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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
asthma pathogenesis
- 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
26
pathological findings in asthma
- curschmann spirals | - Charcot-Leyden crystals (aggregates of major basic protein)
27
nonallergic causes of asthma
- exercise - ***aspirin (nasal polyps) - viral - occupational exposures
28
bronchiectasis
- dilation of upper airways leads to loss of tone and air trapping
29
causes of bronchiectasis
- 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
principles of restricted disease
cant fill lung - lower TLC - low FVC, low FEV1 - higher FEV1:FVC ratio - increased in elastic recoil due to fibrosis
31
idiopathic pulmonary fibrosis
- fibrosis of interstitium - cyclical lung injury - healing from TGF-beta - other cause must be excluded
32
fibrosis pathologically is called...
honeycombing
33
pneumoconioses
occupational exposure - small particles - mediated by macrophages - fibrogenic - chronic exposure
34
coal workers pneumoconiosis
- carbon in macrophages - massive fibrosis - black lung - shrunken - associated with RA** (Caplan syndrome)
35
silicosis
- silica from sandblasters - upper lobes - only one at risk for TB*** - impaired *phagolysosome* in macrophages
36
anthracosis
build up of carbon in lungs, not a big problem, common
37
berylliosis
beryllium in miners and aerospace - noncaseating granulomas in lung and other organs - very similar to sarcoidosis - increased in lung cancer
38
asbestosis
shipyard workers - fibrosis in lung/pleura - way more likely to get carcinoma*** but can get mesothelioma - asbestos bodies with iron deposits
39
sarcoidosis
- 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
hypersensitivity pneymonitis
- granulomatous reaction to antigen - better with removal - chronic = interstitial fibrosis - eosinophils are associated
41
pleura is lined by....
mesothelial cells
42
spontaneous pneumothorax
usually caused by rupture of emphysematous bleb | - trachea shifts to side of bleb
43
definition of pulmonary hypertension
above 25
44
characteristics of pulmonary hypertension
- atherosclerosis - smooth muscle hypertrophy - intimal fibrosis - **plexiform lesions - groups of capillaries together
45
primary hypertension
- idiopathic, young females | - seen in BMPR2** (proliferation of vascular smooth muscle)
46
BMPR2
mutation in primary hypertension
47
causes of secondary pulmonary hypertension
- hypoxemia - increase volume - recurrent pulmonary embolism
48
ARDS
- damage to capillary/alveolar membrane - hyaline change*** - thick diffusion barrier - diffuse collapse of lung with no gas exchange
49
cells damaged in ARDS
type 1/2 pneumocytes
50
treatment of ARDS
ventilation with PEEP - keep the lung open to decrease stress
51
why do you get interstitial fibrosis in ARDS?
loss of type 2 pneumocytes
52
xray findings in children respiratory distress
diffuse granularity
53
how to screen for surfactant production
L:S ratio, lecithin increases
54
major component of surfactant
phosphatitdylcholine
55
inhibitor of surfactant production
insulin - why its seen in mothers with diabetes
56
complications of children respiratory distress
PDA stays open, NEC, free radical injury from oxygen
57
what to do when you see solitary nodule on xray
compare to xrays in the past
58
benign lung lesions
- granuloma (TB, or histoplasmosis | - bronchial hamartoma (too much cartilage - calcified)
59
small cell carcinoma
- no surgery (too small) - treated with chemo - poorly differentiated neuroendocrine tumor - smokers - central - ADH, ACTH or Eaton Lambert syndrome
60
small cell/squamous mnemonic
S=small so smokers, central, syndrome (paraneoplastic)
61
squamous cell carcinoma
- keratin pearl or intercellular bridges - smokers and central - parathyroid hormone production
62
adenocarcinoma
- glands or mucin - female and nonsmokers - peripheral - no syndrome
63
large cell carcinoma
- none of the other stuff - poor prognosis - can be anywhere
64
bronchioloalveolar carcinoma
- from Clara cells - grows along bronchioles and alveoli - peripheral - present with pneumonia like consolidation - excellent prognosis
65
carcinoid tumor
- **chromogranin positive - neuroendocrine tumor - no smoking - classically polyp in bronchus - not usually carcinoid syndrome
66
most common sources of breast metastasis
breast and colon
67
special site for lung metastasis
adrenal gland
68
most common tumor with pleural involvement
adenocarcinoma because it is usually peripheral

Pathoma (11 decks)

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