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Resp II > lung path II > Flashcards

lung path II Flashcards

1
Q

PE

A

10% of acute hospital deaths
underdiagnosed
elevated LDH

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2
Q

PHTN

A

abnormal when pressurs reaches 1/4 of systemic

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3
Q

pulmonary arterial HTN

A

primary idiopathic arterial HTN
autoimmune CT disorder
drugs

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4
Q

idopathic primary pulmonary HTN

A

adults mostly females 20-40

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5
Q

rare familiar primary PHTN

A

autosomal dominant with only 10-20%
mutation in BMPR2
in vascular smooth m cells BMPR2 inhibits proliferation and favors apoptosis
mutation inactivated inhibition

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6
Q

secondary PHTN

A

endothelium dysfunction and normal reduction of pulmonary aa to increased pressure

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7
Q

diffuse alveolar hemorrhage syndrome

A

goodpasture syndrome
idiopathic pulmonary hemosiderosis
vasculitis (wegners, hypersensativity pneumonitis, SLE)

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8
Q

goodpastures

A

autoimmune, anti-basement membrane Abs
alpha 3 chain of collagen IV
proliferative rapidly progressive glomerulonephritis
necortizing hemorrhagic interstitial pneumonitits
M>F, young smokers
renal failure usually COD

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9
Q

idiopathic pulmonary hemosiderosis

A

rare condition usually in children
episodes of diffuse hemorrhage
no antivascular Abs have been found, but immunosupression works
diffuse hemosiderin deposistion in macrophages and alveolar walls

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10
Q

symptoms of idiopathic pulmonary hemosiderosis

A

productive cough, hemoptysis, anemia, weight loss

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11
Q

polyangitis w/granulomatosis

A

necrotizing granulomatous arteritis of lungs and URT
necrotizing crescentic glomerulonephritis
hard to diagnose
M>F 5th decade
immunoRx
variable prognosis
cytoplasmic pattern anti-neutrophil Abs (PR3/c-ANCA)

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12
Q

nasopharynx defenses

A

nasal hair
turbinates
mucociliary apparatus
IgA

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13
Q

oropharynx defenses

A

saliva
sloughing of epi
local complement production
interference from resident flora

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14
Q

trachea and bronchi defenses

A

cough, epiglottic reflexes
sharp angled branching of airways
mucocilliary apparatus
IgM, IgG, IgA

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15
Q

lower respiratory tract defenses

A 
alveolar lining fluid
cytokines
alveolar macros
polymorphonuclear leukocytes
cell-mediated immunity
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16
Q

community acquired acute penumonia

A 
alveolar exudates
strep pneumoniae
H. influenza
M. catarrhalis
Staph aureus
legionella penumophilia
enterbacteriaceae
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17
Q

strep pneumonaie

A

community acquired
G+ diplococci
most common
increased risk w/splenectomy/sickle cell -> need vaccine

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18
Q

H. influenza

A 
community acquired
also meningitis and pink eye
G- pleomorphic 
vaccine for encapsulated form 
#1 in COPD
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19
Q

M. catarrhalis

A

community acquired
G- diplococci
#2 in COPD

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20
Q

Staph aureus

A

community acquired
G+ cocci
common in post viral pneumonia w/IVDA

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21
Q

legionella pneumophilia

A

community acquired
gram - rod
macrophages in small bronchioles
legionellas disease and pontiac fever

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22
Q

enterobacteriaceae

A

community acquired
klebsiella pneumoniae
pseudomonas aerginosa

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23
Q

klebsiella pneumoniae

A

community acquired
Gram - rod
seen in debilitated/malnourished (alcoholics) with bloody thick sputum

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24
Q

pseudomonas aeruginosa

A

community acquired
gram neg coccobacilli
CF and neutropenia
angioinvasive

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25
Q

community acquired atypical pneumonia

A 
patchy or interstitial inflammation
mycoplasma pneumoniae
chlamydia
coxiella burnetti
viruses
26
Q

mycoplasma

A

community acquired atypical
sperhical to filimentoud w/o cell wall
gram -
have cold agglutinins

27
Q

viruses w/atypical pneumoniae

A 
respiratory synctial virus
parainfluenza
human metapneuomia virus
influenza A and B
adenovirus
rhinoiviruses
rubeola
varicella
SARS
28
Q

health care associated and hospital acquired pneumonia

A

gram neg rods
enterobacteriae
psudomonas
staph aureus (MRSA)

29
Q

aspiration pneumonia

A

anaerobic and aerobic bacteria

30
Q

necrotizing pneumonia and lung abscesses

A

anaerobic bacteria
staph aureus
klebsiella
strep pyogenes

31
Q

chronic pneumonia

A

nocardia

actinomyces

32
Q

granulomatous chronic pneumonia

A 
TB
atypical myobacterium
histoplasma capsulatum
coccidodes immitis
blastomyces dermatitdis
33
Q

pneumonia in immunocompromised host

A 
CMV
pneumocytis jirovecci
myocobacterium avium-intracellulare
invasive aspergillosis
invasive candidiasis
34
Q

lobar pneumonia

A

mostly caused by strep pneumonia

35
Q

stages of bacterial pneumonia

A

acute- early red hepatization
early organization- streams thru the pore of kohn
advanced organizing pneumonia

36
Q

viral pneumonias

A

usually self-limiting ‘chest cold’, but can be lethal
co-exist with bronchitis
can be epidemic

37
Q

pulmonary abscess organisms

A 
staph aureus and other gram neg
mixed, including anaerobic:
bacteriodies fragilis
fusobacterium
peptococcus
38
Q

complications of pulmonary abscesses

A

empysema
hemorrhage
brain abscess/meningitis
amyloidosis

39
Q

symptoms of pulmonary abscesses

A 
cough
fever
fould smelling, purulent and/or bloody sputum
chest pain
weight loss
40
Q

pulmonary abscess sources

A 
#1- aspiration
antecedent lung bacterial infection
septic emboli
neoplasia
penetrating wounds
infection from adjacent organ
hematogenous spread of infection
41
Q

perinatal infections timing

A

early onset 0-7 days: group B strep and E. coli

late onset 7-90 days: listeria, candida

42
Q

transcervical/ascending perinatial infections

A

inhalation of infected amniotic fluid in utero or infected passing thru birth canal
most bacterial, some viral
pneumonia, sepsis, and meningitis common

43
Q

tranplacental infections

A

most parasitic (malaria, toxoplasma) or viral (hep B, HIV) few bacterial
TORCH
pneumonia, encephalitis, chorioretinitis, myocarditis, dermatitis

44
Q

TORCH

A 
Toxoplama
Rubella
CMV
Herpes
other (treponema palllidum)
45
Q

Respiratory synyctial virus (RSV) bronchiolitis

A

most common cause of bronchiolitis and pneumonia in children <12months
initial URT infection but in 1-2days spread to lower airways moving cell-cell
associated otitis media
can cause pneumonia in elderly
xray shows areas w/entrapped air
supportive Tx

46
Q

chronic penumonias

A

frequently a localized lesion immunocompetent patients

many are granulomatous processes: TB, leprosy, fungal

47
Q

TB primary infection

A

Ghon complex

granulomatous response, usually asymptomatic and self limiting but clinically symptomatic in 5%

48
Q

Ghon complex

A

parenchymal lesion and involved lymph nodes

49
Q

secondary TB

A

reactivation of old walled off lesions, usually apical

cavitary caseous necrosis w/subsequent scarring or progressive disease

50
Q

miliary TB

A

occurs when tubercle erodes into a vessel

51
Q

immunosupressed TB

A

may see w/o granulomas

at risk for dissemination

52
Q

dimorphic fungal pneumonias

A

fungal spores ubiquitous
induce localized granulomatous response OR may be disseminated
can have angioinvasion, thrombosis, and septic infarcts

53
Q

histoplasma capsulatum

A

ohio and miss river and carribean
soil spores from birds or bat feces
microcondia and macorcondia

54
Q

blastomyces dermatidis

A

central and SE USA, canada, mexico, middle east, africa, india
soil spores
microconidia

55
Q

coccidioides

A

SW, far west, and mexico
soil spores
arthroconidia

56
Q

pulmonary diffuse pneumonias HIV

A

pneumocystis hirovecii
CMV
mycobacterium avium complex

57
Q

pulmonary focal pneumonias HIV

A

aspergillus

cnadida albicans

58
Q

diseases that warrant lung transplant

A

emphysema
idiopathic pulmonary fibrosis
CF
idiopathic/familial PHTN

59
Q

complications of lung transport

A

infections
acute regjection
chronic rejections
79% 1yr, 53% 5yr, 30%10yr survival rates

60
Q

pneumocystis pneumonia

A

foamy cotton candy exudate and cup and saucer- shaped organisms

Resp II (15 decks)

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