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Term 5 > Pathophys: Pulm > Flashcards

Pathophys: Pulm Flashcards

1
Q

DDX Cough

A

Asthma, post-nasal drip, GERD, bronchitis/PNA, TB, COPD, foreign body, cancer

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2
Q

What is the screening recommendation for smokers with > 30 pack years aged 55-74?

A

CT screening

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3
Q

Name several risk factors for lung cancer that act synergystically with smoking.

A

Asbestos, uranium miners

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4
Q

Type of lung cancer associated with a scar…

A

Adenocarcinoma

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5
Q

Hemoptysis, dyspnea, chest pain, Virchow’s node in a smoker…

A

Lung ca

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6
Q

Name several local symptoms of lung cancer

A

PNA, Horner’s (inferior cervical ganglion), SVC syndrome, RLN (L), phrenic nerve involvement, pleural effusion, pericardial invovlement, pleural involvement, chest wall/vertebral bodies

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7
Q

Horner’s syndrome

A

Inferior cervical ganglion: ptosis, miosis, anhydrosis

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8
Q

Sites of mets of lung cancer.

A

Adrenal, bone, brain, liver

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9
Q

Which type of lung cancer is most associated with PTH paraneoplasm?

A

Squamous cell carcinoma

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10
Q

Diagnostic options in lung cancer.

A

Old films, bronchoscopy, needle biopsy, surgical resection, watchful waiting, PET scan

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11
Q

Most lung cancers arise from… (anatomic location)

A

Bronchial epithelium near the hilum

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12
Q

Best prognosis among lung cancers… (type of ca)

A

Squamous cell

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13
Q

What subtype of adenocarcinoma can present with a air-fluid bronchogram on CT?

A

Bronchoalveolar

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14
Q

Differentiate between limited and extensive small cell lung cancer.

A

Limited: one side of chest & regional LN’s
Extensive: all other

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15
Q

What are the 4 stages of NSCLC?

A

I: single mass

2: single mass with LN
3: Invasion important sx
4: Mets

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16
Q

Pathogenesis of pulmonary infections: step 1

A 
Entry
Aspiration: S. pna
Inhalation: MTb, viral
Inoculation: contam
Colonization: COPD
Heme spread: sepsis
Direct spread: abscess
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17
Q

Acute cough illness that has been present for less than 3 weeks. Majority viral/bacterial? Culprits?

A

Acute bronchitis; viral

. Influenza, M. pna, C. pna, B. pertussis

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18
Q

3 stages of B. pertussis clinical course

A
  1. Catatarrhal phase- early/indisting from viral
  2. Paroxysmal phase- bursts
  3. Convalescent phase- resolves over 2-3 weeks
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19
Q

Definition of PNA

A

Inflammation of the lung, resulting in consolidation due to exudate within the lung tissue and airspaces

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20
Q

Which type of PNA is patchy and which type is confluent in distribution?

A

BronchoPNA: patchy
Lobar: confluent

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21
Q

Most common organism to present as lobar PNA.

A

S. pna (can also present as bronchopna)

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22
Q

Common organisms in aspiration PNA.

A

S. pna, H. flu, anaerobes, hospitalized: Pseudomonas, S. aureus

23
Q

Key pathogens of CAP vs. ICU patients

A

S. pna, viral, M. pna, H. flu, C. pna, Legionella, unknown (ICU: Legionella, GNR, S. aureus)

24
Q

The best procedure to visualize Legionella (aside from urinary Ag)

A

Sputum direct fluorescent Ab test

25
Q

In which type of patient is a TB skin test of 5 mm considered indicative of latent TB?

A

HIV patient

26
Q

Are people with TB infection, but no disease, infectious?

A

No

27
Q

What aspect of TB stimulates the cell-mediated immune response?

A

Waxy cell wall rich in mycolic acids

28
Q

What are the 2 virulence factors of TB

A

Waxy cell coat, Cord factor (inhibits phagosome-lysosome fusion)

29
Q

The most useful/specific test for latent TB infection:

A

IFN-gamma release assay

30
Q

Tuberculin reaction > 5mm postitive in:

A

HIV, close contacts, +CXR, IVDU, IS/steroids

31
Q

Tuberculin reaction > 10mm postitive in:

A

IVDU (HIV-), medically underserved, young children

32
Q

Tuberculin reaction > 10mm postitive in:

A

All people with no known risk factors for TB

33
Q

Emergence of MDR-TB has resulted from…

A

Monotherpay, errors in diagnosis, non-complicance

34
Q

Pathophysiology of wheezing

A

Bronchial hyper-responsiveness, inflammation of airways, mucus hypersecretion

35
Q

Difference between polyphonic & monophonic wheezing.

A

Polyphonic: most common
Monophonic: single airway obstruction

36
Q

DDX Wheezing

A

Asthma, COPD, infection, CHF, tumor, foreign object, PE, aspiration

37
Q

Pathogenesis of asthma involves these immune cells

A

CD4+ cells & eosinophils (reversible)

38
Q

Pathogenesis of COPD involves these immune cells

A

CD8+ cells & PMN’s

39
Q

T/F Lipoxygenase produces lead to airway hyperresponsiveness, secretion, microvascular leakage.

A

True

40
Q

Which cytokine recruits eosinophils?

A

IL-5

41
Q

What is Poiseuille’s law?

A

R (resistance) is proportional to 1/R^4

42
Q

How do asthmatics become hypoxemic?

A

Blood is shunted away from obstructed alveoli.

43
Q

The 3 most important measurements in spirometry.

A

FEV1, FVC, FEV1:FVC

44
Q

A positive bronchodilator response is defined as…

A

FVC, FEV1 improve by at least 12%.

45
Q

An extrathoracic obstruction impacts inspiration or expiration?

A

Inspiration

46
Q

An intrathoracic obstruction impacts inspiration or experiation?

A

Expiration

47
Q

Emphysema is caused by….

A

Dynamic or fixed airway narrowing/blockage

48
Q

Chronic bronchitis is caused by…

A

Impaired ciliary function

49
Q

Which type of emphysema is associated with smoking vs. A1At deficiency?

A

Smoking: centrilob (apical)
A1AT: panacinar (base)

50
Q

Bronchiectasis

A

Irreversible destruction of distal airways 2/2 poor secretion clearance and resultant chronic airway inflammation

51
Q

The cause of irreversible damage in emphysema.

A

Fibrosis and narrowing of the airways; loss of elastic recoil due to alveolar destruction

52
Q

Is DLCO normal in asthma?

A

Yes

53
Q

Is bronchodilator reversibility positive in emphysema?

A

No

54
Q

Is DLCO decreased in parenchymal disease vs. NM disease?

A

Parenchymal

Term 5 (9 decks)

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