is the repeated cessation of breathing for > 10 seconds during sleep causing daytime somnolence and nocturnal hypoxia. What is the PaO2 in the day?

A

Normal

77
Q

What complications can nocturnal hypoxia cause?

A

Systemic/Pulmonary HTN

Arrhythmias

Sudden death

78
Q

What 2 things result in hyperressonant lungs to percussion?

A

**Pneumothorax - **tension or spontaneous

79
Q

What will result in increased tactile fremitis?

A

Consolidation - lobar pneumonia, pulmonary edema

80
Q

What are common symptoms of lung cancer?

A

Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic “coin” lesion on x-ray, or noncalcifided nodule on CT

81
Q

What is the most common tumor in the lung?

A

Mets

Breast, colon, prostate, bladder

82
Q

Where does lung cancer like to travel to?

A

Adrenal, brain, bone (path fx), liver (jaundice, hmegaly)

83
Q

What are the key risk factors for lung cancer?

A

Cigarette smoke, radon, and asbestos

84
Q

Where does radon come from?

A

Radioactive decay of uranium - closed spaces i.e. basements

85
Q

What other things can produce a “coin” lesion?

A

Granuloma - TB/fungus

Bronchial hamartoma - calcified

86
Q

Small cell carcinoma is a neoplasm of ______________ cells that shows _______________. It is treated with _______ It may produce _____, ______, or Eaton Lambert Syndrome (antibodies against presynatptic Ca channels)

A

Neuroendocrine (Kulchitsky) cells, poorly diff

Rapid growth/early mets

**Chemo - **not surgically resectable

ADH or ACTH

87
Q

What is the most common lung tumor in male smokers?

A

Squamous Cell CA

88
Q

Squamous cell carcinoma (lung)

A

Central - keratin perals or intercellular bridges

PTHrP (hypercalcemia)

89
Q

What is the most common lung tumor in female smokers and non-smokers?

A

Adenocarcinoma - peripheral - glands/mucin

90
Q

What mutations are associated w/ adenocarcinoma?

A

k-ras, EGFR, and ALK

Associated w/ hypertrophic osteoarthropathy - clubbing

91
Q

Bronchioloalveolar is a subtype of adenoCA that arises from _________, and grows along preexisting bronchioles. CXR shows hazy infiltrates similar to ___________.

A

Clara cells

Pneumonia

**excellent prognosis**

92
Q

Large cell CA is a highly anaplastic undifferentiated tumor of _________________ and it occurs _____________.

A

Pleomorphic giant cells

Peripherally

93
Q

Bronchial carcinoid tumor is a low grade malignancy composed of ___________________, it is located ______________, and has a ______ prognosis.

A

Nests of neuroendocrine cells

Central or peripheral

Good

94
Q

Mesothelioma

A

Malignancy of the pleura - associated w/ asbestosis

Hemorrhagic pleural effusions and pleural thickening

95
Q

Pancoast tumor

A

Tumor occuring in the apex of the lung - may affect cervical sympathetic plexus → Horner , SVC syndrome, sensorimotor deficits, hoarsness

96
Q

SVC syndrome

A

Obstruction that impairs SVC drainage from:

  • Head: facial plethora
  • Neck: JVD
  • Upper extremities: edema

Due to malignancy or thrombosis from indwelling catheter

Severe: headeache, dizziness, ↑risk of aneurysm/rupture

97
Q

Pneumonia is an infection of the lung __________ that occurs when ________________________.

A

Parenchyma

Normal defenses are impaired - cough reflex, mucociliary escalator, mucus plugging

98
Q

Diagnosis of pneumonia is made by what three things?

A

CXR

Sputum gram stain and culture

Blood culture

99
Q

Lobar pneumonia is usually _________, and the most common causes are _________, _____________, and ____________. (3)

A

Bacterial

S. pneumo, Legionella, Klebsiella

100
Q

What are the 4 classic gross phases of lobar pneumonia?

A
  1. Congestion - congested vessels and edema
  2. Red Hepatization: exudate, neutrophils, and hemorrhage - spongy
  3. Grey hepatization: degreadation of red cells in exudate
  4. Resolution
101
Q

What cell regenerates the lung?

A

Type II pneumocytes

102
Q

What bugs are the most common cause of bronchopneumonia?

A

S. pneumo, S. aureus, H. flu, Klebsiella

103
Q

What type of pneumonia is characterized by “scattered patchy consolidation, centered around bronchioles, often multifocal and bilateral”?

A

Bronchopneumonia

104
Q

Bacteroides, Fusobacterium, and Peptococcus are common causes of what?

A

Aspiration Pneumonia

Alcoholics and comatose patients

105
Q

What bugs commonly cause interstitial (atypical) pneumonia?

A

Viruses: Influenza, RSV, adenovirus

Mycoplasma

Legionella

Chlamydia

106
Q

What type of pneumonia is characterized as “diffuse patchy inflammation localized to interstitial areas at alveolar walls, ≥1 lobe involved”

A

Interstitial/Atypical pneumonia

107
Q

Lung abscesses are caused by bronchial obstruction or ___________________.

A

Aspiration of oropharyngeal contents - alcoholics/epileptics

108
Q

What are the 3 types of pleural effusions?

A

Transudate

Exudate

Lymphatic

109
Q

True or false: Transudate pleural effusion has ↓ protein content and is due to CHF, nephrotic syndrome, or cirrhosis.

A

True

110
Q

What are the causes of exudate pleural effusion?

A

Malignancy

Pneumonia

Collagen vascular disease

Trauma

111
Q

What causes spontaneous pneumothorax?

A

Rupture of apical blebs — tall, thin, young males

112
Q
A

Respiratory (6 decks)

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