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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
In which type of patient is a TB skin test of 5 mm considered indicative of latent TB?
HIV patient
26
Are people with TB infection, but no disease, infectious?
No
27
What aspect of TB stimulates the cell-mediated immune response?
Waxy cell wall rich in mycolic acids
28
What are the 2 virulence factors of TB
Waxy cell coat, Cord factor (inhibits phagosome-lysosome fusion)
29
The most useful/specific test for latent TB infection:
IFN-gamma release assay
30
Tuberculin reaction > 5mm postitive in:
HIV, close contacts, +CXR, IVDU, IS/steroids
31
Tuberculin reaction > 10mm postitive in:
IVDU (HIV-), medically underserved, young children
32
Tuberculin reaction > 10mm postitive in:
All people with no known risk factors for TB
33
Emergence of MDR-TB has resulted from...
Monotherpay, errors in diagnosis, non-complicance
34
Pathophysiology of wheezing
Bronchial hyper-responsiveness, inflammation of airways, mucus hypersecretion
35
Difference between polyphonic & monophonic wheezing.
Polyphonic: most common Monophonic: single airway obstruction
36
DDX Wheezing
Asthma, COPD, infection, CHF, tumor, foreign object, PE, aspiration
37
Pathogenesis of asthma involves these immune cells
CD4+ cells & eosinophils (reversible)
38
Pathogenesis of COPD involves these immune cells
CD8+ cells & PMN's
39
T/F Lipoxygenase produces lead to airway hyperresponsiveness, secretion, microvascular leakage.
True
40
Which cytokine recruits eosinophils?
IL-5
41
What is Poiseuille's law?
R (resistance) is proportional to 1/R^4
42
How do asthmatics become hypoxemic?
Blood is shunted away from obstructed alveoli.
43
The 3 most important measurements in spirometry.
FEV1, FVC, FEV1:FVC
44
A positive bronchodilator response is defined as...
FVC, FEV1 improve by at least 12%.
45
An extrathoracic obstruction impacts inspiration or expiration?
Inspiration
46
An intrathoracic obstruction impacts inspiration or experiation?
Expiration
47
Emphysema is caused by....
Dynamic or fixed airway narrowing/blockage
48
Chronic bronchitis is caused by...
Impaired ciliary function
49
Which type of emphysema is associated with smoking vs. A1At deficiency?
Smoking: centrilob (apical) A1AT: panacinar (base)
50
Bronchiectasis
Irreversible destruction of distal airways 2/2 poor secretion clearance and resultant chronic airway inflammation
51
The cause of irreversible damage in emphysema.
Fibrosis and narrowing of the airways; loss of elastic recoil due to alveolar destruction
52
Is DLCO normal in asthma?
Yes
53
Is bronchodilator reversibility positive in emphysema?
No
54
Is DLCO decreased in parenchymal disease vs. NM disease?
Parenchymal

Term 5 (9 decks)

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