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Pulm > Pathoma Respiratory Part II > Flashcards

Pathoma Respiratory Part II Flashcards

1
Q

Group of diseases characterized by airway obstruction + air trapping; decreased FVC, FEV1, FEV1/FVC ratio; increased TLC, RV, FRC

A

Obstructive lung dz:

  1. chronic bronchitis
  2. emphysema
  3. asthma
  4. bronchiectasis
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2
Q

Chronic productive cough (due to excessive mucus production) lasting at last 3 months over at least two years; characterized by hypertrophy of bronchial mucinous glands (goblet cells); leads to increased thickness of mucus glands relative to bronchial wall thickness (Reid index > 50%; normal

A

Chronic bronchitis

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3
Q
  1. Productive cough
  2. Cyanosis (“blue bloaters”) - mucus plugs trap CO2 –> increased PaCO2 + decreased PaO2
  3. Increased risk of infection and cor pulmonale
A

Chronic bronchitis

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4
Q

Highly associated with SMOKING –> pollutants –> irritation and inflammation –> mucinous gland hypertrophy + hyperplasia

A

Chronic bronchitis

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5
Q

Destruction of alveolar airs sacs –> loss o f elastic recoil and collapse of airways during exhalation; due to imbalance of proteases and antiproteases

A

Emphysema

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6
Q

Smoking –> inflammation + protease-mediated damage

A

CENTRIACINAR emphysema in UPPER lobe

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7
Q

Inflammation in the lungs normally leads to

A

release of proteases by neutrophils and macrophages

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8
Q

Alpha-1-antitrypsin normally …

A

neutralizes proteases

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9
Q

Lack of anti-protease leaves the air sacs vulnerable to protease-mediated damage; mutated protein accumulates in the ER of hepatocytes (pink, PAS+ globules on biopsy_–> cirrhosis; due to PiZ mutation

A

Alpha-1-antitrypsin deficiency –> PANACINAR emphysema in LOWER lobes

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10
Q
  1. Dyspnea + cough with minimal sputum
  2. Prolonged expiration w/ pursed lips (“pink puffers”)
  3. Weight loss
  4. Increased AP diameter of chest (“barrel chest”)
  5. Hypoxemia due to destruction of capillaries in the alveolar sac and cor pulmonale are late complications
A

Emphysema

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11
Q

Type I HS –> reversible AW bronchoconstriction

A

Atopic asthma

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12
Q

Allergens –> TH2 –> IL4 + IL5 + IL10

Re-exposure –> IgE mediated activation of mast cells –> release of preformed histamine granules + LTC4, LTD4, LTE4 –> bronchoconstriction, inflammation and edema

A

Asthma (early phase reaction)

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13
Q

Mediates class switch to IgE

A

IL-4

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14
Q

Attracts eosinophils

A

IL-5

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15
Q

Stimulates TH2 cells and inhibits TH1

A

IL-10

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16
Q

Asthma: Allergens –> TH2 –> ?

A

IL4, IL5, IL10

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17
Q

Inflammation, especially MAJOR BASIC PROTEIN derived from eosinophils, damages cells and perpetuates bronchoconstriction

A

Late-phase reaction

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18
Q 
Curschmann spirals (spiral-shaped mucus plugs)
Charcot-Leyden crystals (eosinophil-derived)
A

Asthma

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19
Q

Besides allergens, what else can provoke asthma

A
  1. Exercise
  2. Viral infxn
  3. Aspirin (NASAL POLYPS)
  4. Occupational exposures
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20
Q

Permanent dilatation of bronchioles and bronchioles and bronchi; loss of airway tone results in air trapping; due to necrotizing inflammation with damage to airway walls.

A

Bronchiectasis

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21
Q

Causes of bronchiectasis include:

A
  1. CF
  2. Kartagener syndrome
  3. Tumor or foregoing body
  4. Necrotizing inflection
  5. Allergic bronchopulmonary aspergillosis (ABPA)
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22
Q

What is Kartagener syndrome?

A

Inherited defect of the dynein arm, which is necessary for ciliary movement –> sinus, infertility (poor motility of sperm), + situs inversus

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23
Q

Cough, dyspnea, foul-smelling sputum –> hypoxemia w/ cor pulmonale + secondary amyloidosis

A

Bronchiectasis

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24
Q

Characterized by restrictive filling of the lungs; decreased TLC, FEV1, FVC; increased FEV1: FVC ratio; most commonly due to interstitial diseases of the lung; may also arise with chest wall abnormalities (obesity)

A

Restrictive pulmonary dz

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25
Cyclical lung injury --> TGF-Beta from injured pneumocytes --> Fibrosis of lung interstitium
Idiopathic pulmonary fibroiss
26
What are the secondary clauses of interstitial fibrosis?
1. Bleomycin 2. Amiodarone 3. Radiation therapy
27
Diffuse fibrosis on CT with end-stage honeycomb lung
Idiopathic pulmonary fibrosis
28
Treatment for pulmonary fibrosis?
Transplant
29
Interstitial fibrosis due to chronic exposure to small particles that are fibrogenic --> alveolar macrophages engulf foreign particles that induce fibrosis
Pneumoconioses
30
Massive exposures leads to diffuse fibrosis ("black lung") associated with rheumatoid arthritis (Caplan syndrome)
Coal Workers' Pneumoconiosis (exposure to carbon dust)
31
Mild exposure to carbon results in WHAT? (collections of carbon laden macrophages that are not clinically significant)
Anthracosis
32
Fibrotic nodules in upper lobes of the lung; leads to impaired phagolysosome formation by macrophages + increased risk for TB
Silicosis (seen in sandblasters and silica miners)
33
Noncaseating granulomas in the lung, lilac lymph nodes, and systemic organs --> increased risk for lung cancer
Berylliosis, seen in beryllium miners and workers in the aerospace industry
34
Fibrosis of lung and pleura (plaques) with increased risk for lung carcinoma (MORE COMMON) and mesothelioma; lesions may contain long, golden brown fibers with associated iron (ferruginus body) which confirm exposure
Asbestosis
35
Noncaseating granulomas + hilar lymphadenopathy in an African American female due to CD4+ helper T cell response to an unknown antigen --> restrictive lung disease;
Sarcoidosis
36
Uveitis Cutaneous nodules or erythema nodosum Dry eyes / mouth (salivary + lacrimal glands) Restrictive lung disease
Sarcoidosis
37
- Dyspnea or cough (most common presenting sx) - Elevated serum ACE - Hypercalcemia (1-alpha hydroxyls activity of EPITHELIOD HISTIOCYTES (diagnostic) converts vitamin D to its active form) - Stellate inclusions ("asteroid bodies") are often seen w/i giant cells of the granulomas
Sarcoidosis
38
Treatment for sarcoidosis
Steroids, but often resolves spontaneously
39
Granulomatous rxn to inhaled organic antigens (e.g. pigeon-breeder's lung); presents with fever, cough, and dyspnea hours after exposure; resolves w. removal of the exposure (chronic exposure --> interstitial fibrosis)
Hypersensitivity pneumonitis
40
Definition of pulmonary HTN
MAP > 25 (normal is 10)
41
Characterized by atherosclerosis of the pulmonary trunk, smooth muscle hypertrophy of pulmonary arteries, and intimal fibrosis; leads to right ventricular hypertrophy with eventual cor pulmonale
Pulmonary HTN
42
PLEXIFORM LESIONS
Pulmonary HTN
43
Saddle emboli
sudden death
44
Classically seen in young adult females; some familial forms related to INACTIVATING mutation in BMPR2 --> proliferation of vascular smooth muscle
Primary pulmonary HTN
45
Due to hypoxemia or increased volume in the pulmonary circuit; may also arise with recurrent PE
Secondary pulmonary HTN
46
Diffuse damage to the alveolar-capillary interface -- leakage of protein-rich fluid --> edema that combines with necrotic epithelial cells to form HYALINE MEMBRANES
ARDS
47
"White out" on x ray (diffuse alveolar collapse on expiration)
ARDS
48
Hypoxemia and cyanosis with respiratory distress due to thickened diffusion barrier and collapse of air sacs (increased surface tension)
ARDS
49
Activation of neutrophils in ARDS induces protease- and free radical mediated damage of
type I and type II pneumocytes
50
Respiratory distress due to inadequate surfactant levels
Neonatal RDS
51
What produces surfactant?
Type II pneumocytes; phosphatidylcholine (lecithin) is the major component
52
Components of surfactant
Lecithin (phosphatidylcholine) and sphingomyelin --> L:2 ratio > 2 = mature lungs
53
Risk factors for NRDS
``` Prematurity C-section delivery (steroids increase synthesis and release of surfactant) Maternal diabetes (insulin decreases surfactant) ```
54
Increased respiratory distress after birth, tachypnea w/ use of accessory muscles; grunting; hypoxemia + cyanosis; diffuse granular ("ground glass") appearance on CXR
NRDS
55
Hypoxemia in infant w/ NRDS increases risk of:
persistence of PDA | necrotizing enterocolitis
56
Supplemental O2 given to infant w/ NRDS
Blindness
57
Lung damage w. NRDS
Bronchopulmonary dysplasia
58
Most common cancers by incidence
1. Breast/prostate 2. Lung 3. Colorectal
59
Key risk factors for lung caner
Cigarettes, radon, asbestos
60
Coin-lesion on xray
1. Granuloma 2. Bronchial hamartoma 3. Small cell 4. Non-small cell The firs thing you should do is review previous CXRs.
61
Surgery does not help which lung cancer?
Small cell
62
Benigh tumor composed of lung tissue and cartilage; often calcified on imaging
Hamartoma
63
Pleural involvement is classically seen with
adenocarcinoma
64
Distended head and neck veins with edema and blue discoloration of arms and face
Superior vena cava syndrome
65
Hoarseness
Involvement of recurrent laryngeal nerve
66
Diaphragmatic paralysis
Involvement of the phrenic nerve
67
What are the mutagenic components of cigarettes?
Polycyclic aromatic hydrocarbons; arsenic;
68
Horner syndrome
Pancoast tumor (apical tumor)
69
Poorly differentiated; arises from neuroendocrine (Kulchisky) cells
Small cell carcinoma
70
Keratin pearls or intercellular bridges
Squamous cell carcinoma
71
Lung cancer: glands or mucin on histology
adenocarcinoma
72
Poorly differentiated large cells (with no keratin bridges intercellular bridges, glands, or mucin)
Large cell carcinoma
73
Columnar cells that grown along preexisting bronchioles and alveoli; arises from Clara cells
Bronchioalveolar carcinoma
74
Well differentiated neuroendocrine cells; chromogranin positive
Carcinoid tumor
75
Multiple "cannon ball" nodules on imaging
Metastasis to lung
76
Lung cancers associated with smoking
Small cell Squamous cell Adenocarcinoma Large cell carcinoma
77
Lung cancers not associated with smoking
Bronchioalveolar carcinoma | Carcinoid tumor
78
Most common tumor in male smokers
Squamous cell carcinoma
79
Another (not the most common) tumor associated with male smokers
Small cell carcinoma
80
Most common tumor in nonsmokers and female smokers
Adenocarcinoma
81
Central tumors
Small cell | Squamous cell
82
Peripheral tumors
Adenocarcinoma | Bronchioalveolar
83
Can be central or peripheral
Large cell | Carcinoid
84
Polyp-like mass in the bronchus
Central carcinoid tumor
85
Rapid growth and early metastasis; may produce ADH or ACTH (Cushing) or cause Eaton-Lambert syndrome
Small cell
86
May produce PTHrP leading to hypercalcemia
squamous cell
87
May present with pneumonia-like consolidation on imaging
Bronchioalveolar
88
Pneumothorax in a tall, thin, young man
Spontaneous pneumothorax due to rupture of emphysematous bleb, trachea shifts towards collapse
89
Pneumothorax following penetrating chest wall injury
Tension pneumothorax; trachea is pushed OPPOSITE to side of injury
90
Trachea shifts away from the pneumothorax
Tension pneumothorax
91
Trachea shifts toward the pneumothoraz
Spontaneous pneumothoraz
92
Highly associated with occupational exposure to asbestos
mesothelioma
93
Recurrent pleural effusions, dyspnea, and chest pain
Mesothelioma

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