Gen Path Exam 2 - Respiratory Pathology Flashcards
What disease category?
Pneumonia
Infectious
What disease category?
TB
Infectious
What disease category?
COPD
Injury
What disease category?
Chronic bronchitis
Injury
What disease category?
Emphysema
Injury
What disease category?
Sarcoidosis
Immune-mediated
What disease category?
Asthma
Immune-mediated
What disease category?
Lung cancer
Neoplastic
What is the primary function of the lungs?
Gas exchange
What is the site of gas exchange in the lungs?
Alveoli
What disease?
Caused by infection of the lung
Pneumonia
In pneumonia, what does an infection of the lung cause?
Inflammation
Neutrophilic exudate
What disease?
Often follows a viral upper-respiratory tract infection
Pneumonia
What disease?
Most often bacterial, but can be viral or fungal
Pneumonia
What is the most common cause of community-acquired acute pneumonia?
Strep pneumoniae
What is the most common cause of pneumonia in children and young adults?
Mycoplasma pneumoniae
What are the 4 common bacteria that cause pneumonia?
Strep pneumoniae
Mycoplasma pneumoniae
Haemophilus influenzae
Klebsiella pneumoniae
What disease?
Can be community-acquired, health care-associated, or hospital-acquired
Pneumonia
Why do the lungs get infected?
Airborne microbes are inhaled
Nasopharyngeal flora aspirated during sleep
Other lung diseases lower local immune defenses
What disease?
Demographics include children, elderly, smokers, immunocompromised, COPD
Pneumonia
What disease?
Clinical presentation includes fever, chills, productive cough, possible hemoptysis
Pneumonia
Coughing up blood
Hemoptysis
What disease?
Diagnosis includes sputum culture and CBC
Pneumonia
In pneumonia, what will you see in the CBC?
Leukocytosis
Left shift
Elevated WBC count
Leukocytosis
Increase in immature neutrophils
Left shift
Increase in mature white blood cells
Right shift
Immature white blood cells in the _______ convert to mature white blood cells in the ________
left; right
In pneumonia, what is the treatment for bacterial origin?
Antibiotics
In pneumonia, what is the treatment for viral origin?
Supportive care
In pneumonia, what is the treatment for fungal origin?
Antifungal
What are the complications of pneumonia?
Tissue destruction and necrosis
Spread of infection to pleural cavity
Bacterial dissemination to critical structures
In pneumonia, what can tissue destruction and necrosis lead to?
Abscess formation
In pneumonia, what can spread of infection to pleural cavity lead to?
Emphysema
In pneumonia, what can bacterial dissemination to critical structures lead to?
Metastatic abscesses
Endocarditis
Meningitis
Suppurative arthritis
What bacteria causes TB?
Mycobacterium tuberculosis
Primary or secondary TB?
Spread via airborne droplets
Primary TB
Primary or secondary TB?
Alveolar macrophages engulf bacteria
Primary TB
Primary or secondary TB?
Cell-mediated immunity results in hypersensitivity to tubercular antigens
Primary TB
Primary or secondary TB?
TH1 cells cause formation of caseating granulomas
Primary TB
What 2 things can happen if primary TB is not controlled?
Cavitation
Dissemination
Pathologic cavity in lung
Cavitation
(can happen if primary TB is not controlled)
Can occur locally within lung or hematogenous spread
Dissemination
(can happen if primary TB is not controlled)
Widespread infection with multiple organ involvement
Hematogenous spread in TB
Called “miliary” TB
Hematogenous spread in TB
1-2 mm foci of disease, looks like millet seeds
Hematogenous spread in TB
Primary or secondary TB?
Occurs in previously infected host
Secondary TB
Primary or secondary TB?
Reactivation of dormant primary lesions or reinfection
Secondary TB
Primary or secondary TB?
Tissue response can cause cavitation
Secondary TB
Primary or secondary TB?
May disseminate
Secondary TB
What disease?
Demographics include immunocompromised and regions with poverty/crowding
TB
What disease?
Organisms present, may or may not cause symptoms. Not contagious
TB infection
What disease?
Infection causing clinically significant tissue damage and accompanying symptoms. Contagious
TB disease
What disease?
Clinical presentation includes persistent cough, hemoptysis, night sweats, weight loss, fatigue, varying symptoms depending on organs involved
TB
What disease?
Oral manifestation is rare, but possible
TB
What are the possible oral manifestations of TB? What is the most common site?
Chronic ulceration/swelling
Most common site = tongue
What disease?
Calcification of cervical lymph nodes is possible
TB
What disease?
Can be diagnosed by detecting bacteria via culture or PCR amplification
TB
What disease?
Can be diagnosed by skin test
TB
What disease?
Can be diagnosed by chest X-Ray, biopsy, or Bacillus Calmette-Guerin vaccine
TB
What are the 5 ways to diagnose TB?
Detection of mycobacterium tuberculosis (culture, PCR)
Skin test
Chest X-Ray
BCG vaccine
Biopsy
A positive TB skin test shows _____-medaited hypersensitivity to ___________ antigens
Cell-mediated; tubercular
What does a TB skin test NOT differentiate between?
TB infection vs TB disease
T/F: There can be false positive and false negative TB skin test results
True
What can result in a false positive TB skin test?
BCG vaccine
What would you see in a TB biopsy?
Caseating granulomas
+ for AFB (acid-fast bacilli) stain
What disease?
Tx is long term antibiotic regimen
TB
What specific antibiotics are used to treat TB?
“RIPE”
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
In the dental office, what should you do if your pt has had a recent + TB skin test?
Treat as having TB until proven otherwise
Need to see PCP for exam and chest X-Ray
If pt is under medical tx and confirmed to be absent of active TB, they can be treated w/o special precautions
In the dental office, what should you do if your pt has symptoms of undiagnosed, active TB?
Refer ASAP for medical exam
Defer elective dental tx until confirmed pt doesn’t have TB
Urgent dental tx should be provided in facility w/ airborne infection isolation (hospital)
In the dental office, what should you do if your pt has been recently diagnosed for active TB?
May be treated after receiving antibiotics for 3+ weeks (if physician confirms they are non-infectious)
In the dental office, what should you do if your pt has a history of TB?
Degree of disease involvement
Type/duration of therapy received
Current status of disease activity
Med consult w/ PCP to obtain/confirm this info
What disease?
Caused by a significantly decreased expiratory flow rate
COPD
What disease?
Demographic is cig smokers
COPD
What disease?
Damage is largely irreversible
COPD
What disease?
6th leading cause of death in US
COPD
What disease?
Caused by a significantly decreased expiratory flow rate in the large airways only
Chronic bronchitis
What disease?
Caused by a significantly decreased expiratory flow rate in the acinus only
Emphysema
What are the 2 subcategories of COPD?
Chronic bronchitis
Emphysema
Low, moderate, or high risk?
Pts with known active, sputum-positive TB and/or symptoms of active TB
High risk
Low, moderate, or high risk?
Pts with oral manifestations of TB
High risk
Low, moderate, or high risk?
Pts with + TB skin test, but no evidence of active disease
Moderate risk
Low, moderate, or high risk?
Pts with chest X-Ray findings suggestive of prior TB involvement, but no evidence of active disease
Moderate risk
Low, moderate, or high risk?
Pts with inadequately treated TB, but no evidence of active disease
Moderate risk
Low, moderate, or high risk?
Pts with known TB who have been adequately treated, with no evidence of active disease
Low risk
Low, moderate, or high risk?
Pts with a history of exposure to TB, but - skin test and no evidence of active disease
Low risk
What disease?
Caused by chronic inflammation of bronchi
Chronic bronchitis
In chronic bronchitis, what does chronic inflammation of bronchi lead to?
Hypertrophy of mucous glands
Hypersecretion of mucous
Mucus plugging of bronchiolar lumen
What disease?
Demographics include smokers, industrial workers, and exposure to pollutants
Chronic bronchitis
What disease?
Clinical presentation includes productive cough, shortness of breath, wheezing
Chronic bronchitis
What disease?
May experience hypercapnia, hypoxemia, cyanosis
Chronic bronchitis
Increased CO2
Hypercapnia
Low O2 in blood
Hypoxemia
Bluish discoloration because of hypoxemia
Cyanosis
What disease?
Eventually leads to pulmonary hypertension
Chronic bronchitis
Emphysema
What disease?
Diagnosed by productive cough for at least 3 months in two consecutive years
Chronic bronchitis
What disease?
Tx includes stop smoking, bronchodilators, corticosteroids, and O2 therapy
Chronic bronchitis
What disease?
Caused by inflammation and oxidative stress due to smoking
Emphysema
What disease?
Proteases are released from inflammatory and epithelial cells, leading to a break down of CT
Emphysema
What disease?
Destruction of alveolar walls
Emphysema
What disease?
Permanently enlarged air spaces
Emphysema
What disease?
Demographics include smokers and alpha-1-antitrypsin deficiency
Emphysema
Tissue-protective protein
Alpha-1-antitrypsin
(deficient in emphysema)
What disease?
Clinical presentation is progressive dyspnea, prolonged expiration, weight loss, barrel-chest, tripod position, pulmonary hypertension
Emphysema
Why do patients with emphysema have weight loss?
Increased metabolic rate
Why do patients with emphysema have barrel-chest?
Trapped air in lungs
Bent forward with arms on knees
Tripod position (emphysema)
What disease?
Diagnosed by pulmonary function tests - reduced FEV1 and chest X-Ray showing hyperinflation
Emphysema
Test showing amount of air exhaled in 1 second
FEV1
(used to diagnose emphysema)
What disease?
Tx is stop smoking, bronchodilators, pulmonary rehab, O2 therapy in severe cases
Emphysema
What are the 3 dental considerations of COPD?
Semisupine or upright chair position (avoid orthopnea)
Caution administering respiratory depressants (narcotic analgesics and benzos)
Pulse ox during tx (administer extra O2 if needed)
Which of the following is a key characteristic of emphysema?
a. productive cough
b. alveolar wall destruction
c. increased mucus production
d. hyperreactive airways
b. alveolar wall destruction
What disease?
Caused by exaggerated immune response of unknown etiology
Sarcoidosis
What disease?
Caused by granulomatous inflammation in many tissues and organs
Sarcoidosis
What disease?
Lungs affected in 90% of pts
Sarcoidosis
What disease?
Demographics include african americans, women, 20-40 year olds, non-smokers
Sarcoidosis
What disease?
Clinical presentation can be asymptomatic, respiratory symptoms, constitutional symptoms, peripheral lymphadenopathy, eye involvement, splenomegaly, hepatomegaly, skin lesions
Sarcoidosis
What are the respiratory symptoms in sarcoidosis?
Shortness of breath
Dry cough
What are the constitutional symptoms in sarcoidosis?
Fever
Fatigue
Weight loss
Describe the skin lesions in sarcoidosis
Raised, red, tender nodules on legs
What disease?
Diagnosed by chest X-Ray showing bilateral hilar lymphadenopathy and biopsy showing non-caseating granulomas
Sarcoidosis
What is the major finding at presentation in most cases of sarcoidosis?
Chest X-Ray showing bilateral hilar lymphadenopathy
What disease?
Tx is corticosteroids
Sarcoidosis
What disease?
Pts may develop progressive pulmonary fibrosis and cor pulmonale
Sarcoidosis
When you see atopic, think…
Allergic
What is the main cell involved in atopic asthma? What does it make and activate?
TH2
Makes IgE
Activates mast cells + eosinophils
What type of inflammation is involved with asthma, acute or chronic?
Chronic
What disease?
Caused by chronic airway inflammation and recurring episodes of reversible bronchoconstriction
Asthma
What disease?
Triggered by allergens, exercise, environmental factors, respiratory infections, cold air
Asthma
What type of asthma?
Exaggerated immune response to environmental allergens
Atopic asthma
What type of asthma?
Production of IgE and activation of mast cells
Atopic asthma
What type of asthma?
No clear antigen sensitization
Non-atopic asthma
What is involved in the early phase of asthma?
Bronchoconstriction
Mucus production
Vasodilation
What is involved in the late phase of asthma?
Smooth muscle hypertrophy
Mucus gland hyperplasia
Increased vascularity
Collagen deposition
What disease?
Demographics are broad, genetic predisposition, increased incidence in recent decades
Asthma
What disease?
Clinical presentation is recurring episodes, wheezing, shortness of breath, chest tightness, cough
Asthma
What disease?
Diagnosed by pulmonary function test showing reversible airflow obstruction
Asthma
What are the 3 categories of asthma?
Atopic
Non-atopic
Drug-induced
What type of asthma?
Most common
Atopic asthma
What type of asthma?
Begins in childhood
Atopic asthma
What type of asthma?
Type 1 hypersensitivity rxn
Atopic asthma
What type of asthma?
Triggered by environmental antigens
Atopic asthma
What type of asthma?
Skin tests w/ antigen result in wheal and flare rxn
Atopic asthma
What type of asthma?
No evidence of allergen sensitization (- skin tests)
Non-atopic asthma
What type of asthma?
Less likely to have family history
Non-atopic asthma
What type of asthma?
Common triggers are environmental pollutants and viral infections
Non-atopic asthma
What type of asthma?
Commonly caused by aspirin and other NSAIDs
Drug-induced asthma
What is the tx for asthma based on?
Severity
What are the levels of severity for asthma?
Intermittent
Mild persistent
Moderate persistent
Severe persistent
What disease?
Tx is lifestyle modification to avoid triggers, inhaled corticosteroids, and bronchodilators
Asthma
How do you identify undiagnosed asthma?
Coughing, wheezing, SOB
If your pt has a prior diagnosis of asthma, what should you evaluate?
Level of management (Asthma Control Test - ACT)
An Asthma Control Test (ACT) of ______ or below indicates inadequately controlled asthma
19
When should you make a med consult for asthma?
Suspicion of undiagnosed asthma
Poorly controlled asthma based on ACT score
How can you avoid asthma attacks in your office?
Manage stress/anxiety
Avoid other known triggers (NSAIDs, LAs, strong odors)
If your pt has a short-acting bronchodilator inhaler like albuterol, what should you make sure they do?
Bring to appt and place in easily accessible location
What are the related oral conditions in pts with asthma?
Xerostomia
Increased caries risk
Oral candidiasis
In atopic asthma, which immunoglobulin is
primarily involved in the allergic response?
IgE
What disease?
Caused by smoking, radon exposure, and occupational exposure (asbestos)
Lung cancer
85% of lung cancer cases is caused by what?
Smoking
What disease?
Demographics are smokers and > 50 yrs old
Lung cancer
What disease?
2nd most commonly diagnosed cancer in US
Lung cancer
What disease?
Leading cause of cancer death in US
Lung cancer
What are the tumor types found in lung cancer?
Carcinomas (95%)
Neuroendocrine carcinoma
Sarcomas
Lymphomas
What are the 2 types of carcinomas found in lung cancer?
Adenocarcinoma
Squamous cell carcinoma
Which type of carcinoma in lung cancer?
More common in women
Adenocarcinoma
Which type of carcinoma in lung cancer?
Non-smokers
Adenocarcinomas
Which type of carcinoma in lung cancer?
More common in men
Squamous cell carcinoma
Which type of carcinoma in lung cancer?
Smokers
Squamous cell carcinoma
What are the 2 types of neuroendocrine carcinomas in lung cancer?
Small cell carcinoma
Large cell carcinoma
What disease?
Clinical presentation includes cough, sputum, weight loss, fatigue, dyspnea, hemoptysis, chest pain
Lung cancer
What disease?
Diagnosed by chest X-Ray, CT scan, biopsy via bronchoscopy or needle aspiration
Lung cancer
What disease?
Tx is dependent on stage
Lung cancer
What disease?
Tx is surgical resection, chemo, radiation, immunotherapy
Lung cancer
