PULMONARY Flashcards by megan king

benign
lung tissue + cartilage
calcified on imaging

bronchial hamartoma

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list subtypes (4) of non-small cell carcinoma

adenocardinoma
squamoud cell carcinoma
large cell neuroendocrine carcinoma
carcinoid tumour

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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

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what is a unique site of distant metastasis of primary lung carcinoma

adrenal gland

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lung cancer causing horseness is likely affecting

recurrent laryngeal nerve

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lung cancer at apex
ptosis
miosis
anhidrosis

pancost tumour
(apex of lung)

Horner syndrome - SNS chain involvement

affected by lung cancer

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what mutations (2) may be present in adenocarcinoma of lung

EGFR
ALK translocation

common non-smoking asian females

EGFR = tyrosine kinase receptor

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what lung cancer subtypes affect male smokers, are located centrally and posess paraneoplastic syndromes

SCLC
SCC (squamous)

SCLC - LEMs, ADH, ACTH
SCC - PTHrP

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what group of persons is adenocarcinoma of lung most seen in

female non-smokers

EFGR mutation association - asian non-smoking females

cancer located peripherally

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male
smoker
mitotic changes
necrosis
poorly differentiated small cells
chromogranin (+)
LEMs

SCLC

PNP syndrome - also ADH, ACTH

central location
male smokers
small cells

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male
smoker
hypercalcaemia

SCC
(squamous cell carcinoma)

keratin pearls
intercellular bridges

central
male smoker
PNP syndrome - PTHrP

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glands
mucin
nonsmoker
female
peripheral tumor
pneumonia-like consolidation

adenocarcinoma lung

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lepidic pattern
columnar cells along preexisting brtonchioles/aveoli
peripheral
pneumonia-like consolidation
good prognosis

adenocarcinoma in situ = bronchioalveolar carcinoma

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what lung cancer is determined by diagnosis of exclusion

large cell neuroendocrine carcinoma

smoking
central or perihpheral

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well differentiated
neuroendocrine cell nests
chromogranin (+)
polyp like

carcinoid tumour

can cause carcinoid syndrome
central = polyp-like
peripheral

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flushing
diarrhoea
abdominal pain
wheezing
tumour

carcinoid syndrome

serotonin secreting - can be from carcinoid tumour (rare)
Tx with so

but common on exam Q

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2 causes of emphysema

smoking
a-1 antitrypsin deficiency
*
(imbalance proteases:antiproteases)*

centriacinar - smoking - UL
panacinar - a-1 AT - LL

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centriacinar and panacinar emphysema affects which parts of the lung

centriacinar = UL (smoking)
panacinar = LL (a-1 AT)

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cause of a1-AT deficiency

misfolding of mutated protein

ccumulates in endoplastic reticulum of hepatocytes –> liver damage

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what marker is seen in a-1 AT

PAS (+)

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what is the function of a-1 AT

neutralises proteases

deficiency a-1 AT = increased proteases (inflammation)

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what is the PiM allele in a-1 AT

normal
(PiM or PiMM)

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what allele mutation is associated with low levels of a-1 AT

PiZ

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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** ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote normal A-a gradient = 10mmHg (physiologic shunt) **hypoventilation** causing CO2 retention = normal A-a gradient as *decreased gas exchange, but**no** disruption to diffusion or perfusion*

difuse wheeze dry cough dyspnoea tachycardia, tachypnoea prolonged expiration decreased tactile fremitis URTI common trigger in children

astha exacerbation ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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)

main cause of penumonia (CAP)

streptococcus penumoniae (gram positive cocci in pairs) | also main cause of **pneumonia + pericardial effusion** ## Footnote by direct spread or haematogenous spread pleural effusion, empyema or bacteremia

enlarged airspaces with macrophage predominant infiltrates

centriacinar emphysema

environmental irritant exposure lymphocyte predominant interstitital inflammation non-necrotising granulomas

hypersensitivity pneumonitis

acute exaccerbation causes of COPD (Infectious) | AECOPD ## Footnote 3 viral / 3 bacterial

**3 viral:** rhinovirus influenza RSV **3 bacterial:** haemophylis influenza (non-typable) moraxella catarrhalis strep pneumo ## Footnote **staph aureus:** follows **viral** respiratory ifnection i.e. **postinfuenza**