pulm Flashcards
MC location and pathogen of rhinosinusitis?
maxillary sinus in adults
viral URI MCC (can get superimposed bacterial infection (S pneumo, H flu, M cat))
MC location of epistaxis?
anterior segment of nostril = Kiesselbach plexus
location of life-threatening epistaxis?
posterior segment - sphenopalatine artery (branch of maxillary artery)
what are lines of Zahn?
alternating areas of pink (platelets, fibrin) and red (RBCs)
found in thrombi formed PRE-mortem only
Reid index?
thickness of gland layer / total thickness of bronchial wall
** chronic bronchitis: Reid index > 50%
centriacinar vs panacinar emphysema?
centriacinar: smoking
panacinar: alpha1 antitrypsin
what are Curschmann spirals?
shed epithelium –> whorled mucus plugs
happens in ASTHMA
what are Charcot Leyden crystals?
eosinophilic hexagonal double-pointed needle-like crystals
formed from breakdown of eos in sputum
happens in ASTHMA
drugs that cause restrictive lung disease?
bleomycin
busulfan
amiodarone
methotrexate
rheumatoid arthritis and pneumoconioses with intrapulmonary nodules?
Caplan syndrome
shipbuilding/roofing/plumbing, ivory white calcified supradiaphragmatic/pleural plaques?
asbestosis
increased incidence of lung ca (bronchogenic > mesothelioma)
LOWER lobes
** asbestos bodies = golden-brown fusiform rods that look like dumbbells
aerospace and manufacturing industries, granulomas?
berylliosis
UPPER lobes
occasionally responsive to steroids
prolonged coal dust exposure?
coal workers’ pneumoconiosis
macrophages laden with carbon –> inflammation and fibrosis
UPPER lobes
anthracosis?
asymptomatic condition found in many urban dwellers exposed to sooty air
foundries/sandblasting/mines, lung fibrosis?
silicosis
silica disrupts phagolysosomes and impairs macrophages –> increased susceptibility to TB
increased risk of bronchogenic carcinoma
UPPER lobes
** eggshell calcification
neonatal respiratory distress syndrome?
surfactant deficiency –> increased surface tension –> alveolar collapse - ground glass
lecithin:sphingomyelin < 1.5
persistently low O2 –> risk of PDA
risks with therapeutic supplemental O2 in NRDS?
retinopathy of prematurity
intraventricular hemorrhage
bronchopulmonary dysplasia
risk factors for NRDS?
prematurity maternal diabetes (increased fetal insulin C-section delivery (decreased fetal glucocorticoid release)
tx of NRDS?
give mom steroids before birth
artificial surfactant after birth
ARDS histologic findings?
intra-alveolar hyaline membranes
mechanism of damage in ARDS?
release of neutrophilic substances toxic to alveolar wall
activation of coag cascade
O2-derived free radicals
histologic findings in pulmonary HTN?
arteriosclerosis
medial hypertrophy
intimal fibrosis
heritable cause of PAH?
inactivating mutation in BMPR2 gene - normally inhibits vascular smooth mm proliferation
categories of pulm HTN?
PAH 2/2 L heart dz 2/2 lung dz/hypoxia 2/2 chronic thromboembolism multifactorial
when does trachea deviate toward lesion?
atelectasis/bronchial obstruction
MCC of lobar PNA?
S pneumoniae
Legionella
Klebsiella
MCC of bronchopneumonia
S pneumo
S aureus
H flu
Klebsiella
MCC of atypical PNA?
viruses
Mycoplasma
Legionella
Chlamydia
MCC of lung abscesses?
anaerobes (Bacteroides, Fusobacterium, Peptostreptococcus)
S aureus
tx of lung abscesses?
clinda
hemorrhagic pleural effusion, pleural thickening, psammoma bodies?
mesothelioma
effects of Pancoast tumor?
Horner’s
SVC syndrome
sensorimotor deficits
hoarseness
facial plethora, neck and upper extremity edema?
SVC syndrome
causes: malignancy (Pancoast), thrombosis from indwelling catheters
** if severe, can raise ICP
paraneoplastic syndrome of small cell lung ca?
ACTH
SIADH
Lambert Eaton
myelitis/encephalitis
gene changes in small cell?
amplification of myc
histology of small cell?
neuroendocrine Kulchitsky cells
small dark blue cells
Chromograinin A +
gene changes of adenocarcinoma of lung?
KRAS
EGFR
ALK
histology of adenocarcinoma of lung?
glandular pattern
mucin +
bronchioalveolar subtype: growth along alveolar septa - look thickened
paraneoplastic syndrome of squamous cell lung ca?
PTHrP –> hypercalcemia
findings in squamous cell lung ca?
hilar mass - arising from bronchus
cavitation
kertain pearls and intercellular bridges
large cell carcinoma of lung can secrete what?
b-HCG
histology of large cell carcinoma of lung?
pleomorphic giant cells
bronchial carcinoid tumor?
sx due to mass effect, occasional carcinoid syndrome
** histo: nests of neuroendocrine cells, chromogranin A +
which lung ca are central?
small cell
squamous cell
which lung ca is inoperable?
small cell
which lung ca is unresponsive to chemo?
large cell ca
