Resp Flashcards
Emphysema types
Centroacinar - upper lobes, smokers, 95%
Panacinar - lower lobes alpha 1 antitrypsin defic
Paraseptal/ distal - upper lobe, spont pneum, scarring
Irreg - all over, asymptimatic from scarring
Emphysema vs bronchitis
Bronchitis - younger, more sputum, cor pulmonale blue bloater
Emphysema - older, small heart, v sob, pink puffer
ARDS histology
Hyaline membranes
Oedema
Scattered neutrophils and macrophages
Epithelial necrosis
Asthma cellular response
Pathogen
Th2 cell
IL 4 (B) 5 (eosinophil) and 13
B cell releasrs IgE
Mast cell activated
Main inflamatory cell in asthma
Eosinophil
Bronchiectasis
Destruction smooth muscle and elastic tissue, distal airways
Necrotising infections
Permanent dilation bronchioles
Thick sputum cough
CF
Pulmonary hypertension
Greater than 25
Community typical pneumonia
S pneum
H influenze
Moroxella
Staph aureus
Legionella
Klebsiella (gram -ve)
Community atypical
Mycoplasma
Chlamydia
Coxiella
Viruses
HAP organisms
Gram -ve rods (klebsiella, serratia, e coli, pseudomonas)
Staph aureus
Strep pneum
Most common
Gram positive dipplococci
Tx penicillin
Heamophilis inf
Gram -ve pleomorphic
5% encapsulates causes bad illness
Meningitis and pink aya in kids
Attaches to endothelium and stops cilia beating and degrades IgA
Moraxella catarrhalis
Elderly
Second most common copd
Gram -ve dipplococus
Staph aureus
Gram +ve cocci
Post viral
Endocarditis ivdu
Abscess risk
Hosp aquired
Klebsiella
Gram -ve rod
Hosp aquired
Malnourished alcoholic
Thick gelatinous sputum
Pseudomonas
Aerobic gram -ve rod
Hospital acquired
CF neutropenic
Invades blood vessels extra pulm spread
Legionella
Aerobic gram -ve rod
Aerosol
Immunoconoeomised
Antigen in urine,sputum fluorescent AB test
‘Pontiac fever’
Stages lobar pneumonia
Congestion - vascular engorgement
Red hepatisation - confluent exudation, neutrophils and fibrin ain alveoli
Grey hepatisation - red cells disintegrate, fibrin stays
Resolution - exudate enzymatically digested
Mutation adenocarcinoma
EGFR and KRAS
4 main causes pulmonary exudate
Pulmonary infarction
Microbial invasion
Viral pleuritis
Cancer
Lung metastases
More common than primary
Periphery of lung
Bowel, breast, kidney, thyroid, liver, lung
Lung cancer hormone production
Small cell - ACTH, gastrin related peptide, calcitonin, ADH
Non small cell (mainly squamous) - PTHrP
Histology hypersensitivity pneumonitis
Loose, poorly formed non caseating granulomas
Pregnancy airway changes
Increased RR
Increased TV 45%
Decreased FRC by 20-30%
Increased O2 req and CO2 production 60%
Decreases airway resistance due to progesterone
Atelectasis
Resorption - obstructive e.g. mucous, fb.mefiastinum towards collapse
Compression - fluid or air in pleural cavity, mediastinum away
Contraction - fibrosis, non reversable
Pneumonia assoc cd4 <50
Cmv
Mycobacterium avium
Pneumonia assoc CD4 <200
PCP, fungal
Dry cough
Squamous cell carcinoma lung
20% lung Ca
Smoke related
Along peribronchial tree
Male
Hypercalcaemia
Small cell lung ca
14% cancers
Assoc cushings and siadh
V smoke related
Super invasive
Initially responsive chemo
Carcinoid lung tumour
Slow growing
Female <40
Assoc carcinoid syndrome
Collar button lesions
Adenocarcinoma lung
Most common lung ca
Female non smokers
Peripheral bronchoalveolar
Large cell lung cancer
3%
Undifferentiated cells
Small smell lung cancer histology
small hyperchromatic nuclei with fine chromatin pattern, indistinct nucleoli, diffuse sheet of cells and dense core granules
