Pulmonary, TBP Flashcards
1
Q
2 types of acute respiratory failure
A
1) Hypoxic
2) Hypercapnic
2
Q
Hypoxemic respiratory failure is characterized by pO2 levels of
A
Less than 60 mmHg
3
Q
Hypercapnic respiratory failure is characterised by pCO2 level of
A
> 45mmHg
4
Q
General mechanism of atelectasis
A
Airways and alveoli are unable to fill hence blood is shunted from arteries to veins without adequate oxygenation
5
Q
Type of atelectasis: Lesion external to the lungs (pleural cavity)
A
Compressive
6
Q
Type of atelectasis: Lesion in the airway
A
Obstructive/resorptive
7
Q
Type of atelectasis: Loss of surfactant
A
Microatelectasis
8
Q
Type of atelectasis: Localized or generalised fibrosis
A
Contraction
9
Q
Disease of the lungs that impairs the ability of air to leave the alveoli during expiration
A
Obstructive lung disease
10
Q
Obstructive lung diseases (4)
A
BACE
1) Bronchiectasis
2) Asthma
3) Chronic bronchitis
4) Emphysema
11
Q
Disease process characterized by loss of pulmonary parenchyma (septae and walls) and dilation of terminal airways
A
Emphysema
12
Q
Type of emphysema: Affects respiratory bronchioles
A
Centriacinar
13
Q
Type of emphysema: Affects alveoli and alveolar acini and eventually respiratory bronchioles
A
Panacinar
14
Q
Type of emphysema: Involves upper lobes
A
Centriacinar
15
Q
Type of emphysema: Associated with smoking
A
Centriacinar
16
Q
Type of emphysema: Involves lower lobes
A
Panacinar
17
Q
Associated with α1-antitrypsin deficiency
A
Panacinar
18
Q
Loss in emphysema: Pulmonary elastance vs pulmonary compliance
A
Pulmonary elastance
19
Q
Mechanism of air-trapping in emphysema
A
When the patient breathes out, the airways collapse, trapping air because of reduced driving pressure
20
Q
General mechanism of emphysema
A
Imbalance in protease-antiprotease and oxidant-antioxidant
21
Q
Mechanisms of centriacinar emphysema by cigarette smoking (3)
A
1) Induction NFkβ that attracts neutrophils with resultant production of TNF and IL-8 that activate neutrophils causing them to release damaging proteases
2) Inactivation of antiproteases
3) Production of ROS
22
Q
Complication of emphysema: Hypoxia-induced vasospasm and loss of vascular surface area
A
Pulmonary htn
23
Q
Complication of emphysema: Right-sided heart failure secondary to pulmonary hypertension
A
Cor pulmonale
24
Q
Complication of emphysema: Shunting of blood to areas of poor ventilation
A
VQ mismatch
25
Emphysema: Gross (2)
1) Spiderweb-like appearance
| 2) Bullae formation at pleural surface
26
Emphysema: Signs and symptoms
1) Pink puffers
2) Increased expiratory phase
3) ECG: Small amplitude QRS and right axis deviation
27
Classic type of tachycardia in COPD
Multifocal atrial tachycardia (MAT)
28
T/F Asthma is also associated with chronic inflammation
T
29
Type of asthma: A type I hypersensitivity
Atopic/allergic
30
Type of asthma: Strong familial tendencies
Atopic/allergic
31
Type of asthma: Viral infection
Non-atopic/non-allergic
32
Type of asthma: No family history
Non-atopic/non-allergic
33
Type of asthma: Normal IgE levels
Non-atopic/non-allergic
34
Type of asthma: Occurs more frequently in children
Atopic/allergic
35
Type of asthma: Occurs more frequently in adults
Non-atopic/non-allergic
36
Type of asthma: Exercise
Non-atopic/non-allergic
37
Type of asthma: Cold air
Non-atopic/non-allergic
38
Type of asthma: Hay fever and eczema
Atopic/allergic
39
Type of asthma: Pollen
Atopic/allergic
40
Type of asthma: Drugs
Non-atopic/allergic
41
Type of asthma: GERD
Non-atopic/allergic
42
Stage of asthma: Due to release of mediators from cells that promote bronchoconstriction
Early
43
Stage of asthma: Mast cell tryptase
Early
44
Stage of asthma: Enzymes from eosinophils and neutrophils
Late
45
Stage of asthma: Prostaglandins
Early
46
Stage of asthma: Responsible for morphologic changes
Late
47
Sloughed epithelial cells in mucous that cast in the shape of airways
Curschmann spirals
48
Composed of major basic protein from eosinophils
Charcot-Leyden crystals
49
Asthma, classic triad
1) Persistent wheezing
2) Chronic episodic dyspnea
3) Chronic nonproductive cough
50
Reason why asthma may be worse or only present at night time
Physiologic drop in cortisol secretion
51
Asthma symptom: Dark rings under eyes
Allergic shiners
52
Asthma symptom: Dark transverse crease on the nose
Allergic salute
53
Prolonged asthmatic attack that can be fatal
Status asthmaticus
54
CO2 in acute asthma exacerbation
Low due to hyperventilation
55
Often precedes respiratory failure in acute asthma exacerbation
Rising CO2 concentration
56
Basic description of chronic bronchitis
Productive cough for at least 3 MONTHS in 2 CONSECUTIVE YEARS
57
Chronic bronchitis: Pathogenesis
Chronic irritation of airway by cigarette smoke causing increased mucus production and hyperplasia of mucous-secreting glands
58
Measured in microscopic sections of chronic bronchitis
Reid index
59
Reid index
Thickness of mucous glands in relation to thickness of the wall
60
Reid index is a measure of
Submucosal gland hypertrophy
61
Reid index in chronic bronchitis
>0.40
62
Signs and symptoms of chronic bronchitis
1) Blue bloaters
| 2) Hypercapnia
63
Refers to the abnormal permanent dilation of airways
Bronchiectasis
64
2 components required to bring about bronchiectasis
1) Infection
| 2) Obstruction
65
Bronchiectasis: Upper lobes vs lower lobes
Lower
66
Bronchiectasis: Right vs left lung
Right
67
Bronchiectasis: Characteristic cough
Large amounts of purulent sputum and hallitosis
68
Clubbing of fingers is aka
Pulmonary osteoarthropathy
69
Bronchiectasis: Chest radiograph
Parallel lines in peripheral lung fields representing non tapering thickened bronchial walls
70
Chronic bronchitis vs emphysema: Anatomic diagnosis
Emphysema
71
Chronic bronchitis vs emphysema: Clinical diagnosis
Chronic bronchitis
72
Cause of death in patients with COPD (2)
1) Respiratory acidosis
| 2) Cor pulmonale
73
COPD: Earliest symptom
Chronic productive cough
74
COPD: Characteristic PE
Barrel chest
75
COPD: 2 interventions demonstrated to influence natural history of disease
1) Smoking cessation
| 2) O2 therapy
76
Clinical term for acute restrictive lung disease
ARDS
77
Pathologic term for acute restrictive lung disease
Diffuse alveolar damage
78
Stages of diffuse alveolar damage (in order)
1) Exudative stage
2) Proliferative stage
3) Fibrosis
79
Stage of diffuse alveolar damage: Protein and necrotic cells layer out on the alveolar septa forming hyaline membranes
Exudative stage
80
Stage of diffuse alveolar damage: Type II pneumocytes undergo hyperplasia
Proliferative stage
81
4 main causes of diffuse alveolar damage
1) Severe pulmonary infection
2) Aspiration
3) Sepsis
4) Severe trauma with shock
82
Diffuse alveolar damage of undetermined etiology
Acute interstitial pneumonitis
83
Diffuse alveolar damage: Gross
Firm lungs
84
Diffuse alveolar damage: Microscopic
Depends on stage
85
Diffuse alveolar damage: Symptoms
Pink frothy sputum within 72h of exposure to inciting agent
86
4 categories of chronic restrictive lung disease
1) Autoimmune
2) Work-related
3) Drug-related
4) Idiopathic
87
Autoimmune diseases that cause chronic restrictive lung disease (3)
1) SLE
2) Wegener's
3) RA
88
Work-related causes of chronic restrictive lung disease (3)
1) Asbestosis
2) Silica-induced lung disease
3) Coal-induced lung disease
89
Drug-related causes of chronic restrictive lung disease
1) Bleomycin
2) Busulfan
3) Amiodarone
4) Methotrexate
5) O2 therapy
90
Chronic restrictive lung disease: Gross
Honeycomb lung (end-stage ILD)
91
Lung disease arising due to exposure to inorganic or organic dust or to chemical fumes or vapors
Pneumoconiosis
92
Cancer associated with asbestosis
1) Bronchogenic
| 2) Mesothelioma
93
T/F Asbestosis and smoking are synergistic for the development of bronchogenic CA
T
94
Type of asbestos fibers: Straight and less soluble therefore penetrate deeper and more damaging
Amphibole
95
Type of asbestos fibers: Curvy and more soluble, therefore do not penetrate as deeply as straight fibers and are cleared by mucociliary escalator
Chrysotile
96
Complication of asbestosis brought about by exposure to amphibole fibers
Mesothelioma
97
T/F Smoking increases the risk for development of mesothelioma in patients with asbestos exposure
F
98
Refers to asbestos particles coated with iron by macrophages
Ferruginous bodies
99
3 forms of coal-induced lung disease
1) Anthracosis
2) Simple coal workers' pneumoconiosis
3) Complicated coal workers' pneumoconiosis
100
Form of coal-induced lung disease: Coalescence of pigment-laden macrophages into 1-2 mm macules and slightly larger nodules
Simple
101
Form of coal-induced lung disease: Development of large scars (2-10cm) in the pulmonary parenchyma
Complicated
102
Complicated coal workers' pneumoconiosis is aka
Progressive massive fibrosis
103
Acute vs chronic silicosis: Appears similar to pulmonary alveolar proteinosis
Acute
104
Acute vs chronic silicosis: Nodular fibrosis, progressing to progressive massive fibrosis
Chronic
105
Classic radiographic appearance of chronic silicosis (2)
1) Nodules on upper lobe
| 2) Eggshell-like calcification of hilar nodes
106
T/F Silicosis predisposes to infection with mycobacteria
T
107
Silicosis with infection to mycobacteria
Silicotuberculosis
108
Pneumoconiosis characterised by the presence of granulomas in the alveolar septae
Chronic berylliosis
109
Multisystem disease of probably immune etiology that produces noncaseating granulomas
Sarcoidosis
110
Sarcoidosis: Most commonly affected organ
Lung
111
Sarcoidosis: Second most commonly affected organ
LN
112
Sarcoidosis: Smokers vs nonsmokers
Nonsmokers
113
Sarcoidosis: Microscopic features
1) Noncaseating granulomas
2) Asteroid bodies
3) Schaumann bodies (concentrically calcified bodies)
114
Sarcoidosis: Mechanism of hypercalcemia
Mononuclear cells produce the active form of vitamin D
115
Sarcoidosis: Associated thymic abnormality
Pure thymic hyperplasia
116
Disease occurring as a result of hypersensitivity to certain allergens that affects the alveolar septae
Allergic pneumonitis
117
Disease-associaed cause of allergic pneumonitis: Pigeon breeder's lung
Pigeon serum
118
Disease-associaed cause of allergic pneumonitis: Humidifier lung
Thermophilic actinomyces
119
Disease-associaed cause of allergic pneumonitis: Farmer's lung
Mircopolyspora faeni (hay mold)
120
2 causes of diffuse pulmonary hemorrhage
1) Goodpasture syndrome
| 2) Idiopathic pulmonary hemosiderosis
121
Goodpasture syndrome is what type of hypersensitivity
Type II
122
Antibodies in Goodpasture syndrome
Anti GBM specifically to a3 chain of Type IV collagen
123
Goodpasture syndrome: Male vs female
Male
124
Goodpasture syndrome: Type of glomerulonephritis
Crescentic
125
Idiopathic pulmonary hemosiderosis: Children vs adults
Children
126
Pulmonary htn: BP in pulmonary circulation
>20 mmHg
127
Pulmonary htn: More of primary vs secondary
Secondary
128
Primary pulmonary htn: Male vs female
Female
129
Primary pulmonary htn: Microscopy (4)
1) Medial hypertrpohy (Grade 1)
2) Intimal hypertrophy (Grade 2)
3) Pipestem fibrosis with near obliteration of lumen (Grade 3)
4) Plexiform pulmonary arteriopathy (Grade 4)
130
Causative agent implicated in bacterial pneumonia in chronic alcoholics
Klebsiella pneumoniae
131
Bronchopneumonia vs Lobar pneumonia: Patchy distribution of neutrophilic infiltrates and bacteria in 1 or many loves
Bronchopneumonia
132
Bronchopneumonia vs Lobar pneumonia: Confined to 1 lobe of the lung
Lobar pneumonia
133
Lobar pneumonia: Almost all cases due to
Streptococcus pneumoniae
134
Bronchopneumonia vs Lobar pneumonia: Can occur in an otherwise healthy individual
Lobar pneumonia
135
Lobar pneumonia: Morphologic stages
1) Edema and congestion
2) Red hepatization
3) Grey hepatization
4) Resolution
136
Red vs grey hepatization: Neutrophils, fibrin, and RBCs
Red
137
Red vs grey hepatization: Lysed RBCs, fibrin, macrophages
Grey
138
Causative agent: Pneumonia with blood-tinged currant jelly sputum
Klebsiella pneumoniae
139
Causative agent: Pneumonia often with extra pulmonary symptoms such as headache, hyponatremia, bradycardia, and diarrhea
Legionella pneumophila
140
Typical vs atypical pneumonia: Follows a viral URTI
Typical
141
Typical vs atypical pneumonia: Acute symptoms
Typical
142
Typical vs atypical pneumonia: Moderate symptoms and PE findings
Atypical
143
Typical vs atypical pneumonia: Viruses
Atypical
144
Typical vs atypical pneumonia: Mycoplasma
Atypical
145
Typical vs atypical pneumonia: Klebsiella
Typical
146
Typical vs atypical pneumonia: Chlamydia
Typical
147
Pneumonia-associated causative agent/s: Nosocomial (2)
1) G- bacilli
| 2) Pseudomonas
148
Pneumonia-associated causative agent/s: Aspiration
Mixed aerobic and anaerobic flora
149
Complication of aspiration pneumonia
Lung abscess
150
Interstitial pneumonia: Microscopic
Lymphocytic infiltrate
151
Interstitial pneumonia: Etiology
Viral or mycoplasmal
152
Chronic pneumonia: Causative agents
1) M. tuberculosis
| 2) Dimorphic fungi
153
Components of Ghon complex
1) Ghon focus
| 2) Enlarged hilar LN
154
Refers to a granuloma at the periphery of the lung near the inter lobar grove
Ghon focus
155
T/F Primary PTB lesions heal on their own
T
156
T/F As the primary PTB lesion heals, the organism is eliminated by the body
F
157
PTB that morphologically has the appearance of bronchopneumonia usually due to PTB in an immunocompromised patient
Primary progressive
158
Hematogenous dissemination of M. tuberculosis to the lungs, liver, and spleen producing a millet seed appearance
Miliary tuberculosis
159
PTB involvement of the vertebral column
Pott disease
160
Dimorphic fungi that cause chronic pneumonia (3)
1) Histoplasma capsulatum
2) Blastomyces dermatitidis
3) Coccidioides immitis
161
Dimorphic fungi-geographic distribution: Histoplasma capsulatum
Ohio and Mississippi River Valleys
162
Dimorphic fungi-geographic distribution: Blastomyces dermatitidis
Overlap with H. capsulatum in central and southeastern US
163
Dimorphic fungi-geographic distribution: Coccidioides immitis
San Joaquin Valley in California and Arizona
164
CD4 count-likely associated organism: >200 cells/uL
Bacterial
165
CD4 count-likely associated organism: Less than 200 cells/uL
Pneumocystis
166
CD4 count-likely associated organism: Less than 50 cells/uL
CMV or M. avium-intracellulare
167
Usual location of pulmonary abscesses
Lower lobes, more on the right
168
Most common sites of metastases of pulmonary neoplasms in descending order
1) Liver
2) Brain
3) Bone
169
3 types of non-small cell CA
1) SCC
2) AdenoCA
3) Large cell
170
SCC of lung: Age
55-60
171
SCC of lung: Gender
M
172
SCC of lung: Location
Central
173
SCC of lung: Risk factor
Cigarette smoking
174
Lung CA with the highest rate of p53 mutations
SCC of lung
175
SCC of lung: Associated condition
Hypercalcemia due to production of PTH-like protein
176
SCC of lung: Gross
Cavitation
177
SCC of lung: Microscopic
Keratin pearls
178
AdenoCA of lung: Age
Less than 45
179
AdenoCA of lung: Gender
F
180
AdenoCA of lung: Location
Peripheral, perihilar
181
AdenoCA of lung: Relation to smoking
Weak
182
Growth of adenoma along alveolar septa is referred to as
Lepidic growth
183
AdenoCA of lung: Classic symptom
Bronchorrhea
184
Small cell lung CA: Gender/age
Older males
185
Small cell lung CA: Location
Central, along bronchi
186
Small cell lung CA: Risk factor
Smoking
187
Small cell lung CA: Mutation
c-MYC and Rb
188
Lung CA with associated paraneoplastic syndromes
Small cell lung CA
189
Small cell lung CA: Associated paraneoplastic syndromes
1) ACTH, ADH, calcitonin
| 2) Lambert-Eaton syndrome
190
Enlarged supraclavicular LN in pulmonary neoplasms
Virchow node
191
External compression of SVC obstructing blood return to heart from upper body
SVC syndrome
192
Erosion of lung tumor through apex of lung
Pancoast tumor
193
Lung CA with no definitive squamoid or glandular differentiation
Large cell CA
194
Source of pleural effusion, exudate: Elevated RBC count
1) Trauma
| 2) Malignancy
195
Source of pleural effusion, exudate: Elevated WBC count
Empyema
196
Source of pleural effusion, exudate: Elevated eosinophil
1) Collagen vascular disease
2) Pneumothorax
3) Hemothorac
197
Source of pleural effusion, exudate: pH
1) Malignancy
2) RA
3) Infection
198
Source of pleural effusion, exudate: Elevated amylase
1) Esophageal rupture
| 2) Acute pancreatitis
199
Source of pleural effusion, exudate: TG > 100 mg/dL
Chylous effusion
200
Sharp chest pain in pleural effusions is due to involvement of
Parietal pleura
201
Defect in the pleura that acts as a one-way valve (ball-valve)
Tension pneumothorax
202
T/F Most non tension pneumothorax spontaneously resolve
T
203
Tension vs non tension pneumothorax
1) Mediastinal shift
| 2) Hemodynamic changes (hypotension and elevated JVP)
204
Classic spontaneous pneumothorax exists in
Tall, thin, young male
205
Malignant tumor of the pleural cavity derived from mesothelial cells
Mesothelioma
206
Mesothelioma is almost always due to
Asbestos exposure
207
Population where vocal cord nodules are seen
1) Singers
| 2) Smokers
208
SCC of larynx: Present earlier due to earlier symptoms
Glottic
209
SCC of larynx: Metastasize sooner
Supraglottic (rich in lymphatics)
210
SCC of larynx: Less likely to metastasize
Glottic
211
SCC of larynx: Most common location
Glottic
212
SCC of larynx: Present late in the course of disease
Subglottic
213
Refers to phenomena where development of CA in one area precede development in another or may by synchronous due to cigarette smoking
Field effect
