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Pathoma > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

most common cause of rhinitis

A

adenovirus

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2
Q

mechanism of allergic rhinitis

A

type 1 hypersensitivity reactions

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3
Q

child with nasal polyps, think…..

A

cystic fibrosis

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4
Q

aspirin intolerant asthma can develop….

A

nasal polyps

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5
Q

angiofibroma

A
  • adolescent males

- profuse epistaxis

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6
Q

nasopharyngeal carcinoma

A
  • EBV driven
  • Chinese adult or African children
  • pleomorphic keratin-positive epithelial cells in background of lymphocytes
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7
Q

acute epiglottitis

A
  • H. flu in all children
  • massive inflammation
  • fever, sore throat, drooping, muffled voice, inspiratory stridor
  • *airway obstruction
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8
Q

laryngotracheobronchitis (croup)

A
  • parainfluenza virus

- hoarse barking cough and inspiratory stridor

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9
Q

laryngeal papilloma

A
  • HPV 6/11
  • benign tumor of vocal cords
  • single in adult, bilateral in children
  • can progress to carcinoma
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10
Q

risk factors for laryngeal carcioma

A

alcohol and tobacco

- hoarseness, cough and stridor

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11
Q

three types of pneumonia chest x rays

A
  • lobar
  • bronchopneumonia
  • interstitial pneumonia
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12
Q

two most common causes of lobar pneumoia

A

s. pneumoniae (community acquired) and klebsiella (aspirated enteric flora)

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13
Q

common causes of bronchial pneumonia

A
  • staph = secondary pneumonia
  • h flu = secondary pneumonia in COPD
  • pseudomonas = cystic fibrosis
  • moraxella = over COPD
  • legionella = over COPD or in HIV, silver stain
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14
Q

atypical pneumonia causes

A
  • mycoplasma = young adults, hemolytic anemia IgM, no gram stain
  • chlamydia
  • RSV = infants
  • CMV = immunosuppression
  • influenza = secondary (not killed by flu)
  • coxiella = farmers and vets, high fever (Q), spores
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15
Q

causes of aspiration penumonia

A

anaerobic bacteria, right lower lobe (easier to go down)

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16
Q

primary TB

A
  • focal caseating necrosis in lower lobe
  • fibrosis and calcification (Ghon complex), subpleural
  • usually asymptomatic
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17
Q

secondary TB

A
  • due to AIDS or aging
  • at apex of lung (oxygen tension)
  • cause bronchopneumonia
  • red acid fast bacilli
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18
Q

high yield tissue of TB

A
  • meningitis at base of brain
  • bone (Pott disease)
  • kidney (sterile)
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19
Q

physiology of airway obstruction

A
  • low FVC, low FEV
  • low FEV:FVC ratio**
  • high TLC
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20
Q

chronic bronchitis

A
  • productive cough for at least 3 months for minimum of 2 years
  • ***smoking
  • overproduce mucus due to toxins (>50% Reid index)
  • increased infection
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21
Q

emphysema

A
  • destruction of alveolar air sacs
  • loss of elastic recoil
  • collapse of smaller airways, air trapping
  • imbalance of protease and antiproteases
  • caused by smoking due to inflammation and toxins
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22
Q

smoking emphysema

A
  • centriacinar emphysema

- more severe in upper lobes (smoke goes up)

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23
Q

alpha 1 anti-trypsin deficiency

A
  • panacinar emphysema
  • lower lobes
  • liver cirrhosis = misfolded protein in liver builds up
  • PAS positive staining globules
  • PiZ is mutation, PiM is normal
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24
Q

pink puffer

A
  • prolonged expiration with pursed lips
  • weight loss
  • increased AP diameter (barrel-chest)
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25
Q

asthma pathogenesis

A
  • usually type 1 HSR
  • history of atopy
  • TH2 in CD4 - IL4, IL5, IL10
  • IL4- IgE
  • IL5 - eosinophils
  • IL10 - TH2 cells
  • reexposure = mast cell activation
  • histamine = arteriolar vasodilation and venous permeability
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26
Q

pathological findings in asthma

A
  • curschmann spirals

- Charcot-Leyden crystals (aggregates of major basic protein)

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27
Q

nonallergic causes of asthma

A
  • exercise
  • ***aspirin (nasal polyps)
  • viral
  • occupational exposures
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28
Q

bronchiectasis

A
  • dilation of upper airways leads to loss of tone and air trapping
29
Q

causes of bronchiectasis

A
  • CF = leads to damage of airways
  • kartagener syndrome = dynein arm in cilia leading to lung infection
  • foreign body
  • necrotizing infection
  • allergic bronchopulmonary aspergillosis (asthmatics and CF patients)
30
Q

principles of restricted disease

A

cant fill lung

  • lower TLC
  • low FVC, low FEV1
  • higher FEV1:FVC ratio
  • increased in elastic recoil due to fibrosis
31
Q

idiopathic pulmonary fibrosis

A
  • fibrosis of interstitium
  • cyclical lung injury
  • healing from TGF-beta
  • other cause must be excluded
32
Q

fibrosis pathologically is called…

A

honeycombing

33
Q

pneumoconioses

A

occupational exposure

  • small particles
  • mediated by macrophages
  • fibrogenic
  • chronic exposure
34
Q

coal workers pneumoconiosis

A
  • carbon in macrophages
  • massive fibrosis
  • black lung
  • shrunken
  • associated with RA** (Caplan syndrome)
35
Q

silicosis

A
  • silica from sandblasters
  • upper lobes
  • only one at risk for TB***
  • impaired phagolysosome in macrophages
36
Q

anthracosis

A

build up of carbon in lungs, not a big problem, common

37
Q

berylliosis

A

beryllium in miners and aerospace

  • noncaseating granulomas in lung and other organs
  • very similar to sarcoidosis
  • increased in lung cancer
38
Q

asbestosis

A

shipyard workers

  • fibrosis in lung/pleura
  • way more likely to get carcinoma*** but can get mesothelioma
  • asbestos bodies with iron deposits
39
Q

sarcoidosis

A
  • granulomas (noncaseating)
  • CD4 and unknown antigen
  • epithelioid histiocyte
  • black females
  • asteroid body
  • hilar lymph node leading to restrictive lung disease
  • elevated serum ACE**
  • hypercalcemia due to 1 alpha hydroxylase
40
Q

hypersensitivity pneymonitis

A
  • granulomatous reaction to antigen
  • better with removal
  • chronic = interstitial fibrosis
  • eosinophils are associated
41
Q

pleura is lined by….

A

mesothelial cells

42
Q

spontaneous pneumothorax

A

usually caused by rupture of emphysematous bleb

- trachea shifts to side of bleb

43
Q

definition of pulmonary hypertension

A

above 25

44
Q

characteristics of pulmonary hypertension

A
  • atherosclerosis
  • smooth muscle hypertrophy
  • intimal fibrosis
  • **plexiform lesions - groups of capillaries together
45
Q

primary hypertension

A
  • idiopathic, young females

- seen in BMPR2** (proliferation of vascular smooth muscle)

46
Q

BMPR2

A

mutation in primary hypertension

47
Q

causes of secondary pulmonary hypertension

A
  • hypoxemia
  • increase volume
  • recurrent pulmonary embolism
48
Q

ARDS

A
  • damage to capillary/alveolar membrane
  • hyaline change***
  • thick diffusion barrier
  • diffuse collapse of lung with no gas exchange
49
Q

cells damaged in ARDS

A

type 1/2 pneumocytes

50
Q

treatment of ARDS

A

ventilation with PEEP - keep the lung open to decrease stress

51
Q

why do you get interstitial fibrosis in ARDS?

A

loss of type 2 pneumocytes

52
Q

xray findings in children respiratory distress

A

diffuse granularity

53
Q

how to screen for surfactant production

A

L:S ratio, lecithin increases

54
Q

major component of surfactant

A

phosphatitdylcholine

55
Q

inhibitor of surfactant production

A

insulin - why its seen in mothers with diabetes

56
Q

complications of children respiratory distress

A

PDA stays open, NEC, free radical injury from oxygen

57
Q

what to do when you see solitary nodule on xray

A

compare to xrays in the past

58
Q

benign lung lesions

A
  • granuloma (TB, or histoplasmosis

- bronchial hamartoma (too much cartilage - calcified)

59
Q

small cell carcinoma

A
  • no surgery (too small)
  • treated with chemo
  • poorly differentiated neuroendocrine tumor
  • smokers
  • central
  • ADH, ACTH or Eaton Lambert syndrome
60
Q

small cell/squamous mnemonic

A

S=small so smokers, central, syndrome (paraneoplastic)

61
Q

squamous cell carcinoma

A
  • keratin pearl or intercellular bridges
  • smokers and central
  • parathyroid hormone production
62
Q

adenocarcinoma

A
  • glands or mucin
  • female and nonsmokers
  • peripheral
  • no syndrome
63
Q

large cell carcinoma

A
  • none of the other stuff
  • poor prognosis
  • can be anywhere
64
Q

bronchioloalveolar carcinoma

A
  • from Clara cells
  • grows along bronchioles and alveoli
  • peripheral
  • present with pneumonia like consolidation
  • excellent prognosis
65
Q

carcinoid tumor

A
  • **chromogranin positive
  • neuroendocrine tumor
  • no smoking
  • classically polyp in bronchus
  • not usually carcinoid syndrome
66
Q

most common sources of breast metastasis

A

breast and colon

67
Q

special site for lung metastasis

A

adrenal gland

68
Q

most common tumor with pleural involvement

A

adenocarcinoma because it is usually peripheral

Pathoma (11 decks)

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