PULMONARY Flashcards
benign
lung tissue + cartilage
calcified on imaging
bronchial hamartoma
list subtypes (4) of non-small cell carcinoma
adenocardinoma
squamoud cell carcinoma
large cell neuroendocrine carcinoma
carcinoid tumour
seen in
small cell carcinoma
(lung)
mitotic activity
poorly differentiated small cells
smoking
sentral tumour (central)
syndromes - paraneoplastic (ADH, ACTH, LEMs) - lambert eaton
Tx with chemotherapy
what is a unique site of distant metastasis of primary lung carcinoma
adrenal gland
lung cancer causing horseness is likely affecting
recurrent laryngeal nerve
lung cancer at apex
ptosis
miosis
anhidrosis
pancost tumour
(apex of lung)
Horner syndrome - SNS chain involvement
affected by lung cancer
what mutations (2) may be present in adenocarcinoma of lung
EGFR
ALK translocation
common non-smoking asian females
EGFR = tyrosine kinase receptor
what lung cancer subtypes affect male smokers, are located centrally and posess paraneoplastic syndromes
SCLC
SCC (squamous)
SCLC - LEMs, ADH, ACTH
SCC - PTHrP
what group of persons is adenocarcinoma of lung most seen in
female non-smokers
EFGR mutation association - asian non-smoking females
cancer located peripherally
male
smoker
mitotic changes
necrosis
poorly differentiated small cells
chromogranin (+)
LEMs
SCLC
PNP syndrome - also ADH, ACTH
central location
male smokers
small cells
male
smoker
hypercalcaemia
SCC
(squamous cell carcinoma)
keratin pearls
intercellular bridges
central
male smoker
PNP syndrome - PTHrP
glands
mucin
nonsmoker
female
peripheral tumor
pneumonia-like consolidation
adenocarcinoma lung
lepidic pattern
columnar cells along preexisting brtonchioles/aveoli
peripheral
pneumonia-like consolidation
good prognosis
adenocarcinoma in situ = bronchioalveolar carcinoma
what lung cancer is determined by diagnosis of exclusion
large cell neuroendocrine carcinoma
smoking
central or perihpheral
well differentiated
neuroendocrine cell nests
chromogranin (+)
polyp like
carcinoid tumour
can cause carcinoid syndrome
central = polyp-like
peripheral
flushing
diarrhoea
abdominal pain
wheezing
tumour
carcinoid syndrome
serotonin secreting - can be from carcinoid tumour (rare)
Tx with so
but common on exam Q
2 causes of emphysema
smoking
a-1 antitrypsin deficiency
*
(imbalance proteases:antiproteases)*
centriacinar - smoking - UL
panacinar - a-1 AT - LL
centriacinar and panacinar emphysema affects which parts of the lung
centriacinar = UL (smoking)
panacinar = LL (a-1 AT)
cause of a1-AT deficiency
misfolding of mutated protein
ccumulates in endoplastic reticulum of hepatocytes –> liver damage
what marker is seen in a-1 AT
PAS (+)
what is the function of a-1 AT
neutralises proteases
deficiency a-1 AT = increased proteases (inflammation)
what is the PiM allele in a-1 AT
normal
(PiM or PiMM)
what allele mutation is associated with low levels of a-1 AT
PiZ
what allele mutation is associated with increased risk of emphysema with smoking
PiMZ
what allele mutation is associated with increased risk of panacinar emphysema and cirrhosis
PiZZ
a Ried index of >50% is seen in
chronic bronchitis
hypertrophy of bronchial mucous glands
smoking
productive cough
cyanosis
chronic bronchitis
produceive cough lasting >3 months over min of 2 years
what induces fibrosis in idiopathic pulmonary fibrosis
TGF-B (tissue healing factor)
injured pneumocytes induce fibrosis
what drugs induce pulmonary fibrosis
Methotrexate
nitrofurantoin
carmustine
bleomycin
busulfan
amiodarone
progressive dyspnoea, cough
subpleural bilateral fibrosis
honey combing
interstitial pulmonary fibrosis
what induces fibrosis in pneumoconioses
alveolar macrophages
engulf partciles and induce fibrosis
small particles
AA female
non-caseating granulomas
hilar LN
uveitis
dry mough/eyes
erythema nodosum
sarcoidosis
increased serum ace
hypercalcaemia
DxDx - berylliosis (same s/s but JOB = aerospace, beryllium miner)
how does hypercalcaemia in sarcoidosis or berylliosis occur
non-caseating granulomas posess 1-a hydroxylase activity of epithyloid histiocytes
convert vitamin D to active form -> calcium reabsorption
type of granuloma in sarcoidosis
non-caseating
1-a hydroxylase activity –> hypercalcaemia
also occurs in berylliosis (non-caseating)
caplan syndrome is what and related to what
rheumatoid arhtritis in coal workers pneumoconiosis
anthracosis
carbon laden macrophages
coal workers pneumoconiosis
silicosis occurs in what part of lung, and has increased risk for what condition
upper lung
TB
how does silicosis affect the lung
impairs phagolysosome formation by macrophages
asbestosis can be seen in
construction
plumbers
shipyard workers
abestos causes fibrosis or carcinoma of
lung and pleura
carcinoma of pleura = mesothelioma
lung carcinoma MORE COMMON than mesothelioma
seen in
(asbestos bodies)
ferruginous bodies
asbestosis
brown with iron deposits
granulomatous reaction
pigeon breeder
hypersensitivity pneumonitis
affects upper acinar
smokers, coal miners
___acinar
centriacinar
affects entire acinus
lower zones
a1-AT deficiency
___acinar
panacinar
hypoxaemia
respiratory acidosis (from CO2 retention)
normal alveolar-arterial gradient
respiratory depression
(hypoventilation)
i.e. barbituates
normal A-a gradient = 10mmHg (physiologic shunt)
hypoventilation causing CO2 retention = normal A-a gradient as decreased gas exchange, butno disruption to diffusion or perfusion
difuse wheeze
dry cough
dyspnoea
tachycardia, tachypnoea
prolonged expiration
decreased tactile fremitis
URTI common trigger in children
astha exacerbation
chest RADs normal
pulmonary function tests normal (between epsides)
obstructive (during episode)
decreased tactile fremitis - air trapping (obstructive)
m/c cause pneumococcal pneumonia
strep pneumoniae
fever
dyspnoea
productive cough
pleuritic chest pain
consolidation;
increased tactiel fremitis
how is COPD best evaluated (test)
spirometry
decreased breath sounds
prolonged expiration
distant heart sounds
FEV1 65%
FVC 90%
FEV1/FVC 60%
COPD
FEV1/FVC <80%
tachycardia
hypotension
JVD
pulsus paradoxus
muffled heart sounds
S3, S4 gallop
cardiac tamponade
malaise
dyspnoea
nonproductive cough
pleuritic chest pain
tachypnoea
pulmonary crackles
pleural rub
recent radiation
radiation pneumonitis
late stges - contraction and fibrois (atelectasis)
collapse and deflation of pulmonary alveoli
atelectasis
contraction
ARDS is characterised by
pulmonary capillary leakage
i.e. caused by e coli –> sepsis –> ALI –> ARDS
sepsis most comon
Sepsis (most common), aspiration pneumonia, burns, trauma, pancreatitis, drowning injuries.
best test to use for recurrent pneumonias in same location
bronchoscopy
(risk of obstructive pneumonia from i.e. tumour)
