Repiratory Tract Flashcards

Question

CMV

Answer 1

Interstitial/atypical pneumonia | See in posttransplant people receiving immunosupressive therapy

Answer 2

Interstitial/atypical pneumonia see in elderly, immunocompromised, and preexisting lung disease Also increases risk for superimposed S aureus or H influenzae bacterial pneumonia

Answer 3

Interstitial/atypical pneumonia atypical but with high Q fever. See in farmers and verterinarians is a ricketsial organism but does not cause typical skin rashand does not require a arthropod becuase it can survive as highly heat resistant endospore

Answer 4

Inhalation of aerosolized Mycobacterium tuberculosis Results from initial exposure and leads to focal, caseating necrosis in lower lobeof lung and hilar lymph nodes that udnergoes fibrosis and calcification to form the "ghon complex" Generally asymptomatic but will have a postive PPD

Answer 5

reactivation in AIDS or elderly Occurs at apex of lung where lymph drainage is poor and high oxygen tension forms cavitary foci of caseous necrosis, may lead to miliary TB or tuberculous pneumonia high fevers, night sweats, cough with hemoptysis, weight loss Biopsy reveals caseating granulomas and AFB stain reveals acid fast bacilli

Answer 6

Meninges - meningitis at BASE of brain Kidneys- sterile pyuria Lumbar vertebrae - Pott disease

Answer 7

Group of diseases characterized by airway obstruction, lung does not empty air decreased FVC, and even greater decrease in FEV1 (air breathed out in 1second) Total loung capacity is usually higher as well

Answer 8

Chronic productive cough lasting at least 3 months over a minimum of 2yrs. Characterized by hypertrophy of bronchial mucinous glands (Reid index increases to >50%) Clinically see productive cough, cyanosis (blue bloaters), and increased risk of infection and cor pulmonale

Answer 9

Destruction of alveolar air sacs due to either excess production of proteases or lack of alpha1 antitrypsin. Get a loss of elastic recoil and collapse of airways during exhalation. Clinically see 1)dyspnea and cough with minimal sputum 2) prolonged expiration with purse lips "pink-puffer" 3) weight loss 4) Increased anterior-poterior diameter of chest (barrel chest) 5) Hypoxemia from desturction of capillaries in alveolar air sacs) 6) cor pulmonale is a late complication

Answer 10

Inflammation in the lung normally leads to release of proteases by neutrophils and macrophages. Alpha 1 antitrypsin neutralizes proteases excessive inflammation or lack of A1AT leads to emphysema

Answer 11

Smoking introduces a lot of pollutants which leads to excessive inflammation and protease mediated damage results in CENTRIACINAR emphysema mostly in UPPER LOBES

Answer 12

Lack of antiprotease leaves air sacs vulnerable to protease mediated damage. Get PANANCINAR emphysema in LOWER LOBES Liver cirrhosis may be present as mutant A1AT accumulates in ER of hepatocytes resulting in liver damage Biopsy shows pink, PAS+ globules in hepatocytes PiM is normal allele. PiZ is abnormal allele PiMZ is susceptible to emphysema if smoke PiZZ significant risk for panacinar emphysema

Answer 13

Reversible airway bronchoconstriction most often due to allergic stimuli and often associated with allergic rhinitis, eczema, and family history of atopy. Presents with wheezing, dyspnea, productive cough with spiral shaped mucus plus = "Curschmann spirals" and eosinophil derived crystals = "Charcot-Leyden crystals. Is a Type I hypersensitivity where 1) allergens induce TH2 phenotype in CD4+ Tcells --> TH2 cells secrete IL4(mediates class switch to IgE) IL5 (attracts eosinophils) and IL10 (stimulates TH2 cells and inhibits TH1) 2) Reexposure to allergen leads to IgE mediated activation of mast cells that release preformed histamine granules (vasodilation and increased vascular permeability) and generation of leukotrienes C4, D4, and E4 lead to bronchoconstriction, inflammation, and edema 3) Inflammation and release of major basic protein derived from eosinophils damages cells and perpetuates bronchoconstriction

Answer 14

Permanenet dilation of bronchiloes and bronchi due to necrotizing inflammation with damage to airway walls Cuases include: CF, Kartanger syndrome defect in dynein arm in cilia), tumor or foreighn body, necrotizing infection, or allergic bronchopulmonary aspergilliosis Presents with cough, dyspnea, and foul-smelling sputum Complications include hypoxemia and cor pulmonale and secondary (AA) amyloidosis

Answer 15

Fibrosis of lung interstitium with unknown etiology but likely related to cyclical lung injury; TGF-beta from injured pneumocytes induces fibrosis. Present with progressive dyspnea and cough, fibrosis on CT (subpleural plaques progress to diffuse fibrosis with "honeycomb" appearance"

Answer 16

bleomycin amiodarone radiation therapy

Answer 17

Interstitial fibrosis due to occupational exposure | Alveolar macrophages engulf foreign particles and induce fibrosis

Answer 18

Carbon dust in coal minors. Massive exposure leads to diffuse fibrosis Associated with Rheumatoid Arthritis / Caplan Syndrome

Answer 19

Mild exposure to carbon results in collects on carbon-laden macrophages but not clinically significant

Answer 20

Seen in sandblasters and silica miners Fibrotic nodules in UPPER lobes Increased risk for TB Silica impairs phagolysosome formation by macrophages

Answer 21

Beryllium miners and Aerospace workers Noncaseating granulomas in the lung, hilar lymph nodes, and systemic organs Increased risk for lung cancer Resembles sarcoidosis

Answer 22

Construction workers, plumbers, and shipyard workers Fibrosis of lung and pleura with increased risk for lung CARCINOMA and also mesothelioma See Asbestos bodies = long, golden brown fibers with associated iron

Answer 23

SYSTEMIC disease characterized by NONCASEATING granulomas in multiple organs. African American Females most commonly Unkown etiology but likely CD4+ Helper T-Cells response to unknown antigen Most commonly affects the hilar lymph nodes and lung See characteristic stellate inclusions/asteroid bodies within giant cells of the granuloma Can mimic sjorgen syndrome with granulomas in lacrimal and salivary glands Present with dyspnea or COUGH, elevated serum ACE, hypercalcemia (due to increased 1-alpha hydroxylase activity of epitheliod histocytes converting vitamin D to its active form)

Answer 24

Granulomatous reaction to inhaled organic antigens (pigeo breeders lung). Fever, cough and dyspnea after exposure and resolve with removal of exposure. Chronic exposure however leads to interstitial fibrosis see granulomas with EOSINOPHILS

Answer 25

High pressure in pulmonary circuit (>25mmHg) Characterized by atherosclerosis of pulmonary trunk, smooth muscle hypertrophy of pulm arteries, and intimal fibrosis PLEXIFORM LESIONS Presents with exertional dyspnea and right sided heart failure

Answer 26

Classically seen in young adult females Etiology Unknown Familial forms are related to inactivation mutations of BMPR2, leading to proliferation of vascular smooth muscle

Answer 27

Due to hypoxemia (close arteries to shunt blood elsewhere but increases pressure) Increased volume in pulmonary circuit Recurrent pulmoanry embolisms

Answer 28

Diffuse damage to the alveolar-capillary interface Leakage of protein rich fluid leads to edema and formation of hyaline membranes in alveoli Presents with hypoxemia, cyanosis, (thickened diffusion barrier and collapse air sacs), and white out on chest x-ray Activation of neutrophils induces protease and free radical mediated damage of type I and II pneumocytes Ventilate with Positive End Expiratory Pressure(PEEP) to keep the alveoli open Loss of Type II leads to scarring and fibrosis

Answer 29

Inadequate surfactant production by the Type II pneumocytes. Surfactants normally decreases surface tension so increase leads to alveolar collapse and hyaline formation Phophatidylcholine (lecthin) ifs the major component of surfactant Presents as increasing respiratory effort, tachypnea with use of accessory muscles and grunting. See cyanosis and hypoxemia

Answer 30

1) Prematurity = surfactant production begins at 28 weeks and not adequate until 34 weeks. Screen for lung maturity by looking at ratio of Phophatidylcholine (lecthin) to sphingomyelin. Lecthin increases while spoingo remains the same. Ratio > 2 means lungs are mature 2) C-section = lack of stress induced steroids hen have a c-section and these steroids increase synthesis of surfactant 3) Maternal diabetes = insulin decreases surfactant production

Answer 31

hypoxemia can cause a persistent patent ductus arteriosus hypoxemia can also make necrotizing enterocolitis more likely Treatment with supplemental oxygen can cause retinal injury that can lead to blindness

Answer 32

Cigarette smoking, radon (formed by decay or uranium which is present in soil so can build up in basements), and asbestos

Answer 33

Granuloma = TB or fungus (especially histoplasma in Midwest) | Bronchial Hamartoma = beign tumor composed of lung tissue and cartiallage that often calcifies to appear on imaging

Answer 34

``` Small = chemo Non-small = surgery ```

Answer 35

Poorly differentiated small cells arising from neruoendocrine (kulchitsky) cells Male Smokers Central Rapid growth and early mets May produce ADH or ACTH Cna also cause an Eaton-Lambert Syndrome = make autoantibodies against presynaptic calcium channels that leads to muscle weakness that improves with use

Answer 36

Keratin pearls or intracellular bridges Most common tumor in male smokers Central may produce PTHrP

Answer 37

Flans or Mucin Most common in non-smokers or female smokers Peripheral Can involve the pleura

Answer 38

Poorly differentiated large cells smoking central or peripheral poor prognosis

Answer 39

Columnar cells that grow along preexisting bronchioles and alveoli (arise from Clara cells) no relation to smkoing may present with Pneumonia like consolidation on imaging Good prognosis

Answer 40

well differentiated neuroendocrine cells that are chromogranin positive not related to smoking central (classically presents as a polyp like mass in the bronchus) low grade malignancy

Answer 41

Most common source is breast and colon get multiple cannon ball nodules more common than primary lung tumors

Answer 42

1) adenocarcinoma occurs on periphery and can involve the pleura 2) growth can obstruct the SVC and cause distended head and neck veins with edema and blue discoloration of the arms and face 3) Press on laryngeal nerve = hoarsenss 4) press on phrenic nerve = diaphragmatic paralysis 5) Compress sympathetic chain = pancoast/apical tumor = Hornerys syndrome = ptosis (drooping eyelid), miosis (pinpoint pupil), and anhidrosis (no sweating)

Answer 43

Adrenal gland

Answer 44

Rupture of an emphysematous bleb, usually seen in young adults Results in collapse of a portion of the lung Trachea shifts TOWARDS the side of collapse

Answer 45

Arises from a penetrating chest wall injury Air enters the pleural space but cannot exit Trachea is pushed AWAY from side of injury Treat with insertion of a chest tube

Answer 46

Malignant neoplasm of mesothelial cells highly associated with asbestos exposure Presents with recurrent pleural effusions, dyspnea, chest pain Tumor encases the lung

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Repiratory Tract Flashcards

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