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Respiratory System > Pathology > Flashcards

Pathology Flashcards

1
Q

What is Emphysema?

A

Emphysema is characterized by permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls without significant fibrosis

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2
Q

What are the types of Emphysema?

A

Centriacinar
Irregular
Panacinar
Distal acinar

“Not COPD but CIPD”

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3
Q

In Centriacinar emphysema which parts of the acini is damaged?

A

Central and Proximal Acini

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4
Q

True or False? Centriacinar emphysema are normally found in the Lower lobes of the lungs while Panacinar (Panalobular) are found in the Upper lobes of the lungs.

A

FALSE!! Centriacinar is found in Upper lobes while Panacinar is found in theLower lobes.

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5
Q

What type of Emyphesema is associated with a α1-anti-trypsin deficiency?

A

Panacinar Emphysema

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6
Q

Fill in the blank. “ In Distal (paraseptal)Acinar emphysema , the ______ part of acini is damaged.

A

Distal
- it’s literally in the name…

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7
Q

Which inflammatory mediators are released in Emphysema?

A

Leukotriene B4, IL-8, TNF

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8
Q

Which inflammatory cells are released in Emphysema?

A

Neutrophils, macrophages, and CD4+ and CD8+ T cells

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9
Q

What is the function of α1-anti-trypsin in the body?

A

α1-anti-trypsin is a major inhibitor of proteases (particularly elastase) secreted by neutrophils during inflammation.

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10
Q

Where is α1-anti-trypsin produced in the body?

A

In the liver

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11
Q

Where is α1-anti-trypsin found in the body?

A

Serum
Tissue fluids
Macrophages

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12
Q

The term ‘blue bloater’ is associated with which disease?

A

Chronic bronchitis

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13
Q

The term ‘pink puffer’ is associated with which disease?

A

Emphysema

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14
Q

Why are these patients called pink puffers?

A

Because of prominent dyspnea and adequate oxygenation of haemoglobin.

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15
Q

What is Compensatory emphysema ?

A

The dilation of residual alveoli in response to loss of lung substance else- where, such as occurs after surgical removal of a diseased lung or lobe.

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16
Q

Fill in the blanks. “__________ refers to any form of emphysema that produces large subpleural blebs or bullae.

A

Bullous emphysema

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17
Q

What type of emphysema can be developed in children with Whooping cough?

A

Mediastinal (interstitial) emphysema

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18
Q

What is Mediastinal (interstitial) emphysema?

A

This is caused by entry of air into the interstitium of the lung, from where it may track to the mediastinum and sometimes the subcutaneous tissue

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19
Q

What is a common cause of Obstructive overinflation ?

A

Subtotal obstruction of an airway by a tumor or foreign object.

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20
Q

What are factors for the development of emphysema (Pathogenesis)

A

Inflammatory cells and mediators
Protease–anti-protease imbalance
Oxidative stress
Airway infection

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21
Q

What are the macroscopic features of Panacinar emphysema

A

Pale, voluminous lungs
Hypercrepitant
Diffused dilated spaces

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22
Q

Which type of Emphysema is associated with Anthrocosis ( Black pigment- black discoloration of bronchial mucosa)

A

Centriacinar

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23
Q

True or False? In patients with Emphysema , there is an increased lung compliance and decreased lung elastance?

A

TRUE!!!

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24
Q

How is a deficiency of α1-anti-trypsin connected to emphysema?

A

α1-anti-trypsin is a INHIBITOR of elastase, During Emphysema a lot of elastase is released from the Neutrophils. This elastase released destroys & degrades elastin fibers in the lung tissue, leading to the destruction of alveolar walls, enlarges airways and reduces surface area.

In lungs, ( decreased 1-antitrypsin ->
uninhibited elastase in alveoli -> decreased elastic tissue ->panacinar emphysema

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25
Q

How are α1-anti-trypsin alleles represented?

A

PiMM = normal α-1 antitrypsin levels
PiMZ = intermediate α -1 antitrypsin levels
PiZZ = very low α-1 antitrypsin levels

M - normal, S -intermediate, Z- marked decrease

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26
Q

True or false? Eosinophils are present in Chronic bronchitis?

A

FALSE!! They are NOT present.

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27
Q

What are histologic features of Chronic Bronchitis?

A

-Mucous gland hypertrophy and hyperplasia
Reid index
– Goblet cell hyperplasia
– Squamous metaplasia
– Oedema and increased vascularity
– Chronic inflammatory cell infiltration
– Mucopurulent exudate (infection)

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28
Q

What is the normal thickness of mucous glands to thickness of bronchial wall using the Reid Index?

A

0.36-0.41

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29
Q

What value using the Reid scale indicates Chronic Bronchitis?

A

0.44 -0.79

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30
Q

What is the time period used to diagnose Chronic Bronchitis?

A

3 months per year for 2 consecutive years

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31
Q

What is Asthma?

A

Asthma is a chronic inflammatory disorder of the airways that causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night and/or early in the morning.

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32
Q

What are the hallmarks of Asthma?

A

Reversible airway obstruction
Chronic bronchial inflammation with eosinophils
Bronchial smooth muscle cell hypertrophy and Hyperreactivity; and increased mucus secretion.

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33
Q

What are the cells that play an active role in Asthma?

A

Eosinophils
Mast cells
Macrophages
Lymphocytes
Neutrophils and epithelial cells

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34
Q

What are the major factors contributing to Asthma?

A

Genetic predisposition to type I hypersensitivity (atopy)
Acute and chronic airway inflammation
Bronchial hyperresponsiveness to a variety of stimuli.

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35
Q

What are the subdivisions of Asthma?

A

Atopic and Non-Atopic

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36
Q

In which subdivision of Asthma is associated with type 2 helper T (TH2) cell activation?

A

Atopic

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37
Q

Which cytokines produced by T helper cells is involved with IgE production?

A

IL-4 and IL-13

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38
Q

True or False? In Atopic Asthma, the activated T helpers cells produces cytokine IL-5 which causes mucus production.

A

FALSE!!
IL-5 produces Eosinophils

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39
Q

Fill in the blank .” Cytokine _____ is involved with mucus production “

A

IL-13.

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40
Q

How can one diagnose Atopic Asthma?

A

Serum radioallergosorbent tests (RASTs) that identify the presence of IgEs that recognize specific allergens.

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41
Q

What is the most common drug associated with Drug induced Asthma?

A

Aspirin

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42
Q

What is Occupational Asthma?

A

Occupational asthma may be triggered by fumes (epoxy resins, plastics), organic and chemical dusts (wood, cotton, platinum), gases (toluene), and other chemicals.

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43
Q

What are the different mediators in Asthma and what are their roles?

A

-HISTAMINE & LEUKOTRIENES:
Bronchoconstriction
↑ vascular permeability → submucosal oedema → narrowing of bronchial lumen
↑ Mucus secretion from goblet cells → mucus plugs in the airways
-PROSTAGLANDINS:
Bronchoconstriction
Vasodilation → submucosal oedema
- PLATELET ACTIVATING FACTOR:
Aggregation of platelets → Release of histamine

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44
Q

What are the different chemotactic factors involved with Asthma?

A
  • Neutrophil chemotactic factor→
    Accumulation & activation of neutrophils →
    Release of O2 free radicals → Tissue Damage
  • Eosinophil chemotactic factor →Accumulation of eosinophils → Discharge of granules → cationic protein & major basic protein → Impairment of ciliary function & damage to bronchial epithelial cells
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45
Q

What are the histologic features present in Asthma?

A

1)Thickening of basement membrane
2)↑ Inflammatory cells in lamina propria (Eosinophils & Mast cells)
3)Hypertrophy of bronchial smooth muscle
4)↑ # of submucosal glands

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46
Q

What distinct features can be found in the sputum of Asthmatic patients?

A

Curshmann’s spirals
Charcot- Leyden crystals

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47
Q

What is Curshmann’s spirals?

A

Mucus & shed bronchial epithelium in spirals

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48
Q

What is Charcot- Leyden crystals?

A

Bipyramidal structures derived from membrane of degenerate eosinophils as well as eosinophil proteins (galectin -10)

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49
Q

What is Bronchiectasis?

A

Bronchiectasis is the permanent dilation of bronchi and bronchioles caused by destruction of smooth muscle and the supporting elastic tissue; it typically results from or is associated with chronic necrotizing infections.

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50
Q

What are the causes of Obstructive bronchiectasis?

A

Bronchial tumours
Aspirated foreign bodies
Mucus plugs in airways
Enlarged hilar lymph nodes – Tb, Metastatic tumours

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51
Q

What are the causes of Congenital Non-Obstructive bronchiectasis?

A

Defective cilia: Kartagener’s Syndrome
( Bronchiectasis + Situs Inversus + Sinusitis)
Defective mucus secretion: Cystic Fibrosis

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52
Q

What are the causes of Acquired Non-Obstructive bronchiectasis?

A
  • Infections: Necrotizing pneumonia
    (Staphylococcus, Pseudomonas, Measles &
    Whooping cough)
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53
Q

True or False? In Congenital non-obstructive bronchiectasis, the issue is confined to one lobe while in acquired non-obstructive bronchiectasis the issue is confined to all lobes of bronchi.

A

TRUE!!

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54
Q

What percentage of of non-smokers worldwide develop lung cancer?

A

25%

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55
Q

What percentage of heavy smokers develop lung cancer?

A

11%

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56
Q

What is the most common benign lung tumor?

A

Hamartoma

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57
Q

What are the four major histologic types of carcinomas of the lung?

A

Adenocarcinoma
Squamous cell carcinoma
Small cell carcinoma
Large cell carcinoma

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58
Q

What is the most common type of lung carcinoma in people?

A

Adenocarcinoma

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59
Q

What are other carcinogenic nfluences associated with occupational exposures to develop lung carcinoma?

A

Asbestos
High-dose ionizing radiation
Nickel
Arsenic chromium
Uranium
Vinyl-chloride

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60
Q

What is the increased risks of exposure to asbestos to smokers?

A

55 times

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61
Q

Which type of lung carcinoma is normally peripherally located but may be close to the Hilum?

A

Adenocarcinoma

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62
Q

What are the growth patterns of Lung adenocarcinomas?

A

Acinar (gland- forming)
Papillary
Solid sheets of cells with mucin

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63
Q

What is the putative precursor of adenocarcinoma?

A

Atypical adenomatous hyperplasia (AAH)

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64
Q

What is another name for Adenocarcinoma in situ?

A

Bronchioloalveolar carcinoma

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65
Q

Where do Adenocarcinomas in situ grow?

A

Along alveolar septa

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66
Q

Which lung carcinomas are strongly associated with smoking?

A

Squamous cell carcinoma and Small cell carcinoma
S& S associated with S-moking

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67
Q

Which lung carcinoma is mostly located centrally in major bronchi and eventually spread to local hilar nodes?

A

Squamous Cell carcinoma

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68
Q

Fill in the blanks.” Squamous cell carcinomas often are preceded by the development, over years, of _______ or _______ in the ________epithelium, which then transforms to________ a phase that may last for several years

A

Squamous metaplasia
Dysplasia
Bronchial epithelium
Carcinoma in situ

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69
Q

What histological findings are associated with Squamous cell carcinoma?

A

Keratin pearls and Intercellular bridges to poorly differentiated neoplasms exhibiting only minimal squamous cell features.

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70
Q

What is the main location for Small cell carcinomas?

A

Centrally located masses that extend into the lung parenchyma.

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71
Q

Which lung carcinoma is associated with a salt and pepper like appearance?

A

Small cell carcinoma

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72
Q

What neuroendocrine cells do small carcinoma originate from?

A

Kulchitsky cells ( Enterochromaffin cells)

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73
Q

What neuroendocrine markers are expressed on small cell carcinoma cells?

A

Synaptophysin, chromogranin A, and CD56

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74
Q

What other disease can be associated with smAll cell carcinoma?

A

-Acth(Adrenocorticotropic hormone) production causing Cushing’s syndrome
-siAdh (Syndrome of inappropriate antidiuretic hormone )
- Antibodies against presynaptic Ca2+ channels (Lambert- Eaton myasthenic syndrome

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75
Q

Which lung carcinoma is poorly differentiated ?

A

Large Cell carcinoma

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76
Q

Which lung carcinoma is associated with PTHrP(Parathyroid hormone-related peptide) overproduction, which can cause hypercalcemia ?

A

Squamous cell carcinoma

77
Q

What is Pancoast syndrome?

A

Pancoast tumour aka superior sulcus tumour (tumour in apex of the upper lobe) can grow to involve cervical and thoracic nerves leading to shoulder pain that radiated down the arm

78
Q

Pancoast tumour that paralyses cervical sympathetic nerves leading to: ptosis of upper eyelid; miosis (constriction of pupil); anhidrosis (lack of sweating) can cause?

A

Horner’s syndrome

79
Q

Where does Hematogenous metastasis from Primary lung cancer involve?

A
  • Intraparenchymal spread (within the lungs)
    – Pleura
    – Brain, bone, liver
    – Adrenal glands
80
Q

Where does Lymphatic metastasis to regional lymph nodes from Primary lung cancer involve?

A

Hilar
Mediastinal
Carina
Neck (scalene nodes)
Clavicular regions

81
Q

What is the staging method used for Lung carcinomas?

A

TNM ( tumor node metastasis)

82
Q

What are the most common sites for secondary lung cancer?

A

Breast
Colons
Stomach
Pancreas

83
Q

What are types of Granulomatomas?

A

Necrotizing (has a necrotic centre) and Non-Necrotizing ( solid with no necrotic centre)

84
Q

What is Tuberculosis(TB)?

A

Tuberculosis is a communicable chronic granulomatous disease caused by Mycobacterium tuberculosis. It usually involves the lungs but may affect any organ or tissue in the body.

85
Q

How can one be tested for TB?

A

Tuberculin (Mantoux) test -(Skin test)

86
Q

Which type of TB may present may present with flu-like symptoms, fever and pleural effusions?

A

Primary TB

87
Q

What specific bacteria is responsible for most cases of Tuberculosis?

A

M. tuberculosis hominis

88
Q

Which type of TB bacteria can be contracted by drinking unpasteurised milk?

A

Mycobacterium bovis (T.Bovis)

89
Q

What type of bacterium is Mycobacterium Tuberculosis?

A

Gram -Positive Acid- Fast - because they resist decolorization by acid after staining with carbolfuchsin. This is due to the high lipid content of their cell walls

90
Q

What is the function of IFN-γ in the role of cell mediated immunity against Tuberculosis?

A

IFN-γ ACTIVATES macrophages, making them bactericidal.

91
Q

What substances do these now activated macrophages , in cell mediated immunity against TB, produce and what are their functions?

A

*TNF - TNF helps to form monocytes which then differentiate into epithelial histiocytes. These epithelial histiocytes can fuse together forming GIANT CELLS or aggregate to form granulomas.

  • iNOS ( inducible nitric oxide synthase) - this produces NO which helps with killing mycobacterium

*Anti-microbial peptides (defensins) which are toxic towards mycobacterial organisms.

92
Q

True or False? Ghon complex is at the lower part of upper lobe or upper part of lower lobe.

A

FALSE!!! Ghon focus is!!!
“ Focus on the upper parts”

93
Q

What is Ghon complex?

A

This is the combination of parenchymal and nodal lesions ( focus + hilar lymphadenopathy)

94
Q

Fill in the blanks. “If normal immunity and infection is not overwhelming then there is fibrosis and then calcification of the _______”

A

Ghon complex - this overall can be detectable as a Ranke complex on radiograph.

95
Q

What is miliary pulmonary disease?

A

This occurs when organisms reach the blood- stream through lymphatic vessels and then recirculate to the lung via the pulmonary arteries.

96
Q

When there is Tuberculosis manifested in the vertebrae it is known as?

A

Pott disease

97
Q

Where does secondary tuberculosis normally develop?

A

In the apical areas of the lungs near the clavicles because oxygen tension is highest and these are obligate aerobes.

98
Q

What is the most common extra pulmonary tuberculosis?

A

Lymphadenitis (usually in the cervical region ) aka Scrofula

99
Q

In what areas are systemic millary tuberculosis most prominent?

A

Liver, bone marrow, spleen, adrenal glands, meninges, kidneys, fallopian tubes, and epididymis

100
Q

What is Sarcoidosis?

A

Sarcoidosis is a multisystem disease of unknown etiology characterized by NON-CASEATING granulomatous inflammation in many tissues and organs

101
Q

What is the cardinal histopathologic feature of sarcoidosis, irrespective of the organ involved?

A

Non-necrotizing epithelioid granuloma

102
Q

What are two histologic features present in Sarcoidosis?

A

Schaumann bodies and Asteroid bodies

103
Q

What is the hallmark for acute sarcoidosis?

A

Erythema nodosum (swollen fat under the skin causing bumps and patches that look red or darker than surrounding skin)

104
Q

What are other implications associated with Sarcoidosis

A

Bell’s palsy
Uveitis (choroiditis,retinitis)
Granulomas
Lupus Pernio
Interstitial Fibrosis & Iritis
Erythema Nodosum
Rheumatoid arthritis -like arthropathy
than
Sally - Sicca syndrome( can’t cry)
Mason - Mikulicz syndrome (abnormal enlargement of glands in the head and neck, including those near the ears (parotids) and those around the eyes (lacrimal) and mouth (salivary)

Betty’s sarcoidosis is UGLIER than Sally Mason’s

105
Q

What are the clinical features of Sarcoidosis?

A

shortness of breath, dry cough, vague sub- sternal discomfort, fever, fatigue, weight loss, anorexia, night sweats, peripheral lymphadenopathy, cutaneous lesions, eye involvement, splenomegaly, or hepatomegaly

106
Q

What are implications of Sarcoidosis?

A

Elevated ACE ( angiotensin converting enzyme) levels
Elevated CD4/8 ratio in bronchoalveolar lavagea fluid
Hypercalcemia( due to hypervitaminosis D caused by increased synthesis of 1-α-hydroxylase within the granulomas)

107
Q

What is the treatment for Sarcoidosis?

A

Steroids

108
Q

Where are granulomas normally present in Sarcoidosis?

A

Hilar lymph nodes and parenchyma of lungs

109
Q

What are the types of Rhinitis?

A

Infectious
Allergic

110
Q

What is the etiology of Infectious rhinitis?

A

Adenovirus
Rhinovirus
Echovirus

111
Q

What is the etiology of Allergic (Hay fever) rhinitis?

A

Plant pollen, dust mites, animal allergens

112
Q

Fill in the blanks. “ Empyema, orbital osteomyelitis, bacterial meningitis, dural venous sinus thrombophlebitis are all complications of __________”

A

Sinusitis

113
Q

What cells are found in the stroma of a sinonasal polyp?

A

Eosinophils, lymphocytes, plasma cells

114
Q

What are Sinonasal (Schneiderian) Papillomas?

A

Benign Tumours

115
Q

Which types of type of Schneiderian papilloma is at risk to developing into a papilloma?

A

Inverted and Oncocytic

116
Q

What are the types of Sinonasal papillomas?

A

Inverted
Oncocytic
Exophytic

117
Q

What is the localisation of Exophytic sinonasal papillomas ?

A

Unilateral, Nasal septum

118
Q

What is the localisation of Inverted and Oncocytic sinonasal papillomas ?

A

Unilateral, Lateral nasal wall; paranasal sinuses

119
Q

Which type of Sinonasal papilloma presents with Nasal obstruction; rhinorrhoea,; epistaxis; anosmia; frontal headaches; proptosis; diplopia?

A

Inverted sinonasal papilloma

120
Q

Which sinonasal papilloma has a histologic feature of tall columnar cells with pink granular cytoplasm ?

A

Oncocytic Sinonasal papilloma

121
Q

Fill in the blanks. “ Inverted and Exophytic Sinonasal papillomas has _________ epithelium.”

A

Straified Squamous Epithelium

122
Q

Fill in the blank “________ has epithelium that can be described as fingerlike projections.”

A

Exophytic

123
Q

What are the types of Sinonasal adenocarcinoma?

A

Intestinal and Non-Intestinal Type

124
Q

True or False? Intestinal sinonasal adenocarcinoma is of unknown etiology.

A

FALSE!! It is caused by wood dust &leather dust

125
Q

True or False? Intestinal sinonasal adenocarcinoma is of unknown etiology.

A

FALSE!! It is caused by wood dust &leather dust

126
Q

What type of Nasopharyngel carcinoma is associated with EBV , high salt food intake with nitrosamine & genetic suscebility?

A

Non-Keratinizing nasopharyngeal carcinoma

127
Q

True or False? Keratinizing nasopharyngeal carcinoma is associated with Tobacco smoking & alcohol consumption.

A

TRUE!!

128
Q

Where are laryngeal nodules(singers nodes) normally located?

A

On the true vocal folds.

129
Q

True or False? Recurrent respiratory papillomatosis (RRP) are caused by HPV types 6 & 18

A

FALSE!!! Are caused by types 6 &11

130
Q

True or False? Mucillary blankets are found in the small airways?

A

FALSE!! They are found in the large airways

131
Q

Fill in the blanks.” In the Respiratory Tract Defense mechanisms , _______ traps large particles while ______ traps small particles(less than 5 microns)

A

Mucus(large) & Alveolar macrophages (small)

132
Q

What are the causes of impairment to the lung defence mechanisms?

A

1.Loss /suppression of cough reflex
2.Injury of to the mucociliary apparatus
3.Accumulation of secretions
4. Interference with Phagocytic action
5.Pulmonary congestion & oedema

133
Q

What gram positive bacteria is the most common cause of Community- Acquired Pneumonia?

A

Streptococcus pneumoniae

134
Q

What gram negative bacteria is the most common cause of Community- Acquired Pneumonia?

A

Klebsiella pneumoniae

135
Q

What viruses are responsible for causing Community-Acquired pneumonia?

A

Respiratory syncytial virus (RSV)
Influenza virus types A and B
Adenovirus
Human Coronavirus
* SARS CoV-2

136
Q

What are the most common organisms associated with Health Care acquired pneumonia?

A

Staphylococcus aureus
Pseudomonas aeroginosa

137
Q

What etiologic agents is strongly associated with nasopharyngeal carcinoma?

A

Epstein-Barr Virus (EBV)

138
Q

What is the major immunoglobulin in airway secretions?

A

IgA
A- for Airway

139
Q

What is Hoarseness?

A

Hoarseness is characterized by a change in the quality of voice.

140
Q

What is the time period marked as for persistent Hoarsness?

A

2 weeks

141
Q

What are the causes of hoarseness?

A

*Intrinsic lesion of the true vocal cords
*Neural lesion: vagus or recurrent laryngeal
*Neuromuscular Junction lesion
*Lesion of the laryngeal muscles or arthritis of the cricoarytenoid joint

142
Q

What are examples of Nuclear Lesions of the Vagus nerve?

A

*Bulbar poliomyelitis
*Motor neuron disease
*Lateral medullary syndrome (PICA)

143
Q

Acoustic neuroma & Meningioma are what type of lesions for the vagus nerve?

A

Posterior Fossa Lesions of the Vagus nerve

144
Q

Glomus jugulare & Metastatic carcinoma of the nasopharynx are examples of what type of lesions of the Vagus nerve?

A

Jugular Foramen lesions of the Vagus nerve

145
Q

Give an example of a Supranuclear lesion of the Vagus nerve?

A

Cerebrovascular accident

146
Q

What are examples of Thoracic lesions?

A

Aortic aneurysm or aneurysmal surgery
Carcinoma of oesophagus
Tuberculous or metastatic nodes

‘ACT’

147
Q

What is stridor?

A

A high pitch auditory manifestation of laryngeal or tracheal obstruction with an inspiratory component.

148
Q

Fill in the blank. “ The _______ and _______ is a site of obstruction for Inspiratory and Expiratory stridor.”

A

Subglottis and Trachea

149
Q

A glottic obstruction is an example of what type of stridor ?

A

Inspiratory stridor

150
Q

A persistent hoarseness can be associated with what disease?

A

Cancer of the voicebo

151
Q

Cancer of the voice box normally arises at what location?

A

Anterior 1/3 of vocal chords

152
Q

Which disease accounts for 90% of congenital stridor?

A

Laryngomalacia

153
Q

Give examples of Intrinsic lesions of the true vocal cords?

A

*Acute and chronic laryngitis
*Vocal cord nodules
*Laryngeal papillomatosis
*Carcinoma of the larynx

154
Q

Where are vocal cords nodules(singer nodules) normally located and what type of persons normally have them?

A

Anterior 1/3 and posterior 2/3 of vocal cords

155
Q

True or False? In recurrent laryngeal nerve palsy, the left side is more common than the right side.

A

TRUE!!

156
Q

What is Laryngomalacia?

A

A defect in the development of the cartilage in the Larynx, the airway collapses whenever the child breathes.

157
Q

What shape can be used to describe the epiglottis in patients with Laryngomalacia?

A

Omega type shape

158
Q

What is the aetiology of laryngeal papillatamosis?

A

HPV virus types 6, 11

159
Q

At what location is a tracheostomy done?

A

Between tracheal rings 2&3 ( where the tracheal isthmus is located)

160
Q

What is the most common cause of Epxitaxis?

A

Nose picking

161
Q

Fill in the blank. “ ________ is the cause of an Anterior epistaxis and ________ is the cause of Posterior epistaxis.”

A

Kiesselbach’s Plexus( Little Area) - Anterior bleed
Plexus of Woodruff - Posterior bleed

162
Q

Unilateral bleeding from the nose can be an indication of what?

A

A neoplastic mass

163
Q

What are the general causes of Maxillary carcinoma?

A

*Hypertension
*Pregnancy
*Warfarin, Heparin, NSAID
*Hereditary Haemorrhagic Telangiectasia
*Congenital coagulopathy

164
Q

How can one indicate CSF Rhinorrhoea?

A

One sided drainage from the nose that is crystal clear.

165
Q

Fill in the blanks. ‘________ are present in large airways while _______ are present in small airways”

A

Mucocillary Blanket- Large airways
Phagocytes- Small ariways

166
Q

True or False? Mucus traps small particles.

A

FALSE!!! Mucus traps LARGE particles

167
Q

Which structure phagotysose particles
smaller than 5 microns?

A

Alveolar macrophages

168
Q

What are factors that can interfere with phagocytic action?

A
  • Alcohol
  • Tobacco smoke
  • Anoxia
  • Oxygen intoxification
169
Q

What are factors that can cause injury to the mucociliary apparatus?

A
  • Cigarette smoke
  • Inhalation of hot or corrosive gases
  • Viral diseases
  • Genetic defects of cilia function, eg immotile cilia syndrome
170
Q

Which gram positive bacteria is the most common cause of Community Acquired pneumonia?

A

Streptococcus pneumoniae

171
Q

Which gram negative bacteria is the most common cause of Community- Acquired pneumonia?

A

Klebsiella pneumoniae

172
Q

What are examples of viruses that can cause Community-Acquired pneumonia?

A

Human coronavirus
Adenovirus
Influenza virus type A &B
Respiratory syncytial virus (RSV)

173
Q

What are associated risk factors with Health-care Associated pneumonia?

A
  • Hospitalization of at least 2 days within the recent past
  • Presentation from a nursing home or long-term care facility
  • Attending a hospital or hemodialysis clinic
  • Recent IV antibiotic therapy, chemotherapy or wound care
174
Q

Fill in the blanks.” ______ and ________ are the most common organisms associated with Health-Care associated pneumonia.”

A
  • Staphylococcus aureus
  • Pseudomonas aeroginosa
175
Q

Which gram positive bacteria is the most common cause of Hospital Acquired Pneumonia?

A

Staphylococcus aureus (usually methicillin-resistant)

176
Q

Anaerobic oral flora - ‘Bacteroides, Prevotella, Fusobacterium’ are associated with what type of pneumonia?

A

Aspiration pneumonia

177
Q

Which fungi can be associated with Chronic pneumonia?

A
  • Histoplasma capsulatum
  • Blastomycosis dermatitidis
178
Q

Nocardia & actinomyces - are associated with which type of pneumonia?

A

Chronic pneumonia with non-granulomatous inflammation

179
Q

Fill in the blank. “Bacterial invasion of the lung parenchyma causes exudative solidification called
__________”

A

Consolidation

180
Q

In which stage of Lobar pneumonia has Intra-alveolar exudate of RBC with polymorphs?

A

Red- Hepatization

181
Q

What are some symptoms of Lobar pneumonia?

A
  • Sudden onset malaise, fever, chills, rigors
  • Pleuritic chest pain, pleural rub
  • Rusty sputum
  • Purulent sputum
182
Q

Fill in the blanks. “ Bacterial pneumonia present with ______ & _______ involvement while viral pneumonia present with _______.”

A

Broncho & Lobar - bacterial
Interstitial - Viral

183
Q

What are causes of Interstitial pneumonia?

A
  • Mycoplasma pneumonia
  • Pneumocystis jiroveci
184
Q

What is the main histological feature associated with Acute Respiratory syndrome?

A

Diffuse alveolar damage (DAD)

185
Q

What is Acute Respiratory Distress syndrome?

A

ARDS is a clinical syndrome of progressive respiratory insufficiency caused by diffuse alveolar damage in the setting of sepsis, severe trauma, or diffuse pulmonary infection.

186
Q

What is Atypical pneumonia?

A

Atypical pneumonia is characterized by protracted course of constitutional symptoms and signs with gradual resolution,lack of typical consolidation on CXR,failure to isolate a pathogen on routine bacteriological investigation and lack of response to penicillin therapy

187
Q

What are the classical atypical bacteria associated with Atypical pneumonia?

A

1.) Mycoplasma pneumonia
2.) Chlamydia pneumonia
3.) Legionella pneumonia

188
Q
A

Respiratory System (9 decks)

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